Bridging Gaps: Evaluating SEIR’s Zero-Dose Tool to Identify and Vaccinate Missed Children in Sind

Abstract Background The PDHS 2012-2013 reported a vaccine coverage of 53.8%, with 0.4 million children classified as zero-dose (not receiving any dose of pentavalent vaccine). Traditional immunization tracking systems face challenges in identifying and following up with these children, leading to missed vaccinations. To address this, the Sindh Electronic Immunization Registry (SEIR) introduced a ‘Zero Dose Tab’ to improve tracking and outreach in December 2024. This study evaluates its implementation and impact on immunization tracking and child enrollment in Sindh, Pakistan. Methods During polio campaigns, field teams gather zero-dose data and upload it to the SEIR, where vaccinators access the information through a mobile app. Data is organised by Union Council, enabling targeted outreach. Once located, vaccinators administer vaccines and enroll children in SEIR using a QR code. Results In December 2024, SEIR identified 61,800 zero-dose children, 52% of whom were located in low-coverage districts. The initiative achieved full participation from all 30 districts, with 3,811 vaccinators trained. In December 2024, the number of children enrolled into the immunization system increased from 11,658,928 to 11,848,035, while immunizations performed rose from 142,604,900 to 145,020,907. In January 2025, enrollment continued to grow, reaching 12,023,535, with immunizations reaching 147,520,956. The increase in enrollment from December to January (1.48%) was notably higher than the increase observed from November to December (1.62%), suggesting a positive impact of the introduction of the ‘Zero Dose Tab’. Conclusions The ‘Zero Dose Tab’ in the SEIR facilitates targeted outreach by providing vaccinators with real-time lists of zero-dose children. directly on their mobile phones. Preliminary findings suggest its role in improving immunization tracking, outreach coordination, and enrollment. Further evaluation is needed to assess long-term effects on vaccine coverage and equity. Key messages • The integration of the ‘Zero Dose Tab’ into the Sindh Electronic Immunization Registry (SEIR) has significantly enhanced the identification and tracking of zero-dose children. • The deployment of the ‘Zero Dose Tab’ exemplifies how digital health innovations can address immunization gaps in underserved populations.