Knowledge and home treatment of measles infection by caregivers of children under five in a low-income urban community, Nigeria

Background: Despite the availability of a safe and effective vaccine for over 50 years, measles remains a leading cause of death among young children in developing countries.Aim: This study assessed the knowledge and home treatment of measles by caregivers of children under 5 years.Setting: Abebi community, Ibadan, Oyo State, Nigeria.Methods: A descriptive cross-sectional study of 509 caregivers of children aged 6 months to 5 years in a semi-urban community in Ibadan was conducted using a multi-stage sampling method. An interviewer administered structured questionnaire was used to collect information on socio-demographic characteristics, knowledge of aetiology, main symptoms and signs, and home treatment of measles. Chi-square test and logistic regression were used to explore associations at 5% level of significance.Results: Most of the caregivers were females (96.3%), married (86.1%) and were the biological parents of the children (90.9%). More than half had good knowledge of the cause (59.7%) and main symptoms and signs (52.8%) of measles. However, the composite knowledge was good in 57.6% of caregivers. Over half (54.4%) of the caregivers reported that their children ever had measles. Majority (91.3%) of caregivers whose children had measles gave home treatment, while 24 (8.7%) sought treatment from health facilities alone. There was a significant association between caregivers' educational status, age, tribe and marital status and their knowledge of measles; however, tribe was the only significant predictor of knowledge after regression analysis. Caregivers from other tribes were 3.3 times more likely to have good knowledge of measles than Yoruba caregivers. Caregivers who were 35 years and older compared to those younger than 35 years (OR: 0.625; 95% CI: 0.425­0.921) and those who were not currently married compared to those married (OR: 0.455; 95% CI: 0.273­0.758) had lower odds of having good knowledge of measles, respectively. Conclusion: Home treatment by caregivers of children with measles is high. Health education on the cause, prevention and treatment of measles should be provided for caregivers

Knowledge and home treatment of measles infection by caregivers of children under five in a low-income urban community, Nigeria

Background: Despite the availability of a safe and effective vaccine for over 50 years, measles remains a leading cause of death among young children in developing countries. Aim: This study assessed the knowledge and home treatment of measles by caregivers of children under 5 years. Setting: Abebi community, Ibadan, Oyo State, Nigeria. Methods: A descriptive cross-sectional study of 509 caregivers of children aged 6 months to 5years in a semi-urban community in Ibadan was conducted using a multi-stage sampling method. An interviewer administered structured questionnaire was used to collect information on socio-demographic characteristics, knowledge of aetiology, main symptoms and signs, and home treatment of measles. Chi-square test and logistic regression were used to explore associations at 5% level of significance. Results: Most of the caregivers were females (96.3%), married (86.1%) and were the biological parents of the children (90.9%). More than half had good knowledge of the cause (59.7%) and main symptoms and signs (52.8%) of measles. However, the composite knowledge was good in 57.6% of caregivers. Over half (54.4%) of the caregivers reported that their children ever had measles. Majority (91.3%) of caregivers whose children had measles gave home treatment, while 24 (8.7%) sought treatment from health facilities alone. There was a significant association between caregivers' educational status, age, tribe and marital status and their knowledge of measles; however, tribe was the only significant predictor of knowledge after regression analysis. Caregivers from other tribes were 3.3 times more likely to have good knowledge of measles than Yoruba caregivers. Caregivers who were 35 years and older compared to those younger than 35 years (OR: 0.625; 95% CI: 0.425­0.921) and those who were not currently married compared to those married (OR: 0.455; 95% CI: 0.273­0.758) had lower odds of having good knowledge of measles, respectively. Conclusion: Home treatment by caregivers of children with measles is high. Health education on the cause, prevention and treatment of measles should be provided for caregivers

