Assessing the Relationship Between Zero-Dose Communities and Access to Selected Primary Healthcare Services for Children and Pregnant Women in Emergency Settings

In this study the authors examine the relationship between "zero-dose" communities and access to other healthcare services. This was done by first ensuring the first dose of the Diphtheria Tetanus and Pertussis vaccine was a better measure of zero-dose communities than the measles-containing vaccine. Once the best variable was selected, it was used to examine the association with access to primary healthcare services for children and pregnant women residing in the Democratic Republic of Congo, Afghanistan, and Bangladesh, each of which are currently experiencing emergencies of various contexts and degrees. These services were divided into: a) unscheduled healthcare services such as birth assistance as well as seeking care and treatment for diarrheal diseases and cough/fever episodes and b) other scheduled health services such as antenatal care visits and vitamin A supplementation. Using the most recent Demographic Health Survey data from each country (2014: Democratic Republic of Congo, 2015: Afghanistan, 2018: Bangladesh), data was analyzed via Chi Squared analysis or Fischers Exact Test. If results were significant, a univariate linear regression analysis was performed to examine if the noted association was linear. While the linear relationship observed between children who had received the first dose of the Diphtheria Tetanus and Pertussis vaccine (the reverse to zero-dose communities) and coverage of other vaccines was expected, the results of the regression analysis depicted an unexpected split in behavior between scheduled (and birth assistance) and unscheduled illness treatment services. For scheduled and birth assistance health services, a linear relationship was generally observed. Meanwhile, for unscheduled services associated with infectious disease treatments, a linear relationship was generally not observed. While in our study it does not appear that first dose of the Diphtheria Tetanus and Pertussis vaccine, the best proxy of zero-dose communities, can be used to predict (at least in a direct linear manner) access to some primary (particularly infectious treatments) healthcare services in emergency/humanitarian settings, it can serve as an indirect measure of health services not associated with the treatment of childhood infections such as antenatal care, skilled birth assistance, and to a lesser degree even vitamin A supplementation.