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Measuring Zero-Dose Children: Reflections on Age Cohort Flexibilities for Targeted Immunization Surveys at the Local Level

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by Zero-Dose Learning Hub

Zero-dose (ZD) children is a critical objective in global health, and it is at the heart of the Immunization Agenda 2030 (IA2030) strategy. Coverage for the first dose of diphtheria–tetanus–pertussis (DTP1)-containing vaccine is the global operational indicator used to estimate ZD children. When surveys are used, DTP1 coverage estimates usually rely on information reported from caregivers of children aged 12–23 months. It is important to have a global definition of ZD children, but learning and operational needs at a country level may require different ZD measurement approaches. This article summarizes a recent workshop discussion on ZD measurement for targeted surveys at local levels related to flexibilities in age cohorts of inclusion from the ZD learning Hub (ZDLH) initiative—a learning initiative involving 5 consortia of 14 different organizations across 4 countries—Bangladesh, Mali, Nigeria, and Uganda—and a global learning partner. The ZDLH initiative decided to align on a recommendation to include the age cohort from 18 weeks to 23 months, with enough power to enable disaggregation of key results across the two different cohort years. We argue that flexibilities with the age cohort for inclusion in targeted surveys at the local level may be an important principle to be considered. More research is needed to better understand in which contexts improvements in timeliness of DTP1 in the first year of life will translate to improvements in ZD results in the age cohort of 12–23 months as defined by the global DTP1 indicator.

Gustavo C. Corrêa, Md. Jasim Uddin, Tasnuva Wahed, Elizabeth Oliveras, Christopher Morgan, Moses R. Kamya, Patience Kabatangare, Faith Namugaya, Dorothy Leab, Didier Adjakidje, Patrick Nguku, Adam Attahiru, Jenny Sequeira, Nancy Vollmer and Heidi W. Reynolds
Zero-Dose Learning Hub
Resource Type
Journal article
Technical/Focus Area(s)