Epidémie de rougeole en période post-conflit dans une zone rurale centrafricaine

Introduction : La rougeole est une maladie infectieuse très contagieuse. Les situations de conflit telles que le cas de la République centrafricaine (RCA), peuvent favoriser la survenue des épidémies. L'objectif de ce travail était de décrire l'épidémie de rougeole survenue dans la préfecture sanitaire de Sangha-Mbaéré en termes de temps, lieu et personnes. Patients et méthodes : Il s'agissait d'une étude rétrospective réalisée lors de l'investigation des cas de rougeole survenus à Nola, dans le sud-ouest de la RCA qui a couvert la période du 30 décembre 2015 au 20 avril 2016. La population cible était constituée d'enfants de moins de 15 ans. Nous avons inclus dans l'étude, après consentement éclairé des parents, tout enfant chez qui un agent de santé a suspecté la rougeole avec une fièvre supérieure ou égale à 38°C, une éruption maculo-papulaire généralisée (non vésiculaire) et un des signes suivants : toux, rhinorrhée ou conjonctivite. Les caractéristiques sociodémographiques et cliniques ont été recueillies à l'aide d'un questionnaire anonyme. La saisie et l'analyse des données ont été faites au logiciel Epi Info 7. Résultats : Au total, 31 malades ont été inclus dont 58% de sexe féminin soit un sex-ratio (F/H) de 1,38. L'âge moyen était de 1,9 ± 1,2 ans. Les enfants âgés entre 1 et 4 ans représentaient 74,19% des cas. Tous les enfants (100%) n'étaient pas vaccinés contre la rougeole. Ils provenaient de la commune de Salo dans 51,61% des cas et de Nola dans 48,39%. Le taux d'attaque était de 0,82‰. Dans la commune de Salo, le taux d'attaque était de 2,97‰ (16/5392) et de 0,46‰ (15/32401) à Nola. Le taux de létalité était de 9,68% (3/31). Ce taux était de 33,33% (1/3) avant l'âge d'un an, de 8,70% chez les enfants de 1 à 5 ans. Conclusion : L'épidémie de rougeole survenue à Nola serait liée à une faible couverture vaccinale. Le renforcement de la vaccination et de la surveillance épidémiologique pourrait contribuer au contrôle et à une prévention efficace de la rougeole ainsi que d'autres maladies à potentiel épidémique

Lessons learned from detecting and responding to recurrent measles outbreak in Liberia post Ebola-Epidemic 2016-2017

Introduction: measles is an acute viral disease that remains endemic in much of sub-Sahara Africa, including Liberia. The 2014 Ebola epidemic disrupted an already fragile health system contributing to low uptake of immunization services, population immunity remained low thus facilitating recurrent outbreaks of measles in Liberia. We describe lessons learnt from detecting and responding to recurrent outbreaks of measles two years post the 2014 Ebola epidemic in Liberia.Methods: we conducted a descriptive study using the findings from Integrated Diseases Surveillance and Response (IDSR) 15 counties, National Public Health Institute of Liberia (NPHIL), National Public Health Reference Laboratory (NPHRL) and District Health Information Software (DIHS2) data conducted from October to December, 2017. We perused the outbreaks line lists and other key documents submitted by the counties to the national level from January 2016 to December 2017.Results: from January 2016 to December 2017, 2,954 suspected cases of measles were reported through IDSR. Four hundred sixty-seven (467) were laboratory confirmed (IgM-positive), 776 epidemiologically linked, 574 clinically confirmed, and 1,137 discarded (IgM-negative). Nine deaths out of 1817 cases were reported, a case fatality rate of 0.5%; 49% were children below the age of 5 years. Twenty-two percent (405/1817) of the confirmed cases were vaccinated while the vaccination status of 55% (994/1817) was unknown.Conclusion: revitalization of IDSR contributed to increased detection and reporting of suspected cases of measles thus facilitating early identification and response to outbreaks. Priority needs to be given to increasing the uptake of routine immunization services, introducing a second dose of measles vaccine in the routine immunization program and conducting a high-quality supplementary measles immunization campaign for age group 1 to 10 years to provide protection for a huge cohort of susceptible

