Title : Spatial distribution of zero-dose children in Chiure District, Cabo Delgado, Mozambique, 2025–2026

Background: Zero-dose children represent a population missed by routine immunization services and are at increased risk of vaccine-preventable diseases. Identifying their magnitude and geographic distribution is essential for targeting vaccination interventions and addressing inequities in immunization access. This study described the magnitude and spatial distribution of zero-dose children in Chiúre District, Cabo Delgado Province, Mozambique

Methods: A cross-sectional descriptive study was conducted using data from a community-based survey carried out between 2025 and 2026 across four villages in Chiúre: Maningani, Megaruma, Muajaja, and Namiuta. Data collection involved structured questionnaires administered to household heads. A "zero-dose" child was defined as any child under five years of age who had not received any vaccine doses, based on vaccination cards or caregiver recall. Descriptive analysis was performed using absolute and relative frequencies in Microsoft Excel.

Results: Among 2,130 children under five years included in the study, 104 were identified as zero-dose, corresponding to an overall proportion of 4.9%. These children were identified in 86 households, representing 3.1% of the 2,782 households surveyed. Their distribution varied substantially across villages. Maningani had the highest local proportion, with 15.3% (35/229) of children, followed by Megaruma with 5.2% (55/1,056), Muajaja with 4.1% (7/172), and Namiuta with 1.1% (7/664). Thus, despite representing a smaller population, Maningani had the highest concentration of zero-dose children relative to the number of children surveyed.

Conclusion: Zero-dose children were unevenly distributed across the four surveyed villages, with a particularly high local burden in Maningani. These findings highlight the value of geographically targeted approaches to identify and reach children missed by routine immunization services. Integrated mobile health brigades, proactive zero-dose tracing, and strengthened community-based vaccination strategies could help improve immunization equity in underserved areas of Chiúre.

Keywords: Zero-Dose Children; Vaccine; Spatial Distribution; Chiúre; Cabo Delgado.

To be updated shortly..