{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:12:01Z","timestamp":1760145121087,"version":"build-2065373602"},"reference-count":27,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2024,6,21]],"date-time":"2024-06-21T00:00:00Z","timestamp":1718928000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Kinshasa School of Public Health, University of Kinshasa"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>(1) Background: \u201cZero-dose\u201d (ZD) refers to a child who has not received any doses of the pentavalent (diphtheria\u2013tetanus\u2013pertussis\u2013Haemophilus influenzae type b (Hib)\u2013hepatitis B) vaccine. ZD children are vulnerable to vaccine-preventable diseases (VPDs). Luambo health district (HD) is one of 26 HDs in Kasai Central Province in Democratic Republic of the Congo and had the largest number of ZD children in 2021. This study was conducted to identify factors associated with ZD status among children in Luambo HD. (2) Methods: We conducted a mixed-methods study of children aged 12\u201323 months in Luambo HD. (3) Results: A total of 445 children aged 12\u201323 months were included in the study, including 89 cases and 356 controls. Children who were born in Angola (AOR = 3.2; 95% CI = 1.1 to 9.8; p = 0.046), born at home (AOR = 5.2; 95% CI = 2.1 to 12.5; p &lt; 0.001), whose mothers did not receive antenatal care (AOR = 4.4; 95% CI = 1.2 to 16.3; p = 0.023), or did not know any vaccine preventable disease (AOR = 13.3; 95% CI = 4.6 to 38.4; p &lt; 0.001) were more likely to be ZD than their counterparts. In addition, perceptions of children\u2019s parents influenced child immunization. (4) Conclusions: Factors associated with being a ZD child suggest inequalities in vaccination that need to be addressed through appropriate interventions. Maternal and child health services need to be strengthened while also targeting children\u2019s fathers. This will make it possible to considerably reduce the proportion of ZD and undervaccinated children and effectively fight against VPDs.<\/jats:p>","DOI":"10.3390\/vaccines12070700","type":"journal-article","created":{"date-parts":[[2024,6,21]],"date-time":"2024-06-21T05:33:28Z","timestamp":1718948008000},"page":"700","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Correlates of Zero-Dose Status among Children Aged 12\u201323 Months in the Luambo Health District, Democratic Republic of Congo: A Matched Case\u2013Control Study"],"prefix":"10.3390","volume":"12","author":[{"given":"Esperent","family":"Ntambue Malu","sequence":"first","affiliation":[{"name":"Kasa\u00ef Central Provincial Health Division, Ministry of Public Health, Hygiene and Prevention, Kananga 05101, Democratic Republic of the Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alain Nzanzu","family":"Magazani","sequence":"additional","affiliation":[{"name":"African Field Epidemiology Network (AFENET), Kinshasa 01207, Democratic Republic of the Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean Bosco","family":"Kasonga","sequence":"additional","affiliation":[{"name":"Kinshasa School of Public Health, University of Kinshasa, Kinshasa 01302, Democratic Republic of the Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ad\u00e8le","family":"Mudipanu","sequence":"additional","affiliation":[{"name":"United Nations International Children\u2019s Emergency Fund (UNICEF) Country Office, Kinshasa 01204, Democratic Republic of the Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3843-654X","authenticated-orcid":false,"given":"Michel","family":"Kabamba Nzaji","sequence":"additional","affiliation":[{"name":"Expanded Program of Immunization, Kinshasa 01208, Democratic Republic of the Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel Katuashi","family":"Ishoso","sequence":"additional","affiliation":[{"name":"Kinshasa School of Public Health, University of Kinshasa, Kinshasa 01302, Democratic Republic of the Congo"},{"name":"World Health Organization (WHO) Country Office, Kinshasa 01205, Democratic Republic of the Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5379-0507","authenticated-orcid":false,"given":"Dalau Mukadi","family":"Nkamba","sequence":"additional","affiliation":[{"name":"Kinshasa School of Public Health, University of Kinshasa, Kinshasa 01302, Democratic Republic of the Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,21]]},"reference":[{"key":"ref_1","unstructured":"WHO (2022, October 20). Regional Office for Africa. Immunization, Available online: https:\/\/www.who.int\/health-topics\/immunization."