Article Text
Abstract
Objectives Despite the adoption of WHO’s Expanded Programme on Immunisation in Indonesia since 1977, a large proportion of children are still completely unimmunised or only partly immunised. This study aimed to assess factors associated with low immunisation coverage of children in Indonesia.
Setting Children aged 12–59 months in Indonesia.
Participant The socioeconomic characteristics and immunisation status of the children were obtained from the most recent Demographic and Health Survey, the 2012 Indonesia Demographic and Health Survey. Participants were randomly selected through a two-stage stratified sampling design. Data from 14 401 children aged 12–59 months nested within 1832 census blocks were included in the analysis. Multilevel logistic regression models were constructed to account for hierarchical structure of the data.
Results The mean age of the children was 30 months and they were equally divided by sex. According to the analysis, 32% of the children were fully immunised in 2012. Coverage was significantly lower among children who lived in Maluku and Papua region (adjusted OR: 1.94; 95% CI 1.42 to 2.64), were 36–47 months old (1.39; 1.20 to 1.60), had higher birth order (1.68; 1.28 to 2.19), had greater family size (1.47; 1.11 to 1.93), whose mother had no education (2.13; 1.22 to 3.72) and from the poorest households (1.58; 1.26 to 1.99). The likelihood of being unimmunised was also higher among children without health insurance (1.16; 1.04 to 1.30) and those who received no antenatal (3.28; 2.09 to 5.15) and postnatal care (1.50; 1.34 to 1.69).
Conclusions Socioeconomic factors were strongly associated with the likelihood of being unimmunised in Indonesia. Unimmunised children were geographically clustered and lived among the most deprived population. To achieve WHO target of protective coverage, public health interventions must be designed to meet the needs of these high-risk groups.
- immunisation coverage
- routine immunisation
- determinants
- indonesia
- indonesia demographic and health survey
- multilevel analysis
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Footnotes
Contributors PH and AD participated in the design of the study. PH performed the analysis and prepared the manuscript. AD provided data analysis advice and revision of the manuscript. All authors read and approved the final manuscript.
Funding This study was funded by Indonesia Endowment Fund for Education.
Competing interests PH had financial support from LPDP for the submitted work, no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
Ethics approval This study did not require ethical approval as it used unidentifiable secondary data. Permission to use the dataset was obtained from ICF International, who obtained approval to conduct IDHS in 2012. No identifiable information was included in the dataset and no attempt was made to identify any individual interviewed in the survey.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The electronic datasets analysed in this study are available for legitimate research purposes from the Measure DHS website.