Department of Economics and Australia Indonesia Centre, University of Western Australia, M251, 35 Stirling Highway, Perth, 6009, Australia.
BMC Public Health. 2022 Nov 5;22(1):2023. doi: 10.1186/s12889-022-14408-x.
Childhood immunization is a cost-effective way to protect individuals against communicable diseases. However, although there is a large literature on childhood immunization in Indonesia, there is a paucity of research on the age-appropriateness on measles and DTwP-3 vaccination, and the inequities in immunization coverage across Indonesia.
In this paper, using seven waves of data from the nationally representative Indonesia Demographic and Health Surveys (DHS) covering the period 1991- 2017, we empirically analyse the socio-economic and demographic factors influencing the uptake of four routine vaccines (BCG, Polio-3, DTwP-3, and Measles). Specifically, using multivariate regression analysis, we identify the socio-economic and demographic factors influencing childhood immunization coverage. We further analyse the socio-economic and demographic correlates of the age-appropriateness of the measles and DTwP-3 vaccination coverage.
Our findings show that parental education and use of healthcare services are strong predictors of full immunization and age-appropriate vaccinations. This study also finds evidence of spatial heterogeneity in both full immunization rates and age-appropriate vaccinations for measles and DTwP-3 vaccines.
Our analysis finds that despite an improvement in the timing of vaccinations over the last two decades, a significant proportion of children continue to receive their measles and DTwP vaccinations age inappropriately. In particular, we find that maternal education and maternal engagement with healthcare services are critical in improving age appropriateness of vaccinations. From a policy perspective, these results call for concerted efforts by policy makers to address regional gaps in access to health services and immunization coverage, as well as to improve the age-appropriateness of vaccination.
儿童免疫接种是保护个人免受传染病侵害的一种具有成本效益的方法。然而，尽管印度尼西亚有大量关于儿童免疫接种的文献，但关于麻疹和 DTwP-3 疫苗接种的适宜年龄以及印度尼西亚各地免疫接种覆盖率的不平等问题的研究却很少。
本文利用涵盖 1991-2017 年期间的七个来自全国代表性的印度尼西亚人口与健康调查（DHS）数据集，从经验上分析了影响四种常规疫苗（卡介苗、脊髓灰质炎 3 型、DPT-3 和麻疹）接种的社会经济和人口统计学因素。具体而言，使用多元回归分析，我们确定了影响儿童免疫接种覆盖率的社会经济和人口统计学因素。我们进一步分析了影响麻疹和 DTwP-3 疫苗接种适宜年龄的社会经济和人口统计学相关因素。
我们的研究结果表明，父母的教育水平和使用医疗保健服务是完全接种疫苗和适宜年龄接种疫苗的有力预测因素。本研究还发现，在完全接种疫苗率和麻疹和 DTwP-3 疫苗适宜年龄接种方面存在空间异质性。
我们的分析发现，尽管在过去二十年中疫苗接种时间有所改善，但仍有相当一部分儿童继续不恰当地接种麻疹和 DTwP 疫苗。特别是，我们发现母亲的教育水平和母亲对医疗服务的参与对于提高疫苗接种的适宜年龄至关重要。从政策角度来看，这些结果呼吁政策制定者共同努力，解决在获得卫生服务和免疫接种覆盖率方面的地区差距问题，并改善疫苗接种的适宜年龄。
