Evaluation of Interventions to Improve Vaccination Coverage Among Children Aged 12-23 Months in Urban Slum Areas of Bangladesh Using the WHO Interactive Evidence to Decision (iEtD) Framework: A Stakeholder Perspective.

Abstract

Childhood vaccination is the most cost-effective public health intervention; however, coverage in slum-like areas remains a significant challenge because of unique socio-economic disparities and logistical barriers. We aimed to evaluate the interventions from the literature on improving vaccination coverage among children aged 12-23 months in slum areas using the WHO iEtD framework and the TOPSIS-Entropy method for decision-making in Bangladesh and identify stakeholders ranks and felt needs of interventions across study slums. This cross-sectional study was conducted in six slums in two city corporation areas in Dhaka, Bangladesh involving 67 demand-side and 35 supply-side stakeholders. Rating scores ranged from 0 to 1, indicating priority interventions. Our study highlights that demand-side stakeholders favour incentive interventions, whereas supply-side stakeholders support multicomponent strategies. For all stakeholders, educational interventions were ranked highest with a score of 0.745, followed by multicomponent interventions (score 0.666), incentive (score 0.651), and reminder/recall scoring (score 0.305). Educational interventions were identified as a shared priority (common ground), addressing the felt needs of both demand- and supply-side stakeholders. These findings support tailored context-specific approaches to enhance vaccination coverage and child health in vulnerable communities.