Socioeconomic drivers of vaccine uptake: An analysis of the data of a geographically defined cluster randomized cholera vaccine trial in Bangladesh

Amit Saha, Andrew Hayen, Mohammad Ali, Alexander Rosewell, C Raina MacIntyre, John D Clemens, Firdausi Qadri, Amit Saha, Andrew Hayen, Mohammad Ali, Alexander Rosewell, C Raina MacIntyre, John D Clemens, Firdausi Qadri

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.

Trial registration: ClinicalTrials.gov NCT01339845.

Keywords: Geographic information system; Oral cholera vaccine; Socio-economic drivers; Vaccination program; Vaccine effectiveness; Vaccine uptake.

Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Figures

Fig. 1
Fig. 1
Creation of the spatial database for the study area.
Fig. 2
Fig. 2
The geographic clusters on the study. The cluster numbers are shown inside the clusters. The inset shows the geographic position of the study area in the Dhaka Metropolitan area.
Fig. 3
Fig. 3
Spatial distribution of diarrhoea and cholera cases with population density.
Fig. 4
Fig. 4
A sample of the part map for vaccine operation.

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