Executive Summary

This report presents findings from the Kano Zero-Dose Baseline Survey, conducted in early 2025 to assess vaccination coverage among children aged 12–23 months across 15 Local Government Areas (LGAs) in Kano State, Nigeria. The survey was funded by the Gates Foundation (GF) and establishes a baseline for monitoring the impact of targeted interventions to reduce the number of unvaccinated children in the state. Three sentinel LGAs — Gaya, Gabasawa, and Nassarawa — are the focus of forthcoming partner-led interventions, while twelve additional LGAs serve as a comparison group.

Vaccination Coverage. Overall vaccination coverage across the 15 LGAs is moderate, with pronounced gaps for doses given later in infancy. Three in five children received the Bacille Calmette-Guérin (BCG) vaccine (65.6%) and the birth dose of Oral Polio Vaccine (OPV) (66.1%), while just over half received the hepatitis B birth dose (54.2%). For vaccines given between six weeks and six months of age — including the three-dose pentavalent series — coverage clusters in the 55–63% range, with modest attrition from first to third dose. Once families engage with immunization services early, most continue through this part of the schedule.

Coverage falls sharply from nine months onward: yellow fever coverage stands at 46.3% and meningitis at 45.7%. The drop-off likely reflects fewer scheduled contacts and weaker outreach after the first year.

There is also a large gap between reported and documented vaccination. For the oral polio birth dose, crude coverage was 66.1%, but valid coverage — based on card records and correct timing — was only 26.8%. This reflects both documentation failures and late administration of vaccines. Vaccination records were seen for only about half (54.7%) of surveyed children aged 12–23 months.

Zero-Dose Children. Approximately one in three children aged 12–23 months had not received the first dose of the pentavalent vaccine, the standard indicator for zero-dose status. This is broadly in line with the 2023–24 Nigeria Demographic and Health Survey (NDHS) estimate for Kano (42.2%), though the sentinel LGAs vary considerably: Nassarawa, the most urban LGA, has a notably lower zero-dose rate of 25%, while Gaya and Gabasawa — predominantly rural — hover near the state average.

Zero-dose rates are sharply higher among rural children, those born outside health facilities, Fulani households, and households where caregivers have no formal education. Rural children are about 1.5 times as likely as urban children to be unvaccinated; those in the most sparsely inhabited areas are more than three times as likely as children in cities. The education gradient is steep: children of caregivers with no schooling have a Penta-1 vaccination rate of 55%, compared to 85% for those whose caregivers attended post-secondary education.

Vaccination Completeness. Just over half of children (57%) had received all basic antigens — BCG, three pentavalent doses, a complete polio series, and one measles dose — by 12–23 months. Fewer than two in five (34.8%) met the full national immunization schedule, which additionally requires rotavirus, pneumococcal, yellow fever, and meningitis vaccines.

Caregiver education and settlement type are the strongest structural predictors of how complete a child’s immunization record is, followed by place of delivery and ethnic background. Girls are also slightly more likely to be fully vaccinated than boys.

Timeliness, Dropouts, and Missed Opportunities. Vaccination is frequently delayed. Fewer than 40% of children had a documented first pentavalent dose within the recommended ten-week window. Most children who start the pentavalent series complete it — overall dropout is about 6% — but dropout is higher for the oral polio series (11.3%). Zero-dose status is largely determined in the first few months of life; very little catch-up vaccination occurs after six months of age.

Missed opportunities for simultaneous vaccination — where a child visits a health facility but does not receive all eligible doses — are widespread, affecting 60–81% of children depending on the LGA. Fewer than four in ten such missed opportunities were later corrected in the sentinel LGAs, compared to nearly three in four in non-sentinel areas. Even so, eliminating missed opportunities entirely would increase valid coverage by only one to two percentage points. The main barrier is not poor service quality at the point of contact; it is that many children are never brought into the immunization system at all.

Financial and Behavioral Factors. For most caregivers, vaccination is affordable; direct facility fees are rarely the issue. Households spent an average of about ₦946 (approximately $0.62) per vaccination visit, with most costs going to food, transport, and medications. Still, 41% of caregivers reported that costs had risen since their child’s last visit, which could erode perceived affordability over time.

Vaccination visits are also time-intensive, averaging nearly six hours per trip — a significant burden for working caregivers.

Caregiver attitudes are among the strongest predictors of whether a child gets vaccinated, independent of wealth and location. What the caregiver believes matters: views on vaccine safety, effectiveness, and importance, as well as community norms and trust in health information, are each independently associated with vaccination status. Access improvements alone are unlikely to be enough — the data point to attitudes and community norms as comparably important levers.