THE IMMUNIZATION DIVIDE Who Do Get Vaccinated in Bangladesh?

1. THE IMMUNIZATION DIVIDE Who Do Get Vaccinated in Bangladesh? Bangladesh Health Equity Watch Mushtaque Chowdhury 2004

2. Immunizations in Bangladesh The “Near Miracle” 2% in 1986 70% in 1991 Mushtaque Chowdhury 2004

3. National trends in coverage (%) of children (<12 months) by year of survey, Bangladesh (1992-2001) Source: Government of Bangladesh, (2001) Mushtaque Chowdhury 2004

4. Survey year Boys Girls Girl/ Boy ratio 1999-2000 63.4 57.1 0.900 1996-1997 55.8 52.2 0.935 1993-1994 62.1 55.6 0.893 Percent of children (12-23 months) vaccinated by gender and year Sources: BDHS (1994; 1997; 2001) Mushtaque Chowdhury 2004

5. Percent of children (12-23 months) by dose of antigens received and gender (1999-00) Vaccine dose Boys Girls Girl/Boy ratio BCG 92.5 89.3 0.965 DPT1 90.7 87.0 0.959 DPT2 83.8 79.2 0.945 DPT3 75.9 67.8 0.893 OPV1 94.5 93.8 0.992 OPV2 86.6 83.6 0.965 OPV3 74.8 68.3 0.913 Measles 73.2 68.2 0.931 All 63.4 57.1 0.900 Mushtaque Chowdhury 2004

6. Mushtaque Chowdhury 2004

7. Source Percent Service * 64 Business 31 Day labour 27 Others 37 Children (12-23 months) fully immunized by source of household income in Bhairab, Bangladesh (1997) * Salaried employment in any government or non-government or private institution (mostly white collared) Source: Bhairab Survey (1997) Mushtaque Chowdhury 2004

8. Food security status Percent Surplus 42 Balance 30 Deficit 29 Children (12-23 months) immunized by self-rated annual household food security status in Bhairab (1997) Source: Bhairab Survey (1997) Mushtaque Chowdhury 2004

9. Wealth quintile % immunized Poorest 47.2 Second 43.7 Middle 60.8 Fourth 58.8 Richest 66.7 All 54.1 Poorest/Richest ratio 0.708 Children (12-23 months) immunized by wealth quintile (1996/7) Source: BDHS 1997. Compiled from Gwatkin et al (2000) Mushtaque Chowdhury 2004

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11. Mushtaque Chowdhury 2004

12. Size of Village and Isolation Matter! Mushtaque Chowdhury 2004

13. Immunization coverage of children (12 months) living in selected geographical pockets Characteristics of pockets Percent Low - lying area (Haor)1 5 Chittagong Hill Tracts2 22 Tea Estates:3 • Foreign owned 56 • Bangladeshi owned 27 National 52  Sources: 1. Aziz et al (1999); 2. Karim and Begum (2001); 3. Bhuiya et al. (1999) Mushtaque Chowdhury 2004

14. Ethnic Group Percent Bangalee 33.7 Chakma 8.8 Marma 9.1 Mro 7.6 Tripura 17.0 Total 22 Children (12 months) fully immunized by ethnicity (1998)  in CHT Source: Karim and Begum (2001) Mushtaque Chowdhury 2004

15. Does economic power matter? ‘Health Workers (HW) behave differently with different people...... a HW gave a syringe and a Measles vaccine vial to the porter, just before closing the centre. The porter and the HW then went to a house on the other side of the road to vaccinate a child. The house owner was a rich man and the parents did not want to come to the centre’. Source : Chowdhury et al. (1999: 73) Mushtaque Chowdhury 2004

16. THE CHALLENGE How do we take immunizations to a greater number of children? Mushtaque Chowdhury 2004

17. An Example from the Education Sector in Bangladesh • Girls • Socio-economically poor • Rural areas Good gains in primary school enrollment in the past decade. Gains concentrated in these groups: Mushtaque Chowdhury 2004

18. Affirmative Actions by the Government and NGOs • Food for Education • Secondary education scholarships for girls • Non-formal schools by NGOs Mushtaque Chowdhury 2004

19. Thank You! Mushtaque Chowdhury 2004