EXPANDED PROGRAMME ON IMMUNIZATION
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EXPANDED PROGRAMME ON IMMUNIZATION
TRAINING COURSE ON PLANNING
AND MANAGEMENT
GILL TREMLETT
Disease
Estimates:
Measles
WORLD HEALTH ORGANIZATION
TABLE OF CONTENTS
Page
...........................................................................................................................
M-l
ESTIMATE THE ANNUAL INCIDENCE AND INCIDENCE RATE
OF MEASLES......................................................................................................................
M-2
Exercise A......................................................................................................................
M-3
Exercise B......................................................................................................................
M-5
ESTIMATE THE ANNUAL MORTALITY AND MORTALITY RATE
OF MEASLES.....................................................................................................................
M-6
Exercise C.....................................................................................................................
M-8
Exercise D.....................................................................................................................
M-12
ESTIMATE THE FREQUENCY OF VARIOUS TYPES OF
DISABILITIES FROM MEASLES ..............................................................................
M-14
Exercise E.....................................................................................................................
M-15
DETERMINE IF SEASONAL VARIATIONS OCCUR IN THE
INCIDENCE OF MEASLES ............................................................................................
M-16
Exercise F.....................................................................................................................
M-1.7
CONCLUSION..............................................................................................................................
M-18
SELECTED DATA ON FICTITIA
M’19 to M"23
ANNEX.............................................................................................................................................
M"25
INTRODUCTION
1.0
2.0
3.0
4.0
MEASLES
INTRODUCTION
Measles is an infectious disease characterized by rash, fever, and cough.
It is particularly severe in many developing countries and is one of the major
causes of childhood mortality in some countries.
To estimate the importance of measles in a country, the following steps should
be performed:
1.0
Estimate the annual incidence and incidence rate of measles.
2.0
Estimate the annual mortality and mortality rate of measles.
3.0
Estimate the frequency of various types of disability from measles.
4.0
Determine if seasonal variations occur in the incidence of measles.
This booklet provides detailed guidelines for performing each of these steps.
It also includes practice exercises which require you to perform the steps
using data on Fictitia.
Fold out pages M-19 to M-23, which contain selected data
on measles for Fictitia.
You will use these data to complete the exercises
in the booklet.
Do not read through the entire booklet first, but complete
the exercises and fill in the data for Fictitia as you go along.
M-l
1.0
ESTIMATE THE ANNUAL INCIDENCE AND INCIDENCE RATE OF MEASLES.
The incidence of measles is the number of new cases of the disease in
a defined population during a given time period (for example, one year).
The incidence rate of measles is the frequency of new cases of the
disease in a defined population during a given time period.
Incidence
rate of measles is expressed as the number of new cases of the disease
per 100,000 population.
Serologic surveys have shown that in almost every country without an
immunization programme, virtually every child gets measles.
Therefore,
the average annual incidence of the disease approximates the number of
live births minus the number of children who die before they get measles.
In other words, if the infant mortality rate is 100 per 1000 live births,
90% of the live births would survive to one year of age, after which they
would be likely to get measles.
The procedures for estimating the annual incidence rate and incidence
of measles are described below.
Annual Incidence Rate Per 100,000 Population:
•
Birth
rate
X
Percent of live
births surviving
to 1 year
x
=
100,000
Annual
incidence
rate
Annual Incidence:
•
Annual
incidence
rate
t
100,000
x
M-2
Population
=
Annual
incidence
Exercise A
In this exercise you will estimate the annual incidence rate of measles in
Fictitia.
You will then use this rate to estimate the annual incidence of
measles in the country as a whole and in the Delta Region of the country.
o
Read and follow the instructions carefully.
•
Write your answers in the spaces provided.
©
When you need data, refer to page M-19 in this booklet.
®
If you have questions, consult with a Course Facilitator.
1.
To estimate the annual incidence rate of measles per 100,000 population
in Fictitia:
a.
Record the birth rate in Fictitia (expressed as a
decimal).
b.
Record the percent of live births surviving to one
year (expressed as a decimal).
c.
Multiply vour answer to (a) times your answer to
(b).
6'
x
C*'
(a)
(b)
d.
0• b
Multiply your answer to (c) times 100,000.
2-‘
2.
=
-
x 100,000
To estimate the annual incidence of measles in Fictitia:
a.
Record the annual incidence rate of measles per
100,000 population in Fictitia (from Step Id).
b.
Divide your answer to (a) by 100,000.
3
t
100,000
(a)
c.
