Open Access Open Badges Research article

Local discrepancies in measles vaccination opportunities: results of population-based surveys in Sub-Saharan Africa

Lise Grout1*, Nolwenn Conan1, Aitana Juan Giner1, Northan Hurtado2, Florence Fermon2, Alexandra N’Goran1, Emmanuel Grellety1, Andrea Minetti1, Klaudia Porten1 and Rebecca F Grais1

Author Affiliations

1 Epicentre, 8, rue St Sabin, 75011 Paris, France

2 Médecins Sans Frontières, 8, rue St Sabin, 75011 Paris, France

For all author emails, please log on.

BMC Public Health 2014, 14:193  doi:10.1186/1471-2458-14-193

Published: 21 February 2014



The World Health Organization recommends African children receive two doses of measles containing vaccine (MCV) through routine programs or supplemental immunization activities (SIA). Moreover, children have an additional opportunity to receive MCV through outbreak response immunization (ORI) mass campaigns in certain contexts. Here, we present the results of MCV coverage by dose estimated through surveys conducted after outbreak response in diverse settings in Sub-Saharan Africa.


We included 24 household-based surveys conducted in six countries after a non-selective mass vaccination campaign. In the majority (22/24), the survey sample was selected using probability proportional to size cluster-based sampling. Others used Lot Quality Assurance Sampling.


In total, data were collected on 60,895 children from 2005 to 2011. Routine coverage varied between countries (>95% in Malawi and Kirundo province (Burundi) while <35% in N’Djamena (Chad) in 2005), within a country and over time. SIA coverage was <75% in most settings. ORI coverage ranged from >95% in Malawi to 71.4% [95% CI: 68.9-73.8] in N’Djamena (Chad) in 2005.

In five sites, >5% of children remained unvaccinated after several opportunities. Conversely, in Malawi and DRC, over half of the children eligible for the last SIA received a third dose of MCV.


Control pre-elimination targets were still not reached, contributing to the occurrence of repeated measles outbreak in the Sub-Saharan African countries reported here. Although children receiving a dose of MCV through outbreak response benefit from the intervention, ensuring that programs effectively target hard to reach children remains the cornerstone of measles control.

Measles; Immunization; Expanded program of immunization; Supplemental; Immunization activity; Outbreak response immunization; Vaccine coverage