Sarder Md Alamgir, Lee Ka Yiu, Keramat Syed Afroz, Hashmi Rubayyat, Ahammed Benojir
Statistics Discipline, Science, Engineering and Technology (SET) School, Khulna University, Khulna 9208, Bangladesh.
Swedish Winter Sports Research Centre, Department of Health Sciences, Mid Sweden University, Östersund, Sweden.
Vaccine X. 2023 Mar 23;14:100285. doi: 10.1016/j.jvacx.2023.100285. eCollection 2023 Aug.
Previous studies on childhood vaccinations in Bangladesh relied on single-level analyses and ignored the clustering and hierarchical structure of data collected from people living in different geographical units. This study, therefore, aimed to investigate the association between individual and community-level factors of full childhood immunisation with an improved analytical approach.
Participants were 13,752 children aged 12-59 months. Data were extracted from the Bangladesh Demographic and Health Survey (BDHS) conducted in 2007, 2011, 2014, and 2017-18. A two-level multilevel logistic regression method was used to analyse the data.
Approximately 87% of the children were fully immunised. In the fully adjusted model, at the individual level, mothers who had primary and above education (Adjusted odds ratio [AOR] = 1.78; 95% Confidence Interval [CI]: 1.57, 2.01), mass media exposure (AOR = 1.14; 95% CI: 1.00, 1.30), having vaccination cards (AOR = 3.65; 95% CI: 3.23, 4.14), and having at least 4 antenatal care (ANC) visits (AOR = 1.24; 95% CI: 1.06, 1.44) were strongly associated with full childhood immunisation. At community-level, rural residency (AOR = 1.25; 95% CI: 1.08, 1.44), community women's education (AOR = 1.24; 95% CI: 1.07, 1.43), and community ANC utilisation (AOR = 1.38; 95% CI: 1.19, 1.61) were significantly associated with full childhood immunisation.
Along with individual-level factors, community-level factors have a significant effect on childhood immunisation. Policymakers should target improving community-level characteristics, such as community poverty, education levels, and the number of community-level ANC visits, to increase the national level of childhood immunisation. Public health intervention programs aiming at increasing awareness of childhood immunisation should include elements at both individual and community levels.
此前关于孟加拉国儿童疫苗接种的研究依赖单层次分析，忽视了从生活在不同地理区域的人群收集的数据中的聚类和层次结构。因此，本研究旨在采用改进的分析方法，调查儿童全程免疫的个体和社区层面因素之间的关联。
研究对象为13752名年龄在12至59个月的儿童。数据取自2007年、2011年、2014年以及2017 - 2018年进行的孟加拉国人口与健康调查（BDHS）。采用两级多水平逻辑回归方法分析数据。
约87%的儿童实现了全程免疫。在完全调整模型中，个体层面上，受过小学及以上教育的母亲（调整后优势比[AOR]=1.78；95%置信区间[CI]：1.57，2.01）、接触大众媒体（AOR = 1.14；95% CI：1.00，1.30）、拥有疫苗接种卡（AOR = 3.65；95% CI：3.23，4.14）以及至少进行4次产前检查（ANC）（AOR = 1.24；95% CI：1.06，1.44）与儿童全程免疫密切相关。在社区层面，农村居住（AOR = 1.25；95% CI：1.08，1.44）、社区女性教育程度（AOR = 1.24；95% CI：1.07，1.43）以及社区产前检查利用率（AOR = 1.38；95% CI：1.19，1.61）与儿童全程免疫显著相关。
除个体层面因素外，社区层面因素对儿童免疫也有显著影响。政策制定者应致力于改善社区层面的特征，如社区贫困状况、教育水平以及社区产前检查次数，以提高全国儿童免疫水平。旨在提高儿童免疫意识的公共卫生干预项目应包括个体和社区层面的内容。
