Measles case distribution by age, sex and place
A total of, 4241 measles cases were reported from 475 health facilities and twenty districts to Bale Zone Health office from 2013-2019. From a total cases reported, 51% were males and 49% were females. Mean age of cases were 7.15 years and standard deviation were 8.95 years. Age group of 1-4 years were 40%, followed by 5-15 which were 30% (Table 1).
Table 1 Measles cases reported in Bale from 2013 to 2019 by age categories and sex, Bale Zone Health Office, May 25-June 25/2019.
Age
|
Sex
|
Male
|
|
Female
|
|
Total
|
|
No
|
%
|
No
|
%
|
No
|
%
|
<1
|
235
|
5.5
|
268
|
6.3
|
503
|
11.9
|
1_4
|
759
|
17.9
|
923
|
21.8
|
1682
|
39.7
|
5_15
|
771
|
18.2
|
502
|
11.8
|
1260
|
29.7
|
16-35
|
303
|
7.1
|
333
|
7.9
|
649
|
15.3
|
36_49
|
74
|
1.7
|
52
|
1.2
|
126
|
3.0
|
>50
|
5
|
0.1
|
16
|
0.4
|
21
|
0.5
|
Total
|
2147
|
50.6
|
2094
|
49.4
|
4241
|
100
|
From a total reported measles cases 2,147 (50.6%) were males and 2,094 (49.4%) were females. Female to male ratio was 1:1.04. Sex specific prevalence rate was calculated and the highest prevalence rate was among male with 2.27/1000 slight lower among females 2.2/1000 population. The trend shows that almost distribution of cases was equal among both sexes with slight difference in 2013, 2015 and 2019 as shown in figure 1.
Measles age specific prevalence by time
Prevalence was high in under one year’s children during 2013-1019 with the highest PR 30/1000 reported in 2019. The second most affected age group was 1-4 age categories the highest PR 4.29/1000 in 2019. The prevalence rate was low among greater than 15 years with highest PR of 0.73/1000 observed in 2019 (Table 2).
Table 2 Age specific prevalence/10,000 population of measles in Bale zone from 2013 to 2019, Bale Zone Health Office, May 25 - June 25/2019.
Years
|
Prevalence Rate (PR)/1000 in age groups
|
< 1
|
1_4
|
5_15
|
16-35
|
36-49
|
<50
|
2013
|
1.17
|
0.31
|
0.09
|
0.08
|
0.03
|
0.02
|
2014
|
2.96
|
0.31
|
0.09
|
0.13
|
0.00
|
0.00
|
2015
|
5.31
|
0.42
|
0.22
|
0.09
|
0.03
|
0.03
|
2016
|
6.36
|
0.35
|
0.12
|
0.02
|
0.02
|
0.02
|
2017
|
3.47
|
0.21
|
0.06
|
0.01
|
0.00
|
0.00
|
2018
|
2.34
|
0.33
|
0.13
|
0.10
|
0.01
|
0.01
|
2019
|
29.80
|
4.29
|
1.32
|
0.73
|
0.01
|
0.01
|
Total
|
51.41
|
6.21
|
2.04
|
1.16
|
0.10
|
0.10
|
Prevalence of measles by place
From a total of 4,241 measles cases reported from 2013-2019 years, the highest proportion of measles prevalence were reported from Ginir district (77/10000 population) followed by Gololcha (45.4/10000 population) and Lega Hidha (38.4/10000 population). The lowest proportions of measles prevalence were reported from Guradhamole and Gasara, with a prevalence of 0.6/10000 and 0.9/10000 population respectively as shown in (Figure 2).
Geographical distribution of measles
Regarding measles cases by place of residence, the highest number of cases were reported from rural areas of the zone 3,642 (85.8%) cases; while only 599 (14.1%) measles cases were reported from urban areas.
Trend of measles by month
The highest number of measles cases were reported during autumn (June 1344 (31.6%), May 934 (22%) and April 545 (12%)). From the season of the year it reaches peak level in May and lower number of cases were reported in summer season (October, November and September) as shown in Figure 4.
