Uptake of the Second Dose of the Measles Vaccine and Its Determinants Among Children Aged Less Than 5 Years: Systematic Review and Meta-Analysis (Preprint)

BACKGROUND Ethiopia is faced with poor measles-containing vaccine second dose (MCV2) coverage, leading to recurrent outbreaks. OBJECTIVE This meta-analysis and systematic review aimed at combining evidence of MCV2 uptake in Ethiopia and its determinants to inform interventions for increased vaccination uptake and control of public health challenges. METHODS This review examined observational quantitative research on measles second dose vaccination among children in Ethiopia using databases such as PubMed Central, Cochrane Library, Web of Science, Scopus, MEDLINE, and Embase. The quality of the included studies was assessed using the Newcastle-Ottawa Scale. Heterogeneity was evaluated using I² statistics and the Cochran Q test, and the analysis used a random-effects model. Publication bias was assessed through funnel plots, the Egger test, and nonparametric trim-and-fill tests. RESULTS The overall MCV2 uptake among children aged <5 years in Ethiopia was only 34.4% (95% CI 18.8%-49.9%). Significant determinants of MCV2 uptake included high level of maternal education (adjusted odds ratio [AOR] 3.31, 95% CI 1.32-5.30), attendance to antenatal care follow-ups (AOR 2.02, 95% CI 1.12-2.92), use of postnatal care services (AOR 3.03, 95% CI 1.77-4.28), reduced waiting times at vaccination sites (AOR 2.56, 95% CI 1.98-3.13), good awareness of measles vaccination (AOR 2.17, 95% CI 1.59-2.74), and positive perceptions of the vaccine (AOR 3.58, 95% CI 1.97-6.30). CONCLUSIONS This study found that the uptake of MCV2 among children aged <5 years in Ethiopia was 34%, which is far below the global and national goal of 95%. Key factors contributing to low coverage include mothers’ educational levels, use of antenatal and postnatal care services, waiting times at vaccination sites, and mothers’ awareness of the measles vaccine. Improving community-based education programs, increasing access to antenatal and postnatal care services, reducing waiting times, and raising awareness about immunization all contribute to increasing vaccine uptake. CLINICALTRIAL PROSPERO CRD42024619031; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024619031