Record the total population in Fictitia.
d.
Multiply your answer to (b) times your answer to
(c).
b - ? \ {? x
(b)
(c)
M-3
=
-C t
3.
To estimate the annual incidence of measles in the Delta Region:
a.
Record the annual incidence rate of measles per
100,000 population in Fictitia (from Step Id).
b.
Divide your answer to (a) by 100,000.
100,000
(a)
c.
Record the total population in the Delta Region.
d.
Multiply your answer to (b) times your answer to
(b)
M-4
Exe rc i se B
In this exercise you will compare the estimated annual incidence of measles
in each region of Fictitia with the reported annual incidence in each region.
•
Read and follow the instructions carefully.
•
Write your answers in the spaces provided.
•
When you need data, refer to page M-19 in this booklet.
•
If you have questions, consult with a Course Facilitator.
1.
Record on Table 1, below, the reported annual incidence of measles in
each region of Fictitia.
2.
Record on Table 1 the estimated annual incidence of measles in the Delta
Region (from Exercise A, Step 3d, page M-4).
To save you time, the
estimated annual incidence of measles for the Coastal, Highland, and
Mountain Regions have already been calculated for you and recorded on
the table.
3.
Calculate ’’Reporting Completeness" by dividing the reported incidence
for each region by the estimated incidence for that region.
Then multiply
those, figures times 100 to convert your answers to percentages.
these figures on Table 1 in the last column.
Record
These figures for reporting
completeness reflect the percentage of actual cases of measles reported
in each region.
For example, if reporting completeness for a region is
8%, this means that only 8% of actual cases of measles in the region are
reported.
Do some regions seem to have more reliable reporting systems than others?
If yes, explain.
TABLE 1:
Region
_ -PeltA
Coastal
__H_ig_hla_nd
_ M°unfain _
REPORTING COMPLETENESS OF INCIDENCE
Estima ted
Inc idenee
Repor ted
Inc idence_
____ 6________
2.6
.. a
OTTT-' _ .
____
_____ 7..14
Reporting
Completeness
___
____ ..
____
.. - P.-.Q
____
_j
4. <2 2.
When you have completed Exercise B, discuss your
work on Exe r c_ise_s _A and .A-VAAV. A P?ArAA Fac i l_i t a t o r.
M-5
2.0
ESTIMATE THE ANNUAL MORTALITY AND MORTALITY RATE OF MEASLES.
A critical factor in determining the significance of measles as a health
problem in a country is the mortality resulting from the disease.
Because
routine reporting of measles mortality is rarely accurate, other methods
must be used to estimate mortality.
Estimates can be made using outpatient
records at sentinel sites, but data obtained from these records will be
Inpatient records are even less useful because
very rough estimates.
they include primarily the more severe cases of measles.
Since measles mortality varies significantly with age, estimates of
measles mortality are more accurate when based on age distribution of
cases data and age-jpecific case fatality rates (the percentage of cases
that result in death in each age group) .
In order to make reasonable
estimates of age-specific case fatality rates of measles, a group of
measles cases in selected areas should be followed for outcome.
If both age-specific case fatality rates and age distribution of cases
data are available, the process described below can be used to estimate
the annual mortality and mortality rate of measles.
Annual Mortality:
o
•
•
Annual
inc idence
Percentage distribution
of cases by age
X
Annual
age-speciric
incidence
Annual
mortality for
first age group
Age-specific case
°
r
fatality rate
x
+
=
=
Annual
mortality for
all other
age groups
Annual
age-specific
inc idence
Annual
age-specif ic
mortality
Annual
mortality
Annual Mortality Rate per 100,000 Population:
•
Annual
mortality
Population
x
100,000
Annual mortality
rate
If either age-specific case fatality rates or age distribution of cases
data are not available, estimates of measles mortality can still be made
but they will be less accurate.
These less accurate estimates can be made
if both overall case fatality rates and overall incidence data are
available.
The following process (page M-7) can be used to make these
M-6
less accurate estimates of the annual mortality and mortality rate
of measles.
Annual Mortality:
•
Annual
incidence
x
Case fatality
rate
=
Annual
mortality
Annual Mortality Rate Per 100,000 Population:
g
.
,
Annual
..
mortality
.
-
„
,
.
Population
x
M-7
Annual
,.
100,000
=
mortality
rate
Exercise C
In this exercise you will estimate the annual mortality and mortality rate
of measles in the Delta Region of Fictitia.
•
Read and follow the instructions carefully.
