Community-Led Defaulter Tracking for Catch-Up Vaccination: Implementation Experience in Uganda, 2022 and 2024.

BACKGROUND

In Uganda, COVID-19-related disruptions increased the number of children who missed scheduled routine vaccination (defaulters). Identifying and following up with defaulter children is important for improving vaccination coverage. This paper describes Uganda's experience in revitalizing community-led defaulter tracking to improve vaccination coverage post-COVID-19 in four purposefully selected districts.

METHODS

During two 6-month periods in 2022 and 2024, healthcare workers (HCWs) worked with village health teams (VHTs) to review health facility-based immunization registers, identify and track defaulters aged 0 to 59 months. VHTs visited identified defaulters' homes, reviewed vaccination histories and reminded caregivers to bring defaulters to immunization sites for catch-up vaccination.

RESULTS

Overall, 20,922 defaulters were identified by health register review; VHTs located 15,749 (75.3%) through household visits, of whom 3688 (23.4%) were verified as previously vaccinated based on their home-based vaccination records, leaving 12,061 as true defaulters. Among the true defaulters, 9662 (80.1%) received at least one catch-up vaccination after follow-up by the VHT. The most frequently administered catch-up vaccines were measles-rubella first dose (MR1) at 55.4%, followed by diphtheria-tetanus-pertussis third dose (DTP3) at 48.3% and Bacillus Calmette-Guérin (BCG) at 47.4%. Among the 2399 children who remained unvaccinated after follow-up, the most common reasons were relocation outside the original catchment area (49.5%) and caregiver intention to vaccinate later (16.3%).

CONCLUSION

Community-led defaulter tracking was feasible and improved vaccination uptake in post-COVID-19 Uganda. Strengthening the quality and availability of health facility immunization data, along with targeted community engagement, caregiver reminders and integrated vaccination services would improve identification and follow-up of defaulters, reducing population immunity gaps.