title: Validity of measles mortality data using hospital registers and community surveys.
abstract: BACKGROUND
  Case-fatality rates (CFR) for measles cases have previously been reported to be higher in hospital than in community studies.
  
  
  METHODS
  Data on measles morbidity and mortality obtained in community investigations of measles outbreaks in two rural districts in Kenya were compared to data from the same time period on measles morbidity and mortality in children hospitalized with measles in the respective district hospitals.
  
  
  RESULTS
  The CFR were found to be considerably lower in the respective district hospitals, 1.7 and 2.1%, than in the community surveys, 8.0% and 9.4%, respectively (relative risk [RR] 0.17, 95% confidence interval [CI] 0.10-0.30, and RR = 0.20, 95% CI: 0.05-0.81).
  
  
  CONCLUSIONS
  Hospital-based studies of the CFR in measles infection are not representative of measles mortality in the community. It may be misleading to use hospital data in measles control surveillance systems. Further studies are needed of the mortality after discharge of hospitalized measles cases.
authors.affiliation: Department of International Health and Social Medicine, Karolinska Institute, Kronan Health Centre, Sundbyberg, Sweden.
authors.forename: B
authors.initials: B
authors.lastname: Burström
authors.forename: P
authors.initials: P
authors.lastname: Aaby
authors.forename: D M
authors.initials: DM
authors.lastname: Mutie
mesh_terms: D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003153:Community Health Services; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007630:Kenya / Q000453:epidemiology; D008457:Measles / Q000453:epidemiology / Q000401:mortality*; D011159:Population Surveillance / Q000379:methods*; D012042:Registries; D015203:Reproducibility of Results