All-Cause Mortality Reductions from Measles Catchup Campaigns in Africa

Abstract

As recently as 1999, 13 million measles cases and 500,000 measles-related deaths occurred in sub-Saharan Africa per year. Over the past decade, vaccination coverage across the continent has improved dramatically, largely as a result of the Measles Initiative, an international effort coordinating and funding national mass-immunization campaigns. We estimate the reduction in all-cause child mortality after initial countrywide measles vaccination campaigns using variation in the timing of the campaigns across countries and subnational regions. This framework accounts for competing and complementary risks as well as for contemporaneous trends in mortality rates that may have biased case-based estimates. We use birth and death history data compiled from multiple Demographic and Health Surveys for 25 countries and control for country-specific trends in child mortality and time-varying factors that were associated with campaign timing. Our findings show that the Measles Initiative campaigns raised the probability of a child’s survival to 60 months by approximately 2.4 percentage points for cohorts treated by the campaign. The campaigns cost approximately $109 per child life saved, remarkably low in absolute terms as well as relative to other interventions to reduce global child mortality.