•
Write your answers in the spaces provided.
•
When you need data, refer to pages M-19 and M-21.
•
If you have questions consult with a Course Facilitator.
1.
To estimate the annual mortality from measles in the Delta Region:
a.
Record the annual incidence of measles in the Delta Region (from
Step 3d, page M-4) on Table 2 on page M-9 at the bottom of the column
titled ’’Age-Specific Incidence.”
b.
Record the percentage distribution of cases by age in the Delta Region
on Table 2 in the column titled ”% Distribution by Age.” Express
each percentage as a decimal. These percentages can be obtained from
studies of outpatient records. If percentages are available only for
the entire country or for a region in Fictitia other than the Delta
Region, assume that those percentages also apply to the Delta Region.
c.
Multiply the percent of cases in children aged 0-2 months (in the
column titled ”% Distribution by Age”) times the annual incidence
of measles (at the bottom of the column titled "Age-Specific Incidence”).
Record this figure in the column titled "Age-Specific Incidence."
d.
Repeat Step (c) above, for the remaining age groups and record your
answers in the column titled "Age-Specific Incidence."
e.
Record the age-specific case fatality rates for measles in the Delta
Region on Table 2 in the column titled "Age-Specific Case Fatality
Rate." Express the rates as decimals. These rates can be obtained
from studies of outpatient records.
If rates are available only for
the entire country or for a region in Fictitia other than the Delta
Region, assume that those rates also apply to the Delta Region.
f.
Multiply the age-specific incidence for the 0-2 month age group (in
the column titled "Age-Specific Incidence") times the case fatality
rate for the 0-2 month age group (in the column titled "Age-Specific
Case Fatality Rate"). Record your answer in the last column titled
"Age-Specific Mortality."
g.
Repeat Step (f) for the remaining age groups and record your answers
in the column titled "Age-Specific Mortality.”
h.
Add the figures in the column titled "Age-Specific Mortality," and
record your answer at the bottom of that column.
M-8
AGE DISTRIBUTION OF MEASLES INCIDENCE AND
MORTALITY IN THE DELTA REGION OF FICTITIA
TABLE 2:
Age
Dis tri but ion
By Age
0-2 mos
o____ i
0
---------------
9-14 mos
0 - ze
? 2^'6
; 15-35 mos
I-------------------
0 • W
3 yrs +
;
Total
AgeSpec i f i c
Mortal Ity
Age-Speci f ic
Case Fatality
Rate
(j
3-8 mos
2.
Age- /
Specific
Incidence
!
bZZ
O ■ ao
I b-C
hc-o
To estimate the annual mortality rate of measles per 100,000 population
in the Delta Region:
a.
Record the total annual mortality from measles in
the Delta Region (from Table 2).
b.
Record the population in the Delta Region.
c.
Divide your answer to (a) by your answer
to (b).
^36
:
(aj
d.
/O6
•
■
*? /
O •
I CW ''rJ7'
"'j
■ -■ - '■* - - ■
- -/ -
=
(b)
Multiply your answer to (c) times 100,000.
x 100,000
0
(c)
3.
Fold out page M-ll.
Table 3 contains data on the distribution of measles
incidence and mortality in the Coastal, Highland, and Mountain Regions.
Table 4 contains data on the mortality rate of measles in each of these
regions.
All figures on these two tables were calculated using the
same process described in Steps 1 and 2 for the Delta Region.
Using your calculations for the Delta Region and the tables on page M-ll,
compare the percentage distribution of cases among the 4 regions of
Fictitia.
Are there any differences?
why you think these differences exist.
M-9
If so, explain in the space below
DISEASE ESTIMATES:
MEASLES
—BLE 3:—AGJ^piSTRIBUTION of measles incidence and mortality
"1
A g e -sp e c ific
M o rta lity
0.04
—
?*
j
0.50
180,000
0.05
9,000
0.30
43,200
0.05
2,160
0.10
3,600
0.05
180
0.30
108,000
0.03
3,240
0.40
57,600
0.03
1,728
0.40
14,400
0.03
432
—
—
0.01
—
0.20
28,800
0.01
288
0.50
18,000
0.01
180
—
360,000
—
15,120
—
144,000
—
4,752
—
36,000
—
792
0 ■
5 .
