Determinants of Complete Infant Immunization and Contextual Effect of Community Health Centers: A Multilevel Evidence from Karanganyar, Central Java

Background: Immunization aims to reduce morbidity, mortality, and disability due to vaccine-preventable diseases. Many children in Indo­nesia have not received any immunization, or their immunization status is incomplete. Efforts should be made to raise awareness of parents to participate in completing their child's immunization. This study aimed to analyze the behavioral factors that influence the complete­ness of immunization in infants Subjects and Method: A cross-sectional study conducted at 21 health centers in Karanganyar, Central Java, from January to March 2020. Subjects were 200 mothers with children aged 12-23 months that were selected using a fixed disease sampling technique. The dependent vari­able was the completeness of immunization. The independent variables at level 1 were edu­cation, knowledge, information and education, perceived benefits, perceived barriers, intentions, subjec­tive norms, and attitudes. The independent vari­ables at level 2 were the contextual health center. The data were collected by question­naire and analyzed using a multilevel analysis. Results: Complete immunization in infants probably occurred with high maternal education (OR = 24.02; 95% CI = 1.61 to 359.17; p = 0.021), information obtained (OR = 52.31; 95% CI = 1.35 to 2021.69; p = 0.034), good knowledge (OR = 49.20; 95% CI = 71.54 to 1574.62; p = 0.028), high perceived benefit (OR= 31.26; 95% CI= 1.28 to 762.77; p= 0.035), strong intention (OR= 17.84; 95% CI= 1.59 to 199.83; p= 0.019), sup­portive subjective norm (OR = 94.69; 95% CI = 1.91 to 4683.14; p = 0.022), positive attitude (OR= 68.71; 95% CI= 2.40 to 1967.08; p= 0.013). Completeness of immunization in infants decre­as­ed with big perceived barrier (OR= 0.02; 95% CI= 0.01 to 0.67; p= 0.028). Health center acc­re­ditation showed a contextual effect on the level of completeness of immunization with Intra-Class Correlation (ICC)= 20.42%. Conclusion: Immunization completeness in infants increases with high maternal education, good knowledge, high perceived benefits, strong intentions, supportive subjective norms, positive attitudes. Completeness of immunization decre­as­ed with a big perceived barrier. Health centers have a large contextual influence on the comple­teness of immunization in infants. Keywords: immunization completeness, health center context, multilevel analysis Correspondence: Maharani Ulfah. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: maharaniulf­ahh@gmail.com. Mobile: +62821­35­58003557.