Peer-reviewed article

Targeted assessment of prevalence of zero-dose and under-immunised children in Bangladesh

Zerin Jannat, Hemel Das, Tabita Jannatul, Md. Wazed Ali, Nurul Alam et al. · 1 Dec 2025

Abstract

Introduction Gavi, the Vaccine Alliance and the Global Immunisation Agenda 2030 have intensified their emphasis on equity, with the intent of reaching zero-dose (ZD—missing the first dose of pentavalent) and under-immunised (UI—missing the third dose of pentavalent) children and their communities. In Bangladesh, inequities in immunisation coverage continue and a country learning hub is supporting the Expanded Programme on Immunisation (EPI) with implementation research on how to identify and reach these vulnerable and underserved communities. We report on an assessment of the prevalence of ZD and UI children, and of potential reasons. Methods This cross-sectional household survey was conducted in 12 rural and urban subdistricts, purposefully selected from diverse socio-ecological zones: haor (wetlands), hills, coastal, char (silty lands), plain land and urban slums. We interviewed 12 756 caregivers of children aged 4.5–23 months. Households were selected using cluster sampling methodology. The data were collected from September to December 2023. We used χ 2 tests and binary logistic regression models for data analysis. Results We found that 1.9% of children were ZD and 11.6% were UI. The highest percentage of ZD/UI was in haor areas (21.3%: 2.6% ZD and 18.7% UI). Findings from logistic regression show that children residing in haor (OR 2.0; 95% CI 1.2 to 3.5), coastal (OR 2.1; 95% CI 1.2 to 3.6) and urban slum areas (OR 2.8; 95% CI 1.4 to 5.6) were approximately 2~3 times more likely to be ZD compared with children living in plain areas. Female children were 1.4 times more likely to be ZD than were male children (OR 1.4; 95% CI 1.1 to 1.8). Commonly mentioned reasons for non-vaccination were childhood illness (all areas) and busy schedule of caregivers (char areas). Conclusion ZD and UI children are spread throughout the country, with higher ZD in haor, urban slum and coastal areas. Children who are female and those residing in households located distant from the EPI centre are more vulnerable to becoming ZD or UI. Our study findings provide insight on children of specific areas and gender who require greater attention from the policymakers and EPI managers to design programmes to reduce the number of ZD and UI children and thus improve equity in immunisation coverage.