Assessing the relationship between operationally defined zero-dose communities and access to selected primary healthcare services for children and pregnant women in emergency settings

PLoS One. 2023 Feb 16;18(2):e0281764. doi: 10.1371/journal.pone.0281764. eCollection 2023.

Abstract

In this study the authors examine the relationship between "zero-dose" communities and access to healthcare services. This was done by first ensuring the first dose of the Diphtheria Tetanus and Pertussis vaccine was a better measure of zero-dose communities than the measles-containing vaccine. Once ensured, it was used to examine the association with access to primary healthcare services for children and pregnant women in the Democratic Republic of Congo, Afghanistan, and Bangladesh. These services were divided into: a) unscheduled healthcare services such as birth assistance as well as seeking care and treatment for diarrheal diseases and cough/fever episodes and b) other scheduled health services such as antenatal care visits and vitamin A supplementation. Using recent Demographic Health Survey data (2014: Democratic Republic of Congo, 2015: Afghanistan, 2018: Bangladesh), data was analyzed via Chi Squared analysis or Fischer's Exact Test. If significant, a linear regression analysis was performed to examine if the association was linear. While the linear relationship observed between children who had received the first dose of the Diphtheria Tetanus and Pertussis vaccine (the reverse to zero-dose communities) and coverage of other vaccines was expected, the results of the regression analysis depicted an unexpected split in behavior. For scheduled and birth assistance health services, a linear relationship was generally observed. For unscheduled services associated with illness treatments, this was not the case. While it does not appear that the first dose of the Diphtheria Tetanus and Pertussis vaccine can be used to predict (at least in a linear manner) access to some primary (particularly illness treatment) healthcare services in emergency/ humanitarian settings, it can serve as an indirect measure of health services not associated with the treatment of childhood infections such as antenatal care, skilled birth assistance, and to a lesser degree even vitamin A supplementation.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child
  • Diphtheria* / prevention & control
  • Female
  • Health Services
  • Humans
  • Measles Vaccine
  • Pertussis Vaccine
  • Pregnancy
  • Pregnant Women
  • Primary Health Care
  • Tetanus* / prevention & control
  • Vitamin A
  • Whooping Cough* / prevention & control

Substances

  • Vitamin A
  • Pertussis Vaccine
  • Measles Vaccine

Grants and funding

The authors state that the institutions of Boston University (BU) and the United Nations International Children’s Fund (UNICEF) have entered into a financial partnership during the course of this publication (Unicef PCA 55209094). The completion of this study was made possible with funding provided by UNICEF to MPS and MHZ. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. While RM, EN, AY, VB, and FS were not directly responsible for the source of funding, as members of UNICEF they did assist with the completion of this paper. RM provided extensive guidance and feedback on statistical analysis and ensuring the manuscript was comprehensible to a general health/ medicine reader. FS provided guidance during the study and RM, EN, AY, and VB all provided edits to the manuscript.