Title : Reaching zero-dose children through adaptive immunization strategies in security-compromised areas of Zamfara State, Nigeria
Abstract:
Reaching zero-dose children remains a major challenge to routine immunization in northern Nigeria, particularly in security-compromised settings. Zamfara State has experienced prolonged armed banditry, population displacement, and repeated disruption of basic services, all of which have weakened primary health care delivery. According to national survey estimates, fewer than 30 percent of children aged 12 to 23 months in Zamfara are fully immunized, while between 40 and 50 percent have received no routine vaccine at all. In several conflict-affected local government areas, zero-dose prevalence is estimated to exceed 60 percent, far above the national average. This abstract examines strategies and emerging results from efforts to reach zero-dose children in insecure areas of Zamfara State. Interventions were implemented across selected high-risk wards using security-informed microplanning, community-based service delivery, and adaptive outreach models. These included engagement of traditional and religious leaders, deployment of community health volunteers drawn from affected settlements, and integration of immunization with nutrition screening and basic curative services. Outreach sessions were redesigned to reflect local security realities, with flexible scheduling, reduced session duration, and prioritization of settlements with recent displacement. Routine immunization and outreach data were triangulated with community registers to identify zero-dose pockets and track performance. Program monitoring data indicate that targeted wards recorded a 15 to 25 percentage-point increase in first-dose pentavalent vaccine coverage within 6 to 12 months of implementation. In some partially accessible communities, the proportion of identified zero-dose children declined from about 55 percent at baseline to below 35 percent following intensified community engagement and mobile outreach. Despite these gains, insecurity-related disruptions accounted for an estimated 20 to 30 percent of missed planned sessions, and health worker availability in high-risk areas remained below 60 percent of required staffing levels. Reaching zero-dose children in Zamfara requires immunization strategies that are security-aware, data-driven, and rooted in community trust. Sustained reductions in zero-dose prevalence will depend on strengthening primary health care systems, protecting frontline workers, improving real-time data use, and ensuring predictable financing for outreach services in fragile and conflict-affected settings.
Keywords: Zero-dose children; routine immunization; insecurity
