Original Research

Inequalities in immunization coverage in Indonesia: a multilevel analysis


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Issara Siramaneerat1
PhD , Assistant Professor *

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Farid Agushybana2
PhD, Assistant Professor


1 Department of Social Science, Faculty of Liberal Art, Rajamangala University of Technology, Thanyaburi, Thailand

2 Department of Biostatistics and Population Study, Faculty of Public Health, Diponegoro University, Semarang, Indonesia

ACCEPTED: 30 April 2021

early abstract:

Background: Immunization is one of the most cost-effective methods for reducing the mortality and morbidity rate of children. Children being fully vaccinated helps prevent the occurrence of 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.
Objectives: To quantify the association between child level, parent level and community level determinants and child immunization coverage in Indonesia.
Methods: Data from the 2017 the Indonesian Demographic Health Survey including 4,753 live born children aged 12-24 months from 49,627 women aged 15–49 years. The survey implemented multi-stage random sampling.  The data were examined using descriptive statistics and multilevel logistic regression analysis.
Results: The survey found that in Indonesia, country-wide, 58.22% of children were fully vaccinated. A multilevel logistic regression model after adjusting wealth and PHC percentage 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, the mother's education, father's occupation, antenatal care and region significantly influences the completeness of child immunization. At the community level, the presence of public healthcare centre significantly improved immunization coverage.
Conclusion: Our 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 the birth order, age of mother at delivery, mother's education, father's occupation, ANC, region and percentage of healthcare center. This study emphasizes the need to increase health centers in each community with the objective to narrow disparities in maternal and child health services.