{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T14:21:15Z","timestamp":1788531675083,"version":"build-2803163510"},"reference-count":41,"publisher":"BMJ","issue":"Suppl 1","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"unspecified","delay-in-days":246,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["T32ES015459"],"award-info":[{"award-number":["T32ES015459"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000066","name":"National Institute of Environmental Health Sciences","doi-asserted-by":"publisher","award":["T32ES015459"],"award-info":[{"award-number":["T32ES015459"]}],"id":[{"id":"10.13039\/100000066","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,8,19]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To map interventions and strategies targeting zero-dose children in fragile and conflict-affected settings across the WHO African Region and identify key evidence gaps to inform future research and programming.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Scoping review conducted in accordance with Joanna Briggs Institute methodology and reported using Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources<\/jats:title>\n                    <jats:p>PubMed (MEDLINE), CINAHL, Scopus and Web of Science, supplemented by grey literature searches of the WHO, UNICEF evaluation database and Gavi Alliance resource library (searched November 2025). Reference lists of relevant reviews were manually screened for additional studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Eligibility criteria<\/jats:title>\n                    <jats:p>Studies describing interventions or strategies to improve vaccination coverage or equity among zero-dose, unvaccinated or unimmunised children under 5 years in WHO African Region countries classified as fragile and conflict-affected per the World Bank Group\u2019s harmonised list. Editorials and commentaries lacking empirical or programmatic data were excluded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data extraction and synthesis<\/jats:title>\n                    <jats:p>Data were extracted using a pre-tested form capturing study characteristics, conflict setting, delivery models, target populations, barriers and implementation strategies. Findings were synthesised using deductive thematic analysis guided by the Identify\u2013Reach\u2013Monitor\u2013Measure\u2013Advocate framework. Formal risk of bias assessment was not conducted, consistent with scoping review methodology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Five studies (n=5) published between 2018 and 2025 met inclusion criteria, covering Nigeria, Cameroon, the Central African Republic, South Sudan and Ethiopia. Interventions relied on non-immunisation platforms, integrated service delivery, security-supported or negotiated access and technology-enabled logistics. Evidence was more concentrated on identifying and reaching zero-dose children than on monitoring, measurement or advocacy. Key gaps included limited economic evidence, weak gender-barrier assessment and denominator uncertainty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Zero-dose children in conflict-affected and fragile settings can be reached through flexible, locally adapted strategies. However, the evidence base remains small and largely descriptive. Progress towards Immunization Agenda 2030 requires greater investment in context-appropriate implementation research and more systematic programme documentation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-004861","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T13:41:15Z","timestamp":1788529275000},"page":"e004861","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Reaching zero-dose children in conflict-affected and fragile settings in the WHO African Region: a scoping review of strategies and evidence gaps"],"prefix":"10.1136","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0765-7497","authenticated-orcid":false,"given":"Chinwe","family":"Iwu-Jaja","sequence":"first","affiliation":[{"name":"World Health Organization Regional Office for Africa, Brazzaville, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6832-873X","authenticated-orcid":false,"given":"Olushayo Oluseun","family":"Olu","sequence":"additional","affiliation":[{"name":"World Health Organization Regional Office for Africa, Brazzaville, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chidozie D","family":"Iwu","sequence":"additional","affiliation":[{"name":"School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Nyasulu","sequence":"additional","affiliation":[{"name":"Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1273-4779","authenticated-orcid":false,"given":"Charles Shey","family":"Wiysonge","sequence":"additional","affiliation":[{"name":"Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa"},{"name":"Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"2026090405551765000_4.Suppl_1.e004861.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)00850-X"},{"key":"2026090405551765000_4.Suppl_1.e004861.2","unstructured":"World Health Organization . Immunization dashboard - African region. 2025. Available: https:\/\/immunizationdata.who.int\/dashboard\/regions\/african-region [Accessed 27 Dec 2025]."},{"key":"2026090405551765000_4.Suppl_1.e004861.3","unstructured":"UNICEF . Operational guidance multisectoral zero-dose strategies to improve routine immunization and other child outcomes. 2025."