Introduction
Methods
Data source and study design
Outcome measure
Explanatory variables
Statistical analysis
Results
2011 (N = 3098) | 2014 (N = 3090) | 2017-18 (N = 3313) | P value | ||||||
---|---|---|---|---|---|---|---|---|---|
n | % (95% CI) | n | % (95% CI) | n | % (95% CI) | ||||
Vaccination card
a
| |||||||||
Yes, seen | 1938 | 5.06 (4.34,5.89) | 2175 | 69.69 (68.07,71.26) | 2355 | 70.63 (69.06,72.14) |
< 0.001
| ||
Yes, Not seen | 811 | 61.29 (59.56,63.00) | 764 | 25.87 (24.38,27.42) | 607 | 18.71 (17.43,20.07) | |||
No longer has card | 214 | 26.00 (24.49, 27.58) | 51 | 1.45 (1.09,1.93) | 231 | 7.12 (6.30,8.04) | |||
No card | 134 | 7.64 (6.76, 8.64) | 100 | 2.98 (2.44,3.63) | 120 | 3.54 (2.97,4.22) | |||
Reported vaccinations from vaccination card or mother recall
| |||||||||
BCG a | 3017 | 97.33 (96.70,97.85) | 3000 | 97.70 (97.12,98.17) | 3261 | 98.50 (98.02,98.86) |
< 0.001
| ||
Polio 1b | 3024 | 97.66 (97.07,98.14) | 2990 | 97.48 (96.87,97.97) | 3253 | 98.31 (97.81,98.69) |
< 0.001
| ||
Polio 2c | 2969 | 95.82 (95.06,96.48) | 2940 | 96.12 (95.39,96.73) | 3210 | 97.07 (96.44,97.59) |
0.001
| ||
Polio 3c | 2887 | 93.25 (92.31,94.08) | 2847 | 92.88 (91.93,93.72) | 3135 | 94.83 (94.03,95.53) |
0.001
| ||
Polio vaccination completion (OPV 1–3)
b
| |||||||||
Full | 2886 | 93.13 (92.18,93.97) | 2846 | 92.78 (91.83,93.63) | 3133 | 94.65 (93.84,95.37) |
< 0.001
| ||
Partial | 138 | 4.53 (3.85, 5.33) | 145 | 4.74 (4.05,5.53) | 121 | 3.70 (3.11,4.39) | |||
None | 74 | 2.34 (1.86, 2.93) | 99 | 2.48 (1.99,3.08) | 59 | 1.65 (1.27,2.14) | |||
DTP 1b | 3017 | 97.45 (96.83,97.95) | 2980 | 96.87 (96.20,97.42) | 3257 | 98.41 (97.93,98.79) |
< 0.001
| ||
DTP 2d | 2963 | 95.54 (94.75,96.21) | 2963 | 95.65 (94.89,96.31) | 3229 | 97.54 (96.96,98.01) |
< 0.001
| ||
DTP 3d | 2883 | 92.97 (92.01,93.81) | 2838 | 92.40 (91.43,93.27) | 3175 | 96.01 (95.30,96.63) |
< 0.001
| ||
DTP vaccination completion (DTP 1–3)
b
| |||||||||
Full | 2882 | 92.96 (92.00, 93.81) | 2838 | 92.38 (91.41,93.26) | 3175 | 96.01 (95.30,96.63) |
< 0.001
| ||
Partial | 135 | 4.49 (3.81,5.28) | 142 | 4.48 (3.82, 5.26) | 82 | 2.40 (1.93,2.98) | |||
None | 80 | 2.55 (2.05, 3.17) | 110 | 3.13 (2.58,3.80) | 56 | 1.59 (1.21,2.07) | |||
Measles e | 2747 | 88.66 (87.49, 89.73) | 2668 | 87.22 (86.01,88.33) | 3020 | 91.33 (90.33,92.24) |