Progress towards elimination of measles in Kenya, 2003-2016

Introduction: measles is targeted for elimination in the World Health Organization African Region by the year 2020. In 2011, Kenya was off track in attaining the 2012 pre-elimination goal. We describe the epidemiology of measles in Kenya and assess progress made towards elimination.Methods: we reviewed national case-based measles surveillance and immunization data from January 2003 to December 2016. A case was confirmed if serum was positive for anti-measles IgM antibody, was epidemiologically linked to a laboratory-confirmed case or clinically compatible. Data on case-patient demographics, vaccination status, and clinical outcome and measles containing vaccine (MCV) coverage were analyzed. We calculated measles surveillance indicators and incidence, using population estimates for the respective years.Results: the coverage of first dose MCV (MCV1) increased from 65% to 86% from 2003-2012, then declined to 75% in 2016. Coverage of second dose MCV (MCV2) remained < 50% since introduction in 2013. During 2003-2016, there were 26,188 suspected measles cases were reported, with 9043(35%) confirmed cases, and 165 deaths (case fatality rate, 1.8%). The non-measles febrile rash illness rate was consistently > 2/100,000 population, and "80% of the sub-national level investigated a case in 11 of the 14 years. National incidence ranged from 4 to 62/million in 2003-2006 and decreased to 3/million in 2016. The age specific incidence ranged from 1 to 364/million population and was highest among children aged < 1 year.Conclusion: Kenya has made progress towards measles elimination. However, this progress remains at risk and the recent declines in MCV1 coverage and the low uptake in MCV2 could reverse these gains

Visiting health centers as a risk factor for measles transmission: Kamwenge District, Uganda, April ­ July 2015

Introduction: Uganda has been implementing a one-dose measles vaccination at age 9 months in its national EPI schedule. On 27 April 2015, a measles outbreak, which was confirmed by serum positivity in several patients, occurred in Kamwenge District. Since then, the number of reported measles patients has increased despite the implementation of measures to control the outbreak by the local government. We investigated this outbreak to identify the risk factors for measles transmission, estimate vaccination coverage, determine vaccine effectiveness, and recommend control measures.Methods: we defined a probable case as onset in a Kamwenge District resident of fever and generalized rash from 16 April 2015 onward with ≥ 1 of the following: coryza, conjunctivitis, or cough. A confirmed case was a probable case with positive measles-specific IgM in patient serum. For case-finding we reviewed medical records and found patients in the community with the help of the village health team. We determined vaccination histories by vaccination cards or interviews. In a case-control study, we compared the exposure histories of 50 probable case-persons with 200 asymptomatic control-persons during case-persons' exposure period (i.e., between minimum and maximum incubation). We matched case- and control-persons by age and residence village. We estimated vaccination coverage for children aged ≤ 2 years based on the percent of control-children vaccinated. Results: we identified 213 probable/ confirmed cases from 3 affected sub-counties (attack rate = 5.1/10,000). The epidemic curve showed sustained community transmission. The case-control study showed that 42% (21/50) of case-persons and 12% (23/200) of control-persons visited health centers during case-persons' exposure period (AORM-H = 6.1; 95% CI = 2.7-14). Vaccination coverage among children aged ≤ 2 years was 58% (95% CI = 47-68%). The vaccine effectiveness was 80% (95% CI = 35-94%). We found that all health centers were crowded, with no triaging system to separate suspect measles patients from patients with other illnesses.Conclusion: exposures to measles patients at crowded health centers, low vaccination coverage, and suboptimal vaccine effectiveness facilitated measles transmission in this outbreak. We recommended an emergency immunization campaign targeting young children, triaging and isolating suspect measles patients at health centers, and introducing a second dose of measles vaccine in the immunization schedule