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"5433","DOI":"10.1016\/j.vaccine.2022.07.058","article-title":"Zero- or missed-dose children in Nigeria: Contributing factors and interventions to overcome immunization service delivery challenges","volume":"40","author":"Mahachi","year":"2022","journal-title":"Vaccine"},{"key":"ref_3","first-page":"498","article-title":"Global routine vaccination coverage, 2018\u2014Global routine immunization coverage, 2018","volume":"94","author":"Division","year":"2019","journal-title":"Wkly. Epidemiol. Rec."},{"key":"ref_4","unstructured":"(2022, October 20). Second Demographic and Health Survey 2013\u20132014. Available online: https:\/\/www.unicef.org\/drcongo\/media\/1046\/file\/EDS-RDC%20II%202013-2014.pdf."},{"key":"ref_5","unstructured":"(2022, October 20). The Multiple Indicator Cluster Survey with Malaria Component (MICS6-Palu, DRC, 2017\u20132018). Available online: https:\/\/www.espkinshasa.net\/rapport-mics-2018\/."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Ishoso, D.K., Danovaro-Holliday, M.C., Cikomola, A.M.-W., Lungayo, C.L., Mukendi, J.-C., Mwamba, D., Ngandu, C., Mafuta, E., Dikassa, P.S.L., and Lulebo, A. (2023). \u201cZero dose\u201d children in the Democratic Republic of the Congo: How many and who are they?. Vaccines, 11.","DOI":"10.3390\/vaccines11050900"},{"key":"ref_7","unstructured":"ESP (2022, October 12). Study Report ECV. Available online: https:\/\/www.espkinshasa.net."},{"key":"ref_8","unstructured":"Ministry of Public Health of the DRC (2018). Emergency Plan for the Relaunch of Routine Vaccination Known as the \u201cMarshall Plan on Routine Vaccination\u201d (MASHAKO Plan). Expanded Vaccination Program."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"627","DOI":"10.2471\/BLT.20.279232","article-title":"Subnational inequalities in diphtheria\u2013tetanus\u2013pertussis immunization in 24 countries in the African region","volume":"99","author":"Kirkby","year":"2021","journal-title":"Bull. World Health Organ."},{"key":"ref_10","unstructured":"PAO (2023). Consolidated Operational Action Plan of the Luambo Health District, PAO."},{"key":"ref_11","unstructured":"PEV (2022, October 20). Comprehensive Multi-Year Plan of the PEV of the Democratic Republic of Congo 2015\u20132019. Available online: https:\/\/extranet.who.int\/countryplanningcycles\/sites\/default\/files\/planning_cycle_repository\/democratic_republic_of_congo\/ppac_draft_1_rdc_2015-2019_va_gnm_input_hama_auga_02_02_2015_pm.pdf."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e041163","DOI":"10.1136\/bmjopen-2020-041163","article-title":"Prevalence and determinants of incomplete or not at all vaccination among children aged 12\u201336 months in Dabat and Gondar districts, northwest of Ethiopia: Findings from the primary health care project","volume":"10","author":"Atnafu","year":"2020","journal-title":"BMJ Open"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.2307\/2531743","article-title":"Power Calculations for Matched Case-Control Studies","volume":"44","author":"Dupont","year":"1988","journal-title":"Biometrics"},{"key":"ref_14","first-page":"80","article-title":"Factors Associated with Complete Vaccination in Children 12 to 23 Months in Guinea","volume":"17","author":"Diallo","year":"2021","journal-title":"Eur. Sci. J. ESJ"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"5352847","DOI":"10.1155\/2017\/5352847","article-title":"Vaccination Coverage and Associated Factors among Children Aged 12\u201323 Months in Debre Markos Town, Amhara Regional State, Ethiopia","volume":"2017","author":"Gualu","year":"2017","journal-title":"Adv. Public Health"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1093\/inthealth\/ihu027","article-title":"Determinants