Magnétisme. English. 7303

Includes bibliographical references and indexes.2 v.

Risk factors for measles mortality and the importance of decentralized case management during an unusually large measles epidemic in eastern Democratic Republic of Congo in 2013.

In 2013, a large measles epidemic occurred in the Aketi Health Zone of the Democratic Republic of Congo. We conducted a two-stage, retrospective cluster survey to estimate the attack rate, the case fatality rate, and the measles-specific mortality rate during the epidemic. 1424 households containing 7880 individuals were included. The estimated attack rate was 14.0%, (35.0% among children aged <5 years). The estimated case fatality rate was 4.2% (6.1% among children aged <5 years). Spatial analysis and linear regression showed that younger children, those who did not receive care, and those living farther away from Aketi Hospital early in the epidemic had a higher risk of measles related death. Vaccination coverage prior to the outbreak was low (76%), and a delayed reactive vaccination campaign contributed to the high attack rate. We provide evidences suggesting that a comprehensive case management approach reduced measles fatality during this epidemic in rural, inaccessible resource-poor setting

Nagaland health assessment: High mortality rates and difficulty accessing essential health services in Lahe Township, Republic of the Union of Myanmar.

IntroductionLahe Township belongs to Myanmar`s Naga Self-administered Zone, which is one of the most remote and mountainous areas in Myanmar. However, the limited health data available for the region suggests that there could be neglected health needs that require attention. The purpose of this study was to assess the health status of the population of Lahe Township.MethodsA cross-sectional study design incorporating a two-stage cluster sampling methodology recommended by the WHO was used to conduct a household level survey. In the first stage, 30 village clusters were selected from all villages situated in the Lahe Township through systematic sampling with probability of selection proportional to the population size of each village based on the 2014 Myanmar census. In the second stage, a GPS-based sampling method was used to select 30 households within a village cluster. The head of the household completed the survey for all members of the household. Questionnaires inquired about maternal health, mortality, morbidities, childhood nutritional status, access to health care, and water & sanitation. The resulting data was stratified by urban/rural status.ResultsData was collected on 5,929 individuals living in 879 households, of which 993 individuals (16.7%) were children 5 years old or younger. The median age was 18.0 (IQR 8.0-35.0). Children 15 years old or younger represented 44.7% of the population. 19.8% of households reported at least 1 household member sick during the previous 30 days. The crude mortality rate per 10,000 people per day was 0.58 (95% CI: 0.48-0.69). The under 5 mortality per 10,000 people per day was 0.74 (95% CI: 0.50-1.06). Only 46.7% of households could access a hospital if there was a need.ConclusionOur results demonstrate a high rate of mortality and the inability to access healthcare in Lahe Township, which should be addressed to prevent further deterioration of health

Risk factors for measles mortality and the importance of decentralized case management during an unusually large measles epidemic in eastern Democratic Republic of Congo in 2013 - Fig 2

<p><b>Geospatial representation of CFR from December 25th, 2012 to February 28th 2013 (A), and from March 1st, 2013 to October 9th, 2013 (B) , Aketi Health Zone, Province Orientale, Democratic Republic of Congo.</b> The white cross is at the location of the central hospital of Aketi. The scale represent the CFR expressed in %. The 40 dots represent the cluster locations.</p

Measles vaccination coverage, children 9 to 59 months old, Aketi Health Zone, Province Orientale, Democratic Republic of Congo, October 2013.

<p>Measles vaccination coverage, children 9 to 59 months old, Aketi Health Zone, Province Orientale, Democratic Republic of Congo, October 2013.</p

Suspected measles cases by week, Aketi Health Zone, Province Orientale, DRC, 2013 (source: MSF and MoH).

<p>Suspected measles cases by week, Aketi Health Zone, Province Orientale, DRC, 2013 (source: MSF and MoH).</p

Measles attack rate by age, December 25, 2012 to October 9, 2013, Aketi Health Zone, Province Orientale, Democratic Republic of Congo.

<p>Measles attack rate by age, December 25, 2012 to October 9, 2013, Aketi Health Zone, Province Orientale, Democratic Republic of Congo.</p