Boost Member Publication: An Equity Analysis of Zero-Dose Children in India Using the National Family Health Survey Data
Boost Champion Gunjan Taneja, a Program Officer for Vaccine Delivery at the Bill & Melinda Gates foundation, along with colleagues, recently published a paper in Cureus Journal of Medical Science entitled, "An Equity Analysis of Zero-Dose Children in India Using the National Family Health Survey Data: Status, Challenges, and Next Steps."
This article is concerned with zero-dose children in India: children who have not received a single-dose of any vaccine. Data from pre-COVID 19 analyses show that almost 50% of vaccine-preventable death occur amongst zero-dose children. Since the onset of the COVID-19 pandemic, there has been a historic backsliding in routine immunization, suggesting deaths amongst zero-dose children may be even more prevalent today. These children often live in extremely precarious situations: poor households with multiple levels of deprivation, such as a lack of access to health services, water, and sanitation. Zero-dose children have become an increasingly vital group to identify and integrate into health systems.
This research study explores an analysis across key equity determinants for zero-dose children in India using data from the last two National Family Health Survey (NFHS) rounds. The study aimed to determine the vaccination status of zero-dose children from ages 12-23 months in India, as well as any challenges and necessary actions moving forward. Equity determinants, such as gender, place of residence, religion, birth order, caste, and educational level of the mother, were all analyzed. A correlation analysis was also undertaken to see the association between zero-dose prevalence in children and maternal and child health indicators.
The findings show that there are multiple challenges in targeting zero-dose children in India, especially in the context of the impact of the COVID-19 pandemic as well as the global backsliding in routine immunization. India has shown progress in some regions in reducing the percentage of zero-dose children in the country, but certain areas still lag behind set goals. In particular, those living in urban regions and ethnic and religious minorities make up a significant proportion of zero-dose children in India. The mother's access to health services appears to be an especially strong determinant of vaccination status for children. Therefore, the researchers advise for a continued push to improve maternal health services, as well increased efforts to identify and reach mothers with limited access to health services, in order to reduce zero-dose proportions amongst children. The researchers propose a 4P Framework approach: Policy interventions, identification of Population groups to be reached, leveraging existing Platforms, and establishing Partnerships to accelerate progress.
What are the challenges of reaching zero-dose children in your community? Have you or colleagues implemented any successful programs/strategies to reach zero-dose children? Do you think the 4P Framework approach could be a successful strategy to reach zero-dose children in your community?
Share your thoughts in the "Comment" section below!