Department of Statistics, University of Dhaka, Dhaka, 1000, Bangladesh.
BMC Public Health. 2022 May 24;22(1):1037. doi: 10.1186/s12889-022-13448-7.
Although Bangladesh has an impressive track record in the reduction of maternal and child mortality, tetanus, a dreadful disease, impedes the way to achieve Sustainable Development Goal (SDG) in this respect. Sufficient doses of tetanus toxoid containing vaccine during pregnancy ensure immunity against tetanus to mothers as well as newborns. Since inequalities persist across vaccination programs globally, in this paper, an attempt has been made to examine whether tetanus toxoid immunization (TTI) status among the women of reproductive age in Bangladesh for their most recent live birth born preceding 2 years of the survey changes with their living standard index (LSI).
Five domains of deprivation such as energy use, improved sanitation, drinking water, housing and assets ownership were used to compute the LSI using a approach proposed by Alkire and Foster. The adjusted association between LSI and TTI was established by using logistic regression model. For the purpose of statistical analysis, a nationally representative cross-sectional data extracted from Bangladesh Multiple Indicator Cluster Survey (BMICS), 2019 have been used.
The bivariate analysis revealed that 79.5% (95% CI 78.0-81.0) of women with low and 83.1% (95% CI 81.3-84.9) with moderate living standards had sufficient vaccination coverage for their most recent pregnancies while this percentage was higher for the women who belonged to high living standard (85.2, 95% CI = 84.2-86.2). A strong evidence for greater odds of sufficient immunization with TT among the women maintaining a high standard of living (AOR = 1.24, 95% CI = 1.08-1.42, p < 0.01) was found from regression analysis.
The results depict existing living standard disparity with respect to TT vaccination coverage among women in Bangladesh. Present research suggests that immunization campaigns need to be conducted especially for the disadvantaged people to improve their health care and immunization service utilization among women within the age bracket of 15 to 49. This study proposed a scientific way to enhance TT vaccination among Bangladeshi women, which could help Bangladesh attain a widespread tetanus protection and thus, meet the SDGs for maternal and child mortality reduction.
尽管孟加拉国在降低母婴死亡率方面取得了令人印象深刻的成绩，但破伤风这种可怕的疾病仍然阻碍着该国实现可持续发展目标（SDG）。在怀孕期间接种足够剂量的含破伤风类毒素疫苗可确保母亲和新生儿免受破伤风感染。由于全球疫苗接种计划存在不平等现象，本文试图研究孟加拉国育龄妇女最近一次生育前 2 年内的破伤风类毒素免疫（TTI）状况是否会随着其生活标准指数（LSI）的变化而改变。
使用 Alkire 和 Foster 提出的方法，利用能源使用、改良卫生设施、饮用水、住房和资产所有权等 5 个贫困领域来计算 LSI。使用逻辑回归模型建立 LSI 与 TTI 之间的调整关联。为了进行统计分析，本文使用了 2019 年孟加拉国多指标类集调查（BMICS）提取的全国代表性横断面数据。
单变量分析显示，79.5%（95%置信区间为 78.0-81.0）的低生活水平妇女和 83.1%（95%置信区间为 81.3-84.9）的中生活水平妇女最近一次怀孕时的疫苗接种覆盖率足够，而高生活水平妇女的这一比例更高（85.2，95%置信区间=84.2-86.2）。回归分析结果显示，生活水平较高的妇女接受 TT 充分免疫的可能性更大（AOR=1.24，95%置信区间=1.08-1.42，p<0.01），这一证据非常有力。
结果描绘了孟加拉国妇女 TT 疫苗接种覆盖率方面现有的生活水平差异。本研究表明，需要开展免疫接种运动，特别是为弱势群体提供服务，以改善 15 至 49 岁妇女的医疗保健和免疫接种服务利用。本研究提出了一种提高孟加拉国妇女 TT 疫苗接种率的科学方法，这有助于孟加拉国实现广泛的破伤风保护，从而实现降低母婴死亡率的可持续发展目标。
