Country Learning Hubs

The ZDLH helps generate, synthesize, and share ZD data and evidence at both the global and country levels. The structure is a hub-and-spoke model: JSI, the global learning partner manages learning and evidence at the global level, and four country learning hubs (CLHs) in Bangladesh, Mali, Nigeria, and Uganda, comprised of local partners/consortiums, capture and use country-level programmatic data and evidence to provide insights on how the ZD strategy is being translated at the subnational level through improved monitoring and evidence generation.

The four Learning Hubs include:

1. Bangladesh: Led by the International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b) with partners Jhpiego and RedOrange Communications.
2. Mali: Led by GaneshAID with the Center for Vaccine Development-Mali (CDV-Mali) and the University of Bamako.
3. Nigeria: Led by the African Field Epidemiology Network (AFENET) with the African Health Budget Network (AHBN).
4. Uganda: Led by Infectious Diseases Research Collaboration (IDRC) with partners PATH and Makerere University School of Public Health (MakSPH). 

The Learning Hub countries were selected to ensure variation by region and context, including rural, urban, conflict, or refugee, and based on a relatively high number and proportion of ZD children. Other considerations included feasibility and risk mitigation.

ZDLH Global Consortium

In addition to the four Learning Hubs, the ZDLH mechanism includes a global consortium led by JSI Research & Training Institute, Inc. (JSI), in partnership with the International Institute of Health Management Research, New Delhi (IIHMR) and The Geneva Learning Foundation (TGLF). The global consortium provides technical and operational support to the Learning Hubs and disseminates learnings at the community, regional, national, and global levels.

Technical Assistance

As the global learning partner, ZDLH supports country learning hubs in executing their IRMMA-aligned learning agendas by offering demand-driven and collaborative capacity strengthening, technical assistance, and mentorship. During this reporting period:

• In Bangladesh, JSI supported the Political Economy Assessment and Forcibly Displaced Myanmar Nationals (FDMN) research by reviewing and refining draft reports, providing technical input on research tools and methodologies, and collaborating with icddr,b, IIHMR, and Gavi to ensure ethical and strategic alignment.
• In Mali, JSI supported the Learning Hub by co-developing the implementation research protocol, providing technical leadership on Lot Quality Assurance Sampling (LQAS) survey design and training, and ensuring high-quality data collection, strengthening the Learning Hub’s capacity to generate rigorous evidence for immunization equity.
• In Nigeria, JSI supported the Learning Hub by reviewing and advising on Decentralized Immunization Monitoring (DIM) and LQAS findings, guiding data analysis methods, and facilitating technical discussions to strengthen the interpretation and presentation of vaccine coverage and behavioral and social drivers (BeSD) of vaccination indicators by age cohort.
• In Uganda, JSI supported the Learning Hub to strengthen its theory of change and measurement strategies, facilitating outcome mapping, reviewing research tools and costing materials, and helping pivot the implementation research to document and analyze existing immunization interventions in response to Equity Accelerator Fund (EAF) delays.

Facilitating Learning and Sharing

Knowledge Translation

During this reporting period, the ZDLH finalized and published the Knowledge Translation for Zero-Dose Immunization Research toolkit as a guide for effectively transforming research findings into practical applications, ensuring that evidence-based knowledge is communicated, adopted, and used. The toolkit provides a step-by-step process for developing knowledge translation plans. It includes guiding questions, links to resources, and strategies for engaging stakeholders, particularly in ZD immunization research. The toolkit aims to close the know-do gap, promote evidence-based practices, and drive impactful changes in policies and practices. The toolkit is also available in French.

Zero-Dose Resource Library

The ZDLH resource library features a curated repository of evidence-based measurement, monitoring, and learning resources; tools; guidance; and approaches, as well as existing evidence from each country and resources generated by the ZDLH.

During this reporting period, ZDLH uploaded 27 resources to the website. The most downloaded resources included:

1. Knowledge Translation for Zero-Dose Immunization Research
2. Assessment of the Political Economy Context Surrounding Evidence Use for Zero-Dose Programming and Policies in Nigeria
3. Closing The Immunization Gap: Enhancing Routine Immunization in Nigeria by Reaching Zero-Dose and Under-Immunized Children in Marginalized Communities: Report of a Rapid Assessment
4. Gavi’s Zero-Dose Learning Hub IRMMA Aligned Interventions: Semiannual Update—Bangladesh (October 2024)
5. Nigeria Zero-Dose Landscape

The following section presents data on key immunization indicators in Bangladesh. An explanation of the data sources and interpretation of the figures is presented in the text that follows.

