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  • Title: Measles mortality in India: a review of community based studies.
    Author: Singh J, Sharma RS, Verghese T.
    Journal: J Commun Dis; 1994 Dec; 26(4):203-14. PubMed ID: 7759802.
    Abstract:
    This paper reviews the measles Case Fatality Ratios (CFRs) reported in the community based studies from India. Measles mortality varied considerably in outbreaks, prospective and retrospective studies. A median CFR of 2.5 per cent (0.2-3.7), 0.1 per cent (0-2.2) and 3.7 per cent (0-23.9) was recorded in prospective, retrospective and outbreak studies respectively. The retrospective studies seem to underestimate the measles mortality in Indian setting. Most of the outbreaks recording CFRs equal to or less than the median, 3.7 per cent, occurred in the areas where health care facilities were available for treatment of measles associated complications. Virtually in all studies, the age specific CFRs wherever recorded, were found to be the highest among infants and thereafter the ratios declined progressively. Although suggestive of, the studies did not provide sufficient data to establish an association between malnourishment and the risk of dying from measles. Measles mortality was not consistently high in any particular sex. The study makes a strong case for measles immunization at the earliest recommended age and the provision of better health services as the important public health measures for reducing the measles CFRs. Hospital-based studies of measles indicate overestimation of mortality and underestimation of morbidity. A review is provided of case fatality ratios (CFR) that are calculated in India in community-based studies. Studies are included only if they were household surveys. The 15 studies are grouped as prospective, retrospective, and outbreak studies. Findings indicate that availability of health care facilities is a critical factor that affects the risk of measles mortality in any area. The CFRs vary widely in all studies. In the 10 prospective studies the median CFR is 2.5%, and the range is 0.2-3.7%. In the 5 retrospective studies the median is 0.1% and the range is 0-2.2%. In the 21 outbreak studies the median is 3.7%, and the range is 0-23.9%. Rural outbreaks are shown to have higher CFRs. When age data is available, the findings show that infants have the highest morbidity and mortality in either epidemic situations or nonepidemic situations. There are no gender differences. A few studies involved immunization against measles and health services. Although coverage is low in these studies, the CFRs are found to be zero or under the median recorded. The role of malnutrition was not ascertained, but an association is strongly suspected. Certainly malnourished children are not less likely to suffer from measles, as has been suggested. Immunization plays a role in decreasing the peak of outbreaks and in increasing the inter-epidemic interval. Immunization may also shift the age of the time of infection to older children and adults. The impact of measles on immunized children is found to be less severe and unlikely to be fatal. World Health Organization goals can be attained by better provision of treatment facilities and high immunization coverage.
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