Speaker
Description
Background: Measles remains a significant public health problem contributing to elevated morbidity and mortality among children, especially in sub-Saharan Africa. Outbreaks and vaccination gaps persist in Ethiopia despite campaigns. There is minimal countrywide data documenting the geographic spread of measles cases and vaccination.
Objective: This study aimed to assess the geographical distribution of the number of measles cases across regions and estimate the pooled proportions of vaccination status in Ethiopia.
Methods: A systematic review and meta-analysis were performed according to PRISMA 2020 guidelines. PubMed, Science Direct, African Journals Online, and Google Scholar were searched from January 1 to April 30, 2025 by without restricting publication year. Data were independently extracted by two reviewers using Excel and resolved through discussion in case of disagreement. ArcGIS 10.8 and STATA 17 were used in geospatial mapping and meta-analysis, respectively. The Joanna Briggs Institute checklist was used to assess the quality of studies. Random-effects model was applied to estimate pooled proportions, and heterogeneity was assessed with I² statistic. Subgroup analysis by region, study design, and type of investigation was performed. Publication bias was assessed with funnel plots and Egger's test.
Results: A total of 43 studies with 31,731 cases of measles were reported. The highest reporting cases were from Oromia (39.2%) and Amhara (34.6%), while Benishangul Gumuz, Dire Dawa, Gambella, and Harari did not submit any data. The pooled proportion of vaccinated was 29.9% (95% CI: 25.1–34.7%; I² = 99.2%), unvaccinated was 54.2% (95% CI: 48.2–60.2%; I² = 99.5%), unknown 24.7% (95% CI: 14.7–34.7%), and ineligible 8.9% (95% CI: 7.0–10.8%). The highest proportion of unvaccinated cases was in the Somali region (74.3%), and the highest unknown vaccination status was from Addis Ababa (53.7%).
Conclusion and Recommendation: There is significant spatial concentration of measles cases in Ethiopia, with the greatest majority being reported from Oromia and Amhara. These high levels of unvaccinated and unknown vaccination status cases point to persistent immunization and surveillance gaps. Strengthening routine immunization, improving surveillance data quality, and focusing on low-coverage areas are central to measles control and eventual elimination in Ethiopia.
