Maternal, Newborn, and Child Health
MNCH Immunization Interventions
Maternal, Newborn, and Child Health
MNCH Immunization InterventionsImmunization for Children Under 5
Supporting Young Children’s Health and Wellbeing through Immunization
The early years of childhood constitute a vital period for establishing lifelong protection against infectious diseases. Children under five years of age are especially susceptible to severe illness from vaccine-preventable diseases due to their developing immune systems. In low- and middle-income countries, comprehensive immunization during these formative years becomes fundamental to child survival and optimal development.
Current WHO recommendations outline protection against 13 essential diseases, often delivered through combination vaccines such as the pentavalent vaccine protecting against diphtheria, pertussis, tetanus, hepatitis B, and haemophilus influenzae type b.
The Expanded Program on Immunization (EPI) was established to provide a structured framework ensuring universal access to routine childhood vaccines. However, gaps in coverage remain, particularly among zero-dose children – those who have never received a single routine vaccine. These children are often found in marginalized communities, including:
- Remote rural areas with limited health infrastructure.
- Urban slums, where poverty and migration hinder access to immunization services.
- Conflict zones and humanitarian settings, where displacement and insecurity disrupt routine healthcare.
Identifying and reaching zero-dose children is crucial for achieving universal immunization coverage and preventing the resurgence of deadly diseases. Local governments, healthcare workers, and community leaders play a critical role in strengthening immunization programs, closing coverage gaps, and ensuring every child, regardless of location or circumstance, receives their life-saving vaccines.
This section provides practical guidance and high-impact strategies for implementing and strengthening childhood immunization programs. By implementing these strategies, local governments and healthcare workers can create stronger, more resilient immunization systems, ensuring no child is left behind in the fight against preventable diseases.
What Are the Benefits of Immunization for Children under 5?
- Reduces Child Mortality: Vaccination prevents deadly diseases such as measles, diphtheria, polio, and pneumonia, significantly lowering infant and child mortality rates.
- Prevents Disease Outbreaks: Achieving high immunization coverage prevents the resurgence of vaccine-preventable diseases.
- Cost-Effective Public Health Measure: Immunization saves healthcare costs by reducing hospitalizations and long-term disabilities.
- Promotes Herd Immunity: High coverage levels protect even those who cannot be vaccinated due to medical conditions.
- Improves Overall Community Health: Vaccination contributes to healthier families and communities.
How to Implement
1. Align Policy and Planning for Immunization Success
- Ensure local government policies align with national immunization strategies and goals to maintain consistency in service delivery.
- Allocate sufficient funding for immunization services, including outreach activities, vaccine procurement, and logistics to sustain program effectiveness.
- Engage key stakeholders (such as community leaders, NGOs, and religious groups) to build public trust, increase participation, and support vaccination campaigns.
2. Build the Capacity of Healthcare Workers
- Train health workers on safe vaccine administration, cold chain management, and adverse event monitoring to ensure high-quality service delivery.
- Provide regular refresher courses to update health workers on new vaccine introductions, safety protocols, and emerging immunization challenges.
3. Strengthen Service Delivery and Accessibility
- Establish both fixed and outreach immunization sites to ensure vaccination services reach remote and underserved populations.
- Integrate immunization with other maternal and child health services (e.g., antenatal care, nutrition, and growth monitoring) to maximize efficiency and improve uptake.
4. Engage Communities and Increase Vaccine Demand
- Use community mobilization efforts, media campaigns, and school-based programs to educate families about the importance of routine immunization.
- Address vaccine hesitancy through culturally sensitive education, personalized counseling, and trusted community advocates.
- Disseminate informational and educational materials.
5. Maintain Cold Chain and Logistics Management
- Store and handle vaccines properly to ensure potency and effectiveness by maintaining the recommended temperature range throughout the supply chain.
- Monitor vaccine stock levels to prevent shortages and wastage, ensuring timely replenishment of supplies.
6. Monitor, Evaluate, and Improve Immunization Coverage
- Use real-time data tracking systems to monitor vaccination coverage, identify gaps, and address missed populations.
- Conduct regular performance reviews and supportive supervision to strengthen frontline immunization workers’ effectiveness and improve service delivery.
What’s the Evidence?
- Routine immunization coverage in LMICs has increased dramatically from less than 5% in 1974 to over 80% by 2019, resulting in substantial reductions in child mortality rates across Africa, Asia, and Latin America (UNICEF State of the World’s Children, 2023).
- Every $1 invested in childhood immunization yields an estimated $44 return on investment in LMICs through reduced healthcare costs, increased productivity, and economic growth (Ozawa et al., Health Affairs, 2016).
- Integration of immunization with other maternal and child health services in LMICs has shown promise for improving vaccination coverage and health system efficiency (Wallace et al., Vaccines, 2024. Maternal and neonatal data collection systems in low- and middle-income countries: scoping review protocol – PMC).
Key Indicators
The indicators below are outcome and impact indicators that can be monitored and may vary based on the setting. Consider your country-specific indicators as your country may monitor additional indicators.
Outcome Indicators |
Impact Indicators |
|
Immunization Coverage Rates: Percentage of children receiving vaccines per schedule. |
Zero-dose rates: Proportion of children who have never received any routine vaccines. |
|
Dropout Rates: Percentage of children missing second or third doses of multi-dose vaccines. |
Child Mortality Rates: Number of deaths of children under five per 1,000 live births. |
|
Cold Chain Integrity: Percentage of facilities maintaining appropriate vaccine storage conditions. |
|
|
Community Awareness Levels: Percentage of caregivers aware of immunization schedules and benefits. |
|
Test Your Knowledge
Earn a Certificate
Tips
- Establish strong coordination between governments, health workers, and community organizations.
- Use digital tools for vaccine tracking and reminder systems to improve follow-up.
- Address myths and misconceptions with clear, science-based messaging.
- Provide incentives for caregivers to encourage timely immunization.
- Continuously educate and engage with communities through local leaders and gatekeepers on the benefits of immunizations.
Challenges
- Logistical Constraints: Improve supply chain management and ensure timely vaccine distribution.
- Funding Gaps: Over-reliance on external donor assistance. Advocate for increased local government budget allocation and explore donor partnerships.
- Data Gaps and Monitoring Issues: Implement electronic immunization registries to improve data accuracy.
- Outreach to Hard-to-Reach Areas: Deploy mobile vaccination teams and collaborate with local leaders.
- Vaccine Hesitancy: Strengthen community education & engagement and provide clear information about vaccine safety and efficacy.
Key Resources
- The Expanded Program on Immunization. Caribbean Epidemiology Centre 2012
- Immunization resources. UNICEF
- Vaccination and Immunization Position Papers and Resources. WHO
- Vaccine Resources GAVI
- Immunization Essentials. Global Health eLearning 2016
- Strengthening Immunization Capacity. Sabin
- Immunization Fact Sheet. USAID 2024
