Maternal & Child Health, IRD Pakistan, Karachi, Pakistan.
Gavi, The Vaccine Alliance, Geneva, Switzerland.
BMJ Open. 2022 May 18;12(5):e058985. doi: 10.1136/bmjopen-2021-058985.
To estimate the prevalence of zero dose children (who have not received any dose of pentavalent (diphtheria, tetanus, pertussis, type B and hepatitis B) vaccine by their first birthday) among those who interacted with the immunisation system in Sindh, Pakistan along with their sociodemographic characteristics and risk factors.
We conducted a descriptive analysis of child-level longitudinal immunisation records of 1 467 975 0-23 months children from the Sindh's Zindagi Mehfooz (Safe Life) Electronic Immunisation Registry (ZM-EIR), for the birth cohorts of 2017 and 2018.
Sindh province, Pakistan which has a population of 47.9 million people and an annual birth cohort of 1.7 million.
The primary outcome measure was zero dose status among enrolled children. Logistic regression was performed to identify the risk factors associated with the zero dose status.
Out of 1 467 975 children enrolled in the ZM-EIR in Sindh, 10.6% (154 881/1 467 975) were zero dose. There were sharp inequities across the 27 districts. Zero dose children had a lower proportion of hospital births (28.5% vs 34.0%; difference 5.5 percentage points (pp) (95% CI 5.26 to 5.74); p<0.001) and higher prevalence from slums (49.5% vs 42.3%; difference 7.2 pp (95% CI 6.93 to 7.46); p<0.001), compared with non-zero dose children. Children residing in urban compared with rural areas were at a higher risk (relative risk (RR): 1.20; p<0.001; 95% CI 1.18 to 1.22), while children with educated compared with uneducated mothers were at a lower risk of being zero dose (RR: 0.47-0.96; p<0.001; 95% CI 0.45 to 0.98).
Despite interacting with the immunisation system, 1 out of 10 children enrolled in the ZM-EIR in Sindh were zero dose. It is crucial to monitor the prevalence of zero dose children and investigate their characteristics and risk factors to effectively reach and follow-up with them.
估计在巴基斯坦信德省与免疫接种系统有过互动的儿童中，零剂量儿童（1 岁生日前未接受过任何五联疫苗[白喉、破伤风、百日咳、乙型肝炎和乙型肝炎]剂量）的流行率，并分析其社会人口学特征和危险因素。
我们对信德省 Zindagi Mehfooz（安全生活）电子免疫登记册（ZM-EIR）中的 1467975 名 0-23 个月儿童的纵向免疫记录进行了描述性分析，这些儿童属于 2017 年和 2018 年的出生队列。
巴基斯坦信德省，人口 4790 万，每年出生人数为 170 万。
主要结果测量是登记儿童的零剂量状况。我们进行了逻辑回归分析，以确定与零剂量状况相关的危险因素。
在信德省 ZM-EIR 登记的 1467975 名儿童中，有 10.6%（154881/1467975）为零剂量。27 个区之间存在明显的不平等现象。零剂量儿童的医院分娩比例较低（28.5% vs 34.0%；差异 5.5 个百分点（95%CI 5.26 至 5.74）；p<0.001），来自贫民窟的比例较高（49.5% vs 42.3%；差异 7.2 个百分点（95%CI 6.93 至 7.46）；p<0.001），而非零剂量儿童。与农村地区相比，居住在城市的儿童面临更高的风险（相对风险（RR）：1.20；p<0.001；95%CI 1.18 至 1.22），而与母亲未受过教育的儿童相比，母亲受过教育的儿童零剂量的风险较低（RR：0.47-0.96；p<0.001；95%CI 0.45 至 0.98）。
尽管与免疫接种系统有过互动，但在信德省 ZM-EIR 登记的儿童中，仍有 1 成是零剂量。监测零剂量儿童的流行率并调查其特征和危险因素至关重要，以便有效接触和跟踪他们。
