Peer-reviewed article
Coverage, timeliness of measles immunisation and its predictors in Pakistan: an analysis of 6.2 million children enrolled in the Provincial Electronic Immunisation Registry.
Memon M, Siddiqi DA, Dharma VK, Shah MT, Iftikhar S et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study analyzed measles vaccination data from 6.2 million children aged 12-23 months in Sindh Province, Pakistan. Only 80.6% of children received the first measles dose and 58.1% received the second dose, with just 36.6% and 31.4% receiving them at the recommended ages. Children of more educated mothers were more likely to be vaccinated on time, while vaccinations at outreach sites rather than fixed clinics were associated with delayed vaccination. The findings suggest significant barriers to achieving measles elimination goals by 2030.
Key points
- 80.6% of children received measles vaccine dose 1, but only 58.1% of vaccinated children aged 15-23 months received dose 2
- Only 36.6% received measles-1 and 31.4% received measles-2 at the recommended age ranges
- 26.5% of Union Councils had ≥25% unvaccinated children, indicating geographic hotspots
- Maternal education (≥11 years) increased likelihood of timely vaccination (HR=1.24 for measles-1, HR=1.19 for measles-2)
- Outreach site vaccinations were associated with delayed vaccination compared to fixed sites (HR=0.91 for measles-1, HR=0.93 for measles-2)
Limitations
The study is observational and only covers Sindh Province, so findings may not generalize to other regions of Pakistan or other countries. The analysis cannot establish causation for the predictors identified, only associations with timely vaccination.
Abstract
Background Measles-related morbidity and mortality persists due to suboptimal and delayed vaccination, predominantly in low- and middle-income countries where more than 95% of global measles deaths occur. We evaluated the coverage, timeliness of measles vaccination and its predictors for children aged 12-23 months in Sindh, Pakistan. Methods We analysed immunisation data from Sindh Province's Electronic Immunisation Registry for 6.2 million children aged 12-23 months. We assessed vaccination coverage at specific ages, calculated timeliness using Expanded Programme on Immunisation-Sindh criteria and examined predictors for timely vaccination using Cox proportional hazard regression. Spatial mapping was used to identify zero-dose measles hotspots. Results Among 6 227 450 children aged 12-23 months, 80.6% received the first measles vaccine dose and only 58.1% of those vaccinated children aged 15-23 months received the second dose. Only 36.6% and 31.4% of children received measles-1 and 2 at the recommended age range (measles-1: 270-301 days; measles-2: 453-484 days). Subnational analysis identified 26.5% of Union Councils with ≥25% measles unvaccinated children. Children of educated mothers (≥11 years) compared with uneducated mothers had a higher timely measles vaccination likelihood (measles-1: HR=1.24; 95% CI: 1.23 to 1.26; p=0.010 and measles-2: HR=1.19; 95% CI: 1.18 to 1.21; p<0.001), while children who received the last vaccination at an outreach compared with a fixed site had a lower timely measles vaccination likelihood (measles-1: HR=0.91; 95% CI: 0.90 to 0.91; p<0.001 and measles-2: HR=0.93; 95% CI: 0.93 to 0.94; p<0.001). Conclusion Suboptimal and delayed measles vaccination coverage casts serious doubts on attaining measles elimination by 2030, as stated in the Immunisation Agenda. Continued high-level national commitment and implementation of targeted strategies are imperative to achieving global measles immunisation goals.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Standard measles immunisation programme with vaccination at fixed sites or outreach clinics as part of Sindh Province's routine immunisation services
- Population
- 6.2 million children aged 12-23 months enrolled in Sindh Province's Electronic Immunisation Registry
Key finding
80.6% coverage for measles-1 dose, falling to 58.1% for measles-2 dose
M et al. · Europe PMC · 3 Mar 2025