Socioeconomic drivers of vaccine uptake: An analysis of the data of a geographically defined cluster randomized cholera vaccine trial in Bangladesh. Issue 31 (25th July 2018)

• Record Type: Journal Article
• Authors: Saha, Amit; Hayen, Andrew; Ali, Mohammad; Rosewell, Alexander; MacIntyre, C. Raina; Clemens, John D.; Qadri, Firdausi
• Is Part Of: Vaccine. Volume 36:Issue 31(2018)
• Page Start: 4742
• Page End: 4749
• Publication Date: 2018-07-25
• Subjects: Oral cholera vaccine -- Vaccination program -- Vaccine effectiveness -- Socio-economic drivers -- Vaccine uptake -- Geographic information system; Vaccines -- Periodicals; 615.372
• DOI: 10.1016/j.vaccine.2018.04.084
• Languages: English
• ISSNs: 0264-410X

Abstract

Highlights: Use of the GIS facilitated designing improved vaccination strategy in a large clinical trial. Two-third of the study population received two complete doses of the oral cholera vaccine. Vaccine uptake was significantly higher among females and among younger subjects. Individuals living farther away from the health facilities were more like to receive the vaccine. Socioeconomic drivers of vaccine uptake should be considered in planning for vaccination strategy. Abstract: Background: Evaluations of oral cholera vaccines (OCVs) have demonstrated their effectiveness in diverse settings. However, low vaccine uptake in some settings reduces the opportunity for prevention. This paper identifies the socioeconomic factors associated with vaccine uptake in a mass vaccination program. Methods: This was a three-arm (vaccine, vaccine plus behavioral change, and non-intervention) cluster randomized trial conducted in Dhaka, Bangladesh. Socio-demographic and vaccination data were collected from 268, 896 participants. A geographical information system (GIS) was used to design and implement the vaccination program. A logistic regression model was used to assess the association between vaccine uptake and socioeconomic characteristics. Results: The GIS supported the implementation of the vaccination program by identifying ideal locations of vaccination centres for equitable population access, defining catchment areas of daily activities, and providing daily coverage maps during the campaign. Among 188, 206 individuals in the intervention arms, 123, 686 (66%) received two complete doses, and 64, 520 (34%) received one or no doses of the OCV. The vaccine uptake rate was higher in females than males (aOR: 1.80; 95% CI = 1.75–1.84) and in younger (<15 years) than older participants (aOR: 2.19; 95% CI = 2.13–3.26). Individuals living in their own house or having a higher monthly family expenditure were more likely to receive the OCV (aOR: 1.60; 95% CI = 1.50–1.70 and aOR: 1.14; 95% CI = 1.10–1.18 respectively). Individuals using treated water for drinking or using own tap as the source of water were more likely to receive the OCV (aOR: 1.23; 95% CI = 1.17–1.29 and aOR: 1.14; 95% CI = 1.02–1.25 respectively) than their counterpart. Vaccine uptake was also significantly higher in participants residing farther away from health facilities (aOR: 95% 1.80; CI = 1.36–2.37). Conclusion: The GIS was useful in designing field activities, facilitating vaccine delivery and identifying socioeconomic drivers of vaccine uptake in the urban area of Bangladesh. Addressing these socioeconomic drivers may help improve OCV uptake, thereby effectiveness of the OCV in a community.