< 0.001
| ||
Vaccination status
f
| |||||||||
Full | 2694 | 86.17 (85.46,87.86) | 2611 | 85.13 (83.86,86.33) | 2954 | 89.23 (88.13,90.23) |
< 0.001
| ||
Partial | 336 | 11.13 (10.07,12.29) | 399 | 12.89 (11.78,14.10) | 311 | 9.42 (8.48,10.46) | |||
None | 68 | 2.16 (1.70,2.74) | 80 | 1.97 (1.54,2.52) | 48 | 1.35 (1.01, 1.80) |
Variables | Fully vaccinated | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
2011 (N = 2694) | 2014 (N = 2611) | 2017-18 (N = 2954) | Pooled (N = 8259) | |||||||||
n | % (95% CI) | p | n | % (95% CI) | p | n | % (95% CI) | p | n | % (95% CI) | p | |
Individual and household level variables
| ||||||||||||
Sex of child
| ||||||||||||
Female | 1339 | 84.97(83.11,86.65) |
0.005
| 1289 | 86.05(84.22,87.70) | 0.426 | 1414 | 88.41(86.82,89.83) | 0.560 | 4217 | 87.08 (86.09,88.01) | 0.392 |
Male | 1355 | 88.51(86.80,90.02) | 1322 | 84.30(82.47,85.97) | 1540 | 90.11(88.55,91.47) | 4042 | 88.05 (86.09,88.01) | ||||
Current age of child
| ||||||||||||
12–23 months | 1328 | 85.94(84.11,87.58) | 0.168 | 1281 | 83.79(81.92,85.50) |
0.002
| 1463 | 88.27(86.64,89.72) |
0.044
| 4072 | 86.02 (85.01,86.97) |
< 0.001
|
24–35 months | 1366 | 87.48(85.73,89.04) | 1330 | 86.54(84.75,88.14) | 1491 | 90.18(88.67,91.52) | 4187 | 88.12 (87.17,89.01) | ||||
Maternal age
| ||||||||||||
< 25years | 1436 | 87.56(85.88,89.07) | 0.068 | 1357 | 85.34(83.54,86.97) | 0.307 | 1464 | 88.07(86.45,89.52) | 0.102 | 4257 | 87.01 (86.05,87.91) | 0.061 |
25–34 years | 1079 | 86.30(84.28,88.10) | 1082 | 84.90(82.88,86.73) | 1293 | 90.47(88.84,91.89) | 3454 | 87.32 (86.25.88.32) | ||||
> 34 years | 179 | 82.08(76.04,86.86) | 172 | 85.04(79.73,89.14) | 197 | 90.21(85.43,93.53) | 548 | 85.87 (82.93,88.38) | ||||
Maternal education
| ||||||||||||
No education | 404 | 75.94(72.24,79.29) |
< 0.001
| 295 | 72.24(67.97,76.15) |
< 0.001
| 170 | 78.60(72.69,83.53) |
< 0.001
| 869 | 75.04 (72.56,77.37) |
< 0.001
|
Primary | 764 | 83.41(80.90,85.65) | 688 | 79.89(77.13,82.39) | 778 | 84.71(82.27,86.87) | 2230 | 82.72 (81.27,84.08) | ||||
Secondary | 1235 | 91.69(90.07,93.06) | 1303 | 90.18(88.59,91.58) | 1451 | 91.36(89.89,92.63) | 3989 | 91.05 (90.18,91.85) | ||||
Higher | 291 | 97.05(94.07,98.56) | 325 | 94.50(91.33,96.56) | 555 | 94.73(92.57,96.29) | 1171 | 95.19 (93.77,96.29) | ||||
Wealth index
| ||||||||||||
