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Reaching zero-dose (ZD) children, operationally defined as children who have not received a first dose of the diphtheria, tetanus, and pertussis (DTP1) vaccine, is crucial to increase equitable immunisation coverage and access to primary health care. However, little is known about the approaches already taken by countries to improve immunisation equity. We reviewed all Health System Strengthening (HSS) proposals submitted by Gavi-supported countries from 2014 to 2021 inclusively and extracted information on interventions favouring equity. Pro-equity interventions were mapped to an analytical framework representing Gavi 5.0 programmatic guidance on reaching ZD children and missed communities. Data from keyword searches and manual screening were extracted into an Excel database. Open format responses were analysed using inductive and deductive thematic coding. Data analysis was conducted using Excel and R. Of the 56 proposals included, 51 (91%) included at least one pro-equity intervention. The most common interventions were conducting outreach sessions, tailoring the location of service delivery, and partnerships. Many proposals had “bundles” of interventions, most often involving outreach, microplanning and community-level education activities. Nearly half prioritised remote-rural areas and only 30% addressed gender-related barriers to immunisation. The findings can help identify specific interventions on which to focus future evidence syntheses, case studies and implementation research and inform discussions on what may or may not need to change to better reach ZD children and missed communities moving forward.

Background: Understanding past successes in reaching unvaccinated or “zero-dose” children can help inform strategies for improving childhood immunization in other settings. Drawing from positive outlier methods, we developed a novel approach for identifying potential exemplars in reducing zero-dose children. Methods: Focusing on 2000–2019, we assessed changes in the percentage of under-one children with no doses of the diphtheria–tetanus–pertussis vaccine (no-DTP) across two geographic dimensions in 56 low- or lower-middle-income countries: (1) national levels; (2) subnational gaps, as defined as the difference between the 5th and 95th percentiles of no-DTP prevalence across second administrative units. Countries with the largest reductions for both metrics were considered positive outliers or potential ‘exemplars’, demonstrating exception progress in reducing national no-DTP prevalence and subnational inequalities. Last, so-called “neighborhood analyses” were conducted for the Gavi Learning Hub countries (Nigeria, Mali, Uganda, and Bangladesh), comparing them with countries that had similar no-DTP measures in 2000 but different trajectories through 2019. Results: From 2000 to 2019, the Democratic Republic of the Congo, Ethiopia, and India had the largest absolute decreases for the two no-DTP dimensions—national prevalence and subnational gaps—while Bangladesh and Burundi registered the largest relative reductions for each no-DTP metric. Neighborhood analyses highlighted possible opportunities for cross-country learning among Gavi Learning Hub countries and potential exemplars in reducing zero-dose children. Conclusions: Identifying where exceptional progress has occurred is the first step toward better understanding how such gains could be achieved elsewhere. Further examination of how countries have successfully reduced levels of zero-dose children—especially across variable contexts and different drivers of inequality—could support faster, sustainable advances toward greater vaccination equity worldwide.

Introdução: A Orientação, praticada no Brasil desde os anos 70, encontra dificuldades na popularização e no aumento consistente de participantes em suas principais competições. Nessa condição, torna-se um esporte subestimado no que diz respeito à busca por recursos financeiros e aspectos de visibilidade midiática, visto que possui um altíssimo grau de atratividade envolvendo fatores físicos e cognitivos, tendo como local de prática os cenários naturais que por si só despertariam interesse instantâneo como acontece em vários países do continente europeu.Objetivo: Descrever as características sociodemográficas do atleta brasileiro da Orientação e examinar a temporalidade do início nessa prática esportiva. Métodos: Estudo observacional, transversal, no qual foi utilizado um questionário online por meio do Formulários Google, contendo 68 perguntas. Participaram da pesquisa 638 atletas do Esporte Orientação, de ambos os sexos. Foram realizadas análises estatísticas descritivas em termos de média, desvio padrão e porcentagem.Resultados: Os praticantes, com a faixa etária variando dos 13 aos 77 anos(média 39,3 ±13,7), pertenciam a uma classe social mais elevada, com formação acadêmica privilegiada e teve a iniciação no esporte após os 21 anos de idadeConclusão: Os praticantes de Orientação no Brasil fazem parte de uma faixa socioeconômica mais alta, destoando da média da população nacional. Os resultados indicam que pode haver necessidade de estratégias de desenvolvimento da modalidade que promovam a inclusão esportiva de pessoas de camadas sociais de renda mais baixa.