The months were 51% in 2004 and

The most cost-effective public health initiative to prevent childhood morbidity and mortality has proven to be immunization. Immunization has greatly reduced 2–3 million under-5-year mortality each year due to infectious diseases such as diphtheria, tetanus, pertussis, tuberculosis, polio, and measles 1–3. Even though the global immunization coverage has remained steady for the past few years, the coverage in low-income countries is still far from universal 1,4,5. The World Health Organization (WHO) estimates that 19.4 million infants worldwide are still missing out on basic vaccines 4. In Malawi, the proportions of children who were fully immunized by 12 months were 51% in 2004 and 72% in 2010 6,7. These statistics fall short of the benchmark of 90% recommended by the WHO through the Expanded Immunization Program (EPI) 2,3,8.It is well established that individual-level factors such as child’s characteristics 9–13, mother’s age 1,9,11, education status 1,5,11,13,14, healthcare utilization 1,5,15–19, distance to health care facilities 20–23, household wealth 11,12,14,16,17, immunization plan 1,9,15,17, maternal and paternal occupation 12,18, and exposure to media 1,18,23 have significant effectson childhood immunization. However, very few studies have investigated the influence of community-level factors on childhoodimmunization and whether the effects still exist after controllingfor individual-level characteristics 5,12,14. Prior studies reportedthat the community constitutes a key component of socioeconomicchallenges to good health, since it shapes individual opportunitiesand exposes residents to multiple risks and resources over their lifecourse 24. Thus concentrating on one level can lead to practicaland methodological problems at other levels 25.To the best of our knowledge, no study has until now been conductedin Malawi using a wide range of individual- andcommunity-level factors to assess the likelihood of childhood vaccinationcoverage and complete immunization. We thus aimed toexamine both individual- and community-level risk factors ofchildhood immunization and addressed the relationships with differenttypes of vaccination in Malawi. Specifically, we aimed tocompare immunization coverage and trends in relation to theindividual- and community-level factors between 2004 and 2010MDHS.

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