Young children non‐immunized against measles: Characteristics and programmatic implications

Aim: To examine the presenting characteristics including nutritional status of young children without measles immunization and to suggest appropriate public health measures to improve immunization status. Methods: In this retrospective case-control analysis we studied 4075 children aged 12-23 mo of either sex who attend ICDDRBs Dhaka hospital during 1994-2003. Cases included children who reported to this facility without receiving measles vaccine and the control children were those who received the vaccine. Results: 3181 of 4075 (78%) children including 1227 (39%) girls and 1954 (61%) boys received measles immunization. The proportion of vaccinated children increased from 74% in 1997 to 82% in 2001. Some non-specific effects of measles immunization were observed. Fifty-one percent of the children without measles immunization were stunted 76% were underweight and 48% were wasted. The non-immunized children were twice as likely to be stunted underweight and wasted than the immunized children; they were more often dehydrated (some or severe dehydration)(28% vs 22% p 72h) of hospitalization (15% vs 10% p <0.001) did not receive vitamin A capsule in the previous 6 mo (56% vs 36% p <0.001) and had more frequent abnormal lung auscultation indicative of acute lower respiratory tract infections (8% vs 5% p <0.001). Female children illiterate mother lack of vitamin A supplementation and history of measles were significantly associated with non-immunization against measles after controlling for co-variables. Results were similar when different nutritional indicators (underweight stunning or wasting) were added separately to logistic regression models. Conclusion: Intervention strategies to enhance immunization coverage in infants should target illiterate mothers and their children particularly the females and malnourished ones provide them with measles immunization and vitamin A capsule and encourage their periodic follow-up visits as part of preventive nutritional programme. (authors)