Vaccines (Aug 2023)

Reasons for Being “Zero-Dose and Under-Vaccinated” among Children Aged 12–23 Months in the Democratic Republic of the Congo

  • Daniel Katuashi Ishoso,
  • Eric Mafuta,
  • M. Carolina Danovaro-Holliday,
  • Christian Ngandu,
  • Lisa Menning,
  • Aimé Mwana-Wabene Cikomola,
  • Christophe Luhata Lungayo,
  • Jean-Crispin Mukendi,
  • Dieudonné Mwamba,
  • Franck-Fortune Mboussou,
  • Deo Manirakiza,
  • Moise Désiré Yapi,
  • Gaga Fidele Ngabo,
  • Richard Bahizire Riziki,
  • Adele Daleke Lisi Aluma,
  • Bienvenu Nguejio Tsobeng,
  • Cedric Mwanga,
  • John Otomba,
  • Aimée Lulebo,
  • Paul Lusamba,
  • Marcellin Mengouo Nimpa

DOI
https://doi.org/10.3390/vaccines11081370
Journal volume & issue
Vol. 11, no. 8
p. 1370

Abstract

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(1) Introduction: The Democratic Republic of the Congo (DRC) has one of the largest cohorts of un- and under-vaccinated children worldwide. This study aimed to identify and compare the main reasons for there being zero-dose (ZD) or under-vaccinated children in the DRC. (2) Methods: This is a secondary analysis derived from a province-level vaccination coverage survey conducted between November 2021 and February 2022; this survey included questions about the reasons for not receiving one or more vaccines. A zero-dose child (ZD) was a person aged 12–23 months not having received any pentavalent vaccine (diphtheria–tetanus–pertussis–Hemophilus influenzae type b (Hib)–Hepatitis B) as per card or caregiver recall and an under-vaccinated child was one who had not received the third dose of the pentavalent vaccine. The proportions of the reasons for non-vaccination were first presented using the WHO-endorsed behavioral and social drivers for vaccination (BeSD) conceptual framework and then compared across the groups of ZD and under-vaccinated children using the Rao–Scott chi-square test; analyses were conducted at province and national level, and accounting for the sample approach. (3) Results: Of the 51,054 children aged 12–23 m in the survey sample, 19,676 ZD and under-vaccinated children were included in the study. For the ZD children, reasons related to people’s thinking and feelings were cited as 64.03% and those related to social reasons as 31.13%; both proportions were higher than for under-vaccinated children (44.7% and 26.2%, respectively, p p < 0.001). The distribution of reasons varied between provinces, e.g., 12 of the 26 provinces had a proportion of reasons for the ZD children relating to practical issues that was higher than the national level. (4) Conclusions: reasons provided for non-vaccination among the ZD children in the DRC were largely related to lack of parental/guardian motivation to have their children vaccinated, while reasons among under-vaccinated children were mostly related to practical issues. These results can help inform decision-makers to direct vaccination interventions.

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