Key drivers of measles infection in Ghana, 2014-2023

Abstract

Introduction: Measles remains a major public health challenge, infecting approximately 90% of susceptible contacts. In 2023, approximately 10.3 million cases of measles were reported globally, with over 107,000 deaths. Despite elimination efforts, outbreaks persist. Studies on risk factors of measles in Ghana are essential in achieving the elimination goal. We identified the key drivers of measles infection in Ghana. Methods: We conducted a cross-sectional analysis using data on suspected cases of measles reported through Ghana’s national case-based surveillance system, managed by the Disease Surveillance Department of the Ghana Health Service, from 2014-2023. Extracted Variables included Sociodemographic characteristics, vaccination status, and laboratory results. Cases were defined as samples testing IgM-positive or indeterminate. Multivariable logistic regression was used to identify factors independently associated with measles infection, controlling for potential confounders. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were reported. Results: Of the 2,261 confirmed cases, 65.9% were under five years, with the highest burden in children aged 9–23 months (27.3%). Males accounted for 54.9%, and 63.9% of cases occurred in rural settlements. Compared to infants aged 0–8 months, higher odds of infection were found in children aged 9–23 months (aOR = 2.24; 95% CI: 1.91–2.60), 2–4 years (aOR = 2.24; 95% CI: 1.91–2.60), 5–9 years (aOR = 2.52; 95% CI: 2.12–2.99), and 10–14 years (aOR = 3.80; 95% CI: 3.10–4.67). Urban residence reduced the odds by 18% (aOR = 0.82; 95% CI: 0.75–0.89). Unvaccinated individuals had nearly eight times higher odds of infection (aOR = 7.97; 95% CI: 7.12–8.93). Conclusion: Aging, rural residence, and non-vaccination are key determinants of measles infection in Ghana. These findings highlight the need to strengthen routine immunisation coverage, especially among young children and rural populations, to reduce transmission and sustain measles elimination gains.