Submission ID 116930
| Issue/Objective | Exacerbated by climate change and extreme poverty, armed conflict and violence, humanitarian crises, disasters, and forced migration are likely to heighten child vulnerability and increase family separation. The 2019 UN Resolution on the Rights of the Child highlighted an urgent need for evidence on children lacking parental care. These children may tend to miss out on essential services, especially in low- and middle-income countries (LMICs). We investigated whether community-dwelling orphans (children with one or both parents deceased) and children without parental care (residing with no biological parents) were at risk of sub-optimal vaccination. |
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| Methodology/Approach | Cross-sectional study of 189 population-representative UNICEF Multiple Indicator Cluster Surveys from 82 LMICs, conducted from Jan 1, 2005 to Dec 31, 2022. We used two-level logistic fixed-effects models with individual community-dwelling children aged 12 to 59 months nested within MICS sampling cluster to estimate the effects of orphanhood and lack of parental care on missed vaccinations. We report the confounder-adjusted odds of being a "zero-dose" (ZD) child (failure to receive any diphtheria-tetanus-pertussis-containing (DTP) vaccine doses), an under-immunised child (failure to receive three DTP doses), failure to receive any measles-containing vaccine (MCV), and failure to receive all eight basic vaccine doses. Sensitivity analyses explored uncertainties in model parameters and assumptions. |
| Results | The analysis included 739,506 children of which 20.6% (n=152,314) were ZD, 50.4% (n=372,568) were under-immunised, 50.3% (n=372,089) had not received any MCV, and 57.8% (n=427,558) had not received all 8 basic vaccine doses. Orphans had a consistently higher risk of sub-optimal vaccination. Confounder-adjusted odds ratios were similar for all binary outcomes ZD (ORadj 1.59; 95%CI: 1.48 to 1.71, p<0.001), under-immunised (ORadj 1.46; 95%CI: 1.38 to 1.54, p<0.001), and no MCV and basic incomplete (ORadj 1.42; 95%CI: 1.34 to 1.50, p<0.001) for both). Children lacking parental care experienced similarly elevated risks of sub-optimal vaccination (p<0.001 for all outcomes). |
| Discussion/Conclusion | To support children at risk and uphold their rights, vaccination programmes should prioritise service delivery to community-dwelling orphans and children lacking parental care. |
| Presenters and affiliations | Mira Johri Université de Montréal Mehr Munir University of Minnesota Rose Anne Medeiros Independent consultant Lumana Shakya North Carolina State University Blaine Damte University of Minnesota Anna Bolgrien University of Minnesota |
