Determinants of the measles recrudescence in children aged 6 to 59 months in the Urban Health Zone of Mbandaka, Equateur Provincial Health Division, Democratic Republic of the Congo

Introduction This study addresses the alarming resurgence of measles in the Mbandaka urban health zone, where annual outbreaks persist despite systematic vaccination efforts targeting children aged 6 to 59 months. With a reported measles morbidity rate of 0.6%, the region is lagging behind the global objective of measles elimination by 2030. Purpose The purpose of this study is to identify and analyse the key determinants responsible for the repeated measles epidemics in Mbandaka, with a view to enhancing the effectiveness of prevention strategies. Methods A quantitative, prospective, cross-sectional, and analytical approach was used. Data were gathered through household surveys in the urban-rural health zone of Mbandaka, with a focus on public health variables influencing measles vaccination coverage and infection rates. Results Several socio-demographic and cultural variables were significantly associated with measles incidence and vaccination status. Age emerged as a key determinant: adults aged 30–39 showed a strong positive association with vaccination uptake (β = 0.34, p < 0.001), whereas those over 39 years had a lower likelihood (β = -0.11, p = 0.034). Male respondents (β = 0.09, p = 0.003) and those with primary (β = 0.21, p < 0.001) or university education (β = 0.14, p = 0.005) were more likely to have vaccinated children. Conversely, divorced or widowed individuals were less likely to ensure vaccination (β = -0.26, p < 0.001). Religious affiliation also played a critical role: Kimbanguists (β = 0.27, p < 0.001) and Muslims (β = 0.17, p = 0.014) showed higher vaccination rates, while Pygmies were less likely to vaccinate (β = -0.33, p < 0.001). Ownership of a vaccination card (β = 0.14, p < 0.001) and residence in specific health zones (β = 0.49, p < 0.001) positively influenced coverage. Vaccine abandonment was mainly due to distance to health facilities (β = 0.17, p = 0.022) and forgetfulness (β = 0.11, p = 0.003). Conclusion Measles remains a major public health issue in Mbandaka. Addressing education gaps, improving healthcare access, targeting high-risk religious and ethnic groups, and strengthening vaccination outreach could significantly reduce epidemic recurrence in the region.