Risk factors for measles death during an outbreak: Kyegegwa District, Uganda

Introduction: on 18 August 2015, Kyegegwa District reported 8 deaths during a suspected measles outbreak. We investigated this cluster of deaths to verify the cause, identify risk factors, and inform public health interventions. Methods: we conducted active community case-finding to identify probable measles patients, defined as a Kyegegwa District resident with fever (> 39°C) and generalized rash during 1 February - 15 September, plus ≥ one of the following: coryza, conjunctivitis, and cough. A deceased measles case was defined as death to a probable measles patient. In a case-control study, we compared risk factors between 16 deceased measles cases and 48 probable measles patients who survived (i.e., controls), matched by age (± 4 years) and village of residence. Blood specimens from probable measles patients were tested for measles-specific IgM.Results: we identified 94 probable measles patients. Children aged < 5 years accounted for 68% (64/94) of probable measles patients and all 16 deaths (case fatality ratio = 25%, 16/64). In the case-control study, 63% (10/16) of deceased measles cases and 33% (16/48) of controls received no vitamin A supplementation during illness (ORM-H = 7.1; 95% CI = 1.3-37); 31% (5/16) of deceased measles cases and 2.1% (1/48) of controls were not treated according to guidelines (adjORML = 8; 95% CI = 80-8); 6.3% (1/16) of deceased measles cases and 46% (22/48) of controls were vaccinated against measles (adjORML = 0.0; 95% CI = 0.0-0.33). Of blood specimens collected from probable measles patients, 71% (10/14) were positive for measles-specific IgM.Conclusion: no vaccination, lack of vitamin A supplementation and inappropriate treatment increased risk for measles deaths. The one-dose measles vaccination currently in the national EPI schedule, although providing inadequate protection against infection, did protect against measles death. We recommended enhancing measles vaccination, providing universal vitamin A supplementation, and enforcing treatment guidelines

Measles Outbreak Reveals Measles Susceptibility among Adults in Namibia; 2009 - 2011

BACKGROUND:The World Health Organization; African Region; set the goal of achieving measles elimination by 2020. Namibia was one of seven African countries to implement an accelerated measles control strategy beginning in 1996. Following implementation of this strategy; measles incidence decreased; however; between 2009 and 2011 a major outbreak occurred in Namibia.METHODS:Measles vaccination coverage data were analysed and a descriptive epidemiological analysis of the measles outbreak was conducted using measles case-based surveillance and laboratory data.RESULTS:During 1989 - 2008; MCV1 (the first routine dose of measles vaccine) coverage increased from 56% to 73% and five supplementary immunisation activities were implemented. During the outbreak (August 2009 - February 2011); 4 605 suspected measles cases were reported; of these; 3 256 were confirmed by laboratory testing or epidemiological linkage. Opuwo; a largely rural district in north-western Namibia with nomadic populations; had the highest confirmed measles incidence (16 427 cases per million). Infants aged =11 months had the highest cumulative age-specific incidence (9 252 cases per million) and comprised 22% of all confirmed cases; however; cases occurred across a wide age range; including adults aged =30 years. Among confirmed cases; 85% were unvaccinated or had unknown vaccination history. The predominantly detected measles virus genotype was B3; circulating in concurrent outbreaks in southern Africa; and B2; previously detected in Angola.CONCLUSION:A large-scale measles outbreak with sustained transmission over 18 months occurred in Namibia; probably caused by importation. The wide age distribution of cases indicated measles-susceptible individuals accumulated over several decades prior to the start of the outbreak

Measles Elimination in the WHO African Region: Progress and Challenges

In 2001; countries in the African Region adopted the measles mortality reduction strategies recommended by the WHO and UNICEF. Following the significant reduction in measles cases and deaths with the implementation of the strategies; in 2011; the African Region adopted a measles elimination goal for 2020. To assess progress; performance was reviewed using estimates of the first dose of measles vaccine in routine immunization (MCV1); the reported coverage for measles supplementary immunization activities (SIAs); as well as surveillance data. During 2011-2013; regional MCV1 coverage was stagnant at around 74; while approximately 215 million children were reached in measles SIAs in 43 countries. Regional measles vaccination coverage has not increased and measles incidence has remained high in the past three years. Intensive efforts are required to ensure that routine immunization and SIAs provide high population immunity; and to increase the sensitivity of measles surveillance

