Predictors of Child Immunization: a Case of Nepal

Background and Purpose: It is estimated that over 10 million children die annually and most of these deaths occur in the developing countries. Nearly all studies examining health service utilization support that preventive visit to health services and child immunization substantially reduces infant and child mortality. Since the 1980s, many developing countries have expanded their primary health facilities to improve access to maternal and child health services. According to the World Health Organization's guidelines, children can be fully protected by eight required vaccines that are dispensed within one year of child's life. These vaccines include 3 doses of DPT and Polio and 1dose of BCG and Measles. In spite of massive media campaign and free availability of these vaccines about one in five children in Nepal are not vaccinated. In this paper, using the Anderson's Behavioral Model of health services use, we answer the following question: What predicts mothers' utilization of child immunization services? Methods: We utilized nationally representative sample of 10,793 women between the ages of 15 and 49 from one country, Nepal to understand the factors that contribute to their use of child immunization services. We selected 1,112 mothers who had a child aged 12-23 months as a sample for analysis. We analyzed the weighted data using the STATA statistical software and conducted univariate, bi-variate and multiple logistic regression. Results: Findings from multiple logistic regression showed that women's education and their use of antenatal care significantly increased immunization of children controlling for other factors (including demographic, economic, regional, health needs, and health behavior). For example, women with primary education were three times more likely to have vaccinated their children compared to women without any education. Similarly, mothers who had utilized antenatal care were 2.75 times more likely to have vaccinated their children compared to women who had not utilized antenatal care. Other such empowerment variables as women's access to cash income and their participation in financial decisions concerning household and health care were not significant after controlling for other variables in the model. Conclusions and Implications: In countries like Nepal where over 50% of the sample had no education and nearly a quarter of the pregnant women did not use antenatal care, maternal and child health promotion strategies should include not only media campaign to promote health service use but also ways to improve education of girls.