},{"key":"2026090405551765000_4.Suppl_1.e004861.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)01468-X"},{"key":"2026090405551765000_4.Suppl_1.e004861.5","unstructured":"Classification of fragile and conflict-affected situations. World Bank Group; 2024. Available: https:\/\/www.worldbank.org\/en\/topic\/fragilityconflictviolence\/brief\/harmonized-list-of-fragile-situations [Accessed 14 Dec 2025]."},{"key":"2026090405551765000_4.Suppl_1.e004861.6","unstructured":"World Health Organization . Immunization agenda 2030. 2022.1\u201358. Available: https:\/\/www.immunizationagenda2030.org\/ [accessed 01 Jun 2023]"},{"key":"2026090405551765000_4.Suppl_1.e004861.7","first-page":"1","article-title":"Multilevel Analysis of Zero-Dose Children in Sub-Saharan Africa: A Three Delays Model Study","volume":"13","author":"Wiysonge","year":"2025","journal-title":"Vaccines (Basel)"},{"key":"2026090405551765000_4.Suppl_1.e004861.8","unstructured":"World Health Organization . Progress and challenges with achieving universal immunization coverage. 2025. Available: https:\/\/www.who.int\/publications\/m\/item\/progress-and-challenges [Accessed 12 Dec 2025]."},{"key":"2026090405551765000_4.Suppl_1.e004861.9","unstructured":"Gavi the Vaccine Alliance . Phase 5 (2021-2025). 2025. Available: https:\/\/www.gavi.org\/our-alliance\/strategy\/phase-5-2021-2025 [Accessed 13 Dec 2025]."},{"key":"2026090405551765000_4.Suppl_1.e004861.10","unstructured":"GAVI . Zero-dose funding guidelines guidance on use of Gavi support to reach zero dose children and missed communities. Gavi Vaccine Alliance; 2021.1\u201310."},{"key":"2026090405551765000_4.Suppl_1.e004861.11","unstructured":"Imunization agenda 2030 mid-term review. 2025."},{"key":"2026090405551765000_4.Suppl_1.e004861.12","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2024-017982","article-title":"Reflections on 50 years of immunisation programmes in the WHO African region: an impetus to build on the progress and address the unfinished immunisation business","volume":"10","author":"Petu","year":"2025","journal-title":"BMJ Glob Health"},{"key":"2026090405551765000_4.Suppl_1.e004861.13","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2024-018293","article-title":"The Immunization Agenda 2030 Strategy to reach zero-dose children in low-income and middle-income countries: a scoping review","volume":"10","author":"Beaulieu","year":"2025","journal-title":"BMJ Glob Health"},{"key":"2026090405551765000_4.Suppl_1.e004861.14","doi-asserted-by":"crossref","first-page":"2119","DOI":"10.11124\/JBIES-20-00167","article-title":"Updated methodological guidance for the conduct of scoping reviews","volume":"18","author":"Peters","year":"2020","journal-title":"JBI Evid Synth"},{"key":"2026090405551765000_4.Suppl_1.e004861.15","doi-asserted-by":"publisher","DOI":"10.1097\/XEB.0000000000000050"},{"key":"2026090405551765000_4.Suppl_1.e004861.16","doi-asserted-by":"publisher","DOI":"10.7326\/M18-0850"},{"key":"2026090405551765000_4.Suppl_1.e004861.17","unstructured":"Resource library. Zero-Dose Learning Hub. Available: https:\/\/zdlh.gavi.org\/resources [Accessed 14 Dec 2025]."},{"key":"2026090405551765000_4.Suppl_1.e004861.18","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-016-0384-4"},{"key":"2026090405551765000_4.Suppl_1.e004861.19","doi-asserted-by":"crossref","DOI":"10.1186\/s13031-022-00461-1","article-title":"Impact of periodic intensification of routine immunization within an armed conflict setting and COVID-19 outbreak in Cameroon in 2020","volume":"16","author":"Njoh","year":"2022","journal-title":"Confl Health"},{"key":"2026090405551765000_4.Suppl_1.e004861.20","unstructured":"Gavi The Vaccine Aliance . ZIP: a new way to get vaccines to zero-dose children in some of the world\u2019s toughest regions. 2023. Available: https:\/\/www.gavi.org\/vaccineswork\/zip-new-way-get-vaccines-zero-dose-children-some-worlds-toughest-regions [accessed 12 Dec 2025]"},{"key":"2026090405551765000_4.Suppl_1.e004861.21","doi-asserted-by":"crossref","unstructured":"Mbodji M , Dramane B . Community Engagement in Strengthening Health Systems and Vaccination of Zero-Dose Children in the Central African Republic: The Case of the Kemo-Carnot-Paoua Districts; Challenges and Impacts. TIJPH 2024;12. doi:10.21522\/TIJPH.2013.12.04.Art057","DOI":"10.21522\/TIJPH.2013.12.04.Art057"},{"key":"2026090405551765000_4.Suppl_1.e004861.22","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-018-6188-9","article-title":"Impact of engaging security personnel on access and polio immunization outcomes in security-inaccessible areas in Borno state, Nigeria","volume":"18","author":"Nkwogu","year":"2018","journal-title":"BMC Public Health"},{"key":"2026090405551765000_4.Suppl_1.e004861.23","doi-asserted-by":"crossref","DOI":"10.11604\/pamj.2019.32.28.15464","article-title":"Integrating immunisation services into nutrition sites to improve immunisation status of internally displaced persons\u2019 children living in Bentiu protection of civilian site, South Sudan","volume":"32","author":"Oladeji","year":"2019","journal-title":"Pan Afr Med J"},{"key":"2026090405551765000_4.Suppl_1.e004861.24","doi-asserted-by":"publisher","DOI":"10.3390\/v15010150"},{"key":"2026090405551765000_4.Suppl_1.e004861.25","doi-asserted-by":"crossref","DOI":"10.1186\/s13031-025-00708-7","article-title":"The impact of armed conflict on vaccination coverage: a systematic review of empirical evidence from 1985 to 2025","volume":"19","author":"Headley","year":"2025","journal-title":"Confl Health"},{"key":"2026090405551765000_4.Suppl_1.e004861.26","first-page":"1","article-title":"The Governance of Childhood Vaccination Services in Crisis Settings: A Scoping Review","volume":"11","author":"Abdelmagid","year":"2023","journal-title":"Vaccines (Basel)"},{"key":"2026090405551765000_4.Suppl_1.e004861.27","unstructured":"The Vaccine Alliance . Integrated campaigns. Evidence on pro-equity interventions to improve immunization coverage for zero- dose children and missed communities. Available: https:\/\/zdlh.gavi.org\/sites\/default\/files\/2023-09\/7._integrated_campaigns_evidence_brief.pdf [Accessed 24 Dec 2024]."