Saha Avijit, Sarker Malabika, Hossen Md Tanvir, Hassan Zahid, Adhikari Jucy Merina, Latif Mahbub A H M
BRAC James P Grant School of Public Health, BRAC University, Dhaka 1213, Bangladesh.
Heidelberg Institute of Global Health, Heidelberg University, Heidelberg 69120, Germany.
Lancet Reg Health Southeast Asia. 2023 Jul 24;16:100252. doi: 10.1016/j.lansea.2023.100252. eCollection 2023 Sep.
With an impressive track record in expanding childhood immunization and an inclination to adopt digitalization in healthcare service delivery, Expanded Program on Immunization (EPI) Bangladesh piloted the e-Tracker intervention in Moulvibazar district and Dhaka South City Corporation (Zone-5) from 2019 till the end of 2021.
We retrieved and analyzed the digitalized e-Tracker data of 114,194 infants born between January 1, 2019 and December 31, 2020, with help from Health Management Information System (HMIS) and UNICEF Bangladesh. Childhood vaccination coverage and dropout rates were determined using a 'Traditional approach' traditionally used by WHO and a 'Conditional technique' with a modified denominator. Using a multiple logistic regression model, we examined the effects of COVID-19, birth-cohorts, mother education, and location on vaccination rates (coverages & dropouts) to aid with informed decision-making by the policymakers.
The conditional estimation method yielded a lower full vaccination coverage during pre-COVID period than the national and global reported coverage derived using the 'traditional method' (73.4% vs. 89.0% & 81.0%). As expected, while the coverage has decreased, the dropout rate increased "during-COVID" compared to the "pre-COVID" period. However, dropouts were estimated lower in the 'conditional method.' The average age (in months) for getting BCG was higher in Moulvibazar (∼2.5 months) than that in Dhaka (∼1.4 months). All birth-cohorts from 'the during-COVID period had about 30% lower odds of getting fully vaccinated than those from the 'pre-COVID' period.
Age-cohort-specific analysis showed a decline in coverage rates before and during COVID, but e-Tracker didn't have enough data to draw additional conclusions. The server only stored the child's gender, the caregiver's monthly salary, and the mother's education. It didn't track any other factors related to dropout rates. The e-Tracker is an excellent tool for measuring real coverage and should be scaled nationwide.
UNICEF, Bangladesh.
孟加拉国扩大免疫规划（EPI）在扩大儿童免疫接种方面成绩斐然，且倾向于在医疗服务提供中采用数字化手段，于2019年至2021年底在穆尔维巴扎尔区和达卡南城公司（第5区）试点了电子追踪干预措施。
在孟加拉国卫生管理信息系统（HMIS）和联合国儿童基金会的帮助下，我们检索并分析了2019年1月1日至2020年12月31日期间出生的114,194名婴儿的数字化电子追踪数据。儿童疫苗接种覆盖率和辍学率采用世界卫生组织传统使用的“传统方法”以及分母经过修改的“条件技术”来确定。我们使用多元逻辑回归模型，研究了新冠疫情、出生队列、母亲教育程度和地点对疫苗接种率（覆盖率和辍学率）的影响，以协助政策制定者做出明智决策。
在新冠疫情之前，条件估计方法得出的全程疫苗接种覆盖率低于使用“传统方法”得出的国家和全球报告覆盖率（73.4%对89.0%和81.0%）。不出所料，与“新冠疫情之前”相比，“新冠疫情期间”覆盖率下降，辍学率上升。然而，“条件方法”估计的辍学率较低。穆尔维巴扎尔区接种卡介苗的平均年龄（月）（约2.5个月）高于达卡（约1.4个月）。“新冠疫情期间”的所有出生队列完全接种疫苗的几率比“新冠疫情之前”的队列低约30%。
特定年龄队列分析显示，新冠疫情之前和期间覆盖率有所下降，但电子追踪器没有足够数据得出更多结论。服务器仅存储了儿童性别、照料者月工资和母亲教育程度。它没有追踪任何与辍学率相关的其他因素。电子追踪器是衡量实际覆盖率的出色工具，应在全国范围内推广。
联合国儿童基金会孟加拉国办事处。
