Objective: To evaluate factors associated with non-compliance with having second vaccination against diphtheria, tetanus, and pertussis in a treatment centre in Dhaka to determine which children were most at risk of not completing immunisation.
Design: Cohort study of infants given first dose of the vaccine and followed up six weeks later to ascertain compliance with having second dose. Factors associated with non-compliance were evaluated.
Setting: Dhaka treatment centre of the International Centre for Diarrhoeal Disease Research, Bangladesh.
Subjects: 136 unimmunised children aged 6 weeks to 23 months who lived within reach of the treatment centre. At time of the six week follow up 16 of the children could not be traced and seven had died.
Interventions: All children received their first dose of the vaccine. In each case health education workers had informed the mother about the value of immunisation, and she was given clear instructions to bring the child back after four weeks for the second dose.
Main outcome measure: Rate of non-compliance with advice to return child for second vaccination.
Results: 46 of 113 children (41%) received the second dose of the vaccine. Factors most closely associated with mothers' failure to comply with the second dose were lack of education and low income. Children whose mothers knew most about immunisation at first interview were more likely to have their second dose.
Conclusions: Preventive health care services such as immunisation are appropriately offered in treatment centres, but compliance among children varies with socioeconomic status and mother's education. Further research should be aimed at ways to make health education more effective among uneducated parents.
PIP: Factors associated with noncompliance with have a 2nd vaccination against diphtheria, tetanus, and pertussis in a treatment center in Dhaka were evaluated in order to determine which children were most at risk for not completing their immunization. This cohort study of infants was conducted at the Dhaka treatment center of the International Center for Diarrheal Disease Research, Bangladesh and included 136 unimmunized children ages 6 weeks-23 months who lived within reach of the treatment center. 1st doses of the vaccination were given and followed up 6 weeks later to ascertain compliance with having the 2nd dose. At the 6-week followup, 16 of the children could not be traced and 7 had died. All children received their 1st dose of the vaccine. In each case, health education workers had informed the mother about the value of immunization, and she was provided clear instructions concerning the return of the child after 4 weeks had passed for the 2nd dose. Rate of noncompliance with advice to return the child for 2nd vaccination was the main outcome measure. 46 of 113 children (41%) received the 2nd vaccine dose. Factors most closely associated with maternal failure to comply with 2nd dose were lack of education and low income. Children whose mothers know most about immunization at 1st interview were more likely to have their 2nd dose. Preventive health care services such as immunization are appropriately offered in treatment centers but compliance among children varies with socioeconomic status and maternal education. Further research should be aimed at ways to make health education more effective among uneducated parents.