—
TOTAL
MEASLES MORTALITY
Mortality Rate*
Mortality
Population
Coastal
15,120
10,000,000
151.2
Highland
4,752
4,000,000
118.8
Mountain
792
1,000,000
79.2
21,600
16,000,000
135
Region
Delta
TOTAL
"per 100,000 population
M-ll
7
O
%
A ge-spec i f i c
by Age
7
>
TABLE 4:
In c id e n c e
—
by Age
—
M o rta lity
576
R ate
0.04
A ge-spec if ic
14,400
A g e -sp e c if ic
In c id e n c e
0.10
by Age
2,880
A g e -sp e c if ic
0.04
A g e -s p e c ific
In c id e n c e
72,000
A g e -s p e c ific
M o r ta lity
A ge-spec if ic
Case F a ta lity
R ate
D is tr ib u tio n
A g e -sp e c if ic
D is tr ib u tio n
—
C ase F a ta lity
R ate
M o rta lity
D is tr ib u tio n
C ase F a ta lity
R ate
—
A ge-spec if ic
3 yrs. +
—
0.20
3-8 mos.
15-35 mos.
—
—
0-2 mos.
9-14 mos.
—
MOUNTAIN REGION
—■
A g e -s p e c ific
A g e -s p e c ific
In c id e n c e
by Age
/ D is tr ib u tio n
Age
HIGHLAND REGION
COASTAL REGION
Case F a ta lity
delta region
—- --------------------- -
—
Exercise D
In this exercise you will compare the estimated annual mortality from measles
in each region of Fictitia with the reported annual mortality in each region.
•
Read and follow the instructions carefully.
•
Write your answers in the spaces provided.
•
When you need data, refer to page M-19 in this booklet.
•
If you have questions, consult with a Course Facilitator.
1.
Record on Table 5 on the next page, the reported annual mortality from
measles in each region of Fictitia.
2.
Record on Table 5 the estimated annual mortality from measles in the Delta
Region (from Exercise C, Step Ih, page M-8).
To save you time, the
estimated annual mortality from measles for the Coastal, Highland, and
Mountain Regions have already been calculated for you and recorded on the
table.
3.
Calculate ’’Reporting Completeness” by dividing the reported mortality
for each region by the estimated mortality for that region.
Then multiply
those figures times 100 to convert your answers to a percentage.
these figures on Table 5 in the last column.
Record
These figures for reporting
completeness reflect the percentage of actual deaths from measles that
are reported in each region.
For example, if reporting completeness for
a region is 2%, this means that only 2% of actual deaths from measles in
the region are reported.
4.
Do some regions seem to have more reliable reporting systems than others?
If yes, explain.
* . , -I *
M-12
5.
Compare reporting completeness of measles incidenee in Fictitia (from
page M—5) with reporting completeness of measles mortality in the coun
Are there any differences?
If so, explain in the space below why you
think these differences exist.
TABLE 5:
Region
Delta
Coastal
Highland
Mountain
REPORTING COMPLETENESS OF MORTALITY
Repor ted
Mor tality
______ / Cc
y r. 'r.
f Cl !
t 2C
Estimated
Mortality
Reporting
Completeness
^b
15,120
4,752
792
[b-ol
76-'?
3e • ?
lu
x.
Q,’
hl C -
u
!-
'When you have completed Exercise D, discuss your work
on Exercises C and D with a Course Facilitator.
M-13
-
3.0
ESTIMATE THE FREQUENCY OF VARIOUS TYPES OF DISABILITIES FROM MEASLES.
Measles sometimes results in serious short- and long-term disabilities,
such as pneumonia, damage to one or both eyes or ears, and under
nutrition (especially kwashiorkor).
The frequency of disability, although
difficult to determine accurately, is a factor which contributes to the
importance of measles as a health problem.
Disability data can best be obtained from a longitudinal follow-up study
of measles cases.
Since these disabilities are rarely, if ever, reported
as measles-related, and since they also often occur not associated with
measles, routine reporting systems are not useful in determining the
frequency of disability from measles.
In addition, because persons with the more severe disabilities are more
likely to seek medical attention, estimates based on hospital and clinic
data are falsely high.
M-14
Exercise E
In this exercise you will estimate the frequency of disability from measles
in Fict itia.
o
Read and follow the instructions carefully.
o
Write your answers in the spaces provided.
o
When you need data, refer to page M-21 in this booklet.
o
If you have questions, consult with a Course Facilitator.
.1.
Have any longitudinal follow-up studies of measles cases been conducted
in Fictitia?
o
If no, go to Step 2.
©
If yes, list the major types of disabilities.
Is the rate of disabilities from measles in the study high((— 30%),
,
moderate (15-29%), or low (< 15%)?
2.
3.
