Effect of household relocation on child vaccination and health service utilisation in Dhaka, Bangladesh: a cross-sectional community survey

Objective To explore the relationship between household relocation and use of vaccination and health services for severe acute respiratory illness (ARI) among children in Dhaka, Bangladesh. Design Analysis of cross-sectional community survey data from a prior study examining the impact of Haemophilus influenzae type b vaccine introduction in 2009 on meningitis incidence in Bangladesh. Setting Communities surrounding two large paediatric hospitals in Dhaka, Bangladesh. Participants Households with children under 5 years old who either recently relocated <= 12 months or who were residentially stable living >= 24 months in their current residence (total n=10 020) were selected for this study. Primary outcome measures Full vaccination coverage among children aged 9-59 months and visits to a qualified medical provider for severe ARI among children under 5 years old. Results Using vaccination cards with maternal recall, full vaccination was 80% among recently relocated children (n=3795) and 85% among residentially stable children (n=4713; chi(2)=37.2, p<0.001). Among children with ARI in the prior year, 69% of recently relocated children (n=695) had visited a qualified medical provider compared with 82% of residentially stable children (n=763; chi(2)=31.9, p<0.001). After adjusting for demographic and socioeconomic characteristics, recently relocated children were less likely to be fully vaccinated (prevalence ratio [PR] 0.97; 95% CI 0.95 to 0.99; p=0.016) and to have visited a qualified medical provider for ARI (PR 0.88; 95% CI 0.84 to 0.93; p<0.001). Conclusions Children in recently relocated households in Dhaka, Bangladesh, have decreased use of vaccination and qualified health services for severe ARI.