Peer-reviewed article

Assessing the effectiveness of school-based vaccination checks to identify and reach un - and under-vaccinated students in Zambia.

Alvira Z Hasan, Aliness M Dombola, Christine Prosperi, Webster Mufwambi, Rodgers Sakala et al. · 27 Mar 2026

Summary

Written by AI, not yet AICS's view · claude-haiku-4-5-20251001

This study tested whether screening children's vaccination status in primary schools in Zambia could identify under-vaccinated students and improve their immunisation coverage. Researchers screened 1,839 Grade 1 students in 10 schools across two cities and found that 38% were under-vaccinated, with very low coverage for the second measles dose. Most under-vaccinated children who were referred for catch-up vaccination received at least one additional dose, particularly when vaccination was offered at school, and measles coverage improved significantly after the intervention.

Key points

38.0% of screened Grade 1 learners were under-vaccinated and 1.8% had received no routine vaccines
Second measles vaccine (MCV2) coverage was the lowest at 65.6% before the intervention
68.7% of under-vaccinated learners received at least one catch-up vaccination dose, mostly through school-based delivery
Post-intervention measles coverage improved to 96.6% for MCV1 and 83.5% for MCV2
Under-vaccination was associated with older age, lower maternal education, and lack of vaccination documentation

Limitations

This was a pilot intervention in only two urban districts with a small sample of 10 schools, so findings may not generalise to rural areas or other regions of Zambia or similar countries. The study does not provide long-term follow-up data on whether vaccination coverage was sustained after the intervention ended.

Abstract

BACKGROUND: Measles supplementary immunization activities (SIAs) help close immunity gaps but are resource-intensive and may not effectively reach school-aged children who miss routine vaccination. School-based vaccination screening may offer a complementary platform, yet evidence from low- and middle-income countries (LMICs) is limited. This study evaluated the feasibility and effectiveness of school-based vaccination screening and catch-up vaccination in Zambia. METHODS: A pilot intervention was conducted in 10 public and community primary schools in two urban districts (Ndola and Lusaka). Grade 1 learners were screened for routine vaccination status using under-5 cards or caregiver recall. Learners missing doses of oral poliovirus vaccine (OPV), diphtheria-tetanus-pertussis vaccine (DTP), or measles-containing vaccine (MCV) were referred for catch-up vaccination at health facilities or through school-based outreach. Descriptive and regression analyses assessed coverage, under-vaccination, catch-up uptake, and associated factors. RESULTS: Of 1839 learners screened (98% participation), 38.0% were under-vaccinated and 1.8% were zero-dose. MCV2 coverage was lowest (65.6%) and declined with age. Among 699 under-vaccinated learners, 68.7% received at least one catch-up dose, mostly through school-based activities. Under-vaccination was associated with older age, accompaniment by a non-biological respondent, and low maternal education. Missed catch-up vaccination was associated with longer travel time, lack of an under-5 card, and caregiver unwillingness to accept school vaccination. Post-catch-up coverage increased to 96.6% for MCV1 and 83.5% for MCV2. CONCLUSIONS: School-based vaccination screening was feasible, well-accepted, and substantially improved measles vaccination coverage. Scale-up should emphasize timely catch-up delivery, improved record-keeping and coordinated school-health planning. Future operational studies must assess the use of Early Childhood Learning (ECL) classes to reach children at younger ages.

Findings the Hub has extracted

Each claim below is labelled by its type of design and links back to this report.

Survival

Problem

Un- and under-vaccinated school-aged children in low-income countries miss routine immunisation and are not effectively reached by mass vaccination campaigns, resulting in immunity gaps and risk of vaccine-preventable disease outbreaks.

Intervention: School-based vaccination screening to identify under-vaccinated Grade 1 learners, with referral for catch-up vaccination at health facilities or through school-based outreach vaccination sessions.
Population: 1,839 Grade 1 learners (98% participation rate) in 10 public and community primary schools in Ndola and Lusaka districts, Zambia.

Key finding

38.0% of screened learners were under-vaccinated before intervention

Practitioner