Date of Conferral

8-4-2025

Degree

Ph.D.

School

Public Health

Advisor

Hadi Danawi

Abstract

In 2019, infectious diseases and other conditions claimed the lives of over 5 million children under 5. Global immunization coverage remains below prepandemic levels, leaving behind over 14 million zero-dose children in 2022, of whom 84% lived in low- and middle-income countries. This quantitative cross-sectional study aimed to examine, using two consecutive Demographic and Health Surveys, whether the most significant household characteristics and health service utilization risk factors associated with nonvaccination before the COVID-19 pandemic still hold postpandemic in Mozambique. Andersen's behavioral model of healthcare service utilization was the foundation for this investigation. The sample included N=2034 children aged 12-35 months in 2015 and N=3516 in 2022–2023. Descriptive statistics, bivariate analyses, and binary multiple regression were performed. The Hosmer-Lemeshow test was used to assess the goodness-of-fit of the models. The findings indicated that DTPcv zero-dose prevalence increased from 12.04% in 2015 to 25.77% in 2022–2023, resulting in the backslide of immunization performance and a shift in nonvaccination predictors. Children whose mothers attended four or more antenatal care visits (OR = 0.37, 95% CI [0.17, 0.78], p = .009), whose birth occurred in health facilities (OR = 0.35, 95% CI [0.19, 0.64], p = .001), for whom advice or treatment was sought after presenting with diarrhea (OR = 0.29, 95% CI [0.32,0.89], p = .018), and whose mothers and fathers jointly decided on healthcare (OR = 0.51, 95% CI [0.26, 0.96], p = .038) were less likely to be unvaccinated. A policy shift is needed, and program managers have several levers they can trigger to make significant progress in reducing nonvaccination to impact social change.

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