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 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.