Measles Mortality in High and Low Burden Districts of India: Estimates From a Nationally Representative Study of over 12,000 Child Deaths

Authors: Shaun Morris, Shally Awasthi, Rajesh Kumar, Anita Shet, Ajay Khera, Maryam Nakhaee, Usha Ram, Jose R.M. Brandao, Prabhat Jha

Abstract

Background:

Direct estimates of measles mortality in India are unavailable. Our objective is, to use a nationally-representative study of mortality to estimate the number and distribution of, measles deaths in India with a focus on 264 high burden districts.

Methods: 

We used physician coded verbal autopsy data from the Million Death Study which surveyed, over 12,000 deaths in children aged 1 month to under 15 years from 1.1 million nationally, representative households in 2001-2003.

Results:

We estimate there were 92,000 (99% CI 63,000-137,000) measles deaths in children 1-59, months of age in India in 2005, representing a mortality rate of 3.3 (99% CI 2.3-5.0) per 1000 live, births and about 6% of all 1-59 month deaths. In children under 15 years of age, there were 107,000, (99% CI 74,000-158,000) measles deaths. The measles mortality rate was nearly 70% greater in girls, than in boys, and 60% of the deaths were in three populous states Uttar Pradesh, Bihar, and Madhya, Pradesh. The 1-59 month measles mortality rate in high burden districts was 4.48 (99% CI 3.94-5.02) compared to 2.40 (99% CI 2.28-2.52) per 1000 live births in other districts.

Conclusion:

Measles killed over 100,000 children in India in 2005 and girls were at higher risk than boys. The majority of measles deaths occurred in a few states and high burden districts. The results of this study highlight the importance of focusing measles supplementary immunization activities in high burden districts.