Peer-reviewed article
Leaving no child behind? developing zero-dose and under-immunized child archetypes to improve vaccine uptake in Nigeria.
AbdulMuminu Isah, Ezinwanne Jane Ugochukwu, Chinyere Ojiugo Mbachu, Ifunanya Clara Agu, Chinazom N Ekwueme et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study identifies and characterizes four types of children in Nigeria who receive no vaccines or incomplete vaccination: those in remote rural areas, urban poor children, conflict-affected and nomadic children, and culturally excluded children. Each group faces different barriers to vaccination, ranging from geographic and logistical challenges to affordability, misinformation, displacement, and religious or traditional beliefs. The research emphasizes that solving low immunization rates requires understanding these distinct groups and strengthening cross-sector collaboration.
Key points
- Rural children face long travel distances, difficult terrain, and inadequate transportation to reach health facilities
- Urban poor children experience affordability issues, misinformation, and competing livelihood priorities despite geographic proximity to health centres
- Conflict-affected, nomadic, and migrant children are hindered by displacement, insecurity, and lack of stable healthcare access
- Culturally excluded children experience vaccine hesitancy due to religious or traditional beliefs and distrust of modern medicine
- Immunization inequity is linked to broader determinants including poverty, education, geography, and displacement
Limitations
This is a qualitative characterization study based on stakeholder perspectives and literature review rather than direct measurement of zero-dose children or their families. The study does not evaluate or test any intervention, so it cannot indicate which strategies would effectively increase vaccination uptake for each identified archetype.
Abstract
BACKGROUND: Nigeria bears the highest burden of zero-dose and under-immunized children. This paper characterizes archetypes of zero-dose and under-immunized children in Nigeria through a stakeholder-engaged process, to inform policy and programmatic responses toward reaching the unreached. DESIGN AND METHODS: A qualitative approach was used, comprising a rapid literature review and a qualitative survey over a two-day multi-sector stakeholder co-creation workshop. The workshop involved immunization stakeholders from a variety of sectors. Participants worked in near-homogenous groups to explore four archetypes of exclusion identified from literature, guided by a structured template. Narrative synthesis of group reports was performed and problem definitions for each archetype were discussed and validated in plenary. RESULTS: Each archetype of zero-dose and under-immunized children were linked to broader determinants of health including poverty, education, geography and displacement. Children residing in hard-to-reach rural areas faced significant logistical barriers, difficult terrain and inadequate transportation options including long travel distances to reach health facilities. Urban poor children, while geographically closer to health centres, often encounter affordability issues, misinformation, and competing livelihood priorities of caregivers that hinder immunization uptake. For the conflict-affected, nomadic, and migrant children, frequent displacement, insecurity, and lack of stable healthcare access were reported as primary barriers. Culturally excluded children experience hesitancy due to religious or traditional beliefs, social stigma, and distrust of caregivers in modern medicine. CONCLUSIONS: There are hidden dimensions of immunization inequity that should be fully explored in solving the problem of zero dose and non-vaccination. Addressing underlying causes of non-vaccination requires strengthened collaboration across sectors.