Keywords: Zero dose children; vaccination; Mozambique, Health Demographic Survey

Aim:

Globally around 14.5 million children had not received any routine vaccines, in 2023, mostly in LIC. In Mozambique, immunization coverage in children aged 12 to 23 is around 38%, with 750,000 zero-dose children. We aimed to analyze the level and factors associated with zero dose children aged 12-23 months in Mozambique.

Method:

Using statistical package R-v.4.3.3 we performed a longitudinal analysis of Demographic and Health Surveys data (2022-2023) in Mozambique. The log-Binomial regression model was used to assess zero-dose associated factors where p-value < 0.05 were significant.

Results:

1,801 children were studied, from whom 50.1% female and 72.7% from rural area. The prevalence of zero dose in 2022 was 15%, being prominent in the poorest children 42% (194/461), in children who mothers did not have antenatal care 74%(165/222), who were born outside a healthcare facility 48.0%(263/548), whose mothers mentioned challenges to access any healthcare facility 31.4% (269/858) and whose mothers did not have the child health card 57,3%(318/555). A pregnancy without antenatal care increased 1.9 times (PR = 1,93; CI 95%: 1,38-2,70; P < 0,001) the risk of zero dose children, followed by child delivery out of the health facility 1,43 (PR = 1,43; CI 95%: 1,11-1,84; P = 0,006) and the absence of the child health card 3,94 (PR=3,94; CI95%: 2,94-5,26; P < 0,001).

Conclusions:

This evidence is an important base for other countries with similar characteristics as Mozambique. Zero-dose prevalence is considerably high in the country, especially in the most limited resources provinces from the north. Actions are needed to facilitate the access of the population to primary healthcare and essential vaccines to improve health and well-being in children and society. It is important to explore other potential factors associated to this condition to provide additional subsidies for decision making towards health system strengthening, improving vaccine coverage and reducing zero-dose prevalence