School of Public Health, Taipei Medical University, Taipei, Taiwan; Faculty of Health Science, Universitas Respati Yogyakarta, Yogyakarta, Indonesia.
School of Public Health, Taipei Medical University, Taipei, Taiwan.
Pediatr Neonatol. 2021 Jan;62(1):80-89. doi: 10.1016/j.pedneo.2020.09.004. Epub 2020 Sep 7.
Identifying risk factors of incomplete immunization among children is crucial to developing relevant policies to improve immunization coverage. In this study, we investigated factors associated with incomplete immunization among children in Indonesia and elucidated differences in risk factors between urban and rural areas.
The data came from a national-wide survey, the 2017 Indonesia Demographic Health Surveys. In total, 3264 children aged 12-23 months were included in the study. An incomplete immunization status was defined as a child who did not complete the ten doses of basic vaccinations, consisting of one dose of bacille Calmette-Guérin, one dose of hepatitis B, three doses of pentavalent vaccine (diphtheria, pertussis, tetanus, hemophilus influenza type B, and hepatitis B vaccine), four doses of polio vaccine, and one dose of measles vaccine. Generalized linear mixed models were constructed to examine the effects of different levels of risk factors on the incomplete immunization status. We further conducted stratified analyses by urban and rural areas.
About 40% of the 3264 children were incompletely immunized, among whom 45.3% were in urban areas and 54.7% were in rural areas. Eight of the 34 provinces had incomplete immunization rates exceeding 50%, and the Papua and Maluku regions had the highest rates of incomplete child immunization. The multivariate analyses showed that when women attended fewer than four antenatal care sessions and resided outside the Nusa Tenggara region, their children were more likely to have incomplete immunization in both urban and rural areas. On the other hand, having no health insurance was positively associated with incomplete immunization in urban areas, whereas having received a tetanus vaccination during pregnancy was negatively associated with incomplete immunization in rural areas.
Results of this study suggest that tailored interventions should be developed to address significant risk factors in rural and urban areas.
确定儿童不完全免疫的风险因素对于制定相关政策以提高免疫覆盖率至关重要。在这项研究中，我们调查了印度尼西亚儿童不完全免疫的相关因素，并阐明了城乡地区风险因素的差异。
数据来自全国范围的调查，即 2017 年印度尼西亚人口健康调查。共有 3264 名 12-23 个月大的儿童纳入本研究。不完全免疫状态定义为未完成十种基础疫苗接种剂量的儿童，包括一剂卡介苗、一剂乙型肝炎疫苗、三剂五联疫苗（白喉、百日咳、破伤风、流感嗜血杆菌 B 型和乙型肝炎疫苗）、四剂脊髓灰质炎疫苗和一剂麻疹疫苗。构建广义线性混合模型，以检验不同水平的风险因素对不完全免疫状态的影响。我们进一步按城乡地区进行分层分析。
3264 名儿童中约有 40%未完全免疫，其中 45.3%在城市地区，54.7%在农村地区。34 个省中有 8 个省的不完全免疫率超过 50%，巴布亚和马鲁古地区的儿童免疫不完全率最高。多变量分析表明，当女性接受的产前护理次数少于 4 次且居住在努沙登加拉地区之外时，其子女在城乡地区均更有可能存在不完全免疫。另一方面，在城市地区，没有健康保险与不完全免疫呈正相关，而在农村地区，怀孕期间接受破伤风疫苗接种与不完全免疫呈负相关。
本研究结果表明，应针对城乡地区的显著风险因素制定有针对性的干预措施。
