Journal article
Who Are the Zero-Dose? Identifying Distinct Household Archetypes in High-Burden Indian Regions
Introduction: Zero-dose (ZD) children are those who have not received the first dose of the DPTcV vaccine by their first birthday. This remains a persistent challenge in India’s immunisation landscape, particularly in high-burden states such as Uttar Pradesh (UP) and Bihar. While previous studies have identified key risk factors, few have employed advanced analytic techniques to synthesise these into actionable household-level archetypes.
Methods: We conducted a cross-sectional survey from March to June 2024 across 42 districts in UP and Bihar, covering 1,198 households with zero-dose (ZD), dropout (DO), and fully immunized (FI) children aged 12–23 months. Data were collected using a semi-structured tool with 219 variables across multiple domains. To identify key determinants and household personas of ZD children, we applied Weighted Multiple Correspondence Analysis (MCA) for dimensionality reduction followed by K-Means clustering.
Results: Determinants identified were (1) Behavioural and attitudinal factors including vaccine refusal and fear of side effects (2) Structural and systemic barriers such as home births and missed antenatal care (3) Service delivery gaps including negative interactions with health workers and nutrition program exclusion and (4) Socioeconomic and logistic constraints like financial hardships and digital exclusion. Furthermore, combining MCA with K-means clustering revealed four distinct archetypes among ZD households. These were Systemic Dropouts (48%) with high service initiation but weak follow-up; Resource-Limited Refusers (42%) facing compounded material and administrative exclusion; The Conflicted Caregivers (8%) showing health care services access but persistent vaccine fears; Resistant Traditionalists (2%), characterized by cultural disengagement and service avoidance.
Conclusion: By combining Weighted MCA and K-Means clustering, this study offered a scalable and interpretable framework for persona-based immunization intervention planning. The four archetypes identified demonstrated the need for differentiated policy responses, from culturally tailored engagement to poverty-aligned outreach.
Authors
Languages
- English
Publication year
2026
Type
Journal article
Categories
- Global initiatives
Countries
- India
Organisations
- Gates Foundation
Tags
- Zero-dose
WHO Regions
- South-East Asia Region
ZDLA-India
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The resource is included in the following table:
| Title | Author | Year | Type | Language |
|---|---|---|---|---|
| Zero Dose Children: Exploring the context & drivers of missed vaccination of children in Uttar Pradesh using a gender lens | Uttar Pradesh Technical Support Unit (UP TSU), Gates Foundation | 2025 | Report | English |
| Getting beyond awareness: ‘learning by doing’ to reach zero-dose children in India | Ajay Gupta, Sharda Prasad Veenayak, Amrin Fatma, Ayushi Agrawal, JSI India, Gavi, the Vaccine Alliance | 2026 | Report | English |
| Reaching Zero-Dose Children in India: Four Family Archetypes | Manoj Kumar Shukul, Ajay Gupta, Ram Ratan, Sabin Vaccine Institute | 2026 | Report | English |
| Why children were missing out on routine vaccines, and how listening helped to close the gap | Ram Ratan, Gavi, the Vaccine Alliance | 2026 | Report | English |
| Who Are the Zero-Dose? Identifying Distinct Household Archetypes in High-Burden Indian Regions | Ajay Gupta, Manoj Kumar Shukla, Ram Ratan, Mohit Chaurasiya, Divya Monga, Vidhi Sharma, Mandar Kannure, Disha Aggarwal, Bhupendra Tripathi, Syed Belal Hassan, Vama Shah, Mahesh Kumar Aggarwal, Suresh Kumar Dalpath | 2026 | Journal article | English |
