Peer-reviewed article

Timeliness of measles vaccination in selected districts of Oromia Region, Ethiopia - 2021.

Monica P Shah, Abyot Bekele Woyessa, Almea M Matanock, Binyam Moges Azmeraye, Leuel Lisanwork et al. · 1 Oct 2026

Abstract

BACKGROUND: Delays in vaccination with the first/second dose of measles-containing vaccine (MCV1, MCV2) increases risk of measles transmission. MCV2 was added to Ethiopia's routine immunization schedule in 2019, administered at age 15 months. We describe age at measles vaccination and characteristics associated with timely vaccination following MCV2 introduction. METHODS: A secondary analysis from a 2021 cross-sectional household survey of children aged 12-35 months in Oromia, Ethiopia was conducted. MCV vaccination status and age at vaccination were determined from the child's vaccination card. The cumulative card-confirmed vaccination coverage of MCV1 and MCV2 (among children 24-35 months) by age at vaccination was estimated. Among children who received MCV, vaccination timing was classified as early (MCV1: <9 months; MCV2: <15 months), timely (MCV1: 9 to <10 months; MCV2: 15 to <16 months), or delayed (MCV1: ≥10 months; MCV2: ≥16 months). Characteristics associated with timely MCV1 vaccination were analyzed using multivariate logistic regression, with urban/rural stratification. RESULTS: Overall, 651 children aged 12-35 months (MCV1) and a subset of 270 children aged 24-35 months (MCV2) were analyzed. Cumulative MCV1 coverage was 59.9% by age 9 months and 76.3% by age 12 months, and MCV2 was 33.0% by age 15 months and 44.8% by age 24 months. MCV coverage was generally higher in urban compared to rural areas. Among vaccinated children, the proportion receiving early, timely, and delayed doses was 30.1%, 44.5%, and 25.3% for MCV1, and 28.6%, 41.2%, and 30.3% for MCV2, respectively. Characteristics associated with timely MCV1 vaccination differed in urban and rural areas, but common themes included increased caregiver immunization awareness and service delivery aspects. CONCLUSIONS: Although most children who received MCV1 were vaccinated by 12 months, many received delayed doses. MCV2 coverage was low, irrespective of vaccination timing. Findings highlight the importance of routine catch-up vaccination policies and guidance, and the need for tailored strategies in urban and rural settings to improve MCV coverage and timely vaccination.