Measles Case-based Surveillance and Outbreak Response in Nigeria; An Update for Clinicians and Public Health Professionals

The Federal Ministry of Health recommendations for response during measles epidemics in Nigeria previously focused on case management using antibiotics and Vitamin. A supplements and did not include outbreak response immunization (ORI) campaigns. However; with the revision of the existing national technical guideline on measles case based surveillance and outbreak response in Nigeria in 2012 in line with the World Health Organization recommendation on response to measles outbreak in measles mortality reduction settings; there is a need to update members of the Nigerian public health community on these revisions to ensure appropriate implementation and compliance. This article therefore seeks to provide clinicians and other public health professionals in Nigeria with updates on recent developments in measles case-based surveillance and outbreak response in Nigeria

A sero-survey to identify the window of vulnerability to measles in infants in North-Eastern Nigeria

As infants lose maternal measles antibodies (MMAs); they experience periods when their antibody levels are insufficient to protect them against measles. A prospective study was carried out at the University of Maiduguri Teaching Hospital. Sera collected from neonates at birth; and at six weeks; three months; six months and nine months of age; were analysed for MMAs by enzyme-linked immunosorbent assay. Seventy-seven neonates were enrolled. Of these; 73 (94.8) had protective MMAs at birth. This figure declined to 36 (46.8); 28 (36.4); 13 (16.9) and 4 (5.2) at six weeks; three months; six months and nine months of age (?2 = 154.264; p-value = 0.000). Protective MMAs at birth waned rapidly; resulting in an early window of vulnerability to measles by the age of six months. Protecting infants with early measles immunisation with potent; safe vaccines are recommended

Trends in Performance of the National Measles Case-Based Surveillance System; Ministry of Health and Child Welfare; Zimbabwe (1999 - 2008)

Introduction: Since adoption of the measles case-based surveillance system in Zimbabwe in 1998; data has been routinely collected at all levels of the health delivery system and sent to national level with little or no documented evidence of use to identify risky populations; monitor impact of interventions and measure progress towards achieving measles elimination. We analysed this data to determine trends in the national measles case-based surveillance system (NMCBSS). Methods: A retrospective record review of the NMCBSS dataset for period 1999 -2008 was conducted; assessing trends in proportions of investigated cases; timeliness and nature of specimens received at laboratory; timeliness of feedback of serology results; proportion of cases confirmed as measles and national annualized rates of investigation. Comparisons with WHO performance indicators were done. The secondary data analysis was done in Excel and Epi-Info statistical software. Results: Cumulatively 4994 suspected cases were reported and investigated between 1999 and 2008. Reported suspected and confirmed measles cases declined from 24; 5 and 5.9 respectively in 2000 to 3.9and 1.0 respectively in 2008. Proportion of cases with blood specimens collected and proportion reaching laboratory timely increased from 83 and 65 respectively in 1999; to 100 and 82 respectively in 2008. Proportion of specimens arriving at laboratory in good condition improved from 65 in 2004 to 94 in 2008 while timeliness of feedback of serology results improved from 4 in 2004 to 65in 2008. Sensitivity of the NMCBSS however has been weakening; declining from 9.04 cases investigated per 100 000 population per year in 2000 to 1.58 cases/100 000/year in 2008. Conclusion: The NMCBSS improved in quality; timeliness and feedback of laboratory results of specimens sent for investigation; but its sensitivity declined mainly due to reduced capacity to detect and confirm measles cases. We recommend training staff on active surveillance of cases and more support and supervisory visits to strengthen EPI surveillance

