Abstract:
Background: Despite sustained investments in routine immunization, Nigeria continues to account for one of the world's largest populations of zero-dose children. In fragile settings, geographic barriers, population movement, and limited settlement-level data often result in poorly targeted outreach services, leaving many eligible children unreached. The Strengthening Routine Immunization in Consequential Areas of Adamawa and Niger State (STRICAAN) project was designed to strengthen routine immunization service delivery through a data-driven outreach strategy that combines household enumeration, digital microplanning, community mobilization, and targeted vaccination services. This paper describes the early implementation experience from Adamawa State.
Methods: The intervention is being implemented across ten priority Local Government Areas (LGAs) selected based on zero-dose burden, Pentavalent-1 coverage, measles outbreak history, border proximity, and accessibility. Households are enumerated using the Micro-Coverage Tracking Tool (MCTT), a GIS-enabled digital platform that profiles households, identifies zero-dose and under-immunized children, and generates settlement-level data for microplanning. Enumeration data are synchronized to a real-time dashboard to guide deployment of outreach vaccination teams. Volunteer Community Mobilizers support community engagement, identify defaulters, and refer eligible children for vaccination. Vaccination teams are strategically deployed to settlements with identified zero-dose children, improving the precision and efficiency of outreach service delivery.
Results: As of June 2026, the project has enumerated 56,138 households across 104 wards in 10 LGAs, supporting 104 primary healthcare facilities. Household enumeration identified 13,070 zero-dose children, of whom 7,083 (54%) have received routine immunization through targeted outreach services. The intervention has improved visibility of underserved settlements, strengthened microplanning, enhanced coordination of outreach services, and enabled programme managers to use real-time data for operational decision-making. Integration of outreach services with selected primary healthcare interventions—including nutrition counselling, malaria screening, blood pressure checks, deworming, and MUAC screening—has also improved community acceptance and uptake of vaccination services.
Conclusions: Early implementation findings suggest that combining household enumeration, GIS-enabled microplanning, and community-based mobilization can improve the precision of outreach service delivery and strengthen routine immunization systems in fragile settings. This integrated approach provides a scalable model for reaching zero-dose children while improving equity and efficiency in routine immunization programmes.
Biography:
Genevieve Ozioko is a public health professional and Associate at Sydani Group with expertise in health systems strengthening, implementation science, immunization, and digital health. She leads the implementation of the US Centers for Disease Control and Prevention (US CDC)-funded STRICAAN project, which uses digital innovations to improve immunization coverage and strengthen disease surveillance in northeastern Nigeria. Genevieve has also provided technical advisory support to the
Government of Nepal on Gavi Full Portfolio Planning. Her work focuses on translating evidence and digital innovation into practical solutions that strengthen health systems and improve equitable access to essential health services.
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