Uddin Md Jasim, Larson Charles P, Oliveras Elizabeth, Khan Azharul Islam, Quaiyum Md Abdul, Chandra Saha Nirod
Health Systems and Infectious Diseases Division, ICDDR,B, Mohakhali, Dhaka, Bangladesh.
Asia Pac J Public Health. 2009 Jan;21(1):8-18. doi: 10.1177/1010539508327030.
This article assessed the status of childhood vaccination coverage and the possibility of using selected alternative vaccination strategies in rural hard-to-reach haor (low lying) areas of Bangladesh. Data were collected through survey, in-depth interviews, group discussion, and observations of vaccination sessions. Complete immunization coverage among 12- to 23-month-old children was found to be significantly lower in study areas when compared with the national coverage levels. The study identified reasons for low complete immunization coverage in hard-to-reach areas, including irregular/cancelled extended program on immunization (EPI) sessions, less time spent in EPI spots by field staff, and absence of any alternative strategy for remote areas. The findings indicated that the existing service delivery strategy is not sufficient to improve immunization coverage in hard-to-reach areas. However, most of the strategies assessed are considered possible to implement by health care providers in hard-to-reach areas. The study suggested that before implementing alternative strategies in hard-to-reach areas, feasibility and effectiveness of the possible strategies need to be tested to identify evidence-based strategies.
本文评估了孟加拉国农村难以抵达的豪尔（低洼）地区儿童疫苗接种覆盖率状况以及采用某些替代疫苗接种策略的可能性。数据通过调查、深入访谈、小组讨论以及疫苗接种环节观察收集。与全国覆盖率水平相比，研究地区12至23个月大儿童的全程免疫覆盖率显著较低。该研究确定了难以抵达地区全程免疫覆盖率低的原因，包括免疫规划（EPI）接种环节不规律/取消、现场工作人员在EPI地点花费时间较少以及偏远地区缺乏任何替代策略。研究结果表明，现有的服务提供策略不足以提高难以抵达地区的免疫覆盖率。然而，评估的大多数策略被认为医疗服务提供者在难以抵达地区有可能实施。该研究建议，在难以抵达地区实施替代策略之前，需要测试可能策略的可行性和有效性，以确定基于证据的策略。
