In the World Health Organization (WHO) African region, reported measles cases decreased
by 80% and measles mortality declined by 88% during 2000–2012. Based on current performance
trends, however, focused efforts will be needed to achieve the regional measles
elimination goal. To prioritize efforts to strengthen implementation of elimination strategies,
the Centers for Disease Control and Prevention and WHO developed a measles programmatic
risk assessment tool to identify high-risk districts and guide and strengthen program
activities at the subnational level. This article provides a description of pilot testing of the
tool in Namibia using comparisons of high-risk districts identified using 2006–2008 data with
reported measles cases and incidence during the 2009 outbreak. Of the 34 health districts in
Namibia, 11 (32%) were classified as high risk or very high risk, including the district of Engela
where the outbreak began in 2009. The district of Windhoek, including the capital city of
Windhoek, had the highest overall risk score—driven primarily by poor population immunity
and immunization program performance—and one of the highest incidences during the outbreak.
Other high-risk districts were either around the capital district or in the northern part
of the country near the border with Angola. Districts categorized as high or very high risk
based on the 2006–2008 data generally experienced high measles incidence during the large
outbreak in 2009, as did several medium- or low-risk districts. The tool can be used to guide
measles elimination strategies and to identify programmatic areas that require strengthening