Please note that Wisemart/eJRF data for the period of April through September 2024 are not yet available for this semiannual update and will be incorporated in the next report (October 2025).

[Coming soon]

The following section presents data on key immunization indicators in Mali. An explanation of the data sources and interpretation of the figures is presented in the text that follows. Please note that Wisemart/eJRF data for the period of April through September 2024 are not yet available for this semiannual update and will be incorporated in the next report (October 2025).

Study Sub-Districts in Mali: Trends in DTP1 Coverage from 2022 to 2024

Source: Mali DHIS2 reported in Mali CLH Quarterly Progress Report

This figure presents sub-national data from Mali’s DHIS2 system on DTP1 coverage from Q4 2022 to Q4 2024. Trends across the eight sub-districts targeted by the Learning Hub study reveal notable differences between locations. For example, Pelengana Nord shows increasing DTP1 coverage over the two year period, exceeding 100% in each quarter of the past year (Q1-Q4 2024). Cinzana Gare displays relatively high and stable coverage with recent fluctuations over 100% in Q3 and Q4 2024. Likewise, coverage in N’Debougou is relatively stable and increasing over time, ranging from 54% to 79% during the two year period. Niono Central exhibits substantial fluctuations, with a notable drop to 28% in Q2 2023 from a previous high of 74% in Q1 2023, then a recovery to 78% by Q1 2024. The sharp drop in Niono Central might indicate specific local challenges or disruptions in vaccination services. In contrast, Bougouni Ouest maintains very high coverage rates throughout the reporting period, except for a very sharp drop to 46% in Q4 of 2023 that rebounds to 142% the next quarter. Notably, coverage rates in this sub-district often exceed 100%, reaching as high as 155%, indicating potential data quality issues or underestimated target populations.The most dramatic fluctuations are observed in Boura, with coverage swinging from 64% to 118%, which may reflect significant challenges in vaccine delivery or inconsistencies in data collection. Note that these coverage rates were calculated using a denominator (the number of children under one) based on extrapolated data from the 2009 Mali census. Although a census was conducted in 2022, only a preliminary report is available, and the full data has not yet been released.

The following section presents data on key immunization indicators in Nigeria. An explanation of the data sources and interpretation of the figures is presented in the text that follows.

Please note that Wisemart/eJRF data for the period of April through September 2024 are not yet available for this semiannual update and will be incorporated in the next report (October 2025).

[Coming soon]

The following section presents data on key immunization indicators in Uganda. An explanation of the data sources and interpretation of the figures is presented in the text that follows. Please note that Wisemart/eJRF data for the period of April through September 2024 are not yet available for this semiannual update and will be incorporated in the next report (October 2025).

CLH Study Sub-Districts in Uganda: Trends in DTP1 Coverage from Q4 2022 to Q4 2024

Source: Uganda DHIS2 reported in Uganda CLH Quarterly Progress Report

This figure displays sub-national data from the Uganda DHIS2 on DTP1 coverage from Q4 2022 to Q4 2024. Trends in DTP1 coverage over the last three quarters across the six sub-districts targeted by the Learning Hub are variable. In the Karambi subdistrict of Kasese, coverage peaked in Q1 of 2024, then dropped and has remained steady between 79% and 87%. In Isango sub-district, coverage peaked in Q2 of 2024 and has steadily declined since. In Kiruuma subdistrict of Mubende, coverage has slowly increased from 34% in Q1 of 2024 to 75% in Q4 of 2024. Coverage has slowly declined in Butoloogo sub-district of Mubende, declining from a high of 140% in Q4 of 2023 to 96% in Q4 of 2024 (the lowest reported coverage over the 24 month period). In Wakiso, trends were more similar across sub-districts. In both Bussi and Namugongo, coverage remained largely unchanged until Q4 of 2024, when it spiked in both sub-districts. The spikes in coverage in historically low-coverage sub-districts correspond with the national Big Catch-Up (BCU) activity in November 2024 (Q4), which sought to narrow the coverage gap in routine immunization caused by the COVID-19 pandemic.