Exposure of Zero-Dose Children to Multiple Deprivation: Analyses of Data from 80 Low- and Middle-Income Countries
2. Materials and Methods
2.1. Sample and Study Design
2.2. Immunization Indicator
2.3. Multiple Deprivation Indicators
- Stunting: proportion of children with a length-for-age z-score below 2 standard deviations relative to the median of the WHO Child Growth Standards .
- Wasting: proportion of children with a weight-for-length z-score below 2 standard deviations relative to the median of the WHO Child Growth Standards.
- Lack of improved water: proportion of children living in a household without improved water source. The following sources were considered as improved: piped water into dwelling, plot, or yard; piped water into neighbor’s plot; public tap/standpipe; tubewell/borehole; protected dug well; protected spring; rainwater. Packaged water: bottled, sachet and refill water.
- Lack of improved sanitation: proportion of children living in a household without improved sanitation. The following facilities were considered as improved: sewage is disposed of in a sanitary way (flush or pour-flush to a piped sewer system, a septic tank, or a pit latrine; ventilated improved pit latrine (VIP); pit latrine with slab; composting toilet). Shared sanitary facilities are not considered as improved.
- Lack of long-lasting insecticidal net (LLIN): proportion of children living in a household without a LLIN. This was restricted to malaria-endemic countries with data on LLIN.
- Mother without education: proportion of children whose mothers had no education.
- Mother without demand for family planning satisfied (mDFPS): proportion of children whose mothers (in union and in need of contraception) are using a modern contraceptive method.
2.4. Statistical Analysis
2.5. Individual Level Analyses
2.6. Ecological Analyses
2.7. Additional Analyses
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
- United Nations. Sustainable Development Goals. Available online: https://www.un.org/sustainabledevelopment/ (accessed on 27 October 2021).
- World Health Organization. Immunization Agenda—Leaving No One Behind; WHO: Geneva, Switzerland, 2020.
- WHO/UNICEF. WHO/UNICEF Estimates of National Immunization Coverage. Available online: https://www.who.int/teams/immunization-vaccines-and-biologicals/immunization-analysis-and-insights/global-monitoring/immunization-coverage/who-unicef-estimates-of-national-immunization-coverage (accessed on 6 July 2022).
- Restrepo-Méndez, M.C.; Barros, A.J.; Wong, K.L.; Johnson, H.L.; Pariyo, G.; Wehrmeister, F.C.; Victora, C.G. Missed opportunities in full immunization coverage: Findings from low- and lower-middle-income countries. Glob. Health Action 2016, 9, 30963. [Google Scholar] [CrossRef] [PubMed]
- Santos, T.; de Oliveira Cata Preta, B.; Mengistu, T.; Victora, C.; Hogan, D.; Barros, A.J.D. Assessing the overlap between immunisation and other essential health interventions in 92 low- and middle-income countries using household surveys: Opportunities for expanding immunisation and primary health care. eClinicalMedicine 2021, 42, 101196. [Google Scholar] [CrossRef] [PubMed]
- World Health Organization. Regional Office for Europe, Health Evidence Network and the European Observatory on Health Systems and Policies. In When Do Vertical (Stand-Alone) Programmes Have a Place in Health Systems? Atun, R.A., Bennett, S., Duran, A., Eds.; World Health Organization, Regional Office for Europe: Copenhagen, Denmark, 2008. [Google Scholar]
- UNICEF. UNICEF Immunization Roadmap 2018–2030; UNICEF: New York, NY, USA, 2018. [Google Scholar]
- Alkire, S.; Santos, M.E. Acute Multidimensional Poverty: A New Index for Developing Countries; OPHI Working Papers 38; University of Oxford: Oxford, UK, 2010. [Google Scholar]
- Alkire, S.; Jahan, S. The New Global MPI 2018: Aligning with the Sustainable Development Goals; OPHI: Oxford, UK, 2019; pp. 1–19. [Google Scholar]
- UNDP. Human Development Report 2020: The Next Frontier: Human Development and the Anthropocene; UN: New York, NY, USA, 2020. [Google Scholar]
- De Neubourg, C.; Chai, J.; de Milliano, M.; Plavgo, I. Step-by-Step Guidelines to the Multiple Overlapping Deprivation Analysis (MODA); Innocenti Working Papers; UNICEF: New York, NY, USA, 2013. [Google Scholar]
- Victora, C.G.; Fenn, B.; Bryce, J.; Kirkwood, B.R. Co-coverage of preventive interventions and implications for child-survival strategies: Evidence from national surveys. Lancet 2005, 366, 1460–1466. [Google Scholar] [CrossRef]
- Corsi, D.J.; Neuman, M.; Finlay, J.E.; Subramanian, S.V. Demographic and health surveys: A profile. Int. J. Epidemiol. 2012, 41, 1602–1613. [Google Scholar] [CrossRef] [PubMed]
- Hancioglu, A.; Arnold, F. Measuring coverage in MNCH: Tracking progress in health for women and children using DHS and MICS household surveys. PLoS Med. 2013, 10, e1001391. [Google Scholar] [CrossRef] [PubMed]
- Cata-Preta, B.O.; Santos, T.M.; Mengistu, T.; Hogan, D.R.; Barros, A.J.D.; Victora, C.G. Zero-dose children and the immunisation cascade: Understanding immunisation pathways in low and middle-income countries. Vaccine 2021, 39, 4564–4570. [Google Scholar] [CrossRef] [PubMed]
- Santos, T.M.; Cata-Preta, B.O.; Victora, C.G.; Barros, A.J.D. Finding Children with High Risk of Non-Vaccination in 92 Low- and Middle-Income Countries: A Decision Tree Approach. Vaccines 2021, 9, 646. [Google Scholar] [CrossRef] [PubMed]
- World Health Organization. Implementing the Immunization Agenda 2030: A Framework for Action through Coordinated Planning, Monitoring & Evaluation, Ownership & Accountability, and Communications & Advocacy; World Health Organization: Geneva, Switzerland, 2021.
