Synergistic impact of measles and diarrhoea on nutrition and mortality in Bangladesh

Abstract

The association between measles and diarrhea and their effects on weight and mortality were assessed in a prospective household survey in southeast Bangladesh from August 1975 to July 1976. A total 5775 children in 12 villages were checked weekly. Nutritional status was determined by height and weight at 2 month intervals. Measles epidemics occurred in 2 villages. 923 cases of measles were recorded, 97% in children under 10 years. There were 33 deaths within 30 days of the appearance of rash, a case fatality rate of 3.7% among children. Prolonged diarrhea was the most common complication in fatal cases; pneumonia was the next most common complication. In this population, mortality from measles-associated illness was not related to nutritional status, since in a case-control comparison, the children who died did not differ in nutritional status from controls before their illness. In the 2 largest villages, 2% of measles cases not complicated with diarrhea died, compared to 12% who died of diarrhea with measles (p.0005). This 4-fold mortality suggests that measles and diarrhea combine synergistically to increase mortality. Surviving children with prolonged diarrhea and the greatest weight loss failed to catch up in growth compared to their peers. Until an extensive measles vaccination program is initiated in Bangladesh, nutritional intervention should be aimed at young children convalescing from measles