Uncovering Inequitable Access to Vaccination Programs by Nomadic Bedey Children of Bangladesh

Abstract

Vaccination coverage gaps in children across geographic and ethnic lines exist in Bangladesh. To address this vaccine-divide, the study evaluates whether the current approaches to vaccine-delivery is reaching communities, like the Bedey—an ethnic-minority and once primarily river-dwelling nomadic group—who are highly mobile and have a unique socioeconomic, political, cultural, and historical background. A convergent mixed-methods study was conducted. The cross-sectional survey measured vaccination coverages of Bacille Calmette Guerin (BCG), Pentavalent (DPT, Hepatitis B, Hib), Oral Polio Vaccine (OPV), Pneumococcal Conjugate Vaccine (PCV), Inactivated Poliovirus Vaccine (IPV) and Measles and Rubella (MR) among Bedey and non-Bedey children of ages 0-10 years in Dhaka and Barisal division of Bangladesh from October through December 2018. Vaccination coverage data were collected from vaccine cards, verbal recall, or both sources. The qualitative study explored challenges and facilitators of Bedey communities in accessing vaccination programs through field observations, in-depth and semi-structured interviews of key informants. A total of 208 Bedey and 161 non-Bedey children of ages 0-10 years were enrolled to assess age-appropriate routine vaccination coverage. Overall, only 52% (109/208) of the Bedey children received one dose of BCG compared to 96% (155/161) of the children in the non-Beday comparison group. In the multivariable logistic regression, it was found that the odds of having unreached children in Bedey community were much higher compared to the comparison group after being adjusted for parent, household and child-specific characteristics (OR=10.64, 95% CI: 3.49-32.44, p-value < 0.0001). In the qualitative study, 42 Bedey community members and 7 vaccine service providers participated. Data from this study suggest that a lack of guidelines in categorizing a child as “outsider” vs. “local,” requirements of a child to stay long in an area to avoid dropouts, misinformation about vaccines and their benefits, the Bedey community’s social isolation, and a failure to recognize them as a community all contribute to this low immunization coverage. In conclusion, current approaches to childhood vaccinations are falling short of reaching the Bedey community in Bangladesh. The study results highlight the importance of having tailored vaccination programs for the Bedey reflecting their unique socioeconomic, political and cultural contexts.