title: Young children non-immunized against measles: characteristics and programmatic implications.
abstract: OBJECTIVE
  To examine the presenting characteristics, including nutritional status, of young children without measles immunization and to suggest appropriate public health measures to improve immunization status.
  
  
  METHODS
  In this retrospective case-control analysis, we studied 4075 children aged 12-23 mo of either sex, who attended ICDDR,B's Dhaka hospital during 1994-2003. Cases included children who reported to this facility without receiving measles vaccine, and the control children were those who received the vaccine.
  
  
  RESULTS
  3181 of 4075 (78%) children, including 1227 (39%) girls and 1954 (61%) boys, received measles immunization. The proportion of vaccinated children increased from 74% in 1997 to 82% in 2001. Some non-specific effects of measles immunization were observed. Fifty-one per cent of the children without measles immunization were stunted, 76% were underweight, and 48% were wasted. The non-immunized children were twice as likely to be stunted, underweight, and wasted than the immunized children; they were more often dehydrated (some or severe dehydration) (28% vs 22%, p<0.001), required longer duration (>72 h) of hospitalization (15% vs 10%, p<0.001), did not receive vitamin A capsule in the previous 6 mo (56% vs 36%, p<0.001), and had more frequent abnormal lung auscultation indicative of acute lower respiratory tract infections (8% vs 5%, p<0.001). Female children, illiterate mother, lack of vitamin A supplementation, and history of measles were significantly associated with non-immunization against measles after controlling for co-variables. Results were similar when different nutritional indicators (underweight, stunting, or wasting) were added separately to logistic regression models.
  
  
  CONCLUSIONS
  Intervention strategies to enhance immunization coverage in infants should target illiterate mothers and their children, particularly the females and malnourished ones, provide them with measles immunization and vitamin A capsule, and encourage their periodic follow-up visits as part of a preventive nutritional programme.
authors.affiliation: Clinical Sciences Division, ICDDR,B: Centre for Health and Population Research, GPO Box 128, Dhaka 1000, Bangladesh.
authors.forename: F
authors.initials: F
authors.lastname: Chowdhury
authors.forename: Ashraful I
authors.initials: AI
authors.lastname: Khan
authors.forename: Mohammad I
authors.initials: MI
authors.lastname: Hossain
authors.forename: M A
authors.initials: MA
authors.lastname: Malek
authors.forename: A S G
authors.initials: AS
authors.lastname: Faruque
authors.forename: Tahmeed
authors.initials: T
authors.lastname: Ahmed
authors.forename: Mohammad A
authors.initials: MA
authors.lastname: Salam
mesh_terms: D001459:Bangladesh; D019587:Dietary Supplements / Q000706:statistics & numerical data; D004522:Educational Status; D005260:Female; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data*; D007223:Infant; D008297:Male; D008457:Measles / Q000517:prevention & control*; D008458:Measles Vaccine; D009752:Nutritional Status; D012189:Retrospective Studies; D012737:Sex Factors; D014611:Vaccination / Q000706:statistics & numerical data*; D014801:Vitamin A
chemical_list: D008458:Measles Vaccine; D014801:Vitamin A