Prevalência de zero dose e factores de risco associados em crianças dos 12 aos 23 meses de idade em Moçambique: análise secundária da base de dados do Inquérito Demográfico e de Saúde 2022-23

Abstract

The absence of the DPT vaccine (against Diphtheria, Pertussis and Tetanus) in early childhood indicates a lack of routine immunization, which exposes children to various diseases. Mozambique, a country supported by Gavi (the Vaccine Alliance), is among the ten countries in the world with the highest number of "zero dose" children, which is reflected in vaccination coverage below targets. The scarcity of studies analyzing the risk factors associated with the prevalence of zero dose constitutes a knowledge gap that would be useful in guiding the Expanded Immunization Program in effective strategies to improve the current scenario. This study aimed to analyze the prevalence of zero dose and the associated risk factors in children aged 12 to 23 months. Method: A secondary analysis was performed using data from the 2022-23 Demographic and Health Survey of Mozambique, which included children whose mothers/caregivers presented a health card or other document with vaccination history, or who responded verbally to questions about the child's vaccination. Data analysis was performed using R version 4.3.3. The data were first weighted to obtain accurate estimates, and then summarized using descriptive statistics using frequencies and proportions in tables and graphs. To identify risk factors associated with zero dose, the prevalence ratio (PR) adjusted from the log-binomial regression model with a 95% confidence interval was used. Associations with a p-value <0.05 were considered statistically significant. Result: A total of 1808 children aged 12 to 23 months were included, of which 24.9% were zero dose children. After adjusting the multivariate model, it was observed that children with the following characteristics presented a higher prevalence of zero dose: female gender (PR = 1.30; 95% CI: 1.08-1.57; P = 0.007); belonging to poorer (PR = 2.24; 95% CI: 1.18-4.28; P = 0.014) and poor families (PR = 1.99; 95% CI: 1.01-3.93; P = 0.046); mothers/caregivers who professed the Catholic religion (PR = 1.42; 95% CI: 1.02-1.98; P = 0.037); residents in the provinces of Niassa (PR = 2.97; 95% CI: 1.03-8.57; P = 0.044), Cabo Delgado (PR = 4.82; 95% CI: 1.69-13.73; P = 0.003), Nampula (PR = 5.01; 95% CI: 1.75-14.33; P = 0.003), Zambézia (PR = 4.29; 95% CI: 1.54-11.98; P = 0.006), Tete (PR = 3.47; 95% CI: 1.21-9.94; P = 0.021), Manica (PR = 3.45; 95% CI: 1.22-9.75; P = 0.020) and Sofala (PR = 3.47; 95% CI: 1.22-9.75; P = 0.020). = 3.16; 95% CI: 1.08-9.25; P = 0.036); those whose mothers did not perform any prenatal visit (PR = 1.93; 95% CI: 1.38-2.70; P < 0.001), mothers gave birth at home (PR = 1.43; 95% CI: 1.11-1.84; 0.006) and mothers did not have a health card (PR = 3.94; 95% CI: 2.94-5.26; P < 0.001) or had one but did not present it (PR = 4.33; 95% CI: 2.84-6.60; p = <0.001). Conclusion: Interventions to promote routine immunization are of utmost importance, especially for vulnerable groups of mothers and children, namely those with low wealth, limited access to antenatal care and immunization services, and inadequate facilities for delivery. In this context, there is a need to develop policies that can boost immunization coverage and reduce the prevalence of zero doses and promote the health and well-being of children and the general population.(TRADUÇAO NOSSA)