Immunisation coverage and its determinants among children aged 12-23 months in Kazakhstan: Evidence from UNICEF Multiple Indicator Cluster Survey 2024

Abstract

Introduction Vaccines are one of the greatest public health achievements. They protect children against dangerous infectious diseases such as diphtheria, tetanus, pertussis, polio, measles, hepatitis, pneumonia and many others. Current global challenges in immunisation are incomplete immunisation, zero-dose children, and regional equity gaps. The aim of this study was to assess vaccination coverage and the determinants of basic antigen coverage among children aged 12-23 months in Kazakhstan, using data from the UNICEF MICS 2024 survey. Methods This study is based on secondary analysis of the cross-sectional Multiple Indicator Cluster Survey (MICS), conducted in Kazakhstan in 2024. Data from 1156 children aged 12-23 months were included in the analysis. Vaccination information for them was obtained from multiple sources: health facility records, home vaccination cards and mother recall report. The primary outcome was full coverage of basic antigens among children aged 12-23 months. The following explanatory variables were included in the analysis: child sex, place of residence, region, household wealth quintile, maternal education, and ethnicity of the household head. Descriptive, bivariate and multivariate logistic regression analyses were performed in STATA 18. Results The highest vaccination coverage was observed for the BCG vaccine, with 84.75%. Coverage with basic antigens was 34.65%, meaning approximately only 1/3 of all children had completed the basic vaccine series. In the bivariate analysis, female children had significantly higher odds of getting fully immunised with basic antigens rather than male children (OR=1.39, 95% CI: 1.05-1.85, p=0.022), however there was no statistically significant difference between rural and urban residents. (OR=1.17, 95% CI: 0.89-1.55, p=0.257). Also, children in the richest quintile had significantly lower odds of receiving basic antigens compared with those in the poorest quintile (OR=0.53, 95% CI: 0.32-0.89, p=0.016). Regional differences, maternal education, and the ethnicity of the household head were also significant predictors of basic vaccination, and their associations remained significant after adjustment. Children from the Kyzylorda region had higher odds of receiving basic vaccination (AOR=2.45, 95% CI: 1.18-5.11, p=0.017). Also compared with children whose mothers had low education levels, children with mothers with medium (AOR=0.50, 95%CI:0.30-0.83, p=0.007) and high education levels (AOR=0.52,95%CI: 0.29-0.92, p=0.024) had lower odds of being fully vaccinated against basic antigens. The ethnicity of the household head was also independently associated with basic antigen coverage. Children from families headed by individuals of Russian ethnicity had higher odds of receiving basic antigens compared with those from Kazakh households (OR=2.56, 95%CI: 1.42-4.62, p=0.002). Conclusion Overall, findings revealed that inequalities in immunisation in Kazakhstan are influenced by regional and social factors. Strengthening follow-up systems and developing more targeted strategies for regions and certain population groups with lower coverage may help address current challenges in routine vaccination uptake.