},{"key":"2026090405551765000_4.Suppl_1.e004861.28","unstructured":"Equity in crisis: zero-dose children in humanitarian settings. An advocacy brief. 2022. Available: https:\/\/publichealth.jhu.edu\/sites\/default\/files\/2024-02\/zero-doseadvocacy-brief-maintaining-equity-in-crisisax.pdf"},{"key":"2026090405551765000_4.Suppl_1.e004861.29","doi-asserted-by":"crossref","DOI":"10.3390\/vaccines12091084","article-title":"Exploring Important Attributes, the Potential Use Cases and Feasibility of Introduction of Measles and Rubella Microarray Patches (MR-MAPs): Insights from Nine Countries","volume":"12","author":"Hasso-Agopsowicz","year":"2024","journal-title":"Vaccines (Basel)"},{"key":"2026090405551765000_4.Suppl_1.e004861.30","doi-asserted-by":"publisher","DOI":"10.11604\/pamj.2020.35.4.22703"},{"key":"2026090405551765000_4.Suppl_1.e004861.31","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2023-012247","article-title":"Immunogenicity, safety, usability and acceptability of microarray patches for vaccination: a systematic review and meta-analysis","volume":"8","author":"Berger","year":"2023","journal-title":"BMJ Glob Health"},{"key":"2026090405551765000_4.Suppl_1.e004861.32","unstructured":"WHO guidance on research methods for health emergency and disaster risk management, revised 2022. Geneva World Health Organization; 2022."},{"key":"2026090405551765000_4.Suppl_1.e004861.33","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2020-003567","article-title":"Use of interrupted time series methods in the evaluation of health system quality improvement interventions: a methodological systematic review","volume":"5","author":"Hategeka","year":"2020","journal-title":"BMJ Glob Health"},{"key":"2026090405551765000_4.Suppl_1.e004861.34","doi-asserted-by":"crossref","DOI":"10.1186\/s13063-024-08459-1","article-title":"Implementing a pragmatic randomised controlled trial in a humanitarian setting: lessons learned from the TISA trial","volume":"25","author":"N\u2019Diaye","year":"2024","journal-title":"Trials"},{"key":"2026090405551765000_4.Suppl_1.e004861.35","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-022-08653-4","article-title":"Strengthening vaccination delivery system resilience in the context of protracted humanitarian crisis: a realist-informed systematic review","volume":"22","author":"Ismail","year":"2022","journal-title":"BMC Health Serv Res"},{"key":"2026090405551765000_4.Suppl_1.e004861.36","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-024-11413-1","article-title":"Vaccination governance in protracted conflict settings: the case of northwest Syria","volume":"24","author":"Baatz","year":"2024","journal-title":"BMC Health Serv Res"},{"key":"2026090405551765000_4.Suppl_1.e004861.37","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0003514","article-title":"Innovative strategies and implementation science approaches for health delivery among migrants in humanitarian settings: A scoping review","volume":"4","author":"Reynolds","year":"2024","journal-title":"PLOS Glob Public Health"},{"key":"2026090405551765000_4.Suppl_1.e004861.38","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f6753"},{"key":"2026090405551765000_4.Suppl_1.e004861.39","unstructured":"WHO Team - Health Cluster . Estimation of population denominators for the humanitarian health sector. 2018.1\u201328."},{"key":"2026090405551765000_4.Suppl_1.e004861.40","doi-asserted-by":"crossref","DOI":"10.1016\/j.jmh.2022.100120","article-title":"What we do know (and could know) about estimating population sizes of internally displaced people","volume":"6","author":"Ratnayake","year":"2022","journal-title":"J Migr Health"},{"key":"2026090405551765000_4.Suppl_1.e004861.41","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-021-06370-y","article-title":"A review of geospatial methods for population estimation and their use in constructing reproductive, maternal, newborn, child and adolescent health service indicators","volume":"21","author":"Nilsen","year":"2021","journal-title":"BMC Health Serv Res"}],"container-title":["BMJ Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjph-2025-004861","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T13:41:20Z","timestamp":1788529280000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjpublichealth.bmj.com\/lookup\/doi\/10.1136\/bmjph-2025-004861"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":41,"journal-issue":{"issue":"Suppl 1","published-online":{"date-parts":[[2026,9,4]]},"published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1136\/bmjph-2025-004861"],"URL":"https:\/\/doi.org\/10.1136\/bmjph-2025-004861","relation":{},"ISSN":["2753-4294"],"issn-type":[{"value":"2753-4294","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}