Coverage, timeliness of measles immunisation and its predictors in Pakistan: an analysis of 6.2 million children enrolled in the Provincial Electronic Immunisation Registry

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.