Inequalities in immunization coverage in Indonesia: a multilevel analysis

Immunization is one of the most cost-effective methods for reducing mortality and morbidity rates in children. Children being fully vaccinated helps prevent diseases that would have great societal costs otherwise. Incomplete vaccination poses public health risks and challenges. This study examines the issue of incomplete vaccination in Indonesia. The objectives were to quantify the association between child level, parent level and community level determinants and child immunization coverage in Indonesia.

Data were from the 2017 Indonesian Demographic Health Survey; this study included 4753 children aged 12-24 months. The survey implemented multistage random sampling. The data were examined using descriptive statistics and multilevel logistic regression analysis.

The survey found that in Indonesia, country-wide, 58.22% of children were fully vaccinated. A multilevel logistic regression model after adjusting for household wealth and proportion of public healthcare centers (PHCs) showed that children of first birth order had significantly lower likelihood of being fully immunized than children of second order and higher. The parent level factors, such as age of mother at delivery, mother's education, father's occupation, antenatal care (ANC) and region, significantly influenced the completeness of child immunization. At the community level, the presence of a PHC significantly improved immunization coverage.

The findings indicate that there is a wide range of inequality in immunization throughout the region due to socioeconomic and demographic factors. Findings revealed that complete immunization status was significantly associated with birth order, age of mother at delivery, mother's education, father's occupation, ANC, region, and proportion of PHCs. This study emphasizes the need to increase healthcare centers in each community with the objective to reduce disparities in maternal and child health services.