MEASLES INCIDENCE, CASE-FATALITY, AND DELAYED MORTALITY IN CHILDREN WITH OR WITHOUT VITAMIN-A SUPPLEMENTATION IN RURAL GHANA

Data on measles incidence, acute case fatality, and delayed mortality were collected on 25,443 children aged 0-95 months during the course o f a community-based, double-blind, placebo-controlled, randomized tria l of vitamin A supplementation in rural, northern Ghana between 1989 a nd 1991. Measles vaccine coverage in these children was 48%. The overa ll estimated measles incidence rate was 24.3 per 1,000 child-years, an d acute case fatality was 15.7%. There was not significantly increased mortality in survivors of the acute phase of measles compared with co ntrols (rate ratio = 1.22, 95% confidence interval (CI) 0.65-2.30), Re ported incidence rates and case fatality were higher in families with low paternal education, in the dry season, and in unvaccinated childre n, and case fatality was higher in malnourished children, There was no sex difference in incidence, but acute case fatality was somewhat hig her in girls than boys (adjusted odds ratio = 1.3, 95% CI 0.9-2.1), Me asles incidence was lower in vitamin A-supplemented groups (23.6 per 1 ,000 child-years) than in placebo groups (28.9 per 1,000 child-years), but this difference was not statistically significant (p = 0.33). Amo ng 946 measles cases in clusters randomized to receive vitamin A or pl acebo, there was no marked difference in acute measles case fatality b etween vitamin a-supplemented and placebo groups (15.4% vs, 14.5%, res pectively). The biologic effects of vitamin A supplementation on the s ubsequent clinical manifestations and severity of measles need further elucidation.