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Two thirds of countries have achieved 90 per cent coverage against measles.

Not only has the Latin America/Caribbean region reached the goal, with measles immunization coverage of 93 per cent in 2003, but its coverage is also better than that of any other region, surpassing that of industrialized countries. To bring this about, the region had by far the largest average annual rate of increase in coverage between 1990 and 2003 - 1.3 percentage points.

In addition, Latin America/Caribbean has the lowest under-five mortality of any of the world's developing regions, with 32 deaths per 1,000 live births - although in this respect the region is still far behind the industrialized countries' average of 6 child deaths per 1,000 live births.

Two thirds of the region's countries have already achieved 90 per cent coverage against measles, and another three - Guyana, Trinidad and Tobago, and Venezuela - are likely to achieve it by 2010. Of the high-performing countries, Ecuador and Peru are among the most notable, having improved since 1990 at average annual rates of 3.0 and 2.4 percentage points, respectively, for measles immunization coverage.

Even in this generally successful region, however, the broad-brush averages can be misleading and equity remains an important issue. There are still seven countries in which substantial improvements will be required in measles immunization coverage levels if the goal is to be met by 2010: Bolivia, Dominican Republic, Guatemala, Haiti, Jamaica, Panama and Suriname.

Guatemala has never achieved consistently high coverage against measles. Following a dramatic surge in the 1980s, Suriname reached a peak in measles immunization of 90 per cent in 1992 but has now sunk again to the level that applied in 1983 (71 per cent).

Haiti, which lags behind the rest of the region on most human development indicators, including under-five mortality (118 per 1,000 live births), also has very low levels of measles immunization coverage, at 53 per cent.

Political and economic crises in the region, along with ineffectual efforts in some countries to reform and decentralize health systems, will challenge gains made in immunization and in primary health care. Several countries require a major investment in cold-chain equipment. Peru concluded a countrywide inventory of its cold chain, a major achievement, and plans to invest $10 million in upgrading it as a result.


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