Evaluation of a zero-dose child who missed multiple vaccination opportunities in the urban area of Arsi zone in Oromia region: Gaps in service integration

Abstract

Introduction: Children with special needs often miss essential health services, including routine immunisation, particularly in low- and middle-income countries. This case investigation examines the factors contributing to a zero-dose status in a child born with bilateral clubfoot in an urban area of the Arsi zone in Oromia Region, despite multiple contacts with a health facility. Methods: A three-year-and-four-month-old boy born with bilateral clubfoot who had not received any routine childhood vaccinations was identified during house-to-house monitoring for an integrated measles supplementary immunisation campaign. Data were collected through interviews with the mother and health workers, review of medical records, and direct observation. Results: The child missed 21 vaccination opportunities across health facilities and community service points and remained zero-dose at three years and four months of age. During each health facility visit, both health workers and the mother focused solely on the primary purpose for the visit and the child’s vaccination status was never assessed. Contributing factors included a lack of service integration, limited mother awareness of the vaccination schedule, and concerns related to stigma and social discrimination associated with the child’s conditions. Conclusions: This case report suggests that children with different degrees of birth defects may miss essential health services, including routine immunisation, even when they have frequent contact with health facilities. Strengthening service integration at all points, including rehabilitation centres, assessing vaccination status of all visiting children regardless of the purpose of their visits, and enhancing health workers and caregiver awareness are critical to preventing zero-dose status and reducing missed opportunities for vaccination.