Aug 2026· PLOS Global Public Health· Vol 6, pp. e0006390 - e0006390· 0 citations· 32 references
Medicine
TL;DR
The study revealed a national post-campaign vaccination coverage of 75.3% in 2024, a notable 10-point increase from 65.3% in 2022, however, significant geographical disparities persisted, with lower coverage in large cities compared to landlocked and intermediate districts.
Abstract
Measles remains a significant cause of childhood mortality globally. Despite effective vaccines, the World Health Organisation reported an estimated 10.3 million measles cases worldwide in 2023, a 20% increase from 2022, primarily due to insufficient vaccination coverage. Madagascar faced a major measles epidemic in 2018–2019, prompting vaccination efforts. A convergent parallel mixed-methods design was utilised, wherein quantitative household surveys and semi-structured qualitative interviews were conducted concurrently. Data were integrated during the interpretation phase to triangulate statistical determinants with contextual stakeholder insights regarding the performance of the October 2024 measles vaccination campaign and its determinants across different geographical areas. This retrospective, cross-sectional Post-Measles Campaign Evaluation (PMCE) was conducted from December 2024 to April 2025, following the October 2024 campaign. It involved quantitative household surveys and qualitative interviews in all 23 regions of Madagascar, targeting children aged 9–59 months and their caregivers. A two-stage stratified random sampling approach distinguished large cities, landlocked, and intermediate districts. Multivariate logistic regressions were performed to identify geographical, socio-demographic, economic, and cultural determinants of post-campaign vaccination coverage. The study revealed a national post-campaign vaccination coverage of 75.3% in 2024, a notable 10-point increase from 65.3% in 2022. However, significant geographical disparities persisted (p-value = 0.0233), with lower coverage in large cities (63.2%) compared to landlocked (78.4%) and intermediate (76.2%) districts. Multivariate analysis showed that residing in a large city significantly reduced post-campaign vaccination coverage (OR adjusted = 0.25; p = 0.010). Conversely, male child gender (OR adjusted = 1.33; p = 0.040), birth in a health facility (OR adjusted = 1.38; p = 0.046), possession of a birth certificate (OR adjusted = 2.30; p < 0.001), having a Christian caregiver (OR adjusted = 1.92; p < 0.001), or a housewife caregiver (OR adjusted = 1.97; p = 0.015) were associated significantly higher post-campaign vaccination coverage. The identified statistical determinants, notably the lower coverage among urban residents (ORa = 0.25), were contextualised using qualitative data, which highlighted that ‘urban vaccine hesitancy’ is exacerbated by metropolitan misinformation and the misconception that previously vaccinated children did not require campaign doses. While Madagascar's post-campaign measles vaccination coverage shows encouraging progress, significant geographical and socio-demographic disparities underscore the need for tailored strategies. Addressing urban-specific challenges, strengthening communication, improving logistics, and leveraging community engagement are crucial for achieving equitable immunisation coverage and advancing towards measles elimination targets.
Introduction Globally, measles remains a major cause of child mortality, and rubella is the leading cause of birth defects among all infectious diseases. In Mainland Tanzania, eliminating measles and rubella remains challenging due to geographical diversity, uneven healthcare facilities distribution, and socio-economic disparities across regions. Understanding spatial patterns and associated determinants of vaccination coverage is essential for improving campaign effectiveness. This study aimed to explore the spatial distribution and associated factors of measles-rubella campaign coverage among children aged 9–59 months in Mainland Tanzania. Methods A cross-sectional survey was conducted following the implementation of the February 2024 measles-rubella (MR) vaccination campaign to assess the spatial distribution and factors influencing MR vaccination coverage among children aged 9–59 months in Mainland Tanzania. Spatial autocorrelation was evaluated using Moran’s I to detect clustering, while Local Indicators of Spatial Association (LISA) was used to identify High-High and Low-Low clusters. Hotspot and cold-spot analyses were performed using Getis–Ord Gi* statistics at the 95% confidence level, consistent with standard epidemiological reporting practices, to identify statistically significant spatial clusters. To identify factors associated with the campaign coverage, we used a multivariable logistic regression model. Results The study included 16,703 children, of whom 81.5% received the MR vaccine during the campaign. Vaccination coverage varied notably