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Introduction Malawi's National Immunization Program introduced a second routine dose of measles containing vaccine (MCV2) in 2015 but found coverage lagging. We assessed data quality and gaps in service delivery. Methods Investigators used a modified data quality audit in 6 low performing districts accompanied by questionnaires for health facilities (HF) and households with children with 1 vaccination. Results MCV2 doses administered according to source were 733 in registers, 2364 in reports, 1655 in district reports, 2761 in the elec