Table 4.
Measles case death ratio for infants and older children in African prospective community studies and community surveys
| Country | Period | Type of study | Infants, % (deaths/cases) | Children 1+ year, % (deaths/cases) | Measles case death ratio (95% CI) |
| Studies before the introduction of MV | |||||
| Gambia46 * | 1961 | PCS; rural | 31 (12/39) | 13 (47/356) | 2.33 (1.36–4.00) |
| Guinea-Bissau33 | 1979 | PCS; urban | 28 (22/79) | 14 (55/380) | 1.92 (1.25–2.96) |
| Guinea-Bissau47 | 1980 | PCS; rural | 47 (7/15) | 21 (31/147) | 2.21 (1.18–4.13) |
| Senegal48 | 1983–1986 | PCS; rural | 12 (19/165) | 6 (79/1335) | 1.95 (1.21–3.13) |
| Studies after introduction of MV | |||||
| Kenya49 | 1974–1976 | PCS; rural | 6 (4/63) | 7 (24/361) | 0.96 (0.34–2.66) |
| Kenya49 | 1976–1977 | PCS; rural | 4 (5/125) | 1 (7/540) | 3.09 (1.00–9.56) |
| Kenya22 | 1986 | SUR; rural | 17 (5/29) | 7 (8/110) | 2.37 (0.84–6.71) |
| Kenya38 | 1988 | SUR; rural | 22 (9/41) | 5 (11/207) | 4.13 (1.83–9.33) |
| Senegal48 | 1987–1990 | PCS; rural | 2 (1/43) | 2 (9/598) | 1.55 (0.20–11.9) |
| Senegal36 | 1991–1994 | PCS; rural | 6 (4/72) | 1 (4/499) | 6.93 (1.77–27.1) |
| Guinea-Bissau50 | 1980–1982 | PCS; urban | 30 (7/23) | 9 (10/115) | 3.50 (1.49–8.24) |
| Guinea-Bissau33 | 1983–1984 | PCS; urban | 9 (5/56) | 7 (20/268) | 1.20 (0.47–3.05) |
| Zaire11 | 1974–1977 | PCS; urban | 6 (12/194) | 6 (53/844) | 0.99 (0.54–1.81) |
| Ghana37 | 1989–1991 | PCS; rural | 21 (28/131) | 15 (123/830) | 1.44 (1.00–2.08) |
| Chad39 | 1993 | SUR; urban | 6 (9/156) | 8 (52/668) | 0.74 (0.37–1.47) |
| Niger51 | 2003 | SUR; rural | 16 (13/83) | 9 (79/862) | 1.71 (0.99–2.94) |
| Niger42 ‡ | 1991–1992 | SUR; rural | 40 (16/40) | 13 (65/488) | 3.00 (1.93–4.67) |
| Niger40 | 2003–2004 | SUR; urban | 7 (8/111) | 3 (22/656) | 2.15 (0.98–4.71) |
| Chad40 | 2004–2005 | SUR; urban | 5 (5/97) | 2 (15/609) | 2.09 (0.78–5.63) |
| Nigeria40 | 2004–2005 | SUR; rural | 11 (5/47) | 7 (75/1095) | 1.55 (0.66–3.66) |
| Zimbabwe43 | 1980–1989 | SUR; rural | 13 (13/103) | 3 (15/534) | 4.49 (2.20–9.16) |
| Sudan41 | 2004 | SUR | 3 (1/36) | 1 (9/1108) | 3.42 (0.45–26.28) |
| Longer follow-up than 1 month | |||||
| Burundi45 † | 1989 | SUR; rural; 7-month follow-up | 14 (2/176 person-months) | 6 (20/3816 person-months) | 2.17 (0.51–9.20) |
| Gambia52 | 1981 | SUR; rural; 9-month follow-up | 64 (7/11) | 10 (13/124) | 6.07 (3.07–12.0) |
| Total | 1.87 (1.63–2.14) | ||||
Sources: Reviews of measles case death studies27–31 and PubMed search for community studies of measles mortality/case death in infants or by age in Africa.
The age grouping is 7–12 months and 12–120 months. Measles deaths and total number of children in age group were reported in this study. It has been assumed that all children between 7 and 120 months contracted measles. In this period, there were no measles vaccinations available. The last epidemic had occurred 12–13 years earlier.
The age grouping is 0–8 and 9+ months.
Numbers read from a graph.
MV, measles vaccine; PCS, prospective community study, that is, the population was known before the epidemic and information is likely to have been obtained for all children; SUR, retrospective survey.