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Variations in Routine Childhood Vaccination Gaps: A Decomposition Analysis Across 80 Low- and Middle-Income

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Global childhood vaccine coverage has stalled. This study analyzed over 2.4 million children across 80 countries, finding that the drop-out (DO) group most impacts diphtheria-tetanus-pertussis (DTP3) vaccine coverage changes.

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Area of Science:

  • Global Health
  • Immunization Programs
  • Pediatric Vaccinations

Background:

  • Childhood vaccine access has improved, but global diphtheria-tetanus-pertussis (DTP3) vaccine coverage has plateaued, hindering Immunization Agenda 2030 (IA2030) targets.
  • Achieving higher DTP3 coverage necessitates targeted strategies for unreached populations.
  • This study categorizes children missing DTP3 into zero dose (ZD), missed DTP (MD), and drop-out (DO) groups to analyze coverage dynamics.

Purpose of the Study:

  • To disaggregate children missing DTP3 into ZD, MD, and DO groups.
  • To examine the contribution of each group (ZD, MD, DO) to changes in DTP3 coverage across countries.
  • To inform targeted planning and accelerate progress towards IA2030 equity goals.

Main Methods:

  • Analysis of 295 Demographic and Health Surveys (1986-2023) from 80 countries, encompassing over 2.4 million children.
  • Classification of children into mutually exclusive groups: DTP3 recipients, ZD, MD, and DO.
  • Decomposition analyses using a naïve approach and a structural model with isometric log-ratio transformations and causal mediation.

Main Results:

  • Overall, 63.8% of children received DTP3, with 16.2% classified as DO, 8.8% as MD, and 11.2% as ZD.
  • Significant country-level variations were observed, with some countries primarily reducing ZD, others MD or DO, and some experiencing setbacks.
  • A structural model indicated that the DO group had the strongest direct association with DTP3 coverage changes, followed by MD and ZD.

Conclusions:

  • Intermediate groups (ZD, MD, DO) differentially contribute to variations in DTP3 coverage over time.
  • Understanding the relationship between coverage gains and shifts in ZD, MD, or DO is crucial.
  • This understanding can enhance existing strategies for targeted planning and achieving IA2030 equity goals.