TY - JOUR
T1 - Assessing the effectiveness of school-based vaccination checks to identify and reach un – and under–vaccinated students in Zambia
AU - Hasan, Alvira Z.
AU - Dombola, Aliness M.
AU - Prosperi, Christine
AU - Mufwambi, Webster
AU - Sakala, Rodgers
AU - Kapungu, Kelvin
AU - Chongwe, Gershom
AU - Singh, Prachi
AU - Wang, Qiulin
AU - Siputuma, Kennedy
AU - Luulu, Maybin
AU - Muchengwa, Malalu Mulundika
AU - Sakala, Constance
AU - Kamiji, Elicah
AU - Bobo, Patricia
AU - Sakala, Jacob
AU - Matanda, Kennedy
AU - Mwansa, Francis D.
AU - Ward, Kirsten
AU - Winter, Amy K.
AU - Carcelen, Andrea C.
AU - Truelove, Shaun A.
AU - Moss, William J.
AU - Mutembo, Simon
N1 - Publisher Copyright:
© 2026 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/
PY - 2026/4/19
Y1 - 2026/4/19
N2 - 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.MethodsA 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.ResultsOf 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.ConclusionsSchool-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.
AB - 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.MethodsA 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.ResultsOf 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.ConclusionsSchool-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.
UR - https://www.scopus.com/pages/publications/105034671430
UR - https://www.scopus.com/pages/publications/105034671430#tab=citedBy
U2 - 10.1016/j.vaccine.2026.128453
DO - 10.1016/j.vaccine.2026.128453
M3 - Article
C2 - 41904919
AN - SCOPUS:105034671430
SN - 0264-410X
VL - 79
JO - Vaccine
JF - Vaccine
M1 - 128453
ER -