article · Vaccines
A provincial-level survey across the Democratic Republic of the Congo, covering 51,054 children aged 12 to 23 months, reveals that approximately one in five children, or 19.1 percent, have received no doses of the pentavalent vaccine. Rates of these zero-dose children differ substantially by region, ranging from 2.4 percent in Haut Lomami to 62.4 percent in Tshopo. Statistical analysis indicates that zero-dose status is strongly linked to young maternal age, low maternal education, and poverty indicators such as lacking a telephone or radio. Direct financial barriers, including paying for vaccination cards or related immunisation services, are also significant determinants. In addition, lack of civil registration, inability to name vaccine-preventable diseases, and specific religious affiliations correlate with being unvaccinated. These findings highlight systemic inequalities driving the non-vaccination of infants in the country.
Understanding why infants miss all fundamental vaccines is critical for public health programmes aiming to prevent disease outbreaks. By pinpointing the sociodemographic, geographical, and economic drivers of non-vaccination in the Democratic Republic of the Congo, health authorities and international organisations can better identify underserved communities, address direct financial barriers, and direct resources towards reducing stark regional disparities in basic immunisation coverage.
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(1) Background: The Democratic Republic of the Congo (DRC) is one of the countries with the highest number of never vaccinated or "zero-dose" (ZD) children in the world. This study was conducted to examine the proportion of ZD children and associated factors in the DRC. (2) Methods: Child and household data from a provincial-level vaccination coverage survey conducted between November 2021-February 2021 and 2022 were used. ZD was defined as a child aged 12 to 23 months who had not received any dose of pentavalent (diphtheria-tetanus-pertussis-<i>Haemophilus influenzae</i> type b (Hib)-Hepatitis B) vaccine (by card or recall). The proportion of ZD children was calculated and associated factors were explored using logistic regression, taking into account the complex sampling approach. (3) Results: The study included 51,054 children. The proportion of ZD children was 19.1% (95%CI: 19.0-19.2%); ZD ranged from 62.4% in Tshopo to 2.4% in Haut Lomami. After adjustment, being ZD was associated with low level of maternal education and having a young mother/guardian (aged ≤ 19 years); religious affiliation (willful failure to disclose religious affiliation as the highest associated factor compared to being Catholic, followed by Muslims, revival/independent church, Kimbanguist, Protestant); proxies for wealth such as not having a telephone or a radio; having to pay for a vaccination card or for another immunization-related service; not being able to name any vaccine-preventable disease. A child's lack of civil registration was also associated with being ZD. (4) Conclusions: In 2021, one in five children aged 12-23 months in DRC had never been vaccinated. The factors associated with being a ZD child suggest inequalities in vaccination that must be further explored to better target appropriate interventions.
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DOI: 10.3390/vaccines11050900
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