Journal
VACCINES
Volume 9, Issue 6, Pages -Publisher
MDPI
DOI: 10.3390/vaccines9060646
Keywords
vaccination; immunization; prenatal care; decision trees
Categories
Funding
- Wellcome Trust [101815/Z/13/Z]
- Bill and Melinda Gates Foundation [OPP1199234]
- Associacao Brasileira de Saude Coletiva
- Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior [001]
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The study identified high-risk groups of children who received no vaccines, including those who did not receive the four basic vaccines. One high-risk group included children whose mothers did not receive the tetanus vaccine, had no antenatal care visits, and did not deliver in a health facility. This highlights the need for better integration among services to achieve high and equitable immunization coverage.
Reducing vaccination inequalities is a key goal of the Immunization Agenda 2030. Our main objective was to identify high-risk groups of children who received no vaccines (zero-dose children). A decision tree approach was used for 92 low- and middle-income countries using data from Demographic and Health Surveys and Multiple Indicator Cluster Surveys, allowing the identification of groups of children aged 12-23 months at high risk of being zero dose (no doses of the four basic vaccines-BCG, polio, DPT and measles). Three high-risk groups were identified in the analysis combining all countries. The group with the highest zero-dose prevalence (42%) included 4% of all children, but almost one in every four zero-dose children in the sample. It included children whose mothers did not receive the tetanus vaccine during and before the pregnancy, who had no antenatal care visits and who did not deliver in a health facility. Separate analyses by country presented similar results. Children who have been missed by vaccination services were also left out by other primary health care interventions, especially those related to antenatal and delivery care. There is an opportunity for better integration among services in order to achieve high and equitable immunization coverage.
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