Prevalence, Geographical Distribution and Determinants of Zero Dose Vaccination Status in Uttar Pradesh, India: An Analysis of The National Family Health Survey - 5 Data

BackgroundRecent decades have witnessed considerable progress in immunization, leading to significant improvements in vaccination coverage worldwide. Despite these global achievements, regional disparities in vaccine uptake remain a challenge. In Uttar Pradesh (UP), India, theres been a rise in the number of Zero-dose (ZD) children - those who have not received any routine vaccinations - over the past few years. This study delves into household-level data from the National Family Health Survey (NFHS-5, 2019-2021), aiming to uncover the prevalence and key factors contributing to the ZD status in UP. MethodsUtilizing unit-level data from NFHS-5, we conducted a nested case-control analysis focusing on children aged 12-23 months. The primary outcome variable was ZD children, operationally defined as children who had not received the first dose of the pentavalent vaccine. The study focused on socio-demographic factors, maternal health, post-natal care, and systems engagement as potential predictors for ZD prevalence. These variables included type of residence, caste, religion, economic status, maternal education, place of delivery, antenatal care visits, and post-natal check-ups. Interactions with health workers and benefits received from community health programs were also considered. ResultsThe prevalence of ZD children stands at 6.4% in UP. A significant urban-rural divide was observed, with 11.9% of urban children classified as ZD compared to 8.4% in rural areas. Bi-variate analysis revealed a significant association between ZD prevalence and residence type ({chi}2 =28.6421; p<0.01), with urban children being 37.1% more likely to be ZD than their rural counterparts at 24.5%. Economic status also showed a notable impact, with the poorest wealth quintile having 32.7% ZD children, significantly higher than the richer (23.4%) and richest (27.7%) quintiles. Maternal religion also showed significant association with ZD status, with 34.4% of children from Muslim households being ZD as compared to 24.9% in Hindu households. Maternal health indicators such as children of mothers with no antenatal care visits had 3.7 times higher odds (CI: 2.351 - 5.69; p<0.001) of being ZD compared to those whose mothers had 4+ visits. Engagement with health systems also influenced ZD rates; children from households that had not met community health workers were 1.6 times more likely to be ZD (OR: 1.566; CI: 1.135-2.16; p=0.006). ConclusionsThe higher prevalence of ZD children among specific groups underscores the need for targeted interventions. Strategies to address this issue must encompass an integration of maternal and child health services with existing immunization program.