Assessment of measles related morbidity and mortality following the september 1999 mass measles vaccination campaign in Jinja district.
MetadataShow full item record
INTRODUCTION: Measles continues to be a very serious public health problem in developing countries despite the availability of an excellent vaccine. In 1999, UNEPI launched measles catch-up campaigns in phases by geographic area with jinja and mbale districts being the pilot areas. The aim of the catch up campaign was to build sufficient herd immunity in the community so as to reduce the incidence of the disease and measles related mortality. In jinja district, ass measles vaccination for all children 6-59 months of age, regardless of previous immunization status was carried out during the 2nd round of NIDS for polio in September 1999. OBJECTIVE: To assess measles related mortality and morbidity following the September 1999 mass measles vaccination campaign in Jinja district. METHODOLOGY: The study was carried out as a cross-sectional study with retrospective review of medical records using qualitative and quantitative methods of data collection. The study population consisted of children who were targeted for mass measles vaccination and their mothers/caretakers. Key informant interviews were conducted with health unit in charges and the EPI staff at the DDHS office. Records of reported measles cases over a period of 6 years (1995-2000) from all health units were reviewed as well as case records of measles cases admitted in hospitals a year before and after the mass vaccination campaign. RESULTS: The mass measles vaccination campaign achieved a crude coverage (card or history) of 94.3% and a valid coverage (card only) of 72.3%. Measles cases outpatient attendance trends from all health units shows that the disease is still endemic in the district. However, there has been a progressive drop in the number of reported cases from 4,290 in 1988 to 1,152 in 2000. A year after the campaign, the number of measles cases recorded at kakira hospital dropped by 85.7% from 210 to the previous year to 30, while measles related deaths dropped by 84.6% from 13 to the previous year to only 2 deaths. Similary in jinja hospital, recorded measles cases dropped by 77.2% from 148 the previous year to 34 while measles related deaths dropped by 76.9% from 26 the previous year to only 6 deaths. Cases with measles associated complications dropped from 92.7% (n=107) in the year before the campaign to 71.5% (n=27) a year after the campaign. The main reason for non-vaccination during the campaign was the fear about the safety of the vaccine being given. Children whose mothers/caretakers believed that measles vaccination was useful were more likely to have been vaccinated during the mass vaccination campaign (OR 0.19, CI 0.06-0.62). CONCLUSION: The mass measles vaccination campaign achieved a valid coverage of 72.3%. This level of coverage is insufficient to achieve adequate herd immunity levels in the population hence measles transmission has continued. With persistently low levels (<70%) of routine measles vaccination coverage, measles remained endemic in the district. There is however a decline in the number of measles cases attending OPD in all the health units as well as measles related mortality and associated complications among hospitalized cases following the mass measles vaccination campaign. The main reason for non-vaccination during the campaign was the fear about the safety of the vaccine being given and the negative attitude of the mothers/caretakers of the children towards measles vaccination. RECOMMENDATIONS: Periodic mass measles vaccination should be conducted in the district while routine vaccination should be strengthened. Children who don’t have sufficient evidence of measles vaccination should be vaccinated whenever they make any contact with health services. The possibility of legislation aimed at universal vaccination such as evidence of measles vaccination at UPE entry as a start should be urgently investigated. Health education must be continued as a strategy to enhance immunization coverage by empowering communities and to counter rumors. The mass measles vaccination campaign should be extended to other areas in Uganda possibly with NIDS for polio.