Poor | 1031 | 82.43(80.31,84.37) |
< 0.001
| 964 | 77.30(74.94,79.49) |
< 0.001
| 1210 | 87.38(85.52,89.03) |
0.001
| 3205 | 82.46 (81.26,83.60) |
< 0.001
|
Middle | 506 | 87.92(85.07,90.29) | 508 | 88.70(85.87,91.02) | 520 | 90.14(87.57,92.23) | 1534 | 88.95 (87.42,90.30) | ||||
Rich | 1157 | 91.16(89.36,92.68) | 1139 | 91.39(89.74,92.80) | 1224 | 90.69(89.02,92.14) | 3520 | 91.07(90.12,91.94) | ||||
Media access
| ||||||||||||
Never/less than once | 1256 | 83.70(81.79,85.45) |
< 0.001
| 1176 | 79.25(77.16,81.20) |
< 0.001
| 1306 | 87.43(85.63,89.03) |
0.002
| 3738 | 83.39 (82.28,84.44) |
< 0.001
|
At least once a week | 1438 | 89.82(88.19,91.24) | 1435 | 90.69(89.18,92.00) | 1648 | 90.63(89.23,91.86) | 4521 | 90.41 (89.56,91.19) | ||||
Place of delivery
| ||||||||||||
Home | 1835 | 84.15(82.58,85.60) |
< 0.001
| 1568 | 81.73(79.97,83.36) |
< 0.001
| 1452 | 87.02(85.35,88.53) |
< 0.001
| 4855 | 84.16 (83.22,85.07) |
< 0.001
|
Health facility | 859 | 93.55(91.67,95.03) | 1043 | 90.85(89.08,92.37) | 1502 | 91.54(90.09,92.80) | 3404 | 91.78 (90.84,92.63) | ||||
ANC visit
| ||||||||||||
No visit | 710 | 79.12(76.39,81.61) |
< 0.001
| 484 | 73.93(70.50,77.09) |
< 0.001
| 196 | 82.12(76.78,86.46) |
< 0.001
| 1390 | 77.61 (75.65,79.45) |
< 0.001
|
1 to 3 visits | 1064 | 90.16(88.36,91.71) | 1139 | 86.06(84.13,87.79) | 1148 | 87.33(85.48,88.98) | 3351 | 87.76 (86.71,88.74) | ||||
4 or more visits | 737 | 92.41(90.20,94.16) | 842 | 92.55(90.68,94.07) | 1434 | 92.38(90.93,93.61) | 3013 | 92.44 (91.46,93.31) | ||||
Others# | 226 | 81.90(76.43,86.33) | 146 | 82.34(76.49,86.99) | 176 | 87.08(81.70,91.05) | 505 | 83.67 (80.60,86.34) | ||||
Number of children
| ||||||||||||
Single | 1018 | 89.75(87.82,91.41) |
< 0.001
| 1065 | 86.96(84.95,88.74) |
< 0.001
| 1147 | 90.44(88.72,91.92) | 0.118 | 3230 | 89.07 (88.01,90.04) |
< 0.001
|
Two children | 867 | 87.01(84.80,88.94) | 860 | 87.90(85.79,89.73) | 1030 | 89.16(87.24,90.82) | 2757 | 88.08 (86.91,89.15) | ||||
More than two | 809 | 82.93(80.43,85.17) | 686 | 79.53(76.79,82.02) | 777 | 87.52(85.17,89.54) | 2272 | 83.26 (81.82,84.60) | ||||
Community level variables
| ||||||||||||
Divisions
| ||||||||||||
Barisal | 304 | 86.40(80.39,90.78) |
< 0.001
| 300 | 83.81(77.71,88.50) |
< 0.001
| 289 | 87.19(81.42,91.35) |
0.005
| 893 | 85.78 (82.54,88.50) | < 0.001 |
