COVID-19-related disruptions and measles vaccination uptake among children attending urban health centers in Guelmim, Morocco: a cross-sectional study

BACKGROUND: The COVID-19 pandemic disrupted routine immunization services and may have widened measles immunity gaps. Morocco has experienced a widespread measles outbreak since late 2023. This study assessed the association between COVID-19-related disruptions and measles vaccination uptake among children in Guelmim, Morocco, and described additional informational and access barriers. METHODS: A descriptive cross-sectional study was conducted from March to May 2025 in three urban public health centers in Guelmim. Using an interviewer-administered questionnaire, data were collected from 350 mothers of children aged 0-59 months. Descriptive statistics and Pearson's chi-square tests were used to examine associations between child measles vaccination status and COVID-19-related, informational, and access-related factors. RESULTS: Only 44.29% of children were reported as vaccinated against measles. Lower uptake was significantly associated with delaying child vaccination during COVID-19 (27.27% vaccinated vs. 69.61% among those reporting no delay; p < 0.001), missing a measles dose during the pandemic (28.64% vs. 67.96%; p < 0.001), insufficient vaccine information (28.19% vs. 73.98%; p < 0.001), lack of trust in vaccines offered by the public health system (28.29% vs. 68.92%; p < 0.001), difficulty accessing vaccination services (35.88% vs. 69.32%; p < 0.001), and lack of information on post-pandemic vaccination dates (25.00% vs. 68.83%; p < 0.001). Receipt of a measles catch-up dose was strongly associated with vaccination uptake (82.79% among those receiving catch-up; p < 0.001). CONCLUSIONS: In this urban sample, measles vaccination uptake was low and was associated with both COVID-19-related service disruptions and broader informational, trust, and access barriers. Strengthening catch-up activities, service communication, and trust-building strategies may help close immunity gaps in similar settings.