Ecological and individual effects in childhood immunisation uptake: a multi-level approach

Abstract

Analyses of childhood immunisation uptake have traditionally been conducted at either the ecological or the individual scale. In this paper the problems stemming from these distinct strategies are explored and the potential of a multi-level modelling approach taking simultaneous account of processes at both levels is discussed. This discussion is set in the context of a case-study of pertussis immunisation uptake using data gathered from routine child health surveillance and immunisation uptake monitoring. The role of multi-level modelling in medical geographic research is briefly evaluated.