Chittagong | 529 | 83.12(80.20,85.68) | 524 | 84.45(81.60,86.93) | 501 | 88.46(85.93,90.58) | 1554 | 85.36 (83.80,86.78) | ||||
Dhaka | 439 | 86.39(84.06,88.42) | 484 | 88.18(86.16,89.93) | 786 | 88.50(86.51,90.23) | 1709 | 87.76 (86.58,88.85) | ||||
Khulna | 329 | 91.70(87.91,94.38) | 308 | 87.50(82.85,91.02) | 303 | 92.10(88.38,94.70) | 940 | 90.55 (88.37,92.36) | ||||
Rajshahi | 351 | 90.19(86.87,92.75) | 330 | 86.52(82.29,89.86) | 323 | 91.27(88.06,93.68) | 1004 | 89.54 (87.59,91.20) | ||||
Rangpur | 342 | 91.31(87.64,93.97) | 350 | 93.37(89.96,95.68) | 340 | 92.20(88.92,94.57) | 1032 | 92.28 (90.43,93.80) | ||||
Sylhet | 400 | 81.02(75.47,85.56) | 315 | 63.81(58.15,69.11) | 412 | 85.72(81.05,89.40) | 1127 | 76.30 (73.22,79.12) | ||||
Place of residence
| ||||||||||||
Urban | 902 | 88.78(86.27,90.88) |
0.001
| 845 | 87.77(85.35,89.84) | 0.071 | 1020 | 88.51(86.27,90.44) | 0.920 | 2767 | 88.34 (87.01,89.55) |
0.002
|
Rural | 1792 | 86.07(84.61,87.41) | 1766 | 84.22(82.70,85.63) | 1934 | 89.49(88.21,90.64) | 5492 | 86.63 (85.82,87.39) | ||||
Community literacy level of women
| ||||||||||||
High | 1409 | 90.82(89.23,92.19) |
< 0.001
| 1218 | 88.72(87.11,90.15) |
< 0.001
| 1609 | 92.01(90.64,93.19) |
< 0.001
| 4455 | 90.89 (9005,91.66) |
< 0.001
|
Low | 1285 | 82.98(81.07,84.73) | 1393 | 81.20(79.16,83.09) | 1345 | 86.24(84.47,87.83) | 3804 | 83.14 (82.05,84.18) | ||||
Community wealth index level
| ||||||||||||
High | 1376 | 85.84(84.00,87.49) |
0.017
| 1270 | 80.63(78.64,82.47) |
< 0.001
| 1528 | 88.80(87.24,90.19) |
0.034
| 4014 | 85.16 (84.14,86.12) |
< 0.001
|
Low | 1318 | 87.57(85.83,89.13) | 1341 | 89.91(88.30,91.31) | 1426 | 89.70(88.11,91.10) | 4245 | 89.07 (88.14,89.93) | ||||
Community media exposure
| ||||||||||||
High | 1455 | 89.10(87.51,90.51) |
< 0.001
| 1174 | 89.78(88.24,91.14) |
< 0.001
| 1508 | 89.92(88.41,91.25) |
0.020
| 4356 | 89.26 (88.37,90.08) |
< 0.001
|
Low | 1239 | 83.92(81.92,85.74) | 1437 | 80.00(77.91,81.94) | 1446 | 88.48(86.83,89.95) | 3903 | 84.62 (83.55,85.64) | ||||
Total
| 2694 | 86.71(85.46,87.86) | 2611 | 85.13(83.86,86.33) | 2954 | 89.23(88.13,90.23) | 8259 | 87.06 (86.38,87.72) |
Variables | 2011 | 2014 | 2017-18 | Pooled | ||||
---|---|---|---|---|---|---|---|---|
AOR (95% CI) | p value | AOR (95% CI) | p value | AOR (95% CI) | p value | AOR (95% CI) | p value | |
