Background: Counterfeit travel vaccination certificates pose a significant threat to public health and compromise disease control measures. We investigated the selfreported vaccination status, the validity of yellow fever vaccine (YFV) certificates (ICVPs), and knowledge and perception about the disease and its vaccine among Sudanese travelers departing through the Khartoum International Airport (KIA). Methods: This was a cross-sectional survey using a non-probability convenience sampling technique among Sudanese travelers departing through KIA between October and November 2021. We assessed the self-reported uptake of YFV and subsequently verified the ICVPs among those reported to be vaccinated. We also assessed participants' knowledge about the disease in addition to their knowledge and perception of YFV. Results: Four hundred travelers were interviewed. Most participants (88.0%) reported being vaccinated. However, two-thirds of their ICVPs (63.0%) were counterfeit. More than one-third of the participants (35.3%) had poor knowledge of YF and YFV. Carrying a valid ICVP was associated with participants' overall good level of knowledge about YFV (p = 0.030), knowledge about the nature of infection (p-value = 0.008), disease transmission (p = 0.016) and prevention (p = 0.028), and countries that require a mandatory YFV proof (p = 0.005). Many participants perceived YFV as important (93.3%), safe (86.5%), and effective (82.0%). Conclusion:The proportion of counterfeit ICVPs was high. Many of the participants had a poor level of knowledge about YF and YFV. Counterfeit ICVPs have grievous implications for YF prevention and control in Sudan and other countries. There is an urgent need to revisit the implementation of the International Health Regulations in Sudan to leverage recent technological advancements in immunization information systems such as electronic certification.

This study aimed to evaluate whether measles vaccine uptake can be predicted directly or indirectly by parental perceptions about the availability of measles vaccine services with parental hesitancy towards the measles vaccine as a potential mediator. This was a community-based cross-sectional study conducted at Omdurman locality in Khartoum state, Sudan in February 2019. The study population included parents/guardians having at least one child aged 2–3 years old. Mediation analysis was conducted using two models, the ordinary least squares path analysis and multiple logistic regression. These models considered perceived vaccine accessibility and availability as independent factors, vaccine uptake as dependent factors, and vaccine hesitancy (PACV scores) as a mediator. A total of 495 responded and the mean age of the mothers who participated in the study was 31.1 (SD = 5.73). Half of the respondents (50.1%) completed university education and nearly three-quarters of the respondents (74.7%) were housewives. After controlling for the other factors, including the mother’s age and the number of children, parental perception about the accessibility and availability of the measles vaccine influences the uptake of the measles vaccine indirectly through the mediation effect of measles vaccine hesitancy. We suggest that intervening in measles vaccine hesitancy in addition to measles vaccination access issues will have a positive impact on the uptake and coverage of the measles vaccine in Sudan.

Background: This study aimed to evaluate whether measles vaccine uptake can be predicted directly or indirectly by parental perceptions about the availability of measles vaccine services with parental hesitancy towards the measles vaccine as a potential mediator. Methods: This was a community-based cross-sectional study conducted at Omdurman locality in Khartoum state, Sudan in February 2019. The study population included parents/ guardians having at least one child aged 2 -3 years old. Mediation analysis was conducted using two models, the ordinary least squares path analysis and multiple logistic regression. Results: a total of 495 responded and the mean age of the mothers who participated in the study was 31.1 (SD=5.73). A half of the respondents (50.1%) completed university education and nearly three-quarters of the respondents (74.7%) were housewives. After controlling for the other factors, including the mother’s age and the number of children, parental perception about the accessibility and availability of the measles vaccine influences the uptake of the measles vaccine indirectly through the mediation effect of measles vaccine hesitancy. Conclusions: We suggest that intervening in measles vaccine hesitancy in addition to measles vaccination access issues will have positive impact on the uptake and coverage of the measles vaccine in Sudan.