Profiling zero-dose measles-rubella children in Zambia: Insights from the 2024 post-campaign coverage survey

Moses Mwale, Guissimon Phiri, Francis Dien Mwansa, Peter J Chipimo, Penelope Masumbu, Kennedy Matanda, Princess Kayeye, Kelvin Mwangilwa, Chola Nakazwe, Harriet Namukoko, Simon Mutembo, Freddie Masaninga, Jacob Sakala and Peter Clement Lugala

PLOS Global Public Health, 2025, vol. 5, issue 12, 1-11

Abstract: Measles & Rubella (MR) zero-dose children (unvaccinated for measles–rubella) cluster in underserved communities can sustain measles transmission. We estimated MR zero-dose prevalence after Zambia’s 2024 MR Supplementary Immunisation Activity (SIA) and identified associated risk factors and barriers. A coverage survey (two-stage stratified cluster design) across all 10 provinces, was conducted from 27th December 2024–16th January 2025, involved interviewing caregivers of children aged 9–59 months; vaccination status was verified by card (11.7%) or recall (88.3%). Data were analysed using survey-weighted methods and logistic regression, adjusting for stratification, clustering, and sampling weights. Among 8,634 children, MR zero-dose prevalence was 11.97% (95% CI: 11.03–12.91), highest in Central (19.15%) and Western (17.71%), lowest in Copperbelt (6.69%). Urban residence reduced odds by 24% vs. rural (aOR 0.76, 95% CI: 0.63–0.92). Risks rose with age (>36 months: aOR 1.60, 95% CI: 1.27–2.00), maternal absence (aOR 1.74, 95% CI: 1.33–2.27), or death (aOR 2.40, 95% CI: 1.23–4.68). Most zero-dose children (88.75%) lacked other vaccines, indicating systemic gaps. Key barriers included unawareness (42.58%) and travel time (>2 hours: aOR 3.20, 95% CI: 1.43–7.16). Nearly one in eight Zambian children remained MR zero-dose post-2024 SIA, concentrated in rural, high-prevalence areas, older children, and motherless households. Priorities include health worker-led awareness campaigns, mobile services to cut travel time, and integrated SIA-Routine Immunisation (RI) strategies (microplanning, tracing, catch-up) to address systemic gaps, supporting global measles elimination under Immunisation Agenda 2030.

Date: 2025
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pgph00:0005265

DOI: 10.1371/journal.pgph.0005265

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