Trend of measles prevalence by time
From 2013-2019 the highest suspected measles cases prevalence rates were seen in 2019 and 2015 accounted for 141 per 100,000 and 21 per 100,000 populations respectively. While remarkable decrement of suspected measles cases was reported in year 2017 which was 7.2/ 100000 and in 2013 which was 11.4 /100000 populations (Figure 5).
Measles final case classifications
From a total of 4241 measles cases reported during the study period only 248 (5.8%) cases were confirmed by laboratory for measles IgM and 3,060 (72.1%) were epidemiologically linked to confirmed measles cases. About 497 (11.3%) of the cases were reported as clinically compatible with measles case as shown in Figure 6.
Measles laboratory result
During 2013-2019, 993 serum samples were sent to Ethiopian Public Health Institute (EPHI) central laboratory for confirmation, and about 248 (24.9%) of the samples tested were positive for measles IgM and 375 (37.7%) of samples were discarded (Figure 7).
Inpatient and outpatient cases
From 2013-2019 period, 582 (13.2%) measles cases were admitted in inpatient and 3659 (86.2%) suspected measles cases were treated as an outpatient. The overall admission rate from the treated measles cases were 16 %.
Measles case fatality rate
From all measles suspected cases that were reported from all districts of the zone, the crude case fatality rate (CFR) was 3.07/1000 population and the highest numbers, 9 (69.2 %) of measles related deaths were reported from Ginir district.
Case fatality by sex and age
Fatality was high among females than males with crude case fatality rate (CCFR) of 3.3/1000 among females and 2.8/1000 among males respectively. Measles age specific fatality rate (ASFR) was calculated and highest case fatality rate (4/1000 population) were observed among children less than one year’s age.
Trend of measles CF by year
Regarding the trend of measles mortality, the greatest case fatality was occurred during 2015, which was 5.4/1000, and in 2014 which was 4.4/1000 populations. Measles related death were not reported in 2013, 2017 and 2018 years (Figure 9).
Vaccination status
Out of the total measles case reported, 2620 (62%) were vaccinated, and from which 1480 (34.4%), 1032 (24.3%) and 108 (2.5%) have received a single, two and three doses of measles containing vaccine (MCV) respectively. There were 890 (21%) case patients with no vaccination history and 731 (17.2%) of the case patients with unknown vaccination status (Table 3).
Table 3 Table showing vaccination status of measles cases by sex from 2013-2019 in Bale Zones, May 25 -June 25 /2019.
Vaccination status of reported cases
|
Sex
|
Total
|
Percent
|
Male
|
Female
|
Vaccinated
|
1296
|
1323
|
2619
|
61.8
|
Unvaccinated
|
484
|
406
|
890
|
21.0
|
Unknown
|
369
|
363
|
732
|
17.3
|
Total
|
2149
|
2092
|
4241
|
100
|
Vaccination status by place
Regarding unknown vaccination status, 390 (53.4%) were from Ginir and 107 (14.6%) of unknown vaccination status were from Gololcha. Vaccinated cases were also highest in Ginir, Gololcha and Sewena, which were 981 (37.4%), 400 (15.3) and 213(8.1%) respectively. The proportions of zero doses were 443 (50 %) from Ginir, 88 (10%) from Dawe Serer and 82 (9.2%) from Lega hida. Ginir woreda reported highest number of both vaccinated and zero dose cases.
Vaccination status by time
Concerning vaccination status of measles cases, from a total of 890 unvaccinated cases the highest percentage of unvaccinated cases were reported in 2019 and 2014, with 73.3% and 9% respectively. Regarding those who have vaccination history, the highest percentage of measles case with single dose and two doses of MCV were reported in 2019 and 2015 with 67.9%, 68% and 7.2% and 14% respectively. Lower proportion of cases with single dose and two doses were reported in 2014, 2% single dose and 1.5% of two doses. Forty-one percent of measles cases with unknown vaccination statuses were reported in 2019 which is relatively high.
Measles Data Type
From 4241 total suspected measles cases, 903 (21%) of the cases were reported by case based and 3312 (64.9%) were by line list.