Utilization of measles immunization services among children under 5 years in Lira district, northern Uganda: a community-based cross-sectional study

Background Measles remains a global health concern with high mortality rate, particularly in regions with low vaccine utilization, despite progress in measles control globally. In sub-Saharan Africa, first-dose measles vaccine utilization stands at 74%, well below the 95% target for herd immunity recommended by the World Health Organization (WHO). In northern Uganda, the proportion of children under five who receive the recommended doses of vaccines lags below the national average. This study therefore examined the level and factors influencing measles immunization utilization among children under five in Lira district, northern Uganda. Methodology This was a community-based cross-sectional study in two sub counties in Lira district, northern Uganda that utilized both quantitative and qualitative methods of data collection. We surveyed 409 children under five, selected through systematic random sampling, Data were analyzed using SPSS for univariate, bivariate, and multivariate logistic regression. Qualitative data from in-depth interviews with healthcare providers, opinion leaders, and district health officials were analyzed using thematic analysis. Ethical approval was obtained from Lira University Research and Ethics Committee. Results Measles vaccination completion was 19.6% (79/402). Factors that positively influenced utilization included antenatal (ANC) attendance (aOR = 1.65, p = 0.002), higher education level (aOR = 1.40, p = 0.023), and vaccine availability (aOR = 1.40, p = 0.020). Barriers included high transportation costs (aOR = 0.60, p = 0.010), cultural beliefs (aOR = 0.55, p = 0.006), and denial of vaccination on non-vaccination days (aOR = 0.65, p = 0.010). Qualitative findings highlighted vaccine shortages, cultural beliefs, and poor health facility access as barriers. Conclusion Measles vaccine utilization rate in the study setting of 19.6% was low. Antenatal care attendance, education level, vaccine availability, transportation costs, and cultural beliefs were key determinants of utilization. There is need develop and implement targeted strategies to address this gap, including community sensitization and health education, with emphasis of the benefits of childhood immunization in general.