Children who do not receive the preliminary dose of the DTP-containing vaccine are likely to be known as zero-dose, occurring due to limited access to healthcare services and several sociodemographic patterns. In India, 6.67% points (pp) of children remain zero-dose, and a significant inequality exists due to socioeconomic factors. Therefore, this study measures the magnitude of the socioeconomic gap and quantifies the key determinants that contribute to the zero-dose inequality using the National Family Health Survey fifth round (NFHS-5) data. A cross-sectional sampling data of 41,132 children aged 12-23 months was considered to employ several descriptive statistics, including a chi-squared test. We utilized the Wagstaff concentration curve (WCC) and concentration index (WCI) to represent the zero-dose inequality. Afterwards, WCI was decomposed to determine the major contributing factors to the socioeconomic gap in zero-dose. The overall prevalence of zero-dose children was 6.67 pp, and a socioeconomic gap in zero-dose by the household wealth index was 3.68 pp between the poorest and the richest. The WCI value for zero-dose due to the wealth index was - 0.12 (p < 0.001), revealed 25.15% of the inequality was contributed by the wealth index, 12.48% by maternal education, 11.57% by media exposure, 10.74% by antenatal care (ANC) visits, and 10.05% by place of children's delivery. To reduce zero-dose among children, multi-dimensional interventions and strategies are needed to address not only economic deprivation but also disparities in maternal health education, access to healthcare, and informational reach. While wealth-related inequality is evident, the wealth index captures broader household assets and living conditions beyond income. Similarly, media exposure may reflect extended access to health-related knowledge, including immunization. Strengthening maternal education, improving ANC coverage, enhancing service delivery, and outreach in underserved areas are crucial steps toward equitable immunization coverage.
Dolui et al. (Wed,) studied this question.