Zero-Dose Vaccination of Self-Paid Vaccines Among Migrant and Left-Behind Children in China: Evidence from Zhejiang and Henan Provinces

TL;DR

The study finds that migrant and left-behind children in China are more likely to be unvaccinated, highlighting the need for targeted efforts to improve vaccine access.

Contribution

This study identifies key demographic and socioeconomic factors influencing zero-dose vaccination rates among vulnerable children in China.

Findings

Migrant and left-behind children are significantly more likely to be zero-dose vaccinated compared to urban local children.

Caregivers with lower education and income are less likely to vaccinate their children with self-paid vaccines.

Many caregivers of unvaccinated children reported not knowing where to access vaccinations.

Abstract

Background/Objectives: As zero-dose vaccination has become a global health concern, understanding the practice of self-paid immunizations in migrant and left-behind children in China is crucial to the prevention and control of infectious diseases. Methods: A cross-sectional study was conducted in 1648 children and their caregivers in urban areas in Zhejiang Province and rural areas in Henan Province. The participants were then classified into four groups: urban local, migrant, non-left-behind, and left-behind. Results: Compared to urban local children, migrant (prevalence ratios: 1.29, 95% confidence intervals: 0.69–2.41), non-left-behind (4.72, 3.02–7.37), and left-behind (4.79, 3.03–7.56) children were more likely to be zero-dose vaccinated. Children aged 1–2 years (odds ratio: 1.60, 95% confidence intervals: 1.14–2.23) and born later (1.55, 1.12–2.14), with caregivers aged >35 years (1.49, 1.03–2.15) and less educated (elementary school or lower: 4.22, 2.39–7.45) were less likely to receive self-paid vaccinations, while caregivers other than parents (0.62, 0.41–0.94) and lower household income (0.67, 0.49–0.90) lowered the likelihood of zero-dose vaccination of self-paid vaccines. For migrant and rural zero-dose children, the majority of caregivers reported they “didn’t know where to get a vaccination”, with responses ranging from 82.3% to 93.8%. Conclusions: Migrant and rural children should be prioritized in the promotion of self-paid immunization in order to accomplish the WHO Immunization Agenda 2030’s goal of “leaving no one behind”.

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