Measles Vaccination Coverage, Caregiver Perceptions, and Information Sources in Five Selected Outbreak Districts of Zambia: A Descriptive Cross-Sectional Study

Abstract Background Measles remains a significant public health concern in sub-Saharan Africa, with Zambia experiencing periodic outbreaks despite ongoing vaccination efforts. Understanding the determinants of vaccination coverage, caregiver knowledge, and information sources is essential for designing effective immunization programs. This study aimed to assess measles vaccination coverage, caregiver perceptions, and information sources among children in five districts of Zambia. Methods A cross-sectional study was conducted among 491 children aged 9 months to 15 years across five districts in Zambia (Chiengi, Kalabo, Kanchibiya, Mungwi, and Mwinilunga). Data were collected through structured interviews with caregivers, review of vaccination cards, and household observations. Descriptive statistics were used to characterize the study population, vaccination history, clinical presentation of measles cases, household environmental factors, and sources of vaccination information. Summary statistics are presented as frequencies, percentages, medians, and interquartile ranges. Results The median age of participants was 6 years (IQR: 2.6 − 10.0), with 57.6% being female. The majority (95.5%) resided in rural areas. Vaccination cards were available for only 29.5% of participants. Among cardholders, 97.2% had documented at least one routine measles dose, while 63.4% had received two routine doses. Caregiver recall indicated that 58.2% of children had participated in a measles vaccination campaign within the previous five years. Most caregivers (93.5%) believed measles is preventable. Health workers were the predominant source of vaccination information (98.8%), followed by traditional or religious sources (51.2%). Among 37 children with a history of prior measles illness, fever and rash were the most commonly reported symptoms (97.3% each). Household overcrowding was observed in 10.6% of households, and poor sanitation in 21.0%. Conclusions While vaccination coverage among children with available records appears adequate, the high proportion of children without vaccination documentation represents a significant gap in monitoring immunization status. Health workers remain the most trusted and utilized source of vaccination information. Strengthening vaccination record-keeping systems, improving community engagement, and leveraging multiple information channels could enhance measles vaccination coverage and outbreak preparedness in Zambia.