- Cherian, T.; Hwang, A.; Mantel, C.; Veira, C.; Malvolti, S.; MacDonald, N.; Steffen, C.; Jones, I.; Hinman, A. Global Vaccine Action Plan Lessons Learned III: Monitoring and Evaluation/Accountability framework. Vaccine 2020, 38, 5379–5383. [Google Scholar] [CrossRef] [PubMed]
- Gavi—The Vaccine Alliance. The Zero-Dose Child: Explained. Available online: https://www.gavi.org/vaccineswork/zero-dose-child-explained (accessed on 27 October 2021).
- Countdown to 2030. Women’s, Children’s and Adolescents’ Health. Available online: http://www.countdown2030.org/ (accessed on 15 May 2022).
- World Health Organization. WHO Child Growth Standards: Length/Height-for-Age, Weight-for-Age, Weight-for-Length, Weight-for-Height and Body Mass Index-for-Age: Methods and Development; WHO: Geneva, Switzerland, 2006.
- The World Bank. Health Nutrition and Population Statistics: Population Estimates and Projections 2021. Available online: https://databank.worldbank.org/source/population-estimates-andprojections (accessed on 10 September 2021).
- Rutstein, S. The DHS Wealth Index: Approaches for Rural and Urban Areas; Macro International Inc.: Calverton, MD, USA, 2008. [Google Scholar]
- Ali, H.A.; Hartner, A.M.; Echeverria-Londono, S.; Roth, J.; Li, X.; Abbas, K.; Portnoy, A.; Vynnycky, E.; Woodruff, K.; Ferguson, N.M.; et al. Vaccine equity in low and middle income countries: A systematic review and meta-analysis. Int. J. Equity Health 2022, 21, 82. [Google Scholar] [CrossRef] [PubMed]
- Yu, W.; Wardrop, N.A.; Bain, R.E.S.; Lin, Y.; Zhang, C.; Wright, J.A. A Global Perspective on Drinking-Water and Sanitation Classification: An Evaluation of Census Content. PLoS ONE 2016, 11, e0151645. [Google Scholar] [CrossRef] [PubMed]
- Berlinski, S.; Duryea, S.; Perez-Vincent, S.M. Prevalence and correlates of disability in Latin America and the Caribbean: Evidence from 8 national censuses. PLoS ONE 2021, 16, e0258825. [Google Scholar] [CrossRef] [PubMed]
- Enkhtuya, B.; Badamusuren, T.; Dondog, N.; Khandsuren, L.; Elbegtuya, N.; Jargal, G.; Surenchimeg, V.; Grundy, J. Reaching every district—Development and testing of a health micro-planning strategy for reaching difficult to reach populations in Mongolia. Rural. Remote Health 2009, 9, 1045. [Google Scholar] [CrossRef] [PubMed]
|Ratio||Difference||p-Value||N of Children||N of|
|Lack of improved water||No-DPT||32.8%||2.60||20.2||<0.001||177,687||80|
|Lack of improved sanitation||No-DPT||71.2%||1.35||18.4||<0.001||177,687||80|
|Lack of LLIN||No-DPT||45.2%||1.02||0.8||0.076||79,229||39|
|Mother without education||No-DPT||53.4%||2.27||29.9||<0.001||177,650||80|
|Mother without mDFPS||No-DPT||69.3%||1.42||20.4||<0.001||116,545||80|
|All 80 Countries||39 Countries with LLIN Information|
|Lack of improved water||0.29||0.32|
|Lack of improved sanitation||0.50||0.45|
|Mother without education||0.43||0.35|
|Mother without mDFPS||0.43||0.45|
|Lack of LLIN||--||0.33|
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Wendt, A.; Santos, T.M.; Cata-Preta, B.O.; Arroyave, L.; Hogan, D.R.; Mengistu, T.; Barros, A.J.D.; Victora, C.G. Exposure of Zero-Dose Children to Multiple Deprivation: Analyses of Data from 80 Low- and Middle-Income Countries. Vaccines 2022, 10, 1568. https://doi.org/10.3390/vaccines10091568
Wendt A, Santos TM, Cata-Preta BO, Arroyave L, Hogan DR, Mengistu T, Barros AJD, Victora CG. Exposure of Zero-Dose Children to Multiple Deprivation: Analyses of Data from 80 Low- and Middle-Income Countries. Vaccines. 2022; 10(9):1568. https://doi.org/10.3390/vaccines10091568Chicago/Turabian Style
Wendt, Andrea, Thiago M. Santos, Bianca O. Cata-Preta, Luisa Arroyave, Daniel R. Hogan, Tewodaj Mengistu, Aluisio J. D. Barros, and Cesar G. Victora. 2022. "Exposure of Zero-Dose Children to Multiple Deprivation: Analyses of Data from 80 Low- and Middle-Income Countries" Vaccines 10, no. 9: 1568. https://doi.org/10.3390/vaccines10091568