Progress in reaching unvaccinated (zero-dose) children in India, 1992–2016: a multilevel, geospatial analysis of repeated cross-sectional surveys

Johri, Mira; Rajpal, Sunil; Subramanian, S. V.

doi:10.1016/s2214-109x(21)00349-1

Cited by 39 publications

(45 citation statements)

References 16 publications

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“…Comparing the results with a recent publication on zero-dose status in India, we find near equivalent distribution in the prevalence in overall zero-dose status across states and comparable prevalence at the national level, despite defining zero-dose as never having received any routine immunization inclusive of DTP1, OPV1, and MCV1, instead of only examining DTP1 ( Johri et al, 2021 ). The authors of that study also found higher concentrations of zero-dose status among those of rural populations, poorer wealth quintiles, and no maternal education with minimal differences between sex of the child.…”

Section: Discussionsupporting

confidence: 53%

A standardized approach for measuring multivariate equity in vaccination coverage, cost-of-illness, and health outcomes: Evidence from the Vaccine Economics Research for Sustainability & Equity (VERSE) project

Patenaude

Odihi

Sriudomporn

et al. 2022

Social Science & Medicine

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Section: Discussionsupporting

confidence: 53%

A standardized approach for measuring multivariate equity in vaccination coverage, cost-of-illness, and health outcomes: Evidence from the Vaccine Economics Research for Sustainability & Equity (VERSE) project

Patenaude

Odihi

Sriudomporn

et al. 2022

Social Science & Medicine

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“…Thus, the current level of empowerment may have been different relative to when vaccination was due. Although we have chosen a zero-dose definition used by the UNICEF and the WHO (those who received no doses of DTP [ 21 , 23 ]) and other studies [ 37 , 38 ], it is not a complete zero-dose. The idea behind the operationalization of zero-dose taking into account only DPT is because having no doses of DPT is a good proxy of poor access to routine immunization and other health services.…”

Section: Discussionmentioning

confidence: 99%

Children of more empowered women are less likely to be left without vaccination in low- and middle-income countries: A global analysis of 50 DHS surveys

et al. 2022

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Background To help provide a global understanding of the role of gender-related barriers to vaccination, we have used a broad measure of women’s empowerment and explored its association with the prevalence of zero-dose children aged 12-23 months across many low- and middle-income countries, using data from standardized national household surveys. Methods We used data from Demographic and Health Surveys (DHS) of 50 countries with information on both women’s empowerment and child immunisation. Zero-dose was operationally defined as the proportion of children who failed to receive any doses of the diphtheria, pertussis, and tetanus containing vaccines (DPT). We measured women’s empowerment using the SWPER Global, an individual-level indicator estimated for women aged 15-49 years who are married or in union and with three domains: social independence, decision-making and attitude towards violence. We estimated two summary measures of inequality, the slope index of inequality (SII) and the concentration index (CIX). Results were presented for individual and pooled countries. Results In the country-level (ecological) analyses we found that the higher the proportion of women with high empowerment, the lower the zero-dose prevalence. In the individual level analyses, overall, children with highly-empowered mothers presented lower prevalence of zero-dose than those with less-empowered mothers. The social independence domain presented more consistent associations with zero-dose. In 42 countries, the lowest zero-dose prevalence was found in the high empowerment groups, with the slope index of inequality showing significant results in 28 countries. When we pooled all countries using a multilevel Poisson model, children from mothers in the low and medium levels of the social independence domain had respectively 3.3 (95% confidence interval (CI) = 2.3, 4.7) and 1.8 (95% CI = 1.5, 2.1) times higher prevalence of zero-dose compared to those in the high level. Conclusions Our country-level and individual-level analyses support the importance of women’s empowerment for child vaccination, especially in countries with weaker routine immunisation programs.

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“…Early childhood immunization in SSA is considerably low [ 52 ]. Studies have reported that approximately 17 million children in LMIC are yet to receive a single dose vaccines [ 18 , 26 , 28 ]. The majority of these unvaccinated children live in the inner communities of SSA countries that are difficult to access by healthcare workers [ 53 ].…”

Section: Discussionmentioning

confidence: 99%

“…As such, countries with large revenues from natural resources could appear better off than others even when few people earn sizeable incomes [ 72 ]. For instance, Nigeria, with a high GDP per capita, has the highest number of zero-dose children [ 28 ]. The number of zero-dose children in countries with high GDP per capita could be attributed to population size, government regulation and unfair health policies.…”

Section: Discussionmentioning

confidence: 99%

“…They are also part of the world’s most vulnerable population, more likely to suffer from disability and mortality that could easily be prevented through immunization [ 24 , 25 , 26 ]. These children are predominantly less privileged, live in rural households, and raised by mothers with little or no education, indicating disparity within countries [ 27 , 28 , 29 ]. Lack of attention to the zero-dose population may pose a public health threat in the future, leading to re-emergence of eradicated diseases such as polio, and/or potential disease outbreak such as measles.…”

Section: Introductionmentioning

confidence: 99%

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Correlates of Zero-Dose Vaccination Status among Children Aged 12–59 Months in Sub-Saharan Africa: A Multilevel Analysis of Individual and Contextual Factors

Ozigbu

Olatosi

et al. 2022

Vaccines

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Despite ongoing efforts to improve childhood vaccination coverage, including in hard-to-reach and hard-to-vaccinate communities, many children in sub-Saharan Africa (SSA) remain unvaccinated. Considering recent goals set by the Immunization Agenda 2030 (IA2030), including reducing the number of zero-dose children by half, research that goes beyond coverage to identify populations and groups at greater risk of being unvaccinated is urgently needed. This is a pooled cross-sectional study of individual- and country-level data obtained from Demographic and Health Surveys Program and two open data repositories. The sample includes 43,131 children aged 12–59 months sampled between 2010 and 2020 in 33 SSA countries. Associations of zero-dose status with individual and contextual factors were assessed using multilevel logistic regression. 16.5% of children had not received any vaccines. Individual level factors associated lower odds of zero-dose status included mother’s primary school or high school education, employment, use of antenatal care services and household wealth. Compared to children in countries with lower GDP, children in countries with relatively high GDP had nearly four times greater odds of being unvaccinated. Both individual and contextual factors are correlated with zero-dose status in SSA. Our results can inform efforts to identify and reach children who have not received any vaccines.

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Progress in reaching unvaccinated (zero-dose) children in India, 1992–2016: a multilevel, geospatial analysis of repeated cross-sectional surveys

Cited by 39 publications

References 16 publications

A standardized approach for measuring multivariate equity in vaccination coverage, cost-of-illness, and health outcomes: Evidence from the Vaccine Economics Research for Sustainability & Equity (VERSE) project

A standardized approach for measuring multivariate equity in vaccination coverage, cost-of-illness, and health outcomes: Evidence from the Vaccine Economics Research for Sustainability & Equity (VERSE) project

Children of more empowered women are less likely to be left without vaccination in low- and middle-income countries: A global analysis of 50 DHS surveys

Correlates of Zero-Dose Vaccination Status among Children Aged 12–59 Months in Sub-Saharan Africa: A Multilevel Analysis of Individual and Contextual Factors

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