PMID- 36851944
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230301
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 15
IP  - 2
DP  - 2023 Feb
TI  - An Equity Analysis of Zero-Dose Children in India Using the National Family 
      Health Survey Data: Status, Challenges, and Next Steps.
PG  - e35404
LID - 10.7759/cureus.35404 [doi]
LID - e35404
AB  - Background While immunization programs across the world have made considerable 
      progress, children and communities continue to be beyond the reach of healthcare 
      services. Globally, they are now referred to as zero-dose (ZD) children (those 
      who have not received a single dose of diphtheria, pertussis, and 
      tetanus-containing vaccine). Pre-COVID-19 pandemic analyses suggest that nearly 
      50% of vaccine-preventable deaths occur among ZD children. Two-thirds of these 
      children live in extremely poor households suffering from multiple deprivations 
      including lack of access to reproductive health services, water, and sanitation. 
      Hence, ZD children have now been prioritized as a key cohort for identification 
      and integration with the health systems as we build back from the pandemic. 
      Methodology Extracting data from the last two National Family Health Survey 
      (NFHS) rounds (NFHS 4, 2015-2016 and NFHS 5, 2019-2021), this study aims to 
      ascertain the status of ZD children aged 12-23 months in India, the challenges, 
      and the necessary action agenda going forward. Data were analyzed for equity 
      determinants such as gender, place of residence, religion, birth order, caste, 
      and mother's schooling. Key determinants included the change in ZD prevalence at 
      the national, state, and district levels; variations across equity parameters and 
      states with maximum improvements; and disparity across these indicators. A 
      correlation analysis was also conducted to understand the nature of the 
      association between ZD prevalence and critical maternal and child health 
      indicators. Results The overall ZD prevalence between the two rounds was reduced 
      by 4.1% (10.5-6.4%). A total of 26 states in the country reported a ZD prevalence 
      of <10% in NFHS 5 compared to 18 in NFHS 4. In total, 324 districts reported a ZD 
      prevalence of <5%, and 145 districts reported a prevalence of >10%. The equity 
      parameters reflected a slow-footed reduction among ZD for girl children, across 
      urban geographies, firstborn children, mothers with 12 or more years of 
      schooling, and children in families with the highest wealth quintiles. A negative 
      correlation accentuated between the two NFHS rounds was established between 
      first-trimester registration, four or more antenatal visits, institutional 
      deliveries, and ZD prevalence. Conclusions The findings point toward sustained 
      improvement across key equity parameters, however, challenges do exist. Moreover, 
      the impact of the pandemic on immunization programs across the globe and in India 
      is bound to halt and reverse the progress and potentiate further inequities. It 
      is thus imperative that continued and augmented efforts are continued to 
      identify, integrate, and immunize ZD children, families, and communities.
CI  - Copyright (c) 2023, Taneja et al.
FAU - Taneja, Gunjan
AU  - Taneja G
AD  - Infectious Disease Cluster, India Country Office, Bill & Melinda Gates 
      Foundation, New Delhi, IND.
FAU - Datta, Eshita
AU  - Datta E
AD  - Social Impact Practice, Evalueserve, New Delhi, IND.
FAU - Sapru, Mahima
AU  - Sapru M
AD  - Social Impact Practice, Evalueserve, New Delhi, IND.
FAU - Johri, Mira
AU  - Johri M
AD  - School of Public Health, University of Montreal, Montreal, CAN.
FAU - Singh, Kapil
AU  - Singh K
AD  - Immunization Division, Ministry of Health and Family Welfare, Government of 
      India, New Delhi, IND.
FAU - Jandu, Harkabir S
AU  - Jandu HS
AD  - Strategy, Clinton Health Access Initiative, New Delhi, IND.
FAU - Das, Shyamashree
AU  - Das S
AD  - Infectious Disease Cluster, India Country Office, Bill & Melinda Gates 
      Foundation, New Delhi, IND.
FAU - Ray, Arindam
AU  - Ray A
AD  - Infectious Disease Cluster, India Country Office, Bill & Melinda Gates 
      Foundation, New Delhi, IND.
FAU - Laserson, Kayla
AU  - Laserson K
AD  - Infectious Disease Cluster, India Country Office, Bill & Melinda Gates 
      Foundation, New Delhi, IND.
FAU - Dhawan, Veena
AU  - Dhawan V
AD  - Immunization Division, Ministry of Health and Family Welfare, Government of 
      India, New Delhi, IND.
LA  - eng
PT  - Journal Article
DEP - 20230224
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC9963392
OTO - NOTNLM
OT  - equity
OT  - immunization
OT  - national family health survey
OT  - vaccination
OT  - zero dose
COIS- The authors have declared that no competing interests exist.
EDAT- 2023/03/01 06:00
MHDA- 2023/03/01 06:01
PMCR- 2023/02/24
CRDT- 2023/02/28 02:07
PHST- 2023/02/23 00:00 [accepted]
PHST- 2023/02/28 02:07 [entrez]
PHST- 2023/03/01 06:00 [pubmed]
PHST- 2023/03/01 06:01 [medline]
PHST- 2023/02/24 00:00 [pmc-release]
AID - 10.7759/cureus.35404 [doi]
PST - epublish
SO  - Cureus. 2023 Feb 24;15(2):e35404. doi: 10.7759/cureus.35404. eCollection 2023 
      Feb.