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Abstract: The study was conducted to assess the impact of combined interventions to improve the child immunization coverage in rural hard-to-reach areas of Bangladesh. The valid coverage increased at endline compared to baseline in the study areas, and the difference of the increase was highly significant (p <0.001). The findings also showed that the number of drop-outs, left-outs, and invalid doses decreased at endline compared to baseline in the study areas, and the difference was also highly significant (p <0.001). The immunization coverage improved significantly in all the four study sub-districts that received interventions, although the relative contribution of each intervention is unknown. The interventions can be implemented in all other hard-to-reach areas of Bangladesh and other countries which are facing similar challenges. [Copyright &y& Elsevier]

Abstract: This article aimed to assess child immunization coverage in rural hard-to-reach hilly and low lying (haor) areas of Bangladesh. Status of fully immunized children was significantly lower in haor areas compared to hilly areas. Fully immunized children in both hilly and haor areas was significantly lower than concerned division as well as national level coverage. The results suggested that the traditional service delivery system is not sufficient for rural hard-to-reach areas of Bangladesh. The policy makers should come forward with innovative approaches for rural hard-to-reach areas of this country for improving immunization coverage. [Copyright &y& Elsevier]