Academic journal article Bulletin of the World Health Organization

Childhood Immunization Coverage in Zone 3 of Dhaka City: The Challenge of Reaching Impoverished Households in Urban Bangladesh

Academic journal article Bulletin of the World Health Organization

Childhood Immunization Coverage in Zone 3 of Dhaka City: The Challenge of Reaching Impoverished Households in Urban Bangladesh

Article excerpt

Introduction

Although Bangladesh has improved its national immunization coverage of children from 2% in 1985 to 76% in 1995 (1, 2), coverage in slum areas of Dhaka City has lagged behind that for the city as a whole. In citywide surveys in both 1990 and 1993, coverage in slum neighbourhoods was only three-quarters of that for the city as a whole (3-5).

The lower coverage in urban slums is a cause for special concern for several reasons. First, vaccine-preventable diseases account for 22% of deaths of under-5-year-olds in the slums of Dhaka City (6). Second, the Dhaka urban population is growing at a rate of 6-9% per year (7, 8); if the growth rate in the urban slums is 9% per year, their population will approximately double in 8 years. Third, because of the crowded conditions in the urban slums, communicable vaccine-preventable diseases (and measles in particular) have higher transmission rates in such areas than in non-slum urban neighbourhoods or rural communities (9).

Also, the levels of malnutrition among Bangladesh's urban slum children are greater than those among children in rural and non-slum urban areas, where malnutrition levels are also quite high by international standards (10). The capacity of malnourished urban slum children to combat infections, including those which are vaccine-preventable, is therefore particularly compromised (11). The higher mortality among urban-slum children with measles compared with that among other children has been attributed to the combined effects of the younger age of cases (among whom the case-fatality rate is higher) and to the higher levels of malnutrition among urban-slum children (12).

To the best of our knowledge, there have been no previous analyses of the various sociodemographic influences on childhood immunization coverage in any of the major urban areas of Bangladesh, although such analyses have been carried out in one smaller municipal area of Bangladesh (13) and in rural areas of the country (14,15).

This article reports immunization coverage of children in one major urban area of Bangladesh, compares the coverage in slum and non-slum populations, and determines the factors which influence immunization status. A companion paper concerning tetanus toxoid immunization among women of reproductive age in Zone 3 has also been published (16).

Methods

With a population of around 450000, Zone 3 is the second largest of the 10 zones within Dhaka City Corporation, which includes approximately half of the 9 million people living within the greater Dhaka metropolitan area. Zone 3 is located in the south-west of the city and borders the Buriganga river.

Approximately one-fifth of the households in Zone 3 report a monthly income of [is less than] US$ 50 and one-third of the population lives in large slum neighbourhoods. One-half of the Zone 3 population lives in substandard housing, which typically has only one room, a roof of non-permanent material, no indoor sanitation or running water, and no amenities such as a television or a refrigerator.

The data for this report have been obtained from the Urban Panel Survey (UPS) of the MCH-FP Extension Project (Urban) of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B). The UPS is a longitudinal health survey of 5940 households containing 30840 persons in 160 geographical clusters in Zone 3. The clusters were selected using a multistaged area sampling procedure. Data were collected from each household every 3 months by a field interviewer who completed a questionnaire on use of health and family planning services and occurrence of vital events.

During the third quarter of 1995, the UPS collected information about previous immunizations received by under-2-year-olds. The data for this report have been obtained from this particular round of the UPS; the survey included 651 respondents who had a child aged 12-23 months. …

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