Zero-Dose Children and Nutrition-Service Gaps: A Case for Integrated Delivery in Low- and Middle-Income Countries.

Background/Objectives: Zero-dose children, defined as those who have not received any routine vaccines, are a central priority of global immunization equity efforts and are widely considered to be among the most deprived children. This study examined whether zero-dose status also identifies children who have not received nutrition services and who are nutritionally vulnerable. Methods: We analyzed data from the Demographic and Health Surveys and Multiple Indicator Cluster Surveys across 55 low- and middle-income countries, including 560,314 children aged 12 to 23 months. We assessed the association between zero-dose status and non-receipt of vitamin A supplementation (VAS) and deworming, and between zero-dose status and the Multidimensional Poverty Index (MPI). Results: Zero-dose status was weakly associated with non-receipt of VAS and deworming (most phi coefficients between 0.1 and 0.3) and with the MPI (mean 0.11), and showed negligible correlation with child nutritional status, measured by stunting and wasting (mean phi 0.03). Most zero-dose children nonetheless had not received these nutrition services, with 62% not receiving VAS and 72% not receiving deworming, amounting to an estimated 12.5 and 14.4 million children, concentrated in a small number of countries. This reflected the generally low coverage of nutrition interventions across all children rather than a specific concentration among the zero-dose. Conclusions: Immunization outreach platforms can therefore be used to extend nutrition services to large numbers of under-reached children.