Evaluation of impact of measles rubella campaign on vaccination coverage and routine immunization services in Bangladesh.

Md Jasim Uddin,Lauren Hashiguchi,Nurul Alam,Md Wazed Ali,Md Shamsuzzaman,Shahabuddin Ahmed,Chris Odell,Gourab Adhikary,Stephen S Lim

doi:10.1186/s12879-016-1758-x

Abstract

BackgroundLike other countries in Asia, measles-rubella (MR) vaccine coverage in Bangladesh is suboptimal whereas 90–95 % coverage is needed for elimination of these diseases. The Ministry of Health and Family Welfare (MOHFW) of the Government of Bangladesh implemented MR campaign in January-February 2014 to increase MR vaccination coverage. Strategically, the MOHFW used both routine immunization centres and educational institutions for providing vaccine to the children aged 9 months to <15 years. The evaluation was carried out to assess the impact of the campaign on MR vaccination and routine immunization services.MethodsBoth quantitative and qualitative evaluations were done before and after implementation of the campaign. Quantitative data were presented with mean (standard deviation, SD) for continuous variables and with proportion for categorical variables. The overall and age- and sex-specific coverage rates were calculated for each region and then combined. Categorical variables were compared by chi-square statistics. Multiple logistic regression analysis were performed to estimate odds ratios (OR) and 95 % confidence intervals (CI) of coverage associated with covariates, with adjustment for other covariates. Qualitative data were analyzed using content analysis.ResultsThe evaluations found MR coverage was very low (<13 %) before the campaign and it rose to 90 % after the campaign. The pre-post campaign difference in MR coverage in each stratum was highly significant (p < 0.001). The campaign achieved high coverage despite relatively low level (23 %) of interpersonal communication with caregivers through registration process. Child registration was associated with higher MR coverage (OR 2.91, 95 % CI 1.91–4.44). Children who attended school were more likely to be vaccinated (OR 8.97, 95 % CI 6.17–13.04) compared to those who did not attend school. Children of caregivers with primary or secondary or higher education had higher coverage compared to children of caregivers with no formal education. Most caregivers mentioned contribution of the campaign in vaccination for the children not previously vaccinated.ConclusionsThe results of the evaluation indicated that the campaign was successful in terms of improving MR coverage and routine immunization services. The evaluation provided an important guideline for future evaluation of similar efforts in Bangladesh and elsewhere.

Highlights

Like other countries in Asia, measles-rubella (MR) vaccine coverage in Bangladesh is suboptimal whereas 90–95 % coverage is needed for elimination of these diseases
The difference in secondary or more education between the high and the low performing divisions was larger than the difference between the urban and rural strata within the divisions
Child registration was associated with higher MR coverage

Summary

Introduction

Like other countries in Asia, measles-rubella (MR) vaccine coverage in Bangladesh is suboptimal whereas 90–95 % coverage is needed for elimination of these diseases. The Ministry of Health and Family Welfare (MOHFW) of the Government of Bangladesh implemented MR campaign in January-February 2014 to increase MR vaccination coverage. Measles and rubella are vaccine-preventable diseases with similar symptoms and are frequently confused with each other. Both viruses cause rash and fever [3]. Rubella and measles are a public health problem in poor countries in Africa and Asia, including Bangladesh, where uptake of the measles and rubella vaccine is relatively low and increasing access to immunization through largescale vaccination campaigns can significantly reduce deaths and illnesses [5]

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