Spatial patterns and determinants of childhood measles vaccination in Somalia a multilevel and geospatial analysis of the 2020 demographic and health survey

Measles remains a significant public health challenge in Somalia, contributing to high rates of childhood morbidity and mortality. This study aimed to explore the spatial distribution and identify the individual and community-level determinants of the first dose of measles-containing vaccine (MCV1) uptake among Somali children. Data from the 2020 Somalia Demographic and Health Survey (fieldwork 2018–2019) were analyzed for 3,436 children aged 12–59 months. Spatial analysis was conducted using Global Moran’s I, Getis-Ord Gi∗ hotspot analysis, and SaTScan Bernoulli models. Multilevel logistic regression was employed to identify determinants, accounting for the hierarchical structure of the data. Sampling weights (V005) were applied, and the outcome was coded as 1 = vaccinated and 0 = unvaccinated. The weighted prevalence of MCV1 was 58.3% (95% CI 55.5–61.1%). Significant spatial clustering was observed (Global Moran’s I = 0.653, p < 0.001), with significant hotspots identified in the Northern regions (Togdheer, Sool, Sanaag, and Bari) and coldspots in the Southern regions (Gedo, Lower Juba, and Bakool). Multilevel analysis revealed that child’s age (AOR = 16.32 for 48–59 months), maternal secondary education (AOR = 1.83), middle-income wealth (AOR = 1.88), and nomadic residence (AOR = 1.60) were significant predictors of vaccination. Regional disparities were profound, with children in Togdheer having 6.3 times higher odds of vaccination compared to the reference region. The Intra-cluster Correlation Coefficient (ICC) indicated that 13.1% of the variance was attributable to community-level factors. Measles vaccination coverage in Somalia remains below the herd immunity threshold and is characterized by significant geographic inequities. Public health interventions should prioritize the identified Southern coldspots and focus on improving maternal health literacy. Expanding mobile vaccination outreach to underserved rural and nomadic populations is essential to close the coverage gap and protect Somalia’s most vulnerable children.