Drivers, Reasons, and Experiences of Default and Missed Measles Vaccination in Ethiopia: A Qualitative Study

Despite the availability of a safe and free vaccine, measles first and second-dose vaccination coverage is still low in Ethiopia.Studies that examine caregivers' reasons for not receiving the measles vaccination in Ethiopia are scarce.Hence, this qualitative study aimed to uncover drivers, reasons, and experiences of default and missed measles vaccination from a caregiver perspective.A case study was conducted from December 2023 to May 2024 in the east Gurage zone of central Ethiopia.Data were collected through sixteen in-depth interviews with mothers who had measles vaccine-missed children and six focus group discussions with women aged 15-49 with children under five years old and mothers who were over 50.Caregivers were asked to answer open-ended questions regarding reasons for missing the measles vaccination.Data were coded, categorized, and analyzed manually by using an inductive thematic analysis approach.The four fundamental trustworthiness metrics for qualitative research were considered.Finally, we presented the themes and sub-themes supporting them with representative quotations.Geographic barriers, transportation costs, inconvenience of vaccination dates, lack of information when to return, mistrust, rumours, poor attendance in pregnant women's conferences, lack of autonomy to travel, workload, economic dependency, poor male involvement, mother-in-laws' influence, rounds of vaccination and administration routes, and adverse events following immunization were identified as reasons for missing measles vaccination.These reasons were found at each stage in the immunization journey.Hence, applying a human-centred design with tailored intervention might be important to address barriers at each stage.