Door-to-door vaccination in a fragile urban setting: results from descriptive observational study in Bangui, Central African Republic

Introduction: routine childhood immunization coverage remains critically low in sub-Saharan Africa, particularly in fragile settings like Central African Republic (CAR). In response, the DREAM program implemented a door-to-door vaccination initiative targeting under-immunized communities. Methods: a descriptive observational study was conducted to evaluate two door-to-door campaigns carried out between November 2023 and May 2025 in 17 neighborhoods of Bangui. Trained community teams assessed immunization status of children under five through household visits, relying on vaccination cards when available or caregiver recall. Identified missing doses were administered by mobile vaccination teams. Primary data included the number of children reached, vaccines administered, and estimated coverage per neighborhood. Results: a total of 10,551 children were screened; 64.2% were found fully immunized for age, while 35.8% were not. Remarkably, no zero-dose children were identified. Among the partially immunized children, 94.3% received at least one additional vaccine dose during the campaign, totaling 14,942 doses administered. Neighborhood-level coverage ranged from 46.9% to 75.8%, reflecting persistent intra-urban disparities. Conclusion: the DREAM door-to-door immunization strategy demonstrated high feasibility and responsiveness in an urban, fragile context. This model may serve as a scalable approach for improving immunization coverage in similar settings, particularly where formal health system access is limited.