Determinants of immunization status of children under two years old in Sumatera, Indonesia: A multilevel analysis of the 2020 Indonesia National Socio-Economic Survey.

Background: The success of a basic immunization program among children has been known as the cheapest and most effective approach in improving child survival against preventable diseases. This study aims to examine the determinant factors at the individual and contextual level that affect the provision of complete basic immunization for children aged 12-23 months in Sumatra, Indonesia.
Methods: Using the 2020 Indonesia National Socio-Economic Survey (SUSENAS) data, a multilevel binary logistic regression model was developed at the individual level and the regency/municipality level as the first and second level of analysis respectively.
Results: There are 30.8% of children aged 12-23 months who received complete basic immunization in Sumatra. Meanwhile, there are still 10.3% of children who did not receive basic immunization at all. The place of residence, mother's education, mother's employment status, and place of delivery had a positive and significant effect on completeness of basic immunization for children, while the health facilities/100,000 population had a negative and significant effect on completeness of basic immunization for children which may correlate to the inequality of health facilities distribution in Sumatra.
Conclusion: The difference in characteristics between regencies/municipalities in Sumatra, Indonesia can be explained by 18.90% of the variation in the coverage of basic immunization completeness for children aged 12-23 months in Sumatra. The Indonesian government and related institutions can further improve the distribution of health workers and adequate health facilities to cover remote areas.
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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