| Tetanus, measles, pertussis and other immunizable diseases remain a significant cause of mortality and morbidity for young children in developing countries. Although the worldwide diffusion of immunization technology to national health service providers has been generally successful, the actual uptake of child immunizations has been less so. This research uses Andersen's theory of health services utilization to view immunization status as a function of predisposing, enabling, and need factors. Vaccine-specific maximum likelihood models are developed to ascertain the effects of individual maternal and child factors upon child uptake of immunizations.; The research is limited to Bolivia, a country where non-acceptance and incomplete immunization of children is of major importance, and whose socio-economic conditions are similar to those of many other developing countries. Data from the 1994 Bolivia Demographic and Health Survey (DHS) are used to illustrate the underlying theory and test the quantitative models. Qualitative data from mothers' focus groups and structured interviews of key policy makers permit a triangulation of results with those obtained from the quantitative analyses.; Use of ordered probit models for the multidose vaccines of DPT and polio account for the ordered, yet non-interval, categorical outcomes of zero, one, two or three doses of the vaccine series and provide a more complete understanding of the explanatory factors as they move a child from one immunization state to another. Significant explanatory variables are the previous use of antenatal services, use of health facility for birth of child, and post-secondary maternal education. Primary and secondary maternal education have strong indirect effects on immunization uptake.; Qualitative data from mothers' focus groups indicate that non-acceptance of immunizations for children is related to a lack of confidence in the health system, including disrespectful or unqualified treatment by health workers, perceptions of poor organization, irregular services and long waiting times. Immunization policy implications are discussed in terms of technological innovations, participative planning, communications strategies, and development of a culture of evidence-based decision making. |
