Peer-reviewed article
Factors associated with low childhood immunization coverage among Rohingya refugee parents in Cox’s Bazar, Bangladesh
Nawshin Ahmed, A. S. M. Ishtiak, Md Faisal Kabir Rozars, Atia Sharmin Bonna, K. M. Pritam Alam et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined why childhood immunization coverage was lower than expected among Rohingya refugee children in Cox's Bazar, Bangladesh. A cross-sectional survey of 224 Rohingya parents found that 63% had completed vaccination schedules, with significantly better compliance in registered camps than makeshift settlements. Living in registered camps and having good knowledge about immunization were the main factors associated with completing vaccination schedules. The study recommends stronger health education and promotion strategies to increase immunization uptake.
Key points
- Only 63.1% of Rohingya parents had completed childhood immunization as per schedule, despite 94.7% having positive attitudes towards vaccination
- Good practice was significantly higher in registered camps (77%) compared to makeshift settlements (49.2%)
- Good knowledge level and living in registered camps were independent determinants of completing vaccinations
- In registered camps, having more than 2 children increased likelihood of completing vaccinations; in makeshift settlements, father's employment and education were significant factors
- Most parents (74.6%) had good knowledge about immunization despite lower vaccination completion rates
Limitations
This was a cross-sectional study without a comparison group, so causality cannot be established. The convenient sampling method may not represent all Rohingya parents, and the study does not explore potential barriers such as vaccine hesitancy, access challenges, or specific health system constraints.
Abstract
INTRODUCTION: Immunization campaigns and Expanded Program on Immunization (EPI) were launched by Government of Bangladesh (GoB) in collaboration with WHO and other Non-governmental Organizations (NGOs) to tackle the increased risk of vaccine preventable disease outbreak in the Rohingya refugee camps. Immunization coverage was found to be lower than expected. However, a few studies explored the factors behind low vaccine uptake among Refugee children. Therefore, this study was aimed. METHODS: A cross sectional study was carried out among Rohingya parents living in registered camps and makeshift settlements located in Teknaf and Ukhiya upazilla of Cox's Bazar, Bangladesh. A total of 224 Rohingya parents were conveniently selected (122 parents from each type of camps). Data was collected using a pretested interviewer-administered semi-structured questionnaire with the help of bilingual volunteers who understand Rohingya dialect. All statistical analyses were carried out in IBM SPSS Version 26 (New York, USA). RESULTS: Total 63.1% of Rohingya parents had good practice regarding childhood immunization (completed EPI vaccination) as per schedule. Of all, 74.6% had good knowledge and 94.7% had positive attitude towards EPI vaccination. Good practice regarding vaccination was significantly more common among parents living in registered camps (77%) than those living in makeshift settlements (49.2%, p<0.001). Multivariable logistic regression analysis revealed that living in registered camps (Adjusted Odds Ratio [aOR]: 2.99; 95% Confidence Interval [CI]: 1.41-6.32) and good knowledge level (aOR: 2.88; 95%CI: 1.32-15.82) were independent determinants of good practice. A separate analysis in both type of camps revealed that in registered camps, good knowledge level (aOR: 3.62; 95%CI: 1.45-9.04) and having >2 children (aOR: 3.71; 95%CI: 1.34-10.27), and in makeshift settlements, father's employment (aOR: 2.33; 95%CI: 1.34-6.72), father's education (aOR: 3.00; 95%CI: 1.34-6.72) and presence of any electronic device (e.g., radio, television, mobile phone) (aOR: 4.01; 95%CI: 0.96-16.84) were significant determinants of good childhood immunization practice. CONCLUSION: Health education and promotion strategies should be implemented to increase knowledge and awareness about EPI immunization benefits among Rohingya parents to ensure greater coverage.