FACTORS ASSOCIATED WITH A MEASLES OUTBREAK IN DISTRICT SKARDU, GILGIT BALTISTAN, PAKISTAN

Abstract

Background: In Pakistan, annually 20,000 children deaths reported due to measles. This outbreak was investigated with the objectives to identify the associated risk factors and recommend appropriate control measures to prevent future outbreaks.
Methods: A case was defined as any child presented with fever, generalized maculopapular rash with one of the following symptoms; cough, coryza or conjunctivitis during March-April 2011 in Skardu district. Two healthy age and sex matched controls were selected for each case from the same neighborhood. Information was collected on demographics, date of onset of illness and possible risk factors.
Results: A total of 29 suspected measles cases were identified. The overall attack rate was 19% and the most affected age group was 9-19 months (attack rates 16%). Measles vaccination was lower among children with measles (OR. 4, C.I 1.8-12.5, p<0.05). The proportion of parents who consider measles as dangerous was significantly higher among the parents of cases (OR 3.6, CI 1.4-9.3, P 0.006). Better educated mothers were more likely to get their child vaccinated (OR 4, CI, 2.1-7.9, p<0.05) and history of contact was found associated with the disease (OR 7.2, CI 3.5-12.7, p 0.002). Multivariate analysis yielded significant association of following risk factors; vaccination status (OR 3.8, CI 1.8-12.5, p 0.005) and history of contact (OR 3.2, CI 1.0-10.7, p<0.05) with the disease.
Conclusion: Lower vaccination coverage and lack of awareness about measles among parents was the most probable cause of this outbreak. Improvement in routine vaccination coverage and health education on the safety of immunization was recommended.