Measuring Zero-Dose Children: Reflections on Age Cohort Flexibilities for Targeted Immunization Surveys at the Local Level
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 sur...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2024-02-01
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| Series: | Vaccines |
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| Online Access: | https://www.mdpi.com/2076-393X/12/2/195 |
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| author | 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 Heidi W. Reynolds |
| author_facet | 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 Heidi W. Reynolds |
| author_sort | Gustavo C. Corrêa |
| collection | DOAJ |
| description | 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. Those considerations may include the need to generate insights on immunization timeliness and on catch-up activities, made particularly relevant in the post-pandemic context; the need to compare results across different age cohort years to better identify systematically missed communities and validate programmatic priorities, and also generate insights on changes under dynamic contexts such as the introduction of a new ZD intervention or for recovering from the impact of health system shocks. Some practical considerations such as the potential need for a larger sample size when including comparisons across multiple cohort years but a potential reduction in the need for household visits to find eligible children, an increase in recall bias when older age groups are included and a reduction in recall bias for the first year of life, and a potential reduction in sample size needs and time needed to detect impact when the first year of life is included. Finally, the inclusion of the first year of life cohort in the survey may be particularly relevant and improve the utility of evidence for decision-making and enable its use in rapid learning cycles, as insights will be generated for the population being currently targeted by the program. For some of those reasons, 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. |
| first_indexed | 2024-03-07T22:11:14Z |
| format | Article |
| id | doaj.art-97bfe29d420c4188aeab8a033b2bf0ad |
| institution | Directory Open Access Journal |
| issn | 2076-393X |
| language | English |
| last_indexed | 2024-03-07T22:11:14Z |
| publishDate | 2024-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Vaccines |
| spelling | doaj.art-97bfe29d420c4188aeab8a033b2bf0ad2024-02-23T15:37:09ZengMDPI AGVaccines2076-393X2024-02-0112219510.3390/vaccines12020195Measuring Zero-Dose Children: Reflections on Age Cohort Flexibilities for Targeted Immunization Surveys at the Local LevelGustavo C. Corrêa0Md. Jasim Uddin1Tasnuva Wahed2Elizabeth Oliveras3Christopher Morgan4Moses R. Kamya5Patience Kabatangare6Faith Namugaya7Dorothy Leab8Didier Adjakidje9Patrick Nguku10Adam Attahiru11Jenny Sequeira12Nancy Vollmer13Heidi W. Reynolds14Gavi, The Vaccine Alliance, Chemin du Pommier 40, Le Grand Saconnex, 1218 Geneva, SwitzerlandInternational Centre for Diarrhoeal Disease Research, Bangladesh, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, BangladeshInternational Centre for Diarrhoeal Disease Research, Bangladesh, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, BangladeshJhpiego, The Johns Hopkins University Affiliate, 1615 Thames Street, Baltimore, MD 21231, USAJhpiego, The Johns Hopkins University Affiliate, 1615 Thames Street, Baltimore, MD 21231, USAInfectious Diseases Research Collaboration (IDRC), Kampala P.O. Box 7475, UgandaInfectious Diseases Research Collaboration (IDRC), Kampala P.O. Box 7475, UgandaInfectious Diseases Research Collaboration (IDRC), Kampala P.O. Box 7475, UgandaGaneshAID, 143 Doc Ngu, Lieu Giai, Ba Dinh, Hanoi 152960, VietnamGaneshAID, 143 Doc Ngu, Lieu Giai, Ba Dinh, Hanoi 152960, VietnamAfrican Field Epidemiology Network (AFENET), 50 Haile Selassie St, Asokoro, Abuja 900103, NigeriaAfrican Field Epidemiology Network (AFENET), 50 Haile Selassie St, Asokoro, Abuja 900103, NigeriaThe Geneva Learning Foundation (TGLF), Av. Louis-Casaï 18, 1209 Geneva, SwitzerlandJSI Research & Training Institute, Inc. (JSI), 2733 Crystal Dr 4th Floor, Arlington, VA 22202, USAGavi, The Vaccine Alliance, Chemin du Pommier 40, Le Grand Saconnex, 1218 Geneva, SwitzerlandZero-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. Those considerations may include the need to generate insights on immunization timeliness and on catch-up activities, made particularly relevant in the post-pandemic context; the need to compare results across different age cohort years to better identify systematically missed communities and validate programmatic priorities, and also generate insights on changes under dynamic contexts such as the introduction of a new ZD intervention or for recovering from the impact of health system shocks. Some practical considerations such as the potential need for a larger sample size when including comparisons across multiple cohort years but a potential reduction in the need for household visits to find eligible children, an increase in recall bias when older age groups are included and a reduction in recall bias for the first year of life, and a potential reduction in sample size needs and time needed to detect impact when the first year of life is included. Finally, the inclusion of the first year of life cohort in the survey may be particularly relevant and improve the utility of evidence for decision-making and enable its use in rapid learning cycles, as insights will be generated for the population being currently targeted by the program. For some of those reasons, 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.https://www.mdpi.com/2076-393X/12/2/195zero-doseequityimmunizationtargeted surveysmeasurement |
| spellingShingle | 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 Heidi W. Reynolds Measuring Zero-Dose Children: Reflections on Age Cohort Flexibilities for Targeted Immunization Surveys at the Local Level Vaccines zero-dose equity immunization targeted surveys measurement |
| title | Measuring Zero-Dose Children: Reflections on Age Cohort Flexibilities for Targeted Immunization Surveys at the Local Level |
| title_full | Measuring Zero-Dose Children: Reflections on Age Cohort Flexibilities for Targeted Immunization Surveys at the Local Level |
| title_fullStr | Measuring Zero-Dose Children: Reflections on Age Cohort Flexibilities for Targeted Immunization Surveys at the Local Level |
| title_full_unstemmed | Measuring Zero-Dose Children: Reflections on Age Cohort Flexibilities for Targeted Immunization Surveys at the Local Level |
| title_short | Measuring Zero-Dose Children: Reflections on Age Cohort Flexibilities for Targeted Immunization Surveys at the Local Level |
| title_sort | measuring zero dose children reflections on age cohort flexibilities for targeted immunization surveys at the local level |
| topic | zero-dose equity immunization targeted surveys measurement |
| url | https://www.mdpi.com/2076-393X/12/2/195 |
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