Citation: Shiferie, F.; Gebremedhin, S.; Andargie, G.; Tsegaye, D.A.; Alemayehu, W.A.; Fenta, T.G. Low Measles Vaccination Coverage and Spatial Analysis of High Measles Vaccination Dropout in Ethiopia’s Underprivileged Areas. Vaccines 2024, 12, 328. https://doi.org/10.3390/ vaccines12030328 Academic Editor: Pedro Plans-Rubió Received: 5 February 2024 Revised: 12 March 2024 Accepted: 15 March 2024 Published: 19 March 2024 Copyright: © 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). Article Low Measles Vaccination Coverage and Spatial Analysis of High Measles Vaccination Dropout in Ethiopia’s Underprivileged Areas Fisseha Shiferie 1,2, * , Samson Gebremedhin 3 , Gashaw Andargie 1 , Dawit A. Tsegaye 1 , Wondwossen A. Alemayehu 4 and Teferi Gedif Fenta 2 1 Project HOPE Ethiopia Country Office, Addis Ababa P.O. Box 45, Ethiopia; gandargie@projecthope.org (G.A.); dtsegaye@projecthope.org (D.A.T.) 2 School of Pharmacy, Addis Ababa University, Addis Ababa P.O. Box 1176, Ethiopia; tgedif@gmail.com 3 School of Public Health, Addis Ababa University, Addis Ababa P.O. Box 1176, Ethiopia; samsongmgs@yahoo.com 4 Project HOPE Headquarters, 1220 19th Street, NW, Suite 800, Washington, DC 20036, USA; wasefa@projecthope.org * Correspondence: fshiferie21@gmail.com Abstract: (1) Background: Measles remains a major cause of disease and death worldwide, especially in the World Health Organization African Region. This study aimed to estimate the coverage of measles vaccinations and map the spatial distribution of measles vaccination dropout in Ethiopia; (2) Methods: A cross-sectional survey was conducted in Ethiopia’s underprivileged areas. The study included 3646 mothers/caregivers of children. ArcGIS for the spatial analysis, Global Moran’s I statistic for spatial autocorrelation, and Getis-Ord Gi* statistics for hot spot analysis were applied; (3) Results: Overall, coverages of measles-containing-vaccine first- and second-doses were 67% and 35%, respectively. Developing regions had the lowest coverages of measles-containing-vaccine first- and second-doses, 46.4% and 21.2%, respectively. On average, the measles vaccination dropout estimate was 48.3%. Refugees had the highest measles vaccination dropout estimate (56.4%). The hot spot analysis detected the highest burden of measles vaccination dropout mainly in the northeastern parts of Ethiopia, such as the Afar Region’s zones 1 and 5, the Amhara Region’s North Gondar Zone, and peripheral areas in the Benishangul Gumuz Region’s Assosa Zone; (4) Conclusions: The overall measles vaccination coverages were relatively low, and measles vaccination dropout estimates were high. Measles vaccination dropout hot spot areas were detected in the northeastern parts of Ethiopia. Keywords: measles; vaccination; spatial distribution; dropout; hot spot analysis 1. Introduction Measles remains a major cause of disease and death worldwide, especially in the World Health Organization (WHO) African Region (AFR) [1]. During 2017–2021, regional coverage of the measles-containing-vaccine first-dose (MCV1) remained stable at 68–70% but below the level necessary to achieve high population immunity against measles (≥95%). The low coverage of MCV1 in populous countries like the Democratic Republic of the Congo, Ethiopia, and Nigeria has largely contributed to AFR’s low coverage [2,3]. Despite the existence of an effective vaccine, regions have varying success in measles control [4]. Currently, infants are receiving 11 different antigens from the Expanded Program for Immunization of Ethiopia through a combination of outreach, static, and mobile activities; services are primarily offered in health centers and health posts. Large-scale, periodic campaigns are also being used to administer the vaccines against meningitis, polio, and measles [5]. Ethiopia introduced the measles-containing-vaccine second-dose (MCV2) program in 2018 and launched it into the routine immunization program in 2019 to boost Vaccines 2024, 12, 328. https://doi.org/10.3390/vaccines12030328 https://www.mdpi.com/journal/vaccines