J Ayub Med Coll Abbottabad 2008;20(2) http://www.ayubmed.edu.pk/JAMC/Past/20-2/Anis.pdf 14 CLINICAL OUTCOME IN MEASLES PATIENTS HOSPITALIZED WITH COMPLICATIONS Anis-ur-Rehman, Tahir Saeed Siddiqui, Muhammad Idris* Department of Paediatrics, and *Department of Pathology, Ayub Medical College, Abbottabad Background: Measles is a highly communicable viral illness and is common cause of childhood mortality and morbidity. Keeping in view the high prevalence of measles in the developing world, we carried out this study to look into the complicated measles cases and clinical outcome in patients admitted in children ward of Ayub Teaching Hospital. Methods: Detailed history and physical examination of all the hospitalized patients with complication of measles were recorded in a proforma. Immunization and nutritional status of each admitted patient was assessed and the clinical outcome of measles was compared with demographic profile. Result: one hundred thirty six hospitalized patients with complications of measles were studied. There was 60.3% male and 57.3% of patients were vaccinated against measles. Malnourished patients were 71.35% and had longer hospital stay (>5 days). Pneumonia (39.7%) and diarrhoea (38.2%) were the commonest complications. Seven children died and encephalitis (57.1%) was the commonest cause of death. Conclusion: the most common complications of measles are pneumonia and diarrhoea with dehydration requiring admission. Malnutrition results in more complications and longer hospital stay. Mortality is significantly associated with encephalitis. Key words: Diarrhoea, Measles, Encephalitis INTRODUCTION Measles is a communicable viral illness. 1 Its incidence in childhood varies from 58% in epidemic to 10–15% in endemic form. 2 Globally about 40 million cases of measles occur every year out of which 7.77×10 5 death occur due to measles, including Pakistan account for 66% of these death. 3 Measles is a common cause of immunosuppression which leads to complications. 4 One out of 20 children with measles gets Pneumonia 5 and 1 out of 1000 gets encephalitis. 1 out of these 15% die and 25–35% are left with permanent neurological sequelae. 1 Children are at increased risk of dying for 9 year after their measles due to impaired immunity. 1 The world summit of children has set a goal of 90% reduction of measles cases and 95% reduction of measles deaths. Compared to pre-vaccine era 6 Pakistan has single dose of Measles vaccination (at 9 months age) coverage of 57% from 2001 7 to 2002 8 . Some countries like Iran, Syria, and U.A.E have started second routine dose of measles at 15 months of age with high coverage of 90% or more. 9 Low vaccines coverage rate with low vaccine efficacy leads to higher rate of complications, some leading to hospitalization which causes financial burden. 10 Therefore children hospitalized with complications of measles can provide the magnitude of problem and its future preventive strategies. PATIENTS AND METHODS This cross sectional analytical study was conducted at children department of Ayub Teaching Hospital from April 2003 to December 2005. Six months to 12 years old children presenting with measles and its complications were hospitalized. Children under 6 months of age were excluded because they were considered to be protected from measles because of maternal antibodies. 4 Clinical measles was diagnosed in patients with generalized maculpapular rash, fever of 101 F or more and having cough, coryza and conjunctivitis. Pneumonia was defined according to WHO criteria of respiratory rate 11 or presence of pulmonary infiltrate on chest radiograph. Central nervous system was considered to be involved if there was lethargy, irritability, headache, fits, disorientation or other neurological deficit. The detailed history, physical examination and measles complications including diarrhoea, otits media, pneumonia and encephalitis were filled in case report form. Immunization status was assessed by examining the immunization cord or parental enquiry on this regard. Weight for age was plotted on national centre for health statistics (NCHS) charts classified as well nourished mild, moderate and severe malnutrition. All patients were given vitamin A orally at admission or on discharge when they were taking and tolerating feed orally. Clinical outcome was compared between males and females, as well as different age groups. RESULTS Results are shown in Tables 1–3. A total of 136 hospitalized patients with measles and its complications were studied. As much as 82 (60.3%) patients were male with male to female ratio 1.5:1 (Table-1). Regarding age, 85 (62.5%) patients were less than 5 years of age and 28 (20.5%) patients