Individual and household level variables
| ||||||||
Sex of child
| ||||||||
Male | Ref | Ref | Ref | Ref | ||||
Female | 0.69 (0.55, 0.88) |
0.002
| 1.00 (0.80, 1.26) | 0.990 | 1.06 (0.83, 1.35) | 0.650 | 0.93 (0.81, 1.05) | 0.241 |
Current age of child
| ||||||||
12–23 months | Ref | Ref | Ref | Ref | ||||
24–35 months | 1.31 (1.03, 1.67) |
0.029
| 1.63 (1.29, 2.06) |
< 0.001
| 1.31 (1.03, 1.69) |
0.031
| 1.40 (1.22, 1.59) |
< 0.001
|
Maternal age
| ||||||||
< 25 years | Ref | Ref | Ref | Ref | ||||
25–34 years | 0.91 (0.66, 1.25) | 0.553 | 1.58 (1.15, 2.17) |
0.004
| 1.51 (1.09, 2.08) |
0.014
| 1.30 (1.09, 1.54) |
0.004
|
> 34 years | 0.80 (0.48, 1.35) | 0.404 | 2.06 (1.21, 3.51) |
0.008
| 1.78 (0.98, 3.22) |
0.059
| 1.39 (1.03, 1.87) |
0.031
|
Maternal education
| ||||||||
No education | Ref | Ref | Ref | Ref | ||||
Primary | 1.45 (1.06, 1.99) |
0.020
| 1.54 (1.11, 2.13) |
0.010
| 1.44 (0.94, 2.22) | 0.094 | 1.53 (1.27, 1.84) |
< 0.001
|
Secondary | 2.31 (1.59, 3.34) |
< 0.001
| 2.11 (1.47, 3.03) |
< 0.001
| 2.36 (1.49, 3.74) |
< 0.001
| 2.39 (1.94, 2.94) |
< 0.001
|
Higher | 7.28 (3.05, 17.39) |
< 0.001
| 4.29 (2.22, 8.32) |
< 0.001
| 3.79 (2.05, 7.02) |
< 0.001
| 4.51 (3.15, 6.45) |
< 0.001
|
Wealth index
| ||||||||
Poor | Ref | Ref | Ref | Ref | ||||
Middle | 1.14 (0.81, 1.61) | 0.437 | 1.10 (0.79, 1.54) | 0.574 | 1.09 (0.74, 1.59) | 0.667 | 1.11 (0.92, 1.35) | 0.266 |
Rich | 1.46 (1.01, 2.12) |
0.045
| 1.45 (1.01, 2.12) |
0.049
| 1.00 (0.68, 1.47) | 0.998 | 1.27 (1.04, 1.55) |
0.020
|
Media access
| ||||||||
Never/ less than once | Ref | Ref | Ref | Ref | ||||
At least once a week | 0.86 (0.64, 1.15) | 0.309 | 1.35 (0.99, 1.82) | 0.053 | 0.90 (0.67, 1.22) | 0.508 | 1.07 (0.91, 1.26) | 0.412 |
Place of delivery
| ||||||||
Home | Ref | Ref | Ref | Ref | ||||
Health facility | 1.44 (1.01, 2.04) |
0.042
| 0.90 (0.68, 1.20) | 0.480 | 1.28 (0.96, 1.70) | 0.087 | 1.15 (0.97, 1.35) | 0.103 |
ANC visit
| ||||||||
No visit | Ref | Ref | Ref | Ref | ||||
1 to 3 visits | 1.42 (0.96, 2.10) | 0.079 | 1.49 (1.12, 1.99) |
0.007
| 1.13 (0.74, 1.73) | 0.580 | 1.41 (1.19. 1.66) |
< 0.001
|
4 or more visits | 1.52 (1.14, 2.03) |
0.005
| 1.73 (1.19, 2.50) |
0.004
| 1.63 (1.01, 2.61) |
0.044
| 1.77 (1.44, 2.17) |
< 0.001
|
