Abstract:-

The 2019 UN Resolution on the Rights of the Child highlighted an urgent need for evidence on children lacking parental care, as they may be vulnerable to violence and exploitation and may tend to miss out on essential services. We investigated whether orphans and children without parental care were at risk of sub-optimal vaccination. We conducted a cross-sectional study of 189 population-representative UNICEF Multiple Indicator Cluster Surveys (MICS) from 82 low- and middle-income countries, conducted from Jan 1, 2005, to Dec 31, 2022. We used two-level logistic fixed-effects models with individual community-dwelling children aged 12 to 59 months nested within MICS sampling cluster to estimate the effects of orphanhood (one or both parents deceased) and lack of parental care (children residing with no biological parents) on missed vaccinations. Models included adjustment for potential confounding. Sensitivity analyses examined assumptions and compared results to 4-level mixed effects models. Our study provides compelling evidence that community-dwelling orphans and children lacking parental care are more likely than their peers to miss out on the benefits of routine immunization. Facilitating access to basic health services such as vaccination is a critical first step towards better supporting children at risk and upholding their rights.