Date of Conferral

7-3-2026

Date of Award

July 2026

Degree

Ph.D.

School

Health Sciences

Advisor

Heba Tawfik

Abstract

Measles remains a public health concern in Nigeria despite the availability of effective vaccines, yet limited research has comprehensively examined spatiotemporal patterns and contextual determinants of vaccination coverage and measles incidence in Katsina State. Guided by the socioecological model, this quantitative ecological study examined spatiotemporal patterns of measles incidence among children aged 9–59 months of age across 183 wards in 34 local government areas of Katsina State, Nigeria, from 2018 to 2022. Confirmed cases (n = 376) were analyzed using negative binomial regression and spatial methods, including Moran’s I, SaTScan, and geographically weighted regression (GWR). Urban wards had higher incidence (IRR = 1.59, 95% CI [1.14, 2.21], p=0.006), although this attenuated after adjustment, suggesting that this may be partially explained by other ward-level characteristics. Poorer healthcare facility accessibility was associated with lower vaccination coverage (B = −14.36, SE = 7.24, p = .049). Vaccination coverage was not associated with measles incidence, despite approximately 90% of cases occurring among unvaccinated children, suggesting that aggregate-level coverage may mask within-ward heterogeneity. Spatial analysis revealed significant clustering of measles with SaTScan identifying high-risk clusters. The GWR model demonstrated spatial heterogeneity, explaining 22% of variation in measles incidence, indicating moderate explanatory power and the influence of unmeasured localized factors. These patterns highlight localized vulnerabilities in vaccination coverage and healthcare access with implications for strengthening public health responses in resource-constrained settings and advancing social change to reduce preventable childhood morbidity and mortality.

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