71% of critically ill measles children fail to get ICU beds: Study

Highlights:

• Population becomes asset through comprehensive human capability development
• Education should prioritise skills, knowledge, and practical application
• Health, training, and opportunity sustain productive human resource development
• Bangladesh underutilises graduates despite growing youth population
• Certificate-focused education leaves graduates unprepared for evolving labour markets
• Rising population growth threatens Bangladesh's human resource development goals

Bangladesh is experiencing its largest measles outbreak in two decades, with mortality that appears disproportionate to the reported case burden. A new study found that 71% of critically ill children could not secure a paediatric intensive care unit (PICU) bed because none were available or existing units were full.

The study, "Beyond immunity gaps: Health-system constraints and measles mortality in Bangladesh," published on 1 July in the journal Tropical Medicine, argues that while declining vaccination coverage has been widely blamed, structural weaknesses in the health system have also driven child deaths.

Infograph: TBS

Conducted by Biomedical Research Foundation scientist Mohammad Sorowar Hossain, also a professor at Independent University, Bangladesh, the research reviewed 34 media-reported paediatric measles deaths between March and May.

Critical care shortages worsen outcomes

All 34 children required ICU or PICU care, yet most could not access it, while 82% were transferred between two or more healthcare facilities before receiving definitive treatment.

Researchers identified multiple barriers contributing to fatalities, including inadequate paediatric intensive care capacity, repeated hospital referrals, treatment delays, oxygen shortages, financial hardship and unequal access to critical care. Nearly one-third of the children were referred from district hospitals to Dhaka for advanced treatment.

According to government data cited in the study, 22 of Bangladesh's 64 districts lack public-sector ICU facilities, while 55% of the country's 1,372 government ICU beds are concentrated in just 22 hospitals in Dhaka. 

More than half of the ICU beds established during the Covid-19 pandemic also remained non-functional because of staffing shortages.

Sorowar Hossain told The Business Standard that Bangladesh's measles mortality appears unusually high compared with recent outbreaks elsewhere. The WHO European Region recorded more than 127,000 measles cases in 2024 but only 38 deaths, suggesting healthcare capacity is as critical as immunisation coverage in determining survival.

Delayed treatment and financial hardship

Among the 34 children studied, 18 (56%) were younger than nine months and therefore ineligible for the routine measles-rubella vaccine, while four older children had not been vaccinated.

Government data showed nearly half of laboratory-confirmed measles deaths occurred within two days of hospital admission and all within five days. Researchers said this may indicate delayed referrals, late presentation or inadequate access to critical care.

Financial hardship also delayed treatment. About 65% of families borrowed money or sold jewellery to pay for private ICU care. The study found 38% of cases experienced referral delays of at least one day, while 15% of the children died before reaching, or while being transferred to, a facility capable of providing critical care.

Sorowar Hossain said similar systemic weaknesses were evident during Bangladesh's 2023 dengue epidemic.

Call for stronger health system

Meanwhile, the Directorate General of Health Services (DGHS) recorded the deaths of three more children with measles-like symptoms in the 24 hours preceding 8am yesterday. No laboratory-confirmed measles deaths were reported during the period.

As of 11 July, the DGHS had recorded 110,601 suspected measles cases, including 13,410 laboratory-confirmed infections. 

Since authorities began issuing regular updates on 15 March, 93 people have died from confirmed measles, while 702 others have died with measles-like symptoms. 

Of the 93,491 patients hospitalised with suspected measles, 89,762 have recovered and been discharged.

The researchers said restoring district-level measles-rubella vaccination coverage to at least 95% must go hand in hand with decentralising paediatric critical care, operationalising non-functional ICU beds, ensuring reliable oxygen supplies and removing financial barriers to emergency treatment.

"A child who dies from measles after reaching a hospital is not a failure of vaccination but a failure of the system built to save them," Sorowar Hossain said.