between regions, with Tabora and Pwani having a low coverage rate of 58.8% (95% CI: 51.3%−65.9%) and 61.0% (95% CI: 45.0%−75.0%) respectively. Njombe and Mbeya demonstrated high MR vaccination coverage of 97.4% (95% CI: 90.5–99.3%) and 95.6% (95% CI: 90.9–97.9%), respectively. The household wealth quintile and place of residence, caregiver’s education, caregiver’s age, and their marital status were associated with receiving MR vaccination during the campaign among children aged 9–59 months in Mainland Tanzania. Spatial distribution revealed significant clustering of vaccination coverage (Moran’s I = 0.34, p < 0.01). The LISA identified two distinct categories of clusters: High-High Clusters (high-coverage) and Low-Low Clusters (low-coverage). High-High Clusters, which indicate regions with high MR vaccine rates surrounded by similar neighbors, are concentrated in regions such as Njombe and parts of Mbeya, whereas Low-Low Clusters, representing regions with low MR coverage, are found in areas like Tabora, Katavi, Dar es Salaam and Pwani. The Getis-Ord Gi* hotspot analysis shows significant clustering, with high-confidence hotspots in the southern highlands (Njombe and Mbeya) and notable cold spots in western Tanzania (Tabora and Katavi) and parts of eastern Tanzania. Conclusion This study demonstrates substantial spatial heterogeneity in measles–rubella vaccination coverage across Mainland Tanzania, with persistent geographic inequities driven by socio-economic and demographic factors. These findings demonstrate how integrating geospatial insights with equity-focused planning can support precision public health planning, enabling targeted interventions to close coverage gaps and accelerate progress toward measles and rubella elimination.
Hajirani M. Msuya, Samwel Lwambura, I. Msuya et al.· PLoS ONE· 0 citations
BACKGROUND
Achieving the goals of Immunisation Agenda 2030 (IA2030) requires a clear understanding of vaccination timeliness and its determinants. We assessed vaccination timeliness and associated factors in two rural districts of northern Ghana.
METHODS
We conducted a community-based analytical cross-sectional study among 3371 caregivers of children aged 0-59 months in Gushegu (n = 1361) and Nanumba South (n = 2010) Districts, Northern Ghana, from 24 April to 4 May 2025. The study examined the timeliness of 19 vaccine doses in Ghana's national immunisation schedule. Vaccination status was classified as early, age-appropriate, delayed, unvaccinated, or up to date based on recommended age windows. Cox proportional hazards models were used to identify factors associated with vaccination timeliness.
RESULTS
Timely vaccination declined progressively across the immunisation schedule in both districts. Bacille Calmette-Guérin had the highest age-appropriate coverage (64.2% in Gushegu and 52.6% in Nanumba South), whereas timeliness decreased across multi-dose vaccine series. Age-appropriate coverage for pneumococcal conjugate vaccine declined from 60.9% to 20.5% in Gushegu and from 51.1% to 21.5% in Nanumba South between the first and third doses. Similarly, timely Pentavalent vaccination declined from 59.6% to 19.8% and from 52.1% to 23.0%, respectively. Rotavirus vaccine age-appropriate coverage dropped to 8.6% in Gushegu and 9.4% in Nanumba South for the third dose. Delays increased with successive doses and were greater in Nanumba South. Possession of a vaccination card was the strongest predictor of timely vaccination (Gushegu: aHR 30.82, 95% CI 12.02-79.03; Nanumba South: aHR 19.09, 95% CI 6.84-53.26). Higher caregiver education improved timeliness, while home or traditional birth attendant delivery reduced timeliness.
CONCLUSION
Timely vaccination remains suboptimal in both districts, with marked declines across the immunisation schedule. Strategies to improve vaccination card retention, caregiver education, access to vaccination services, and facility-based deliveries may enhance vaccination timeliness.
M. Konlan, R. Bhandari, M. Adjei et al.· Vaccine· 0 citations
This study provides the first evidence of suboptimal measles antibody response among children from a tribal area of Odisha, India, despite high vaccination coverage.
B. Dwibedi, Gayatri Patra, Abhilipsa Behera et al.· The Indian journal of medica...· 0 citations
Background: Measles is a highly contagious disease that primarily affects children, particularly those aged 1–4 years, who account for the highest proportion of cases both nationally and in Jambi Province. The decline in routine immunization coverage during and after the COVID-19 pandemic has widened the immunity gap, triggering a surge in measles cases across Indonesia, including Jambi Province, where the incidence rate of suspected measles rose sharply from 0.55 per 100,000 population in 2021 to 25.05 per 100,000 in 2023, leading to outbreaks in 2022 and 2023. However, epidemiological research using individual-level surveillance data remains limited in Jambi Province.