Is any other information available on measles disability in Fictitia?
•
If no, go to Step 3.
•
If yes, summarize the information.
Use the information from Steps 1-2 to determine if the rate of disabilities
from measles in Fictitia is high ( — 30%), moderate (15-29%), or low (s 15%).
M-15
.0
DETERMINE IF SEASONAL VARIATIONS OCCUR IN THE INCIDENCE OF MEASLES.
Having as much information as possible about differences in measles
incidence at various times of the year will increase the chances that
efforts are directed where and when they can have the greatest impact.
For example, if a programme manager knows when measles incidence is
greatest, he or she can conduct a periodic measles immunization programme
before the transmission season, rather than during or after.
If
information is available from sentinel reports in the country in which
you are working or in a similar country, it should be compiled for
consideration when planning an immunization programme.
M-16
Exercise F
In this exercise you will determine if seasonal variations occur in measles
incidence in Fictitia.
o
Read and follow the instructions carefully.
o
Write your answers in the spaces provided.
o
When you need data, refer to page M-23.
o
If you have questions, consult with a Course Facilitator.
Have measles reports from sentinel sites,^particular regions, or the country
as a whole been compiled on a monthly or quarterly basis?
®
If no, consider how monthly or quarterly reports could be compiled to
provide data.
•
If yes, do the reports suggest any seasonal patterns in measles incidence?
If so, describe these patterns in the space below.
M-17
CONCLUSION
This booklet has described procedures for estimating the incidence and mortality
of measles, the frequency of various types of disability from measles, and
seasonal variations which occur in the incidence of measles.
can be used to plan an effective immunization programme.
These estimates
Qnce a programme
is operating, these estimates can be used to evaluate that programme’s success
in preventing measles.
The Annex to this booklet, which begins on page M-25, contains extra copies
of guidelines for estimating the incidence and mortality of measles.
These
guidelines can be used to estimate the impact of the disease in your country.
When you have completed this booklet on measles, discuss your
work on Exercises E and F with a Course Facilitator.
__________ ______________________________
M-18
[
‘
1
SELECTED DATA ON FICTITIA
Annual Birth Rate
40/1000 population or 0.04
Infant Mortality Rate (< 1 year olj)
100/1000 live births or 0.10
Population of Fictitia
POPULATION
REGION
Delta
1,000,000
Coastal
10,000,000
Highland
4,000,000
Mountain
1,000,000
Total
16,000,000
Reported Data on Measles
In 1980, the following reports of measles cases and deaths were received
by the Ministry of Health.
CASES
DEATHS
190
150
Coastal
47,000
3,050
Highland
4,900
1,841
Mountain
140
125
REGION
Delta
—continued
M-19
Selected Data on Fictitia, continued
Survey to Determine Age Distribution of Measles Cases and Age-Specific Case
Fatality Rates
Thirty village outbreaks of measles were investigated in each of the 4 regions
of Fictitia to determine the age distribution of measles cases.
The results
are summarized in the following table:
Percent Distribution by Age
Delta
Coastal
■ ■
Highland
Mountain
0-2 months
0.00
0-00
0.00
0.00
3-8 months
0.00
0.20
0.10
0.00
9-14 months
0.20
0.50
0.30
0.10
15-35 months
0.40
0.30
0.40
0.40
3 years +
0.40
0.00
0.20
0.50
Age
expressed as a decimal
During 1977 and 1978 the Department of Community Medicine of the Fictitia
Teaching Hospital carried out a follow-up of 500 cases of measles.
found that 17 cases had died.
Lt was
The age distribution of cases and deaths was
as follows:
Cases
De;aths
Case Fatality Rate
0-2 months
3-8 months
9-14 months
15-35 months
36 + months
0
50
150
200
100
—
0
2
8
6
1
—
4%
5%
3%
1%
TOTAL
500
17
3%
Age
Among the 483 survivors, 150 (or 31%) had one or more of the following
disabilities related to the measles episode:
Frequency
Disability
Pneumonia
Dehydration
Undernutrition
Otitis
Ocular damage
Central Nervous System
complications
58
54
35
18
5
1
—continued
M|-21
Selected Data on Fictitia, continued
Seasonal Variations in the Incidence of Measles
The records of the Cualkyer Hospital were reviewed for the period July 1976 June 1979 for monthly measles admissions and deaths.
M-23
ft
ANNEX:
EXTRA COPIES OF GUIDELINES FOR ESTIMATING
INCIDENCE AND MORTALITY OF MEASLES
NOTE:
The guidelines in this Annex may be adapted for use in planning
your country’s immunization programme.
