Population-Level Risk Factors Related to Measles Case Fatality: A Conceptual Framework Based on Expert Consultation...

Area of Science:

• Epidemiology
• Public Health
• Global Health

Background:

• Estimating measles mortality burden and intervention impact requires understanding population-level factors influencing measles case fatality.
• Measles case fatality ratios (CFRs) are influenced by complex, interconnected population-level determinants.

Purpose of the Study:

• To develop a conceptual framework outlining mechanisms associated with measles CFR.
• To assess the scope of evidence for population-level indicators linked to these mechanisms.

Main Methods:

• Expert consultation was used to develop a conceptual framework of measles CFR mechanisms.
• A comprehensive literature review of PubMed (searched October 31, 2021) identified studies examining associations between indicators and measles CFR.
• Included studies were assessed for quality, focusing on original data and human subjects.

Main Results:

• Five key mechanisms influencing measles CFR were identified through expert consultation.
• A review of 3,772 studies identified 49 studies demonstrating significant associations between 15 indicators and measles CFR.
• Indicators with significant associations included vaccination coverage, nutritional status, healthcare access, and conflict. Five indicators showed non-significant associations.

Conclusions:

• The study provides a framework and summarizes evidence on population-level factors affecting measles CFR.
• Findings can inform more accurate estimations of measles mortality and the effectiveness of public health interventions.