A multilevel analysis of individual and community-level factors associated with childhood immunisation in Bangladesh: Evidence from a pooled cross-sectional survey.

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.