Title : Level and factors associated with zero-dose children in Mozambique
Abstract:
In 2023, around 14.5 million children globally, had not received any routine vaccines, in 2023, mostly in LIC and LMIC. In Mozambique, immunization coverage in children aged 12 to 23 in 2023 was 38%, reflected in 750,000 zero-dose children. We aimed to analyze the level and factors associated with zero- dose children aged 12-23 months in Mozambique. This is a longitudinal data analysis from two nationally representative community surveys, namely, the Demographic and Health Survey 2022/2023 and the Immunization, Malaria, and HIV/AIDS Indicators Survey in Mozambique 2015. The focus is on immunization among children aged 12–23 months at the time of the survey. The prevalence of zero-dose children was estimated by child, maternal, and household characteristics. A log-linear regression model was used to assess the association between the factors and zero-dose children, where p-value < 0.05 was significant. A total of 1,801 children were studied, from whom 50.1% were female and 72.7% were from rural areas. The national prevalence of zero-dose children increased from 5.6% (63/1130) in 2015 to 15.0% (269/1798) in 2022, corresponding to an absolute difference (AD) of 9.4% (95% CI: 5.5–13.2%). Children living in Zambezia (AD: 24.0%, 95% CI: 10.4–37.8%) and Cabo Delgado (AD: 9.6%, 95% CI: 5.0–14.3%) experienced the most significant increases in AD. This prevalence was prominent in the poorest children 42% (194/461), in children whose mothers did not have antenatal care 74% (165/222), in children born
outside a healthcare facility 48.0% (263/548), whose mothers mentioned challenges to access any healthcare facility 31.4% (269/858) and whose mothers did not have the child health card 57,3% (318/555). A pregnancy without antenatal care increased 1.9 times (PR = 1,93; CI 95%: 1,38-2,70; P < 0,001) the risk of zero-dose children, followed by child delivery out of the health facility, 1,43 (PR = 1,43; CI 95%: 1,11- 1,84; P = 0,006) and the absence of the child health card, 3,94 (PR=3,94; CI95%: 2,94-5,26; P < 0,001). Between 2015 and 2022, the prevalence of zero-dose children in Mozambique tripled, with Zambézia and Cabo Delgado provinces recording the largest increases. Antenatal care visits and institutional deliveries were associated with an increase of Zero-dose children, highlighting the critical role of these services in promoting immunization uptake. Actions are needed to facilitate the population´s access to primary healthcare and to essential vaccines and to improve health and well-being in children and society. It is important to explore other potential factors associated with this condition to provide additional subsidies for decision-making towards health system strengthening, improving vaccine coverage, and reducing zero- dose prevalence.
