title: Measles mortality in high and low burden districts of India: estimates from a nationally representative study of over 12,000 child deaths.
abstract: BACKGROUND
  Direct estimates of measles mortality in India are unavailable. Our objective is, to use a nationally-representative study of mortality to estimate the number and distribution of, measles deaths in India with a focus on 264 high burden districts.
  
  
  METHODS
  We used physician coded verbal autopsy data from the Million Death Study which surveyed, over 12,000 deaths in children aged 1 month to under 15 years from 1.1 million nationally, representative households in 2001-2003.
  
  
  RESULTS
  We estimate there were 92,000 (99% CI 63,000-137,000) measles deaths in children 1-59, months of age in India in 2005, representing a mortality rate of 3.3 (99% CI 2.3-5.0) per 1000 live, births and about 6% of all 1-59 month deaths. In children under 15 years of age, there were 107,000, (99% CI 74,000-158,000) measles deaths. The measles mortality rate was nearly 70% greater in girls, than in boys, and 60% of the deaths were in three populous states Uttar Pradesh, Bihar, and Madhya, Pradesh. The 1-59 month measles mortality rate in high burden districts was 4.48 (99% CI 3.94-5.02) compared to 2.40 (99% CI 2.28-2.52) per 1000 live births in other districts.
  
  
  CONCLUSIONS
  Measles killed over 100,000 children in India in 2005 and girls were at higher risk than boys. The majority of measles deaths occurred in a few states and high burden districts. The results of this study highlight the importance of focusing measles supplementary immunization activities in high burden districts.
authors.affiliation: Centre for Global Heath Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada; Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada and Department of Pediatrics, University of Toronto, 555 University Avenue, Toronto, Ontario, M5G1X8, Canada. Electronic address: shaun.morris@sickkids.ca.
authors.forename: Shaun K
authors.initials: SK
authors.lastname: Morris
authors.forename: Shally
authors.initials: S
authors.lastname: Awasthi
authors.forename: Rajesh
authors.initials: R
authors.lastname: Kumar
authors.forename: Anita
authors.initials: A
authors.lastname: Shet
authors.forename: Ajay
authors.initials: A
authors.lastname: Khera
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Nakhaee
authors.forename: Usha
authors.initials: U
authors.lastname: Ram
authors.forename: Jose R M
authors.initials: JR
authors.lastname: Brandao
authors.forename: Prabhat
authors.initials: P
authors.lastname: Jha
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D008297:Male; D008457:Measles / Q000401:mortality*; D012307:Risk Factors; D016019:Survival Analysis
keywords: Childhood; Immunization; India; Measles; Mortality; Vaccine