Despite Malawi’s progress in immunization, with 89% of children receiving DPT1 and 84% receiving DPT3, gaps persist due to geographical disparities, leaving many children unprotected against vaccine-preventable diseases. Zero-dose and under-immunized children remain highly vulnerable, contributing to preventable disease burdens and hindering progress toward Immunization Agenda 2030 and SDG target 3.3. This study models the spatial variability of these children. The study adopted a quantitative cross-sectional design using secondary data from the 2015-2016 Malawi Demographic and Health Survey (MDHS). It focused on children aged 12 to 35 months, with zero-dose and under-immunized status as the outcome variables. Key covariates included maternal age, ethnicity, religion, region, residence type, birth order. Exploratory spatial data analysis (ESDA) was conducted to map the spatial distribution of zero-dose and under-immunized children and assess spatial autocorrelation. A copula-based spatial modeling approach using Generalized Joint Regression Modeling (GJRM) was applied to examine the joint spatial dependency of immunization indicators and associated risk factors. Markov Random Field (MRF) smoothing was used for district-level analysis. Of the 5668 children aged 12-35 months, 2.32% were zero dose and 6.72% were under immunized. The joint modelling revealed that children from poorest families, those children from homes where parents have no education background were more likely to be zero dose and under immunized. On contrary children from the northern region and from rural type of residence are more likely to be non-zero dose and non under immunized children. The spatially data revealed districts with more proportions of zero dose and under immunized children which included: Nsanje, Chikwawa, Thyolo, and Phalombe. The joint modelling further revealed strong positive correlation between zero dose and under immunized. Applying copula provided a flexible approach to the study in identifying areas that need major intervention for scaling up immunization status. The presented maps and the analysis approach demonstrated a mechanism for monitoring zero dose and under immunized children in Malawi.

Despite Malawi’s progress in immunization, with 89% of children receiving DPT1 and 84% receiving DPT3, gaps persist due to geographical disparities, leaving many children unprotected against vaccine-preventable diseases. Zero-dose and under-immunized children remain highly vulnerable, contributing to preventable disease burdens and hindering progress toward Immunization Agenda 2030 and SDG target 3.3. This study models the spatial variability of these children. The study adopted a quantitative cross-sectional design using secondary data from the 2015-2016 Malawi Demographic and Health Survey (MDHS). It focused on children aged 12 to 35 months, with zero-dose and under-immunized status as the outcome variables. Key covariates included maternal age, ethnicity, religion, region, residence type, birth order. Exploratory spatial data analysis (ESDA) was conducted to map the spatial distribution of zero-dose and under-immunized children and assess spatial autocorrelation. A copula-based spatial modeling approach using Generalized Joint Regression Modeling (GJRM) was applied to examine the joint spatial dependency of immunization indicators and associated risk factors. Markov Random Field (MRF) smoothing was used for district-level analysis. Of the 5668 children aged 12-35 months, 2.32% were zero dose and 6.72% were under immunized. The joint modelling revealed that children from poorest families, those children from homes where parents have no education background were more likely to be zero dose and under immunized. On contrary children from the northern region and from rural type of residence are more likely to be non-zero dose and non under immunized children. The spatially data revealed districts with more proportions of zero dose and under immunized children which included: Nsanje, Chikwawa, Thyolo, and Phalombe. The joint modelling further revealed strong positive correlation between zero dose and under immunized. Applying copula provided a flexible approach to the study in identifying areas that need major intervention for scaling up immunization status. The presented maps and the analysis approach demonstrated a mechanism for monitoring zero dose and under immunized children in Malawi..