Abstract
Introduction: Globally immunization programs have been adversely impacted by the COVID-19 pandemic, with the number of Zero Dose (ZD) children (those who have not received a single dose of Diphtheria, Pertussis and Tetanus containing vaccine) increasing from 13 million in the pre-pandemic period to 18 million in 2021. Reflecting global trends, the immunization program in India has also been impacted with the country accounting for the most un and under vaccinated children. The number of ZD children has increased from 1.6 million in 2019 to 3.1 million in 2020, the highest rise across all the countries. ZD children and missed communities have now been prioritized as a key cohort for identification and integration with the health systems as we build back from the pandemic.
Methods: Using National Family Health Survey (NFHS) data, the current status of ZD children in India, the challenges, and next steps are explored. Progress achieved between the last two NFHS rounds (NFHS 5 (2019-21) and NFHS 4 (2015-16)) is analyzed for equity determinants as gender, place of residence, religion, birth order, caste, and mother’s schooling. Key determinants studied include the change in ZD prevalence at the national, state and district levels, proportion of reduction in ZD for equity determinants and states with maximum improvements and disparity across these indicators. A correlation analysis was also conducted to understand the nature of association between ZD prevalence and critical Maternal and Child Health indicators.
Results: The overall ZD prevalence between the two rounds has reduced by 4.1% (10.5% – 6.4%). Data is available and comparable for 30 states in the country between the two rounds out of which in NFHS 5; 9 states reported a ZD prevalence of 0 – <5%, 17 states a prevalence of 5% – <10% and 2 states each a prevalence of 10% – <15% and 15% and above. The corresponding figures for NFHS 4 being 9, 9, 5 and 7, respectively. Data was analyzed for 680 districts from NFHS 5, out of which 324 districts have reported a prevalence of 0 – <5% and 145 districts a prevalence of 10% and higher. The equity parameters reflect a slow-footed reduction among ZD for girl children, across urban geographies, first born child, mothers with 12 or more years of schooling and children in families with highest wealth quintiles. A negative correlation which is accentuated between the two NFHS rounds is established between first trimester registration, four or more antenatal visits, institutional deliveries and ZD prevalence.
Conclusion: The analysis provides important insights into the current status of ZD children in India and the need for continued efforts. The data from the NFHS rounds corresponds to the period before the pandemic and therefore needs to be assessed accordingly. Moreover, the early trends sourced from the NFHS reports need to be complemented with detailed analysis from the NFHS micro data to better identify and understand the inter-play of the equity determinants at the national, state and district levels.