Where girls are less likely to be fully vaccinated than boys: Evidence from a rural area in Bangladesh

Background: Immunization is one of the most successful and effective health intervention to reduce vaccine preventable diseases for children. Recently, Bangladesh has made huge progress in immunization coverage. In this study, we compared the recent immunization coverage between boys and girls in a rural area of Bangladesh. Setting: The study is based on data from Chakaria Health and Demographic Surveillance System (HDSS) of icddr,b, which covers a population of 90,000 individuals living in 16,000 households in 49 villages. Methods: We calculated the coverage of fully immunized children (FIC) for 4584 children aged 12–23 months of age between January 9, 2012 and January 19, 2016. We analyzed immunization coverage using crude FIC coverage ratio (FCR) and adjusted FCR (aFCR) from binary regression models. The dynamic of gender inequality was examined across sociodemographic and economic conditions. Main outcome measure: The adjusted female/male (F/M) FIC coverage ratios in various sociodemographic and economic categories. Results: Among children who lived below the lower poverty line, the F/M aFCR was 0.89 (0.84–0.94) compared to 0.98 (0.95–1.00) for children from the households above lower poverty line (p = 0.003, test for interaction). For children of mothers with no high school education, the F/M aFCR was 0.94 (0.91–0.97), whereas it was 1.00 (0.96–1.04) for children of mothers who attended high school (p = 0.04, test for interaction). The F/M aFCR was 1.01 (0.96–1.06) for first born children but 0.95 (0.93–0.98) for second or higher birth order children (p = 0.04, test for interaction). Conclusions: Fewer girls than boys were completely vaccinated by their first birthday due to girls’ lower coverage for measles vaccine. The tendency was most marked for children living below the poverty line, for children whose mothers did not attend high school, and for children of birth order two or higher. In the study setting and similar areas, sex differentials in coverage should be taken into account in ongoing immunization programmes.