of uptake of third doses of oral polio and DTP vaccines in the Ibadan North Local Government Area of Nigeria","volume":"6","author":"Fatiregun","year":"2014","journal-title":"Int. Health"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Ozigbu, C.E., Olatosi, B., Li, Z., Hardin, J.W., and Hair, N.L. (2022). Correlates of Zero-Dose Vaccination Status among Children Aged 12\u201359 Months in Sub-Saharan Africa: A Multilevel Analysis of Individual and Contextual Factors. Vaccines, 10.","DOI":"10.3390\/vaccines10071052"},{"key":"ref_18","unstructured":"Udessa, G., Sena, L., and Berhanu, S. (2018). Health Care: Current Reviews Vaccination Status and Factors Associated with It among Children Aged 12\u201323 Months in Wadera District, South East Ethiopia. Health Care Curr. Rev., 6."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Acharya, P., Kismul, H., Mapatano, M.A., and Hatl, A. (2018). Individual- and community-level determinants of child immunization in the United States: A multilevel analysis. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0202742"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Tesema, G.A., Tessema, Z.T., Tamirat, K.S., and Teshale, A.B. (2020). Complete basic childhood vaccination and associated factors among children aged 12\u201323 months in East Africa: A multilevel analysis of recent demographic and health surveys. BMC Public Health, 20.","DOI":"10.1186\/s12889-020-09965-y"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Nchinjoh, S.C., Saidu, Y., Agbor, V.N., Mbanga, C.M., Jude Muteh, N., Njoh, A.A., Ndoula, S.T., Nsah, B., Edwige, N.N., and Roberman, S. (2022). Factors Associated with Zero-Dose Childhood Vaccination Status in a Remote Fishing Community in Cameroon: A Cross-Sectional Analytical Study. Vaccines, 10.","DOI":"10.3390\/vaccines10122052"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"S435","DOI":"10.1016\/j.amepre.2015.05.008","article-title":"Predictors of Vaccination in India for Children Aged 12\u201336 Months","volume":"49","author":"Shrivastwa","year":"2015","journal-title":"Am. J. Prev. Med."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Eryurt, M.A., and Yal\u00e7in, S.S. (2022). Zero-dose children in Turkey: Regional comparison of pooled data for the period 1990 to 2018. BMC Infect. Dis., 22.","DOI":"10.1186\/s12879-022-07416-0"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Chikako, T.U., Seidu, A.-A., Hagan, J.E., Aboagye, R.G., and Ahinkorah, B.O. (2021). Bayesian Analysis of Predictors of Incomplete Vaccination against Polio among Children Aged 12\u201323 Months in Ethiopia. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph182211820"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"220","DOI":"10.11604\/pamj.2017.26.220.11453","article-title":"Individual and socioeconomic factors associated with childhood immunization coverage in Nigeria","volume":"26","author":"Oleribe","year":"2017","journal-title":"Pan Afr. Med. J."},{"key":"ref_26","first-page":"221","article-title":"Mothers\u2019 management of childhood diseases in Yorubaland: The influence of cultural beliefs. Health Transit","volume":"7","author":"Feyisetan","year":"1997","journal-title":"Rev. Cult. Social. Behav. Determ. Health"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e015790","DOI":"10.1136\/bmjopen-2016-015790","article-title":"Determinants of immunization coverage of children aged 12\u201359 months in Indonesia: A cross-sectional study","volume":"7","author":"Herliana","year":"2017","journal-title":"BMJ Open"}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/12\/7\/700\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:02:06Z","timestamp":1760108526000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/12\/7\/700"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,21]]},"references-count":27,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2024,7]]}},"alternative-id":["vaccines12070700"],"URL":"https:\/\/doi.org\/10.3390\/vaccines12070700","relation":{},"ISSN":["2076-393X"],"issn-type":[{"type":"electronic","value":"2076-393X"}],"subject":[],"published":{"date-parts":[[2024,6,21]]}}}