Reasons for Being “Zero-Dose and Under-Vaccinated” among Children Aged 12–23 Months in the Democratic Republic of the Congo

Author:

Ishoso Daniel Katuashi12,Mafuta Eric2ORCID,Danovaro-Holliday M. Carolina3ORCID,Ngandu Christian4,Menning Lisa3,Cikomola Aimé Mwana-Wabene5,Lungayo Christophe Luhata5,Mukendi Jean-Crispin5,Mwamba Dieudonné4,Mboussou Franck-Fortune6ORCID,Manirakiza Deo7,Yapi Moise Désiré1,Ngabo Gaga Fidele1,Riziki Richard Bahizire18,Aluma Adele Daleke Lisi9,Tsobeng Bienvenu Nguejio1,Mwanga Cedric1ORCID,Otomba John1ORCID,Lulebo Aimée2,Lusamba Paul2,Nimpa Marcellin Mengouo1

Affiliation:

1. Immunization and Vaccines Development (IVD) Program, World Health Organization (WHO), Country Office, Kinshasa 01205, Democratic Republic of the Congo

2. Kinshasa School of Public Health (KSPH), University of Kinshasa, Kinshasa 01302, Democratic Republic of the Congo

3. Immunization, Analytics and Insights (IAI), Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization (WHO), 1211 Geneva, Switzerland

4. National Institute of Public Health, Kinshasa 01209, Democratic Republic of the Congo

5. Expanded Program of Immunization, Kinshasa 01208, Democratic Republic of the Congo

6. Communicable and Noncommunicable Diseases Cluster, World Health Organization Inter-Country Support Teams Central Africa, Libreville BP 820, Gabon

7. United Nations Children’s Fund (UNICEF) Country Office, Kinshasa 01204, Democratic Republic of the Congo

8. Public Health Section, Higher Institute of Medical Techniques of Nyangezi, Sud-Kivu 11213, Democratic Republic of the Congo

9. Independent Researcher, Moroni 99397, Comoros

Abstract

(1) Introduction: The Democratic Republic of the Congo (DRC) has one of the largest cohorts of un- and under-vaccinated children worldwide. This study aimed to identify and compare the main reasons for there being zero-dose (ZD) or under-vaccinated children in the DRC. (2) Methods: This is a secondary analysis derived from a province-level vaccination coverage survey conducted between November 2021 and February 2022; this survey included questions about the reasons for not receiving one or more vaccines. A zero-dose child (ZD) was a person aged 12–23 months not having received any pentavalent vaccine (diphtheria–tetanus–pertussis–Hemophilus influenzae type b (Hib)–Hepatitis B) as per card or caregiver recall and an under-vaccinated child was one who had not received the third dose of the pentavalent vaccine. The proportions of the reasons for non-vaccination were first presented using the WHO-endorsed behavioral and social drivers for vaccination (BeSD) conceptual framework and then compared across the groups of ZD and under-vaccinated children using the Rao–Scott chi-square test; analyses were conducted at province and national level, and accounting for the sample approach. (3) Results: Of the 51,054 children aged 12–23 m in the survey sample, 19,676 ZD and under-vaccinated children were included in the study. For the ZD children, reasons related to people’s thinking and feelings were cited as 64.03% and those related to social reasons as 31.13%; both proportions were higher than for under-vaccinated children (44.7% and 26.2%, respectively, p < 0.001). Regarding intentions to vaccinate their children, 82.15% of the parents/guardians of the ZD children said they wanted their children to receive “none” of the recommended vaccines, which was significantly higher than for the under-vaccinated children. In contrast, “practical issues” were cited for 35.60% of the ZD children, compared to 55.60% for the under-vaccinated children (p < 0.001). The distribution of reasons varied between provinces, e.g., 12 of the 26 provinces had a proportion of reasons for the ZD children relating to practical issues that was higher than the national level. (4) Conclusions: reasons provided for non-vaccination among the ZD children in the DRC were largely related to lack of parental/guardian motivation to have their children vaccinated, while reasons among under-vaccinated children were mostly related to practical issues. These results can help inform decision-makers to direct vaccination interventions.

Funder

United Nations Children Emergency Funds

Publisher

MDPI AG

Subject

Pharmacology (medical),Infectious Diseases,Drug Discovery,Pharmacology,Immunology

Reference46 articles.

1. WHO (2021). Global Immunization Coverage 2021 [Internet], WHO. Available online: https://www.who.int/news-room/fact-sheets/detail/immunization-coverage.

2. Wigley, A., Lorin, J., Hogan, D., Utazi, C.E., Hagedorn, B., Dansereau, E., Tatem, A.J., and Tejedor-Garavito, N. (2022). Estimates of the number and distribution of zero-dose and under-immunized children across remote-rural, urban, and conflict-affected settings in low and middle-income countries. PLoS Glob. Public Health, 2.

3. Gavi, the Vaccine Alliance (2023, January 18). The Zero-Dose Child: Explained. Vaccines Work. 26 April 2021. Available online: https://www.gavi.org/vaccineswork/zero-dose-child-explained.

4. Ministère de la Santé Publique de la RDC (2023, January 18). Plan D’urgence Pour La relance De La Vaccination De Routine Dit « Plan Marshall Sur La Vaccination De Routine » (Plan MASHAKO). Programme Elargi De Vaccination, Kinshasa, Juillet 2018. Available online: https://www.engagementvaccination.com/monitoring/fr.

5. WHO (2023, January 18). UNICEF. Estimates of National Immunization Coverage 2021, Available online: https://www.who.int/teams/immunization-vaccines-and-biologicals/immunization-analysis-and-insights/global-monitoring/immunization-coverage/who-unicef-estimates-of-national-immunization-coverage.

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