Journal article
Identification of unvaccinated children, Madagascar
Problem: Madagascar has a high number of unvaccinated (zero-dose) children. In 2023, an estimated 74% received any dose of the diphtheria-tetanus-pertussis (DTP) vaccine. In southern Madagascar, service gaps, poverty, drought and limited access leave many children unreached by routine immunization.
Approach: Within the Sorohy ny Aretina Manaova Ezaka Vaksiny initiative, a community-based enumeration and vaccination-status verification was conducted in 16 districts in August 2024-June 2025 under health ministry authorization. A total of 3975 community health workers (CHWs) were recruited and trained to verify the vaccination status of all children younger than 5 years from available documentation in targeted fokontany (lowest administrative unit). Digital tools supported data collection, validation and CHW incentive payments.
Local setting: The southern regions of Atsimo Andrefana, Androy and Anosy have about 3.7 million inhabitants, most in remote areas. Health indicators lag behind national averages. Volunteer CHWs lack training, supervision and financial protection, resulting in incomplete population data and weak microplanning.
Authors
- Nadine Muller
- Apollinaire F. Mahafeno
- Andrinirina C. Rasolofondraibe
- Gabrielle T. Andriantiantsoa
- Andry Ns Randrianirisoa
- Elgiraud Ramarosaiky
- Fanjatiana Rlr Rakotoarisoa
- Fanilo N. Valitera
- Zavaniarivo Rampanjato
- Miora M. Andriamanjay
- Elsa N. Rajemison
- Riana S. Ramanantsoa
- Julius V. Emmrich
- Lara M. Press
- Christian H. Ravelomahafaly
- Maurin Mananatitra
Languages
- English
Publication year
2026
Journal
Bulletin of the World Health Organization
Volume
104
Issue
8
Type
Journal article
Categories
- Programme management
Countries
- Madagascar
Organisations
- World Health Organization (WHO)
Tags
- Zero-dose
WHO Regions
- African Region
