Childhood immunization and age-appropriate vaccinations in Indonesia

Abstract Background 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. Methods 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. Results 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. Conclusions 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.研究背景 儿童免疫接种是保护个体免受传染病侵害的高成本效益手段。尽管现有关于印度尼西亚儿童免疫接种的研究成果颇丰，但针对麻疹疫苗与百白破联合疫苗第3剂（DTwP-3）接种的年龄适宜性，以及印度尼西亚全国范围内免疫接种覆盖率公平性差距的相关研究仍较为匮乏。 研究方法 本文采用1991年至2017年间具有全国代表性的印度尼西亚全国人口与健康调查（Indonesia Demographic and Health Surveys，DHS）的7轮调查数据，对影响4种常规疫苗（卡介苗（BCG）、脊髓灰质炎疫苗第3剂（Polio-3）、百白破联合疫苗第3剂（DTwP-3）与麻疹疫苗（Measles））接种率的社会经济与人口学因素开展实证分析。具体而言，本文通过多元回归分析，明确影响儿童免疫接种覆盖率的社会经济与人口学因素，并进一步剖析麻疹疫苗与百白破联合疫苗第3剂接种覆盖率的年龄适宜性相关社会经济及人口学关联特征。 研究结果 本研究发现，父母受教育程度与医疗服务利用情况是儿童全程免疫接种及接种年龄适宜性的重要预测因素。同时，本研究证实印度尼西亚儿童全程免疫接种率，以及麻疹疫苗与百白破联合疫苗第3剂的接种年龄适宜性均存在空间异质性。 研究结论 本研究分析显示，尽管近二十年来儿童疫苗接种的时间安排有所改善，但仍有大量儿童的麻疹疫苗与百白破联合疫苗接种年龄不符合规范。具体而言，母亲受教育程度与母亲对医疗服务的参与度是提升疫苗接种年龄适宜性的关键因素。从政策层面来看，本研究结果呼吁政策制定者采取协同行动，弥补不同地区在医疗服务可及性与免疫接种覆盖率方面的差距，并进一步提升疫苗接种的年龄适宜性。