PDF(Pubmed)
Abstract：
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.
摘要：
背景虽然世界各地的免疫计划取得了相当大的进展，儿童和社区仍然无法获得医疗保健服务。全球范围内,他们现在被称为零剂量(ZD)儿童(那些没有接受单剂量白喉的人，百日咳,和含破伤风的疫苗)。COVID-19前的大流行分析表明，近50%的疫苗可预防的死亡发生在ZD儿童中。这些儿童中有三分之二生活在极端贫困的家庭，这些家庭遭受多重贫困，包括无法获得生殖健康服务。水,和卫生。因此，随着我们从大流行中恢复过来，ZD儿童现在已被列为识别和与卫生系统整合的关键队列。方法从最近两轮全国家庭健康调查（NFHS）中提取数据（NFHS4，2015-2016年和NFHS5，2019-2021年），这项研究旨在确定印度12-23个月的ZD儿童的状况，挑战,以及未来必要的行动议程。对数据进行了公平决定因素分析，如性别、居住地,宗教,出生顺序,种姓,和母亲的教育。关键决定因素包括全国ZD患病率的变化，state,和地区水平；公平参数和各州之间的差异，并有最大的改进；以及这些指标之间的差异。还进行了相关性分析，以了解ZD患病率与关键母婴健康指标之间的关联性质。结果两组间ZD总体患病率降低4.1%(10.5-6.4%)。全国共有26个州报告NFHS5的ZD患病率<10%，而NFHS4为18。总的来说,324个地区报告ZD患病率<5%，145个地区报告的患病率>10%。公平参数反映了女童ZD的缓慢下降，跨城市地域，长子,受教育12年或以上的母亲，和财富最高的五分之一家庭的孩子。在孕早期注册之间建立了两个NFHS回合之间的负相关，四次或更多产前检查，机构交付，和ZD患病率。结论研究结果表明，关键权益参数的持续改善，然而,挑战确实存在。此外，大流行对全球和印度免疫计划的影响必将阻止和扭转这一进展，并加剧进一步的不平等。因此，必须继续和加强努力，以确定，集成,给ZD儿童免疫,家庭,和社区。