Others# | 0.90 (0.57, 1.40) | 0.635 | 1.26 (0.77, 2.07) | 0.348 | 1.22 (0.66, 2.26) | 0.521 | 1.09 (0.83, 1.43) | 0.533 |
Number of children
| ||||||||
Single | Ref | Ref | Ref | Ref | ||||
Two | 0.89 (0.64, 1.23) | 0.465 | 1.02 (0.75, 1.39) | 0.900 | 0.94 (0.68, 1.30) | 0.702 | 0.97 (0.81, 1.16) | 0.730 |
More than two | 1.13 (0.76, 1.69) | 0.553 | 0.63 (0.43, 0.93) |
0.021
| 0.89 (0.58, 1.38) | 0.612 | 0.86 (0.69, 1.08) | 0.195 |
Community level variables
| ||||||||
Divisions
| ||||||||
Barisal | Ref | Ref | Ref | Ref | ||||
Chittagong | 0.79 (0.47, 1.32) | 0.364 | 1.01 (0.60, 1.68) | 0.967 | 0.99 (0.56, 1.75) | 0.983 | 0.91 (0.66, 1.25) | 0.555 |
Dhaka | 1.03 (0.60, 1.79) | 0.902 | 1.05 (0.62, 1.79) | 0.845 | 1.17 (0.69, 1.98) | 0.562 | 1.21 (0.90, 1.62) | 0.209 |
Khulna | 1.35 (0.72, 2.54) | 0.353 | 0.74 (0.42, 1.30) | 0.292 | 1.32 (0.67, 2.59) | 0.424 | 1.04 (0.73, 1.49) | 0.819 |
Rajshahi | 1.72 (0.94, 3.15) | 0.078 | 1.33 (0.76, 2.35) | 0.317 | 1.43 (0.75, 2.70) | 0.276 | 1.62 (1.13, 2.31) |
0.008
|
Rangpur | 1.51 (0.83, 2.73) | 0.177 | 2.10 (1.16, 3.81) |
0.015
| 1.65 (0.86, 3.15) |
0.133
| 1.72 (1.32, 2.79) |
0.041
|
Sylhet | 0.85 (0.50, 1.46) | 0.556 | 0.37 (0.23, 0.61) |
< 0.001
| 0.98 (0.55, 1.73) | 0.938 | 0.97 (0.65, 1.45) | 0.883 |
Place of residence
| ||||||||
Urban | 1.10 (0.77, 1.56) | 0.596 | 1.48 (1.06, 2.06) |
0.021
| 1.24 (0.88, 1.74) | 0.217 | 1.25 (1.05, 1.49) |
0.012
|
Rural | Ref | Ref | Ref | Ref | ||||
Community literacy level of women
| ||||||||
High | 1.46 (1.04, 2.06) |
0.030
| 1.19 (0.86, 1.64) | 0.293 | 1.46 (1.03, 2.05) |
0.032
| 1.36 (1.12, 1.65) |
0.002
|
Low | Ref | Ref | Ref | Ref | ||||
Community wealth index level
| ||||||||
High | 1.21 (0.85, 1.73) | 0.294 | 0.85 (0.60, 1.22) | 0.390 | 0.96 (0.65, 1.42) | 0.845 | 1.03 (0.84, 1.27) | 0.747 |
Low | Ref | Ref | Ref | Ref | ||||
Community media exposure
| ||||||||
High | 1.19 (0.83, 1.70) | 0.353 | 1.00 (0.70, 1.42) | 0.992 | 0.96 (0.66, 1.40) | 0.826 | 1.02 (0.83, 1.26) | 0.842 |
Low | Ref | Ref | Ref | Ref | ||||
Random-effect parameters
| ||||||||
Cluster effects (95% CI) | 0.78 (0.60, 1.01) |
< 0.001
| 0.79 (0.62, 0.99) |
< 0.001
| 0.88 (0.69, 1.12) |
< 0.001
| 0.59 (0.50, 0.70) |
< 0.001
|
ICC (95% CI) | 0.16 (0.09, 0.23) | 0.16 (0.11, 0.23) | 0.19 (0.13, 0.28) | 0.10 (0.07, 0.13) | ||||
AIC | 2198.66 | 2364.61 | 2165.996 | 6794.70 |