Association Between Vaccination Awareness Program Exposure and Full Immunization Coverage Among Mothers in Rural Bangladesh: A Comparative Cross‐Sectional Study in Jashore District
Halima Khatun, Rezwan Hossain, Md. Sohel MiaABSTRACT
Background and Aims
Childhood immunization is a cost‐effective public health intervention, and Bangladesh has achieved South Asia's highest complete immunization rate, yet village‐level effectiveness of local awareness programs remains poorly evaluated. This study evaluated whether exposure to a village‐level vaccination awareness program was independently associated with full immunization coverage among mothers in Jashore District, Bangladesh, alongside other maternal determinants.
Methods
A community‐based, comparative cross‐sectional study surveyed 1,000 mothers of children aged 0–5 years, sampled by convenience from villages with and without an implemented awareness program, between June and August 2025. Bivariate associations with full immunization status were tested using Chi‐square tests and 95% confidence intervals; multivariable logistic regression estimated adjusted odds ratios (AOR) for all predictors simultaneously.
Results
Of 886 mothers with recorded status, 62.1% (95% CI 58.8%–65.2%) were fully immunized. Maternal education showed the strongest association, rising from 53.6% among mothers with no education to 80.9% among graduates (χ 2 = 52.60, p < 0.001); after adjustment, higher secondary (AOR = 3.42) and graduate education (AOR = 3.64) remained significant, and a supplementary linear‐trend model confirmed a significant dose‐response gradient across education levels (AOR = 1.50 per level, 95% CI 1.31–1.72, p < 0.001). Awareness‐program exposure showed no association with full immunization, either before (61.9% vs. 62.2%, p = 0.98) or after adjustment (AOR = 0.98, p = 0.90). Distance to health facilities (43.2%), fear of side effects (30.9%), and husband disapproval (25.9%) were the leading reported barriers. Mothers with unrecorded EPI status were more often less‐educated than those with recorded status ( p = 0.004), a missingness pattern addressed explicitly in the Discussion.
Conclusion
Maternal education, not awareness‐program exposure, independently predicted full immunization. Program investment should shift from generic exposure toward literacy‐sensitive content, husband‐inclusive counseling, and outreach‐site expansion to help close Bangladesh's remaining immunization gap.