Geographical Heterogeneity of Zero-Dose (Unvaccinated) Children in India: A Multilevel Geospatial Analysis of Cross-Sectional Survey Data

Mriganka Dolui, Central University of Karnataka, Gulbarga, India
Sanjit Sarkar, Central University of Karnataka

Routine immunization for children in India is a strategic priority to prevent child morbidity and mortality. Children who fail to receive the first dose of DTP (diphtheria, tetanus, and pertussis)-containing vaccine are known as zero-dose children due to limited healthcare access, sociodemographic factors and geographical spatiality. The present study aimed to decipher the spatial dependence, heterogeneity and determinants of zero-dose using geocoded data from 707 districts in India from the fifth round of the National Family Health Survey, 2019-21. Moran’s I statistics and Gatis-Gi were used to identify spatial clustering and the degree of clustering (hotspot) of zero-dose, respectively. Multiple regression models, including ordinary least squares (OLS), spatial lag model (SLM), spatial error model (SEM), and geographically weighted regression (GWR), were employed to assess the geographic variation in determinants of children’s zero dose. The overall prevalence of zero-dose was 6.67%, with a spatial dependence of 0.1753. GWR demonstrated the best model performance than OLS, SLM and SEM, revealing that the relationship between zero-dose and its determinants varied across districts in both magnitude and direction. The findings highlight the importance of spatial factors in understanding immunization gaps and can help policymakers in designing region-specific interventions to improve vaccination coverage across India.

Keywords: Health and Morbidity, Geo-referenced/geo-coded data, Multi-level modeling , Spatial Demography

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