Background: Recommended vaccination at nine months of age with measles-containing vaccine (MCV1) has been part of Ethiopia’s routine immunization program since 1980. A second dose (MCV2) was introduced in February 2019 for children 15 months old. From 2019 national survey, MCV1 coverage was reportedly low in Ethiopia (59%) including in Oromia Region (49%). Oromia Region is the largest and most populous region and contributes close to half of the unvaccinated children in the country. In 2021, we examined MCV1 and MCV2 coverage and factors associated with measles vaccination status.

Methods: A cross-sectional household survey was conducted among caregivers of children aged 12-35 months between February to March 2021 in woredas of Oromia Region stratified by urban/rural settlement and measles context (low MCV1, high MCV1, recent outbreak).  Measles vaccination status was sourced from home-based records when available, or caregiver recall. We analyzed the association between MCV1 or MCV2 vaccination status and household, caregiver, and child factors using bivariate and multivariable logistic regression models with adjusted Odd Ratios (aOR) and 95% confidence intervals (CIs) reported.

Results: Caregivers of 598 children aged 12-23 months and 574 aged 24-35 months were interviewed.  MCV1 coverage was 71% (rural: 61%; urban 81%); and MCV2 coverage was 48% (rural: 42%; urban: 53%). The drop-out rate from the first dose of pentavalent vaccine to MCV1 was 22% (rural: 35%; urban 12%) and from MCV1 to MCV2 was 46% (rural: 49%; urban 45%). Caregivers who gave birth at a health facility (aOR: 2.37, CI: 1.30 – 4.47), believed their child had received all recommended vaccines (aOR: 8.29, CI: 4.52 – 16.3), knew the correct number of vaccination visits (aOR: 3.12, CI:1.87 – 5.36) and knew the correct doses of childhood measles vaccine (aOR: 1.62, CI: 1.05 – 2.50) were more likely to vaccinate their child with MCV2. Factors associated with MCV1 vaccination status were similar to identified MCV2 factors.

Conclusion: Two years post-introduction, MCV2 coverage remains low with high measles dropout-rates in the Oromia Region. Caregivers with high awareness of measles vaccine and its schedule were more likely to vaccinate their children. To improve the uptake of MCV2 in the second year of life, intensified demand creation and social mobilization are needed in Oromia Region of Ethiopia.

Keywords: Measles, Measles Containing Vaccine, MCV2, immunization coverage, barriers, Oromia, Ethiopia.