Background: Globally, immunisation averts an estimated 4-5 million deaths annually, yet progress has stalled in 2024, with 14.3 million children under one year remaining completely unvaccinated, termed “zero-dose”. Nigeria bears the second-highest burden, harbouring over 2.5 million zero-dose children, predominantly in its northern region, where socioeconomic inequities, insecurity, and logistical barriers exacerbate coverage gaps. Traditional planning at administrative levels often overlooks fine-scale geographic heterogeneity, limiting targeted interventions. This study presents a high-resolution geospatial analysis of zero-dose children using comprehensive enumeration data from six northern Nigerian states to pinpoint and inform precision strategies.

Methods: We analysed data from the Immunisation Equity and Coverage Verification (IEV) exercise, a large-scale enumeration conducted in 2024-2025 across Jigawa, Kano, Katsina, Kebbi, Sokoto, and Zamfara states. The dataset encompassed 95,576 settlements with georeferenced coordinates and detailed household-level vaccination records for 7,370,000 children under five. Analyses were performed in Python 3.11, incorporating descriptive statistics, kernel density estimation for density mapping, Getis-Ord Gi* hotspot analysis for clustering detection, and Lorenz concentration indices for burden distribution. Spatial autocorrelation and coefficients of variation were computed at local government area (LGA) levels.

Results: Of 7,370,000 enumerated children under five, 4,673,911 (63.4%) were zero-dose, with Kano state contributing the highest absolute burden (1,271,461) and Kebbi the highest rate (78%). Pronounced spatial clustering emerged: 36% of settlements accounted for 80% of the zero-dose burden, with significant hotspots (z-scores > 2.58, p < 0.01) in peri-urban and remote rural clusters. LGA-level variation was extreme, with zero-dose rates ranging from 22% to 78%.