Individual- and community-level determinants of child immunization in the Democratic Republic of Congo: A multilevel analysis

Understanding modifiable determinants of full immunization of children provide a valuable contribution to immunization programs and help reduce disease, disability, and death. This study is aimed to assess the individual and community-level determinants of full immunization coverage among children in the Democratic Republic of Congo. This study used data from the Demographic and Health Survey 2013-14 from the Democratic Republic of Congo. Data regarding total 3,366 children between 12 and 23 months of age were used in this study. Children who were immunized with one dose of BCG, three doses of polio, three doses of DPT, and a dose of measles vaccine was considered fully immunized. Descriptive statistics were calculated for the prevalence and distribution of full immunization coverage. Two-level multilevel logistic regression analysis, with individual-level (level 1) characteristics nested within community-level (level 2) characteristics, was used to assess the individual-and community-level determinants of full immunization coverage. This study found that about 45.3% [95%CI: 42.02, 48.52] of children aged 12-23 months were fully immunized in the DRC. The results confirmed immunization coverage varied and ranged between 5.8% in Mongala province to 70.6% in Nord-Kivu province. Results from multilevel analysis revealed that, four Antenatal Care (ANC) visits [AOR: 1.64; 95%CI: 1.23, 2.18], institutional delivery [AOR: 2.37; 95%CI: 1.52, 3.72], and Postnatal Care (PNC) service utilization [AOR: 1.43; 95%CI: 1.04, 1.95] were statistically significantly associated with the full immunization coverage. Similarly, children of mothers with secondary or higher education [AOR: 1.32; 95% CI: 1.00, 1.81] and from the richest wealth quintile [AOR: 1.96; 95%CI: 1.18, 3.27] had significantly higher odds of being fully immunized compared to their counterparts whose mothers were relatively poorer and less educated. Among the community-level characteristics, residents of the community with a higher rate of institutional delivery [AOR: 2.36; 95%CI: 1.59, 3.51] were found to be positively associated with the full immunization coverage. Also, the random effect result found about 35% of the variation in immunization coverage among the communities was attributed to community-level factors.The Democratic Republic of Congo has a noteworthy gap in full immunization coverage. Modifiable factors-particularly health service utilization including four ANC visits, institutional delivery, and postnatal visits-had a strong positive effect on full immunization coverage. The study underlines the importance of promoting immunization programs tailored to the poor and women with little education.