M-25
GUIDELINES FOR ESTIMATING ANNUAL INCIDENCE
AND INCIDENCE RATE OF MEASLES
1.
Annual incidence rate of measles per 100,000 population in a country:
a.
Record the birth rate in the country (expressed
as a decimal).
b.
Record the percent of live births surviving to
one year of age (expressed as a decimal).
c.
Multiply your answer to (a) times your answer to
(b).
'
X
(I)
d.
(b)
Multiply your answer to (c) times 100,000.
X
100,000
=
(c)
2.
Annual incidence of measles in the country:
a.
Record the annual incidence rate of measles per
100,000 population in the country (from Step Id).
b.
Divide your answer to (a) by 100,000.
T
100,000
(a)
3.
c.
Record the population in the country.
d.
Multiply your answer to (b) times your answer to
(c).
y
A.
(b)
(c)
‘
Annual incidence.of measles in a region of the country:
a.
Record the annual incidence rate of measles per
100,000 population in the country (from Step Id).
b.
Divide your answer to (a) by 100,000.
7
100,000
=
(a)
c.
Record the total population in the region.
d.
Multiply your answer to (b) times your answer
to (c).
X
(b)
M-26
=
(c)
GUIDELINES FOR ESTIMATING ANNUAL MORTALITY
AND MORTALITY RATE OF MEASLES
Use the following process if both age-specific case fatality rates and age
distribution of cases data are available.
1.
Annual mortality from measles in a region:
a.
Record the annual incidence of measles in the region at the bottom of
the column titled "Age-Specific Incidence."
b.
Record the percentage distribution of cases by age in the region.
Express each percentage as a decimal.
c.
Multiply the percent recorded for the first age group times the annual
incidence in the region. Record this figure in the column titled
"Age-Specific Incidence."
d.
Repeat Step (c) for the other age groups.
e.
Record the age-specific case fatality rates for measles in the region.
Express each percentage as a decimal.
f.
Multiply the age-specific incidence for the first age group times the
case fatality rate for that age group to estimate age-specific mortality
for that age group. Record your answer in the column titled "AgeSpecific Mortality."
g.
Repeat Step (f) for the other age groups.
h.
Add the age-specific mortality for all age groups to estimate annual
mortality from measles in the region. Record your answer at the bottom
of the column titled "Age-Specific Mortality."
Age
%
Distribution
by Age
AgeSpecific
Incidence
Age-Specific
Case Fatality
Rate
0-2 months
3-8 months
9-14 months
15-35 months
3 years +
TOTAL
2.
Annual mortality from measles in a country:
a.
Add the annual mortality from measles in each
region in the country.
M-27
AgeSpecific
Mortality
3.
Annual mortality rate of measles per 100,000 population in a region:
a.
Record the total annual mortality from measles in
the region (from Step Ih, page M-27).
b.
Record the population in the region.
c.
Divide your answer to (a) by your
answer to (b).
(b)
(a)
d.
Multiply your answer to (c) times 100,000.
x 100,000
=
(c)
4.
Annual mortality rate of measles per 100,000 population in a country:
a.
Record the annual mortality from measles
in the country (from Step 2, page M-27).
b.
Record the total population in the country.
c.
Divide your answer to (a) by your answer
to (b) .
(b)
U)
d.
Multiply your answer to (c) times 100,000.
x 100,000
=
(c)
Use the following process if either age-specific case fatality rates or age
distribution of cases data are not available.
1.
Annual mortality from measles in a region:
a.
Record the annual incidence of measles in
the region.
b.
Record the case fatality rate in the region.
c.
Multiply your answer to (a) times your answer
to (b) .
=
x
(a)
2.
Annual mortality from measles in a country:
a.
Add the annual mortality from measles in
each region in the country.
M-28
(b)
3.
Annual mortality rate per 100,000 population in a region:
a.
Record the annual mortality from measles
in the region.
b.
Record the population in the region.
c.
Divide your answer to (a) by your
answer to (b)
U)
d.
(b)
Multiply your answer to (c) times 100,000.
x 100,000
=
(c)
4.
Annual mortality rate per 100,000 population in a country:
a.
Record the annual mortality from measles
in the country.
b.
Record the population in the country.
c.
Divide your answer to (a) by your answer to
answer to (b) .
(b)
U)
d.
Multiply your answer to (c) times 100,000.
x 100,000
(c)
M-29
=
- Media
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