Peer-reviewed article
A multilevel analysis of individual and community-level factors associated with childhood immunisation in Bangladesh: Evidence from a pooled cross-sectional survey.
Sarder MA, Lee KY, Keramat SA, Hashmi R, Ahammed B ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study analysed data from over 13,000 children in Bangladesh to identify factors associated with full childhood immunisation. About 87% of children were fully immunised. Both individual factors—such as mothers' education, media exposure, and antenatal care visits—and community-level factors like rural location and community education levels were significantly associated with immunisation rates. The findings suggest that public health programmes should address both individual and community characteristics to improve childhood vaccination coverage.
Key points
- 87% of children aged 12-59 months in Bangladesh were fully immunised
- Maternal education (primary and above) increased the odds of full immunisation by 78%
- Vaccination cards were strongly associated with full immunisation (3.65 times higher odds)
- Community-level factors, including rural residency and community women's education, significantly affected childhood immunisation rates
- At least 4 antenatal care visits by mothers were associated with higher immunisation rates (24% increased odds)
Limitations
This is a cross-sectional analysis pooling surveys from 2007-2018, which cannot establish causation or track changes over time within individuals. The study relies on self-reported data and does not examine barriers to immunisation or reasons for non-compliance in detail.
Abstract
Introduction 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. Methods 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. Results 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. Conclusion 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.