Review of Childhood Measles Admissions at the National Hospital, Abuja

Background: The global disease burden from measles as a vaccine preventable disease remains high despite decades of interventions by various organs and agencies. Objectives: To determine the prevalence and outcome of childhood cases of measles admitted into the children's emergency ward of the National hospital and highlight the possible contributing factors. Design: Retrospective. Subjects : A total number of 43 children with measles presenting at the National Hospital Abuja; seen over a 40 months period; January 2002 and April 2005. Methods: Cases-folders of patients seen at the Emergency Paediatric Unit (EPU) of the National Hospital Abuja during the period under review with the clinical diagnosis of measles were reviewed. Results: The children were aged between seven to 12months; with 25 (58.1) age 24 months and below. Twenty three (53.5) of the subjects had received prior measles vaccination. History of contact with cases of acute measles was present in 26 (60.5). Associated protein energy malnutrition (PEM) was found in 30 (69.8) with 28 (65.1) parents of these children being of lower social economic classes (III; IV etV). Recorded complications included gastroenteritis; bronchopneumonia; laryngo-tracheo-bronchitis as part of croup syndrome; tuberculosis; and otitis media. Three fatalities (7.0) were record in this review; all in association with bronchopneumonia. Conclusion : Measles with its complications still present as a fatal illness even among vaccinated children

Prolonged Hospital Stay in Measles Patients

Background: Measles is still a major cause of childhood morbidity and mortality in Nigeria despite the availability of safe and effective vaccines. The burden of measles using length of hospital stay as a result of complications in hospitalised children with measles is reported. Methods: We carried out a two year retrospective study of children admitted with measles into the department of Paediatrics; University of Maiduguri Teaching Hospital. Results: Three hundred and nine children (11.2of Paediatric admission) aged 6-90 months (median 13 months) with a male: female ratio of 1.6: 1 were admitted with measles. Forty three (14) patients were aged less than 9-months. Seventy two per cent (223) of the subjects were not immunised against measles. Length of stay ranged between 4 and 32 days (mean; 8.7 days; median; 16 days) and total bed days were 3561 days. Forty per cent (124) of the measles admissions were for more than 14 days (prolonged hospitalisation). Infants and unvaccinated from low socio-economic class were more likely to have prolonged hospitalization. The most frequent complication associated with prolonged length of stay was bronchopneumonia (70.2). Two of the children suffered acute measles encephalopathy. Conclusions: Therapy for measles and its complications may be a major drain on medical care resources in this part of Nigeria; especially among young children who are unvaccinated and from low socio-economic class

Encore une epidemie au Burkina Faso

En debut 2009; une epidemie de rougeole a frappe pres de 20 000 personnes au Burkina Faso. Cette maladie touche aussi bien des enfants que des adultes

The Effort to Attain Measles Pre-elimination Targets by 2012 and to Eliminate Measles in the African Region by 2020

Reduction in measles mortality contributes significantly towards attaining the Millennium Development Goal 4 (MDG 4); which aims to reduce overall under-five childhood deaths by two thirds by 2015; compared with 1990 levels. Routine measles immunization coverage is a key indicator for measuring progress towards attainment of this goal. Implementation of measles mortality reduction strategies in the African Region has led to major achievements; notably a reduction of estimated measles deaths by 92between 2000 and 2008. Despite the progress made; renewed commitment by countries is required to attain the pre-elimination targets and subsequently reach the ultimate goal of measles elimination by 2020. Countries will need to strengthen their immunization systems through ensuring that quality immunization services reach the hard-to-reach populations in addition to scaling up implementation of proven approaches and strategies such as the Reaching-Every-District approach. Gaps in the mobilization of resources have had a negative impact on the ability of countries to attain and sustain a high level of routine immunization and supplemental immunization activities coverage. Countries will also need to adopt a stepwise approach towards achieving the measles elimination goal by 2020; beginning with the attainment by 2012 of the proposed pre-elimination targets