School Entry Vaccination Checks Allow Mapping of Under-Vaccinated Children in Zambia

Powell, Megan P.; Mufwambi, Webster; Hasan, Alvira Z.; Dombola, Aliness M.; Prosperi, Christine; Sakala, Rodgers; Kapungu, Kelvin; Chongwe, Gershom; Singh, Prachi; Wang, Qiulin; Chewe, Stella; Mwansa, Francis D.; Sakala, Constance; Kamiji, Elicah; Bobo, Patricia; Matanda, Kennedy; Manda, Joan; Winter, Amy K.; Sauer, Molly; Carcelen, Andrea C.; Truelove, Shaun A.; Moss, William J.; Mutembo, Simon

doi:10.3390/vaccines13090924

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Open AccessArticle

School Entry Vaccination Checks Allow Mapping of Under-Vaccinated Children in Zambia

by

Megan P. Powell

^1,2,†,

Webster Mufwambi

^3,†,

Alvira Z. Hasan

¹

,

Aliness M. Dombola

³,

Christine Prosperi

¹,

Rodgers Sakala

³,

Kelvin Kapungu

³,

Gershom Chongwe

³,

Prachi Singh

¹

,

Qiulin Wang

¹

,

Stella Chewe

⁴,

Francis D. Mwansa

^5,‡,

Constance Sakala

⁵,

Elicah Kamiji

⁵,

Patricia Bobo

⁵,

Kennedy Matanda

⁵,

Joan Manda

⁵,

Amy K. Winter

⁶

,

Molly Sauer

¹

,

Andrea C. Carcelen

¹,

Shaun A. Truelove

^1,2

,

William J. Moss

^1,2

and

Simon Mutembo

^1,*

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¹

Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21231, USA

²

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA

³

National Health Research and Training Institute, Lusaka 71769, Zambia

⁴

Ministry of Education, Government of Republic of Zambia, Lusaka 10101, Zambia

⁵

Ministry of Health, Government of Republic of Zambia, Lusaka 10101, Zambia

⁶

Center for the Ecology of Infectious Diseases, Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA 30602, USA

^*

Author to whom correspondence should be addressed.

^†

These authors contributed equally to this work.

^‡

Current Address: UNICEF, Lusaka 10101, Zambia.

Vaccines 2025, 13(9), 924; https://doi.org/10.3390/vaccines13090924 (registering DOI)

Submission received: 30 July 2025 / Revised: 24 August 2025 / Accepted: 27 August 2025 / Published: 29 August 2025

(This article belongs to the Special Issue Inequality in Immunization 2025)

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Abstract

Background: Geographic information systems (GIS) are a promising tool for mapping vaccination coverage and identifying missed communities, yet their use in low- and middle-income countries (LMICs) remains limited. In settings without standardized addresses such as schools or outreach sites, innovative methods are needed to collect and analyse spatial data. Schools offer a unique platform for identifying under-vaccinated children missed by routine or campaign efforts. Methods: During a pilot school vaccination screening program in Zambia, GIS reference maps of health facility catchment areas were developed from hand-drawn sketch maps, catchment area shapefiles, and coordinates of prominent landmarks. These maps were iteratively refined with input from local health staff. In caregiver interviews, data collectors used the maps to identify the child’s zone of residence within the health facility catchment area. Vaccination status was extracted from paper registries used during screening. Geographic heat maps were generated in ArcGIS to visualize under-vaccination by zone. Results: Of 535 children screened across 25 zones, 29% were under-vaccinated. Under-vaccination varied by zone, with clusters of missed children identified, for example, 50% of children in Kabushi Zone 6 were under-vaccinated, compared with much lower rates elsewhere. Conclusions: Pairing school-based vaccination checks with GIS mapping offers a scalable approach to identifying missed communities in LMICs. This method enables spatial analysis without household visits, supporting targeted immunization planning where traditional data systems fall short. However, because the study was limited to children enrolled in five purposively selected schools, out-of-school children and those in other schools were not represented. This selection bias may underestimate the true extent of under-vaccination, and future evaluations should incorporate broader and more representative populations.

Keywords: geographical information systems; immunization; health systems

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MDPI and ACS Style

Powell, M.P.; Mufwambi, W.; Hasan, A.Z.; Dombola, A.M.; Prosperi, C.; Sakala, R.; Kapungu, K.; Chongwe, G.; Singh, P.; Wang, Q.; et al. School Entry Vaccination Checks Allow Mapping of Under-Vaccinated Children in Zambia. Vaccines 2025, 13, 924. https://doi.org/10.3390/vaccines13090924

AMA Style

Powell MP, Mufwambi W, Hasan AZ, Dombola AM, Prosperi C, Sakala R, Kapungu K, Chongwe G, Singh P, Wang Q, et al. School Entry Vaccination Checks Allow Mapping of Under-Vaccinated Children in Zambia. Vaccines. 2025; 13(9):924. https://doi.org/10.3390/vaccines13090924

Chicago/Turabian Style

Powell, Megan P., Webster Mufwambi, Alvira Z. Hasan, Aliness M. Dombola, Christine Prosperi, Rodgers Sakala, Kelvin Kapungu, Gershom Chongwe, Prachi Singh, Qiulin Wang, and et al. 2025. "School Entry Vaccination Checks Allow Mapping of Under-Vaccinated Children in Zambia" Vaccines 13, no. 9: 924. https://doi.org/10.3390/vaccines13090924

APA Style

Powell, M. P., Mufwambi, W., Hasan, A. Z., Dombola, A. M., Prosperi, C., Sakala, R., Kapungu, K., Chongwe, G., Singh, P., Wang, Q., Chewe, S., Mwansa, F. D., Sakala, C., Kamiji, E., Bobo, P., Matanda, K., Manda, J., Winter, A. K., Sauer, M., ... Mutembo, S. (2025). School Entry Vaccination Checks Allow Mapping of Under-Vaccinated Children in Zambia. Vaccines, 13(9), 924. https://doi.org/10.3390/vaccines13090924

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School Entry Vaccination Checks Allow Mapping of Under-Vaccinated Children in Zambia

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