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Am J Epidemiol. 1997 Oct 15;146(8):646-54.

Measles incidence, case fatality, and delayed mortality in children with or without vitamin A supplementation in rural Ghana.

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1
London School of Hygiene and Tropical Medicine, United Kingdom.

Abstract

Data on measles incidence, acute case fatality, and delayed mortality were collected on 25,443 children aged 0-95 months during the course of a community-based, double-blind, placebo-controlled, randomized trial of vitamin A supplementation in rural, northern Ghana between 1989 and 1991. Measles vaccine coverage in these children was 48%. The overall estimated measles incidence rate was 24.3 per 1,000 child-years, and acute case fatality was 15.7%. There was not significantly increased mortality in survivors of the acute phase of measles compared with controls (rate ratio = 1.22, 95% confidence interval (CI) 0.65-2.30). Reported incidence rates and case fatality were higher in families with low paternal education, in the dry season, and in unvaccinated children, and case fatality was higher in malnourished children. There was no sex difference in incidence, but acute case fatality was somewhat higher in girls than boys (adjusted odds ratio = 1.3, 95% CI 0.9-2.1). Measles incidence was lower in vitamin A-supplemented groups (23.6 per 1,000 child-years) than in placebo groups (28.9 per 1,000 child-years), but this difference was not statistically significant (p = 0.33). Among 946 measles cases in clusters randomized to receive vitamin A or placebo, there was no marked difference in acute measles case fatality between vitamin A-supplemented and placebo groups (15.4% vs. 14.5%, respectively). The biologic effects of vitamin A supplemented on the subsequent clinical manifestations and severity of measles need further elucidation.

PIP:

As part of a community-based, placebo-controlled trial of vitamin A supplementation in rural northern Ghana in 1989-91, data were collected on measles incidence and mortality among 25,433 children 0-95 months of age. Measles vaccination coverage was 48%. A total of 961 measles cases were identified, with a median age at onset of 41 months. The overall measles incidence rate was estimated at 24.3/1000 child-years and the acute case fatality rate was 15.7%. Both measles incidence and fatality were higher in families with low paternal education, in the dry season, and in unvaccinated children. Case fatality was also higher in malnourished children. There was a lower, although nonsignificant, measles incidence in vitamin-A supplemented groups (23.6/1000 child-years) than in placebo groups (28.9/1000 child-years). Among 946 measles cases in clusters randomized to receive vitamin A or placebo, there was no marked difference in acute measles case fatality (15.4% and 14.5%, respectively). These findings confirm the importance of sustained measles vaccination in Africa.

PMID:
9345118
[Indexed for MEDLINE]
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