Why do some parents decide not to immunise their children? Are decisions based on health issues or social and cultural factors? Researchers from the UK University of Southampton and the USA Population Council evaluated the child vaccination programme in Bangladesh.

They report that most decisions about immunisation are taken at the household level. Factors that influence child vaccination include power relationships in the household, the family’s socio-economic status, and whether the mother herself had been immunised. Women who are members of women’s savings groups (WSG) are also more likely to support vaccination.

The Expanded Programme on Immunisation (EPI) was launched by the World Health Organisation in 1974. Under the EPI, children are vaccinated against six major childhood diseases before their first birthday. The aim was universal immunisation of children by 1990.

The EPI had a late start in Bangladesh. In 1985, the programme covered only two percent of all children. However, in 1989, the Ministry of Health and Family Planning joined forces with other government bodies and non-governmental organisations to improve the service. As a result, over 65 percent of children were covered by 1990.

Immunisation levels were analysed statistically for four rural areas of Bangladesh. The study examined key influences at the individual, household, and village level, including membership of a WSG. Save the Children have created women’s savings groups for the poorest rural women with the aim of increasing their economic participation and raising their status within the household. The study showed that mothers who are members of a WSG are more likely to have their children immunised. Children are also more likely to be vaccinated if their mother was immunised during pregnancy. Other factors affecting immunisation status include:

• socio-economic status - households with access to tube-well drinking water, sanitary latrines or separate kitchens are more likely to have their children immunised.
• attitudes to health care in the household or local community.
• power relationships within the household – if the family live with the father’s parents, the mother-in-law makes most of the household’s health decisions and is less likely to support immunisation.
• accessibility of healthcare and effectiveness of healthcare workers.

Key messages for health policy include:

• It is important to discover the pathways that lead to an increase in immunisation for WSG members.
• As most decisions about health care are taken within the household, it is advisable to target programmes at this level.
• More research is needed to identify the factors that influence immunisations at the village level.

Source(s):
‘Immunization uptake in rural Bangladesh: a multilevel analysis’ by F. Steele, I. Diamond and S. Amin, Journal of the Royal Statistical Society 159 (1996)

Funded by: UK Economic and Social Research Council; US Agency for International Development

id21 Research Highlight: 26 January 2001

Further Information:
Fiona Steele
Institute of Education
University of London
20 Bedford Way
London WC1H 0AL
UK

Tel: +44 (0) 20 7612 6657
Contact the contributor: F.Steele@ioe.ac.uk

Institute of Education, University of London, UK

Ian Diamond
Department of Social Statistics
University of Southampton
Highfield
Southampton
SO17 1BJ
UK

Tel: +44 (0)23 8059 2518
Fax: +44 (0)23 8059 3846
Contact the contributor: idd@socsci.soton.ac.uk

University of Southampton

Sajeda Amin
Population Council
1 Dag Hammarskjold Plaza
New York
New York 10017
USA

Tel: +1 212 339 0500
Fax: +1 212 755 6052
Contact the contributor: samin@popcouncil.org

Population Council

Other related links:
The WHO has factsheets on many vaccine preventable diseases.

The Children's Vaccine Programme provides a range of resources on vaccination.