National trends of childhood vaccination coverage in Bangladesh: Understanding gaps from 2011, 2014 and 2017-18 Demographic and Health Surveys data

Abstract

Background Vaccination is a safe and cost-effective strategy for protecting children from life-threatening diseases. This study aimed to investigate the changes over time in proportion of vaccination coverage across demographic subgroups in Bangladesh. Method Vaccination coverage for children 12–59 months of age was obtained from Bangladesh’s 2011, 2014, and 2017-18 Demographic and Health Surveys. Three multivariable binary logistic regression models with complete vaccination status at each survey data were used to generate adjusted odds ratios to uncover immunization variations across socio-demographic categories. Further, to detect potential geographic disparities, changes over time were analyzed at both the country and district levels. Findings Vaccination coverage grew from 88.1% in 2011 to 89.2% in 2017–2018, indicating a gap of more than ten percent for complete immunization coverage among children aged 12–59 months. Children aged 23–35 were more likely to have full vaccination compared to those aged 12–23 in 2011 (AOR = 1.6, 95% CI = 1.3–1.9), 2014 (AOR = 1.6, 95% CI = 1.3-2.0), and 2017-18 (AOR = 1.4, 95% CI = 1.1–1.7). The likelihood of full vaccination of children increased with maternal education with the highest odds among women with higher education in 2011 (AOR = 7.2, 95% CI = 4.0-12.9), 2014 (AOR = 4.0, 95% CI = 2.7–5.9), and 2017-18 (AOR = 5.8, 95% CI = 3.5–9.6) compared to those with no formal education. Children born to mothers who lived in urban areas were more likely to have full vaccination in 2011 (AOR = 1.5, 95% CI = 1.3–1.8), 2014 (AOR = 1.4, 95% CI = 1.2–1.7), and 2017-18 (AOR = 1.4, 95% CI = 1.1–1.7) compared to those who lived in rural areas. Children born to mothers who had at least 4 ANC visits were more likely to have full vaccination compared to those with less than 3 ANC visits in 2011 (AOR = 1.6, 95% CI = 1.2-2.0), 2014 (AOR = 1.5, 95% CI = 1.2-2.0), and 2017-18 (AOR = 1.6, 95% CI = 1.2–2.1 During these three surveys, Rangpur division had the highest vaccine coverage rate, while Sylhet division had the lowest vaccination coverage. Conclusion Although there was an improvement in these nationally representative surveys from 2011 to 2017-18, a portion of children still needs to be vaccinated to ensure full immunization coverage. To achieve 100% immunization coverage for all Bangladeshi children, policymakers must integrate vaccine programs with personalized health messaging and assurances of health safety for impoverished children and low-educated mothers. Increased institutional deliveries and prenatal care visits by mothers could assist increase their children's vaccination coverage.