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 from 2013-2019. From total cases 2147(50.6%) are male and 2094(49.4%) ware females. Mean age of case patients are 7.15 and standard deviation is 8.95. Age group 1-4years were 1685 (39.7%) followed by 5-15and 16-35 with 1260(29%) and 649(15.3%) respectively. (Table 1)
Table 1 Measles cases by age categories and sex 2013-2019 Bale zone
Age category
|
Male
|
Percent
|
Female
|
Percent
|
Total
|
Percent
|
<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 total reported measles cases 2147(50.6%) were males and 2094(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. The trained shows almost cases are equal among both sexes with slight difference in 2013, 2015 and 2019 as shown in figure 2
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 highest PR 4.29/1000 in 2019. The prevalence rate was low among greater than 15 years with greatest Prevalence of 0.73/1000 observed in 2019 (Table 2).
Table 2 Age specific prevalence/10000 population of measles Bale zone
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 4241 cases the highest proportion of measles prevalence were reported from Ginir district followed by Gololcha and Lega Hidha by 77/10000, 45.4/10000 and 38.4/10000 population respectively. The lowest proportions of measles prevalence were reported from Gura dhamole, Gasara, Agarfa, and Berbere with a prevalence of 0.6/10000, 0.9/10000, 1.4/10000 and 1.6/10000 population respectively as shown in (figure3).
Geographical distributionof measles
Regarding measles cases by place of residence the highest number of cases are reported from rural areas of the zone 3 642(85.8%) cases and low among urban residents 599(14.1%)
Trend of measles by month
The highest number of measles cases are reported during autumn ((June 1344(31.6%), May 934(22%) and April 545(12%)) Season of the year and reaches peak level in May. Low number of cases were reported in summer season (October November and September with 85(2%), 41(0.97%) and 98(2.3%)) cases respectively as shown in Figure 5.
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 case was reported in year 2017 which is 7.2 / 100000 and in 2013 which was 11.4 / 100000 populations (figure 6)
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 3060 (72.1%) were epidemiologically linked. Clinically compatible cases are 497(11.3%) of total cases.
Measles laboratory result
During 2013-2019, 993 samples were sent to central laboratory for confirmation and about 248(24.9%) were measles IgM positive and the highest numbers of samples are discarded 375 (37.7%). Only 137(13.8%) cases are negative for measles IgM. (Figure 8)
Inpatient and Outpatient cases
From 2013-2019 years periods 582 (13.2%) measles cases were admitted and 3659 (86.2%) suspected measles cases were treated as an outpatient level. The overall admission rate from the cases was 15.9 %.
Measles Case Fatality Rate
Case fatality by sex
From 2013-2019G.C there are 4241measles suspected cases were reported with a case fatality rate of 3 .07/1000 population. The highest CFR was reported in 2016 among females with CF of 6.6/1000 and in 2015 greatest CF among male cases was occurred 4.7/1000. Fatality was high among females than males with CCFR of 3.3/1000 among females and 2.8/1000 among males respectively. There was no death reported in 2013, 2017 and 2018. From reported death the highest numbers of deaths are reported in 2019 among both sexes 4(66.6%) of death among male and 5(71.4%) of death among females. Regarding mortality of measles by place the highest numbers of measles related deaths are reported from Ginir 9(69.2 %%), D/serer4 (30.8%) and Sewena 15(15.4%).
Case Fatality by Age
Case fatality by age group showing of high case fatality rate of 4/1000 among less than one year of age followed by 3.8/1000 case fatality among 5-15 age category and low among age group of greater than 16 years. As age increase, the fatality of the case is decrease.
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 4.4/1000 populations. The fatality was zero in 2013, 2017 and 2018. (Figure 10)
Vaccination status
Out of the 4241 total case patients 2620(62%) of cases are vaccinated from which 1480(34.4%) ,1032(24.3%) and 108(2.5%) have received a single, two and three doses respectively. There were 890(21%) case patients with no vaccination history and 731(17.2%) of the case patients have unknown vaccination status. (Table 3)
Table 3 Table showing vaccination status of measles cases by sex from 2013-2019 Bale Zones 2019 G.C
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
|
Vaccination Status by Place
Regarding unknown vaccination status 390(53.4%) are from Ginir and 107(14.6%) are from Gololcha. From vaccinated Ginir, Gololcha and Sewena reported 981(37.4%), 400(15.3) and 213(8.1%) Sewena respectively. The highest proportion of zero doses are reported from Ginir 443 (44.3%), 88 (9.9%) from Dawe Serer and 82(92%) from Lega hida
Vaccination Status by Time
Concerning vaccination status of measles cases, from a total of 890 un vaccinated cases the highest percentage of unvaccinated cases are reported in 2019 and 2014 with 73.3% and 8.7% respectively. Regarding those who have vaccination history the highest percentage of single dose and two doses are reported in 2019 and 2015 with 67.9%, 68% and 7.2% and 14% respectively. Lower percentage of single dose and two doses are reported in 2014 2% single dose and 1.5% of two doses. Forty one percent of unknown vaccination statuses also reported in 2019.
Measles Data Type
From 4241 suspected measles cases, 903 (21%) of the cases were reported by case based an3d 3312(64.9%) by line list.