The impact of measles immunization campaigns in India using a nationally representative sample of 27,000 child deaths
- St Michael's Hospital, Canada
- King George's Medical University, India
- Government of India, India
- Postgraduate Institute of Medical Education and Research, India
- National Institute of Medical Statistics, Indian Council of Medical Research, India
Abstract
India comprises much of the persisting global childhood measles mortality. India implemented a mass second-dose measles immunization campaign in 2010. We used interrupted time series and multilevel regression to quantify the campaign's impact on measles mortality using the nationally representative Million Death Study (including 27,000 child deaths in 1.3 million households surveyed from 2005–2013). 1–59-month measles mortality rates fell more in the campaign states following launch (27%) versus non-campaign states (11%). Declines were steeper in girls than boys and were specific to measles deaths. Measles mortality risk was lower for children living in a campaign district (OR 0.6, 99%CI 0.4–0.8) or born in 2009 or later (OR 0.8, 99%CI 0.7–0.9). The campaign averted up to 41,000–56,000 deaths during 2010–13, or 39%–57% of the expected deaths nationally. Elimination of measles deaths in India is feasible.
Data availability
Under legal agreement with the Registrar General of India, the MDS data cannot be redistributed outside of the Centre for Global Health Research. To request MDS data access procedures or to set up a data transfer agreement, please contact the Office of the Registrar General, RK Puram, New Delhi, India (rgoffice.rgi@nic.in). The public census reports can be found at http://www.censusindia.gov.in/vital_statistics/SRS_Statistical_Report.html. Source data files have been provided for Figures 1,2,3,4, Figure 1 - figure supplement 1, and Table 2. National survey data (from Figure 5) can be obtained free of charge from the following websites: http://rchiips.org/nfhs/NFHS-4Report.shtml (NFHS-4); http://rchiips.org/nfhs/report.shtml (NFHS-3); http://rchiips.org/DLHS-4.html (DLHS-4); http://rchiips.org/prch-3.html (DLHS-3); and http://rchiips.org/state-report-rch2.html (DLHS-2).
Article and author information
Author details
Funding
Canadian Institutes of Health Research (FDN154277)
- Prabhat Jha
Bill and Melinda Gates Foundation
- Prabhat Jha
National Institutes of Health (R01TW05991-01)
- Prabhat Jha
External funding is from the Canadian Institutes of Health Research (http://www.cihr-irsc.gc.ca, Grant FDN154277), the US National Institutes of Health (https://www.nih.gov, Grant R01TW05991-01), and the Bill and Melinda Gates Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Ethics
Human subjects: Ethics approval for the MDS was obtained from the Post Graduate Institute of Medical Research, St. John's Research Institute and St. Michael's Hospital, Toronto, Ontario, Canada. Consent procedures have been published earlier (Gomes et al., 2017; Jha et al., 2006a; Registrar General of India, 2016).
Copyright
© 2019, Wong et al.
This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.
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The impact of measles immunization campaigns in India using a nationally representative sample of 27,000 child deaths
eLife 8:e43290.
https://doi.org/10.7554/eLife.43290
Further reading
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Measles vaccination campaigns have saved the lives of about 50,000 Indian children in three years.
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- Epidemiology and Global Health
Background:
Biological aging exhibits heterogeneity across multi-organ systems. However, it remains unclear how is lifestyle associated with overall and organ-specific aging and which factors contribute most in Southwest China.
Methods:
This study involved 8396 participants who completed two surveys from the China Multi-Ethnic Cohort (CMEC) study. The healthy lifestyle index (HLI) was developed using five lifestyle factors: smoking, alcohol, diet, exercise, and sleep. The comprehensive and organ-specific biological ages (BAs) were calculated using the Klemera–Doubal method based on longitudinal clinical laboratory measurements, and validation were conducted to select BA reflecting related diseases. Fixed effects model was used to examine the associations between HLI or its components and the acceleration of validated BAs. We further evaluated the relative contribution of lifestyle components to comprehension and organ systems BAs using quantile G-computation.
Results:
About two-thirds of participants changed HLI scores between surveys. After validation, three organ-specific BAs (the cardiopulmonary, metabolic, and liver BAs) were identified as reflective of specific diseases and included in further analyses with the comprehensive BA. The health alterations in HLI showed a protective association with the acceleration of all BAs, with a mean shift of –0.19 (95% CI −0.34, –0.03) in the comprehensive BA acceleration. Diet and smoking were the major contributors to overall negative associations of five lifestyle factors, with the comprehensive BA and metabolic BA accounting for 24% and 55% respectively.
Conclusions:
Healthy lifestyle changes were inversely related to comprehensive and organ-specific biological aging in Southwest China, with diet and smoking contributing most to comprehensive and metabolic BA separately. Our findings highlight the potential of lifestyle interventions to decelerate aging and identify intervention targets to limit organ-specific aging in less-developed regions.
Funding:
This work was primarily supported by the National Natural Science Foundation of China (Grant No. 82273740) and Sichuan Science and Technology Program (Natural Science Foundation of Sichuan Province, Grant No. 2024NSFSC0552). The CMEC study was funded by the National Key Research and Development Program of China (Grant No. 2017YFC0907305, 2017YFC0907300). The sponsors had no role in the design, analysis, interpretation, or writing of this article.
