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BMJ Open. 2018 Oct 24;8(10):e022634. doi: 10.1136/bmjopen-2018-022634.

Equity and determinants of routine child immunisation programme among tribal and non-tribal populations in rural Tangail subdistrict, Bangladesh: a cohort study.

Author information

Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Expended Program on Immunization Department, Director General of Health Services (DGHS), Government of Bangladesh (GoB), Dhaka, Bangladesh.
Global Consortium for Public Health Research, Liverpool John Moores University, Liverpool, UK.
Community Skilled Birth Attendant Program, Obstetrical and Gynaecological Society of Bangladesh (OGSB), Mohammadpur, Bangladesh.



The study estimated valid vaccination coverage of under 5 children in a rural area under Tangail subdistrict and examined their sociodemographic correlates including ethnicity.


The study sites are three primary areas where tribal and non-tribal population resides together in a rural subdistrict of Bangladesh.


Routine vaccination information of a cohort of 2802 children, born between 1 January 2011 and 31 December 2012, were retrieved from the Expanded Program on Immunization (EPI) registers maintained by the health assistants. Collected data were entered in an Oracle-based computer program. Univariate, bivariate and multivariate analyses were performed in SPSS V.20 to explore coverage and differentials for full valid vaccination coverage in the study area.


Valid vaccination coverage was 90.6% among tribal population and 87.3% among non-tribal population(p=0.25). Compared with females, males had higher valid vaccination coverage (89.2% vs 85.9%) and lower invalid (5.4% vs 6.9%) and no-coverage (5.3% vs 7.3%) (p=0.03). Households with mobile phones had higher valid coverage (90.9% vs 86.5%) and lower invalid (4.5% vs 6.7%) and no coverage (4.5% vs 6.9%) compared with those without mobile phones (p=0.01). Coverage of valid vaccination was higher among children of Oronkhola union than in children of the other two unions.


The study documented that valid vaccination coverage was high in this rural area, and there was no significant ethnic variation which was one of the strengths of the national EPI. However, there is significant variation by gender of the child, household ownership of mobile phones and geographical location of households.


bangladesh; child health; ethnicity; immunization

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