ScalentricCNA for Immunization Decision-Making

Module 21 ยท What drives zero-dose children?

Two roads to too many zero-dose children

By the end of this module you will be able to
  • Frame a zero-dose question for CNA.
  • Read a two-pathway (equifinal) solution joined by OR.
  • Explain what multiple pathways mean for program design.

Now an equifinality example. Conditions, all framed as gaps: no outreach, no community volunteers, no settlement mapping, no outreach funding. Outcome: HighZeroDose, meaning too many children never got a single dose. CNA can report two separate roads joined by OR.

zerodose.R
m_zd <- cna(zerodose_data, outcome = "HighZeroDose")
m_zd
Illustrative solutioncondition: NoOutreach*NoFunding + NoVolunteers*NoMapping <-> HighZeroDose

Interpretation: a district can end up with too many zero-dose children either because outreach was never funded, or because it lacked active volunteers and had no settlement map to work from. The + is the gift here. It tells you there are two different problems wearing the same uniform, so the fix in one district may not be the fix in the next.

Reflect

Think about zero-dose children in two different areas.

  • Could each area be 'zero-dose' for different reasons?
  • How would two pathways change what you'd recommend in each place?