Investigator(s)
| WHO Technical Officer |
Samiuddin Mohammad World Health Organization, India Samiuddin Mohammad 
|
| Principal Investigator |
Dr Manoj Murhekar ICMR, NIE Chennai Dr Manoj Murhekar
|
| Co-Investigator(s) |
Samiuddin Mohammad WHO India Samiuddin Mohammad
|
| Co-Investigator(s) |
Tigran Avagyan World Health Organization, India Tigran Avagyan
|
| Co-Investigator(s) |
Dr. M. Santhosh Kumar Scientist-D ICMR- NIE, Chennai Dr. M. Santhosh Kumar
|
| Co-Investigator(s) |
Dr. V. Saravana Kumar Scientist-D ICMR- NIE, Chennai Dr. V. Saravana Kumar
|
Title(s) and abstract
| Scientific title | Estimation of Pentavalent-1 Coverage among Children 12-23 months of age in 143 Zero Dose Implementation Plan (ZIP) Districts in 11 States of India |
| Public title | Estimation of Pentavalent-1 Coverage among Children 12-23 months of age in 143 Zero Dose Implementation Plan (ZIP) Districts in 11 States of India |
| Background | Globally, 18.1 million children over one year without Pentavalent-1 dose [Zero dose (ZD) children] accumulated ZD children due to Covid-19 disruptions. The concerted efforts improved to 14.3 million ZD children in 2022. The World Health Organization's Strategic Advisory Group of Experts (SAGE) recommended systematic collection and data usage for Realtime Program Monitoring and Action (PMA) for rapidly reducing ZD children and improve coverages. India was home to ≈ 1.6 million zero dose children in 2019 and more than doubled to 3.4 million in 2020 due to Covid-19 disruptions. India recovered and reduced Zero Dose children to 3.2 million in 2021. Due to relentless efforts and proactive oversight, the country has surpassed the pre-Covid-19 level of Pentavalent-1 coverage from 94% to 95% in 2023 (WUENIC). The monitoring data for 2024 showed variations in full immunization coverage across the districts, with inequities among ZD children by high-risk area, urban and community settings. For effective PMA, India has planned for program evaluation for estimating ZD children using WHO Cluster Survey methodology (PE-WCS) in GAVI pre-identified 143 districts in 11 states. |
| Objectives | In alignment with the immunization agenda 2030 and India's road map to 90% full immunization coverage, India’s ZIP targets to achieve 30% reduction in ZD children by 2026 against the 2019 pre pandemic baseline. The PMA will monitor the progress through three annual surveys in 143 ZIP districts for 2024, 2025 and 2026. The first survey to estimate the baseline zero dose children in the year 2024 (before ZIP interventions) is planned in the current year 2025. To estimate the Pentavalent-1 coverage among children aged 12-23 months in each of the pre-identified 143 ZIP districts across 11 states. • To deduce the zero dose children among the same cohort of children 12-23 months. [Note: [Calculation of ZD%: 100 – Percentage coverage of 1st dose of Pentavalent vaccine] • To assess the full immunization coverage (FIC) among the same cohort of children 12-23 months. • To assess socio-demographic variables such as literacy, rural/ urban, gender and religion, caste etc. in relation to zero dose and fully immunized children. • To explore the reasons for zero dose and not fully immunized children for age of the child surveyed. |
| Study Methods | A cross-sectional multi-stage cluster survey in each survey district will be conducted in 5 to 7 random blocks. All named villages/urban wards (enumeration area) will be listed (small villages/area will have contiguous area tagged) to form the sampling unit from which the clusters would be selected through Probability Proportional to Size (PPS). If the selected cluster is of large size that the expected HHs to be interviewed will be divided into equal segments of size equal to the expected HHs. The first HH for the survey will be selected randomly and subsequent HH following right hand rule. Caregiver interview will be conducted for all eligible children in a HH following informed consent. All children 12-23 months, born between 1 February 2022 to 31 December 2023 residing in the study district including the visitor’s child born in the same period and slept in the household the previous night in the selected cluster shall be eligible for the survey. The survey aims an effective sample size (ESS) of eligible children with statistical reference as 95% confidence interval (CI) at 5% precision for the presumed coverage for each survey district factoring a design effect (DEff) of 1.5. Commensurate with birth rate, the child house ratio (C:H) of children below five years from the robust polio campaign data is utilized to estimate HHs to be visited to find a child 12-23 months. Thus, total HHs with completed interview for the desired ESS. Depending upon the number of surveyors, survey days in each survey district and the desired sample size in each cluster, the total number of clusters and HHs to be visited per day are estimated. The number of clusters are estimated as per the latest “WHO Vaccination Coverage Cluster Surveys reference manual March 2019”. |
| Expected outcomes and use of results | The survey is expected to provide the baseline of prevalence of Pentavalent-1 coverage at the district level in each of the 143 pre-identified ZIP districts in the year 2024. The Pentavalent-1 coverage will provide the baseline for deducing the zero dose children and allow the program to measure the full immunization coverage, antigen wise coverage for all the vaccines under the Universal Immunization Program (UIP), the effectiveness of all 11 ZIP interventions and to independently evaluate the progress made following interventions. In addition, to understand the reasons why children are zero dose, partially or unvaccinated, utilize the lessons learnt and inform the program and interventions such as Behaviour and Social Determinants (BeSD) and Community of Practice and Demand (CoPD) to tailor the planned interventions. The pentavalent-1 coverage from this survey conducted over three years with rapid estimates will be crucial for the program managers to customize the interventions for effective programmatic actions. This will contribute to sustainability. The estimates from this survey could be utilized to strengthen data triangulation for area prioritization for actions, conducted annually for three years (2024, 2025 and 2026) will allow comparability and measure the progress in reduction of zero dose children. This survey results will contribute to strengthen immunization system in the ZIP districts and allow global comparability across the countries implementing ZIP strategy. |
| Keywords | Zero dose, children, Prevalence, Routine Immunization, GAVI, districts, Blocks, survey, cluster, Full Immunization, baseline, Pre-Covid 19, annual, objectives, DEff, ESS, sampling, consent, interview, households, caregiver, outcome, analyze, intrventions |
Research Details
| Student research | No |
| Start Date | 15-May-2025 |
| End Date | 15-Feb-2026 |
| Key Implementing Institution | WCO India |
| Multi-country research | No |
| Nationwide research | Yes, with randomly selected geographical areas |
| India | |
| Research Domain(s) | Communicable Disease Research |
| Research field(s) | Immunization/Vaccine Preventable Disease |
| Involves human subjects | Yes |
| Population-Based Survey | |
| Data Collection | Primary data |
| Proposal reviewed by other Committee | Under Review |