International Centre for Diarrhoeal Disease Research Bangladesh, Mohakhali, Dhaka, Bangladesh.
Asia Pac J Public Health. 2011 Apr;23(2):141-50. doi: 10.1177/1010539509342119. Epub 2010 Jun 21.
The present study investigated prospectively programmatic factors relating to dropouts in child vaccination in 6 subdistricts of Bangladesh. A cross-sectional survey (n = 2700) was conducted estimating overall coverage of immunization using cluster sampling. The eligible subsample of children (n = 1064) was followed up prospectively to understand reasons for dropouts. In-depth interviews (n = 73) with mothers/caregivers and service providers were done and EPI (Expanded Programme on Immunization) sessions were observed (n = 131). Irregular EPI sessions were the prime cause of dropouts particularly in low-performing subdistricts. The other programmatic factors linked with dropouts were (a) no reminder about subsequent session/doses, (b) unfriendly behavior or absence of vaccinator, ( c) refusal due to lost card or vaccine exhausted, and (d) short duration of sessions. Providers highlighted constraints such as financial problems for transportation, particularly in the hard-to-reach areas and vacancies of the posts of health assistants. The barriers to completing full schedules of vaccination can be removed to a large extent through programmatic adjustments.
本研究前瞻性地调查了孟加拉国 6 个分区儿童疫苗接种中辍学的规划因素。采用整群抽样方法进行了横断面调查（n=2700），估算了免疫接种的总体覆盖率。对符合条件的儿童亚样本（n=1064）进行了前瞻性随访，以了解辍学的原因。对母亲/照顾者和服务提供者进行了深入访谈（n=73），并观察了 EPI（扩大免疫规划）会议（n=131）。不规则的 EPI 会议是辍学的主要原因，特别是在表现不佳的分区。与辍学相关的其他规划因素包括：（a）没有关于后续会议/剂量的提醒；（b）疫苗接种员态度不友好或不在岗；（c）因疫苗接种卡丢失或疫苗耗尽而拒绝接种；（d）会议持续时间短。服务提供者强调了一些限制因素，如交通方面的财务问题，特别是在难以到达的地区和卫生助理职位空缺。通过方案调整，可以在很大程度上消除完成完整疫苗接种时间表的障碍。
