Date of Conferral



Doctor of Public Health (DrPH)


Public Health


Angela Prehn


Measles is one of the most contagious diseases ever known, infecting as high as 90% of susceptible persons encountering the virus, and globally is one of the main causes of disability and death among children. Measles remains an avoidable disease that can be prevented by receiving a measles containing vaccine using supplemental immunization activities (SIA) implementation strategies. Because national-level measles data may not reflect geographic differences, program capacity, or localized outbreaks, SIAs prompted by and geared toward the subnational level may have a greater impact than a nationwide SIA. The purpose of this retrospective cross-sectional study was to examine the patterns of association between using subnational data in children 12–59 months compared to using national-level data as a basis for SIA timing and implementation in Tanzania. Diffusion of innovation and community mobilization theories were used to guide the study. Tanzania Demographic and Health Survey, measles incidence, and SIA data were analyzed for the period 2010–2016. Results revealed SIAs should be implemented sooner, in a specific geographical location, or with strategic changes to the routine immunization program. Results may be used to develop more strategic and cost-effective measles-elimination efforts by countries willing to use the subnational-level approach. Changing the strategy of planning and implementing SIAs based on subnational-level data would be a paradigm shift from the current national-level approach.