Purpose: To analyze Exploratory Data on Measles Transmission in Children Aged 0-4 Years.
Method: This analytical descriptive research applied the Exploratory Data Analysis (EDA) approach using RStudio software. Secondary data is sourced from the Jambi Provincial Health Office's Measles-Rubella Case Tracking Individual Report Form (MR02). From an initial population of 456 suspected children aged 0-4 years, final samples were obtained from 332 cases that met the inclusion criteria (96 confirmed positive/equivocal cases of measles IgM and 236 negative cases). Analysis and visualization of the place was carried out up to the sub-district level.
Results: The incidence rate of measles under five years jumped sharply from 0.64 per 100,000 population (2021) to a peak of 12.50 per 100,000 population (2023), before finally declining in 2024–2025. Confirmed cases are dominated by the age group of 36-59 months (43.8%) and children with unvaccinated status (56.2%). The age group of 24-35 months is the age group that dominates the immunization status who are not immunized with a proportion of 76.5% of children. Measles cases are distributed almost throughout Jambi Province with the highest case burden in Jambi City (Kota Baru and Lake Sipin Districts), Sarolangun Regency (Pelawan District), and Tebo Regency (Rimbo Bujang, Sumay, and Central Tebo Regencies), which is directly proportional to the low local second dose immunization coverage (MR2). Time-based analysis shows a fluctuating pattern of local transmission and there is a tendency for cases to increase in August-October. Excellent specimen condition (97.9% good condition), but experiencing extreme administrative and diagnostic delays (Turnaround Time / TAT) with the highest median reaching 101 days in 2023.
Conclusion: The incidence of measles in toddlers aged 0-4 years in Jambi Province for the 2021-2025 period shows an uneven distribution according to people, places, and times. The age group of 36-59 months and cases with no immunization history are the most affected groups, with the concentration of cases in Jambi City, Tebo Regency, and Sarolangun Regency. The increase in incidence in 2023 and the still low coverage of MR2 immunization in several risk areas, accompanied by laboratory turnaround time that has not met standards, shows the need to strengthen the immunization program and measles surveillance system.
Naila Nur Ramadani, H. D. Sitanggang, Rd. Halim et al.· THE JOURNAL OF Mother and Ch...· 0 citations
Multiple socioeconomic, structural and operational factors were associated with unvaccinated rates, highlighting the relevance of healthcare service organization even in favorable social contexts and classifying municipalities into risk profiles may help guide interventions to improve coverage.
I. N. Schrarstzhaupt, F. A. Diaz-Quijano, F. Fontana Sutile Tardetti Fantinato et al.· medRxiv· 0 citations
On May 27, 2025 a measles outbreak was confirmed in Kabulasoke Subcounty, Gomba District, Uganda, following a suspected measles-related death. We investigated the outbreak to determine its magnitude, identify risk factors for transmission, estimate measles-rubella vaccination coverage (VC) and vaccine effectiveness (VE), and inform control measures. We defined a suspected case as onset of fever and maculopapular rash plus ≥ 1 of cough, coryza, or conjunctivitis, in a Kabulasoke Subcounty resident during March–August, 2025; confirmed cases had measles-specific IgM antibodies. We compared exposures of 80 case-patients with 160 age- and sex-matched controls. Vaccination coverage was estimated as the proportion of vaccinated controls; VE was calculated as (1–aOR) *100%, using conditional logistic regression. Sociocultural factors were explored through 15 in-depth and key informant interviews, analysed by inductive thematic analysis. We identified 106 cases (5 laboratory-confirmed, 1 death); overall attack rate (AR):2.4/1,000 population. Children aged 9–17 months were most affected (13/1,000), with clustering in infant school X. Response was initiated 33 days after detection. School attendance (aOR = 1.67; 95% CI: 1.05–2.71) and contact with symptomatic peers (aOR = 2.12; 95% CI: 1.21–3.70) were associated with infection, while vaccination was protective (aOR = 0.39; 95% CI: 0.27–0.55). Vaccination coverage was 72%, and VE was 60%. Qualitative findings revealed male-dominated decision-making, vaccine mistrust, and cultural framing of measles as a self-resolving illness as vaccination barriers. This outbreak was driven by suboptimal vaccination coverage, school-based transmission, and delayed detection. Strengthening routine immunisation, integrating schools into outbreak prevention, and addressing sociocultural barriers are essential to prevent future outbreaks.
S. Namasambi, R. Migisha, V. Kigongo et al.· Discover Public Health· 0 citations