The share of MCV1 vaccination coverage in India was reported to be ** percent in 2023. In contrast, the lowest share of vaccination coverage was seen in 1985 with only *** percent. The figure reflects a clear increase in the immunization coverage trend with an increase in time.

The percentage of the target population vaccinated with a WHO-prequalified Measles Containing Vaccines (MCV) vaccine, reflecting immunization efforts and population immunity.

The proportion of children who have not received the first dose of Measles Containing Vaccines (MCV) vaccine, serving as a key indicator of immunization gaps and access to essential health services.

Results from the logistic regression models for the delay of MCV1 vaccination.

Distribution of MCV1 vaccination month

Summary of DHS data and direct (or survey-weighted) estimates of DTP1, 3 and MCV1 coverage for all nine study countries.

The percentage of the target population vaccinated with a WHO-prequalified Measles Containing Vaccines (MCV) vaccine, reflecting immunization efforts and population immunity.

*** Please remove Maksym Bondarenko before validation *** Population of unvaccinated children under one year of age (DPT1, DPT3, MCV1) in 75 countries at a resolution of 30 arc-second (approximately 1km at the equator), 2015-2023. R2025 v1

Outbreak classification protocol.

a: 2009: From week 45; 2010 and 2011: entire year.b: Annualized Incidence rate per 100,000 persons per year;c: 12 cases were epi-linked to a mixed outbreak of measles and rubella.Suspected measles cases by classification and incidence rates per 100 000 persons.

BackgroundCash transfer programmes are increasingly used in humanitarian contexts to help address people’s needs across multiple sectors. However, their impact on the key objectives of reducing malnutrition and excess mortality remains unclear. mHealth interventions show great promise in many areas of public health, but evidence for their impact on reducing the risk factors for malnutrition is uncertain. We therefore implemented a trial to determine the impacts of 2 interventions in a protracted humanitarian context, a cash transfer conditionality and mHealth audio messages.Methods and findingsA 2 × 2 factorial cluster-randomised trial was implemented in camps for internally displaced people (IDP) near Mogadishu, Somalia, starting in January 2019. The main study outcomes were assessed at midline and endline and included coverage of measles vaccination and the pentavalent immunisation series, timely vaccination, caregiver’s health knowledge, and child diet diversity. Twenty-three clusters (camps) were randomised to receive or not receive conditional cash transfers (CCTs) and an mHealth intervention, and 1,430 households were followed up over 9 months. All camps received cash transfers made at emergency humanitarian level (US$70/household/month) for 3 months followed by a further 6 months at a safety net level (US$35). To be eligible to receive cash, households in camps receiving CCT were required to take their children 85%). We conducted intention-to-treat analysis.During the humanitarian intervention phase, the CCT improved coverage of measles vaccination (MCV1) from 39.2% to 77.5% (aOR 11.7, 95% CI [5.2, 26.1]; p < 0.001) and completion of the pentavalent series from 44.2% to 77.5% (aOR 8.9, 95% CI [2.6, 29.8]; p = < 0.001). By the end of the safety net phase, coverage remained elevated from baseline at 82.2% and 86.8%, respectively (aOR 28.2, 95% CI [13.9, 57.0]; p < 0.001 and aOR 33.8, 95% CI [11.0, 103.4]; p < 0.001). However, adherence to timely vaccination did not improve. There was no change in the incidence of mortality, acute malnutrition, diarrhoea, or measles infection over the 9 months of follow-up.Although there was no evidence that mHealth increased Mother’s knowledge score (aOR 1.32, 95% CI [0.25, 7.11]; p = 0.746) household dietary diversity increased from a mean of 7.0 to 9.4 (aOR 3.75, 95% CI [2.04, 6.88]; p < 0.001). However, this was not reflected by a significant increase in child diet diversity score, which changed from 3.19 to 3.63 (aOR 2.1, 95% CI [1.0, 4.6]; p = 0.05). The intervention did not improve measles vaccination, pentavalent series completion, or timely vaccination, and there was no change in the incidence of acute malnutrition, diarrhoea, measles infection, exclusive breastfeeding, or child mortality. No significant interactions between the interventions were found. Study limitations included the limited time available to develop and test the mHealth audio messages and the necessity to conduct multiple statistical tests due to the complexity of the study design.ConclusionsA carefully designed conditionality can help achieve important public health benefits in humanitarian cash transfer programmes by substantially increasing the uptake of child vaccination services and, potentially, other life-saving interventions. While mHealth audio messages increased household diet diversity, they failed to achieve any reductions in child morbidity, malnutrition, or mortality.Trial registrationISRCTN ISRCTN24757827. Registered November 5, 2018.

a: 2009: From week 45; 2010 & 2011: entire year.b: IQR: Inter-quartile range.Suspected measles outbreaks with classification.

Additional file 2: Table S1. Number of districts in Zambia where vaccination coverage for DTP3 and MVC1 is > 100%. Numerator: DTP3 and MCV1 vaccination doses from each country’s DHMISs, as reported to the WHO [38]. Denominator: official population projections from the last census as reported to WHO [38]; WorldPop modelled top-down population estimates [23]; and GRID3 modelled bottom-up population estimate [26, 39].

Additional file 3: Table S2. Number of districts by region in Nigeria where vaccination coverage for DTP3 and MVC1 is > 100%. Numerator: DTP3 and MCV1 vaccination doses from DHMISs, as reported to the WHO [38]. Denominators: official population projection from the last census as reported to WHO [38]; WorldPop modelled top-down population estimate [23]; and GRID3 modelled bottom-up population estimate [39, 40].

Gini index for the third dose of diphtheria-pertussis-tetanus-Hib-HepB (Penta3) and first dose of measles (MCV1) immunizations, by Ethiopian region.

a: Confirmed measles: Laboratory, epidemiologically or clinically confirmed measles cases; Confirmed rubella: Laboratory or epidemiologically confirmed rubella cases; Discarded: Negative laboratory results for measles or rubella.Age distribution of confirmed measles, rubella and discarded cases, 2009–2011a.

a: Vaccinated with at least 1 dose of measles containing vaccine.b: Confirmed measles: Laboratory, epidemiologically or clinically confirmed; Confirmed rubella: Laboratory or epidemiologically confirmed; Discarded: Negative laboratory results for measles or rubella.Number and proportion vaccinated a with measles containing vaccine by age-group and case classification b 2009–2011.

Actual and the most desired sources of vaccination information.

a: For the entire district of Pune;b: For year 2009, indicator calculated as an annualized rate from week 45;c: Target≥2 per 100,000 persons;d: Target≥80% [Cases which were epidemiologically linked to an outbreak of measles, rubella or another infectious disease or to an outbreak of unknown aetiology excluded from denominator];e: Target≥80%.Performance indicators for case based measles surveillance Pune, 2009–2011.

Sociodemographic characteristics of the sample (N = 1467).