Introduction: Zero-dose prevalence refers to children who failed to receive any routine vaccination. Little is known about the "immunisation cascade" in low- and middle-income countries (LMICs), defined as how children move from zero dose to full immunisation.
Methods: Using data from national surveys carried out in 92 LMICs since 2010 and focusing on the four basic vaccines delivered in infancy (BCG, polio, DPT and MCV), we describe zero-dose prevalence and the immunisation cascade in children aged 12 to 23 months. We also describe the most frequent combinations of vaccines (or co-coverage) among children who are partially immunized. Analyses are stratified by country income groups, household wealth quintiles derived from asset indices, sex of the child and area of residence. Results were pooled across countries using child populations as weights.
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Results: In the 92 countries, 7.7% were in the zero-dose group, and 3.3%, 3.4% and 14.6% received one, two or three vaccines, respectively; 70.9% received the four types and 59.9% of the total were fully immunised with all doses of the four vaccines. Three quarters (76.8%) of children who received the first vaccine received all four types. Among children with a single vaccine, polio was the most common in low- and lower-middle income countries, and BCG in upper-middle income countries. There were sharp inequalities according to household wealth, with zero-dose prevalence ranging from 12.5% in the poorest to 3.4% in the wealthiest quintile across all countries. The cascades were similar for boys and girls. In terms of dropout, 4% of children receiving BCG did not receive DPT1, 14% receiving DPT1 did not receive DPT3, and 9% receiving DPT3 did not progress to receive MCV.
The government modestly increased efforts to identify and assist labor trafficking victims, but did not undertake any such efforts in relation to sex trafficking. The government identified and provided care to four Bangladeshi victims of forced labor and assisted 16 potential victims following their interception, an increase from zero identified during the previous reporting period. The government intercepted the 16 potential trafficking victims from Madagascar en route to Kuwait. After acquiring a translator, the government interviewed these potential victims and determined that it needed further information to formally identify them as trafficking victims. Nonetheless, it coordinated with the Government of Madagascar to repatriate all 16 potential victims. There are no shelters specifically for trafficking victims in the country; however, the social affairs department of the Ministry of Health and Social Affairs provided the Bangladeshi victims with accommodations in a private guest house, per diem, access to a social worker and translator, and new work permits. The government provided the 16 Malagasy nationals with accommodations at a hotel until they were repatriated. The Bangladeshi victims reportedly participated in the investigation. The government did not report efforts to identify or assist sex trafficking victims. The law provides for witness protection, medical services, shelter, psychological support, legal advice, repatriation, social integration, and establishment of a fund to help pay for these expenses. The government did not report whether it allocated capital to the fund; however, it did fund assistance to victims. The government conducted training for social workers on how to implement the victim assistance tool, created in 2015, which established standard operating procedures on victim identification, protection, and referral; although, the government did not report implementation of the tool during the reporting period. There were no reports of victims being penalized for unlawful acts committed as a direct result of being subjected to human trafficking; however, because officials did not use standard victim identification procedures, victims likely remained unidentified in the law enforcement system. For example, migrant workers who strike have historically been considered to be in breach of their work contracts and could be deported at their employers' request. There were no reports of such deportations during the reporting period. 2ff7e9595c
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