Time to first dose of measles containing vaccine and associated factors among infants in Ethiopia:, a survival analysis from Performance Monitoring for action (PMA) data

Eyob Tilahun Abeje^1*Ermias Bekele Enyew²Chala Daba³Lakew Asmare¹Fekade Demeke Bayou¹Mastewal Arefaynie⁴Anissa Mohammed¹Abiyu Abadi Tareke⁵Awoke Keleb³Natnael Kebede⁶Yawkal Tsega⁷Abel Endawkie¹Shimels Derso Kebede²Kaleab Mesfin Abera⁷

• ¹Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Wollo University, Dessie, Ethiopia, Dessie, Ethiopia
• ²Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia, Dessie, Ethiopia
• ³Department of Environmental Health College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia., Dessie, Ethiopia
• ⁴Department of Reproductive and Family Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
• ⁵Amref health in Africa, COVID-219 vaccine/EPI technical assistant at West Gondar zonal health department, Gondar, Ethiopia., Gondar, Amhara Region, Ethiopia
• ⁶Department of Health Promotion, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
• ⁷Department of Health System and Management, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia, Dessie, Ethiopia

Abstract Introduction: The measles containing vaccine is a live attenuated vaccine helps to develop lifelong immunity and it prevents measles infection when administered at the right time in measles endemic areas. Many infants received the initial dose of the measles vaccine later than the ideal time frame, and significant others missed the vaccination, causes recurrent measles outbreak in Ethiopia. This study assesses the time to first dose of measles containing vaccine and associated factors among infants in Ethiopia. Methods: A cohort of 1,770 mother-infant pairs was followed using data from the performance monitoring for action Ethiopia dataset. Key independent variables included socio-demographic characteristics, maternal health service utilization, and pregnancy intention. Multiple imputation was used to handle missing data. Shared frailty extended Cox survival analysis was conducted to account for clustering effects and model fitness was assessed using a global model fitness test. Results: Among infants, 90.86% received the first dose of measles containing vaccine (MCV1) by the end of the follow-up period. Only 27% were vaccinated timely within the 9 to 10 months of age, and 53.4% didn't take MCV1 at 12 years months of age. The hazard of time to receive the first dose of measles containing vaccine was 35% lower among pregnancies that were not desired at all compared to those pregnancies desired from the beginning. The hazard of time to the first dose of measles containing vaccine was 21% lower among pregnancies that were initially undesired but later became wanted compared to those pregnancies desired from the beginning. Conclusion: Despite progress in receiving first dose of measles containing vaccine uptake, timely vaccination in Ethiopia is still low, and many infants in Ethiopia miss timely immunization. Institutional delivery, maternal intention regarding pregnancy, religion, and wealth quantile were key predictors of first dose of measles containing vaccine timing. Interventions targeting promoting institutional deliveries, supporting unintended pregnancy, working with religious leaders and continuous outreach immunization service are necessary to improve the first dose of measles containing vaccine uptake timely.