Household survey.

BackgroundVaccination has been an indispensable step in controlling the coronavirus disease pandemic. In early 2021, Bangladesh launched a mass vaccination campaign to boost the COVID-19 vaccination rate when doses were available and immunized millions in the country. Although deemed a success, disparities became conspicuous in vaccination coverage across population of different socioeconomic background.MethodsThe purpose of this cross-sectional study was to assess the vaccination coverage for three doses and detect disparities in uptake of the COVID-19 vaccine among rural population of hard-to-reach areas and urban individuals belonging to the high-risk group -defined in our study as individuals from elusive population such as floating population/street dwellers, transgender, addicts and disabled population. We conducted household survey (n = 12,298) and survey with high risk group of people (2,520). The collected primary data were analysed using descriptive statistical analysis.ResultsOur findings show that coverage for the first dose of COVID-19 vaccination was high among respondents from both rural Hard-to-reach (HTR) (92.9%) and non-HTR (94.6%) areas. However, the coverage for subsequent doses was observed to reduce significantly, especially for third dose (52.2% and 56.4% for HTR and non-HTR, respectively).ConclusionVaccination coverage among urbanites of high-risk group was found to be critically low. Vaccine hesitancy was also found to be high among individuals of this group. It is essential that the individuals of urban high-risk group be prioritized. Individuals from this group could be provided incentives (transport for disabled, monetary incentive to transgenders; food and medicine for drug user and floating people) and vaccination centers could be established with flexible schedule (morning/afternoon/evening sessions) so that they receive vaccine at their convenient time. Community engagement can be used for both high-risk group and rural population to enhance the COVID-19 vaccination coverage and lower disparities in uptake of the vaccine doses nationwide.

背景 疫苗接种始终是控制新型冠状病毒病（coronavirus disease）大流行的不可或缺手段。2021年初，孟加拉国启动大规模疫苗接种运动，在疫苗可及之际提升新冠疫苗（COVID-19 vaccine）接种覆盖率，为国内数百万民众完成免疫接种。尽管该接种运动被认为取得了成功，但不同社会经济背景人群间的疫苗接种覆盖率差异已十分显著。
方法 本横断面研究（cross-sectional study）旨在评估三剂新冠疫苗的接种覆盖率，并探究难以抵达（hard-to-reach, HTR）地区农村人群，以及属于高风险人群（high-risk group）的城市个体——本研究中将其定义为流动人群、街头流浪者、跨性别者、成瘾者与残障群体等边缘人群——的新冠疫苗接种率差异。本研究开展了家庭调查（n=12298）与高风险人群专项调查（n=2520），采用描述性统计分析（descriptive statistical analysis）方法对收集的一手数据进行分析。
结果 研究结果显示，无论是难以抵达（HTR）农村地区受访者（92.9%）还是非HTR农村地区受访者（94.6%），其首剂新冠疫苗接种覆盖率均处于较高水平。但后续剂次的接种覆盖率出现显著下滑，尤以第三剂为甚：HTR与非HTR地区的第三剂覆盖率分别仅为52.2%与56.4%。
结论 本研究发现，城市高风险人群的疫苗接种覆盖率极低，且该群体的疫苗犹豫（vaccine hesitancy）程度同样较高。因此，优先为城市高风险人群提供接种服务至关重要。可针对该群体提供适配的激励措施：为残障人士提供交通支持、为跨性别者发放现金补贴、为成瘾者与流动人群提供食物与药品保障；同时可调整接种点服务时段（早/中/晚场），方便其在便利时段完成接种。此外，可通过社区参与，同时面向高风险人群与农村人群推广新冠疫苗接种，以提升全国范围内的疫苗接种覆盖率，缩小不同人群间的疫苗接种率差异。