Determinants of measles second-dose vaccine coverage in The Gambia – a secondary analysis of 2019 demographic and health survey data
1
Global Health and Infectious Diseases, Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi (Ashanti Region), Ghana
2
Vaccine and Immunity Theme, The Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, Gambia
3
Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
Popul. Med. 2026;8(Supplement Supplement 1):A3859
ABSTRACT
BACKGROUND:
Measles remains a leading cause of vaccine-preventable mortality in Africa, despite the availability of safe and effective vaccines. The World Health Organization recommends ≥95% coverage with two doses of a measles-containing vaccine (MCV) to achieve elimination. In The Gambia, coverage with the second dose of measles containing vaccine (MCV2) remains below this target. Understanding the factors associated with sub-optimal MCV2 coverage in The Gambia is crucial for developing strategies to improve vaccine coverage.
METHODS:
We conducted a secondary analysis of data from the 2019 Gambia Demographic and Health Survey to identify determinants of MCV2 vaccination among children aged 18–35 months (n = 1,010). Multivariable logistic regression was used to assess associations between MCV2 vaccination status and child-, caregiver-, and household-level factors and interactions between these factors.
RESULTS:
MCV2 coverage was 67.7%. In multivariable analysis, completion of the recommended infant vaccine schedule in the first year of life was strongly associated with MCV2 uptake (adjusted odds ratio [aOR]: 7.75; 95% CI: 3.98–15.12). Female children in urban areas had half the odds of vaccination compared to male children (aOR: 0.49; 95% CI 0.31-0.78); while no significant difference was observed in rural areas (aOR: 0.92; 95% CI; 0.60-1.39). Sex also modified the association between age and vaccination status. Among children aged 18-23 months, females had lower odds of vaccination compared to similarly aged males (aOR: 0.41; 95% CI: 0.23-0.76) but the difference was not significant among children aged 24-35 months (aOR: 0.73; 95% CI: 0.46-1.16).
CONCLUSIONS:
MCV2 coverage in The Gambia remains below the elimination threshold. Interventions should focus on strengthening early-life immunization, addressing gender and urban-rural disparities, and encouraging timely vaccination before 2 years of age. These findings highlight the need for context-specific strategies to close immunization gaps in The Gambia and similar settings.
Measles remains a leading cause of vaccine-preventable mortality in Africa, despite the availability of safe and effective vaccines. The World Health Organization recommends ≥95% coverage with two doses of a measles-containing vaccine (MCV) to achieve elimination. In The Gambia, coverage with the second dose of measles containing vaccine (MCV2) remains below this target. Understanding the factors associated with sub-optimal MCV2 coverage in The Gambia is crucial for developing strategies to improve vaccine coverage.
METHODS:
We conducted a secondary analysis of data from the 2019 Gambia Demographic and Health Survey to identify determinants of MCV2 vaccination among children aged 18–35 months (n = 1,010). Multivariable logistic regression was used to assess associations between MCV2 vaccination status and child-, caregiver-, and household-level factors and interactions between these factors.
RESULTS:
MCV2 coverage was 67.7%. In multivariable analysis, completion of the recommended infant vaccine schedule in the first year of life was strongly associated with MCV2 uptake (adjusted odds ratio [aOR]: 7.75; 95% CI: 3.98–15.12). Female children in urban areas had half the odds of vaccination compared to male children (aOR: 0.49; 95% CI 0.31-0.78); while no significant difference was observed in rural areas (aOR: 0.92; 95% CI; 0.60-1.39). Sex also modified the association between age and vaccination status. Among children aged 18-23 months, females had lower odds of vaccination compared to similarly aged males (aOR: 0.41; 95% CI: 0.23-0.76) but the difference was not significant among children aged 24-35 months (aOR: 0.73; 95% CI: 0.46-1.16).
CONCLUSIONS:
MCV2 coverage in The Gambia remains below the elimination threshold. Interventions should focus on strengthening early-life immunization, addressing gender and urban-rural disparities, and encouraging timely vaccination before 2 years of age. These findings highlight the need for context-specific strategies to close immunization gaps in The Gambia and similar settings.
| eISSN: | 2654-1459 |
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