Research Report: Impact of National Immunization Days on Polio-related Knowledge and Practice of Urban Women in Bangladesh

This 9-page article analyses the reasons behind the success of the first two National Immunization Days (NIDs) held in Bangladesh in 1995 (March 16 and April 16) as part of that country's goal to eradicate poliomyelitis by the turn of the century. As this article details, the NIDs brought together government agencies, the media, voluntary organisations, and individual volunteers in social mobilisation and service delivery activities. This paper assesses the impact of these 2 polio NIDs in terms of the immunisation coverage and change in knowledge about the disease among women living in Dhaka city, the capital of the country.

The authors begin by providing background as to the motivation for the NIDs, and the challenges of achieving high coverage rates among all social groups. They indicate that the goals of the first 2 NIDs were to administer 2 doses of the oral polio vaccine (OPV) to all children under the age of 5 years, irrespective of their previous immunisation status. As described here, a large motivation campaign was developed to support the vaccination drive. Information and communication technologies (ICTs) including radio, television, and mobile loudspeakers were used to spread the word, in addition to printed materials (newspapers, posters, and leaflets). Interpersonal exchanges were also drawn upon to galvanise engagement in the campaign; community meetings were held, prominent public figures made announcements, and female field workers and volunteers promoted the NIDs during visits to women's houses.

To evaluate the effectiveness of this approach, the authors carried out pre- and post-NID cross-sectional surveys in a sample of one area of Dhaka city which included slum and non-slum households. In total, trained female interviewers collected NID-related information from 525 mothers (201 of whom lived in slums, and 324 who did not live in slums) and 720 children. Trained interviewers also collected data from 28 non-governmental organisations (NGOs) and 23 government managers.

In short, organisers found that knowledge of polio as a vaccine-preventable disease increased after NIDs among both slum and non-slum women. In addition, the knowledge gap between the 2 groups was significantly reduced. Field workers were the main source of information for women living in slums , while television was cited as the most important source of information by non-slum women. Less than 10% of all the women interviewed mentioned printed materials as a source of information about NIDs, but the proportion was higher in non-slum areas. Neither group of recipients identified local leaders as a source of information about the NIDs.

As indicated here, the communications aspects of the campaign were pivotal in terms of women's involvement (or non-involvement) in the NIDs. Approximately 60% of all women reported that they did not know about the campaign, or were unaware that all children were supposed to be vaccinated regardless of immunisation status. The evaluators concluded that this lack of awareness about the need to immunise all children during the NIDs was the main reason for the non-attendance of non-slum women; however, they cite other constraints (related to the outreach, timing, and location of the outreach sites).

In conclusion, the study suggests that strategies like NID can be effectively used to tap into community resources and to generate political commitments for health programmes. The strategy, in this case, led to 88% of children under 5 years receiving at least one dose of OPV during the NIDs; 67% received 2 stipulated doses, with no significant differences between slum (65%) and non-slum (69%) groups. In addition, 68% of the children contacted during the NIDs were given vitamin A supplementation.