Md Jasim Uddin
International Centre for Diarrhoeal Disease Research, Bangladesh
Md Jasim Uddin has completed his PhD from University of Dhaka on Management Studies (Health). His research area is health systems research and he has published around 50 articles in peer reviewed journals. He has been working as a Consultant Scientist at International Centre for Diarrhoeal Disease Research, Bangladesh.
Statement of the Problem: Rapid urbanization, high density of population, and low coverage of immunization in urban slums of Bangladesh call for the increased emphasis on immunization coverage for vulnerable urban poor children where spread of infection is faster. The study assessed the impact of an EPI intervention package, implemented within the existing service-delivery system, to improve the child immunization coverage in urban slums of Dhaka, Bangladesh.
Methodology: This intervention trial used a pre and post-test design. An intervention package was tested in two urban slums. The intervention package included: (a) an extended EPI service schedule, (b) training for service providers on valid doses and management of side-effects, (c) a screening tool to identify immunization needs among clinic attendants, and (d) an EPI support group for social mobilization. Data were obtained from random sample surveys, service statistics, and qualitative interviews. Analysis of quantitative data was based on a before and after assessment of selected immunization-coverage indicators. Qualitative data were analyzed using content analysis.
Findings: Ninety-nine percent of the children were fully immunized after implementation of the interventions compared to only 43% before implementation. Antigen-wise coverage after implementation of the interventions was also significantly higher compared to before implementation. Only 1% drop-out was observed after the implementation of the interventions while it was 33% before implementation. At baseline, a significantly higher proportion of children of non-working mothers (75%) were fully immunized compared to children of working mothers (14%). Although the proportion of fully-immunized children of both non-working and working mothers was significantly higher at end line, fully-immunized children of working mothers were dramatically improved at end line (99%) compared to baseline (14%).
Conclusion & Significance: The findings suggest the effectiveness of a 'package of interventions' in improving child immunization coverage in urban slums. Therefore, the policy makers and programme managers should implement the package of successful interventions in all the slums of Bangladesh for improving the coverage of child immunization among this marginalized group of people. Other countries who are struggling from the same problem may also implement the interventions.