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 attended ICDDR, B's 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 per cent 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 < 0.001), required longer duration ( > 72 h) 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, stunting, 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 a preventive nutritional programme.