Coverage, timeliness of measles immunisation and its predictors in Pakistan: an analysis of 6.2 million children enrolled in the Provincial Electronic Immunisation Registry
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 ag...
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| Format: | Article |
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BMJ Publishing Group
2025-03-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/10/3/e016717.full |
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| author | Subhash Chandir Hamidreza Setayesh Danya Arif Siddiqi Sundus Iftikhar Vijay Kumar Dharma Mubarak Taighoon Shah Manaksha Memon |
| author_facet | Subhash Chandir Hamidreza Setayesh Danya Arif Siddiqi Sundus Iftikhar Vijay Kumar Dharma Mubarak Taighoon Shah Manaksha Memon |
| author_sort | Subhash Chandir |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-823a60c096bc4d0aa4e80168fc989a44 |
| institution | DOAJ |
| issn | 2059-7908 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj-art-823a60c096bc4d0aa4e80168fc989a442025-08-20T03:00:19ZengBMJ Publishing GroupBMJ Global Health2059-79082025-03-0110310.1136/bmjgh-2024-016717Coverage, timeliness of measles immunisation and its predictors in Pakistan: an analysis of 6.2 million children enrolled in the Provincial Electronic Immunisation RegistrySubhash Chandir0Hamidreza Setayesh1Danya Arif Siddiqi2Sundus Iftikhar3Vijay Kumar Dharma4Mubarak Taighoon Shah5Manaksha Memon62 Maternal and Child Health, IRD Global, Singapore4 Gates Foundation, London, UK2 Maternal and Child Health, IRD Global, Singapore1 Maternal and Child Health, IRD Pakistan, Karachi, Pakistan1 Maternal and Child Health, IRD Pakistan, Karachi, Pakistan2 Maternal and Child Health, IRD Global, Singapore1 Maternal and Child Health, IRD Pakistan, Karachi, PakistanBackground 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.https://gh.bmj.com/content/10/3/e016717.full |
| spellingShingle | Subhash Chandir Hamidreza Setayesh Danya Arif Siddiqi Sundus Iftikhar Vijay Kumar Dharma Mubarak Taighoon Shah Manaksha Memon Coverage, timeliness of measles immunisation and its predictors in Pakistan: an analysis of 6.2 million children enrolled in the Provincial Electronic Immunisation Registry BMJ Global Health |
| title | Coverage, timeliness of measles immunisation and its predictors in Pakistan: an analysis of 6.2 million children enrolled in the Provincial Electronic Immunisation Registry |
| title_full | Coverage, timeliness of measles immunisation and its predictors in Pakistan: an analysis of 6.2 million children enrolled in the Provincial Electronic Immunisation Registry |
| title_fullStr | Coverage, timeliness of measles immunisation and its predictors in Pakistan: an analysis of 6.2 million children enrolled in the Provincial Electronic Immunisation Registry |
| title_full_unstemmed | Coverage, timeliness of measles immunisation and its predictors in Pakistan: an analysis of 6.2 million children enrolled in the Provincial Electronic Immunisation Registry |
| title_short | Coverage, timeliness of measles immunisation and its predictors in Pakistan: an analysis of 6.2 million children enrolled in the Provincial Electronic Immunisation Registry |
| title_sort | coverage timeliness of measles immunisation and its predictors in pakistan an analysis of 6 2 million children enrolled in the provincial electronic immunisation registry |
| url | https://gh.bmj.com/content/10/3/e016717.full |
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