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Thursday, May 24, 2012

Measles Epidemic in Uganda


By Esther Nakkazi

For the past eight years, at the Stanfield 1A building, the children’s ward at Uganda Mulago Referral hospital, the measles ward was not busy. Half way through this period it was closed. There were no measles patients.

Now, at least one patient dies every other day at the measles ward as the country handles an epidemic that started last year in October. 

Measles, a vaccine preventable disease, which was almost wiped out in Uganda in 2009, with 95 percent reduced measles cases, is back and also spreading through porous borders to southern Sudan, northern Kenya and the DR Congo.

Dr. Sabrina Bakeera-Kitaka a pediatrician at Mulago hospital says the biggest problem is that parents forgot to take their children for immunization. ‘There was a general state of laxity by all the players.’

After the long spell of containing measles in the communities and nationwide, parents and health workers relaxed and put other priorities ahead of them. Children admission numbers to this measles ward have now soured recording 183, 206 and 363 cases in the months of February, March and April this year and the severity of the cases has increased.

Deaths statistics have increased in tandem at the ward from an average 0.8 to 1.8 percent to 2.4 to 3.4 percent mortality per month.

According to Caroline Namukwaya, the Sister in Charge at Stanfield ward, most of the patients come in very sick with measles and malnutrition. She blamed cultural inhibitions for fuelling the risks as parents deny children proteins in their diets with the hope that they will feel better without them.

Culturally, while infected with measles, children are not fed on meat or milk. They are stuffed with small fish with no salt and smeared with squashed ripe bananas and sheep’s ghee but this only increases their state of malnourishment in a suppressed immunity.

“When a child gets measles they need all the proteins to keep them healthy. Measles is severe, fatal and patients should not be made to lack any nutrients or kept at home,” said Dr. Bakeera-Kitaka.

Measles presents as an acute viral respiratory disease that affects the largest organ of the body, the skin, and all other organs. It also presents itself especially in children with high fever, rashes and vomiting.

The United Nations Children’s Fund (UNICEF) says about 777,000 childhood deaths occur every year worldwide, with more than half occurring in Africa.

Dr. Richard Nduhura the state minister for Health says there are 5,211 confirmed measles cases in 46 districts. He said the government is planning to respond through a mass measles immunization campaign this week starting on Saturday.

Children between the ages of 6 months and 5 years will be vaccinated in the mass campaign in a move aimed at creating herd immunity, up to 90 percent coverage, in the hope that it will reverse the epidemic.

Of concern now is the falling vaccination national average rates in Uganda, which stand at 67 percent, combined with the fact that immunogenicity wears off after every five years. But there are worries that parents may still not take their children for immunization based on their perceptions about risk.

“I remember in 2002 during a mass measles immunization exercise, we brought our own children to Mulago to how the public that it was not dangerous,” said Dr. Bakeera-Kitaka.

Although health experts have emphasized that vaccinating carries fewer risks than not vaccinating, many parents in the developing world still view vaccination as doing something dangerous to their children.

Vaccines are considered one of public health’s ‘best buys’. A measles vaccine costs less than half a dollar, 0.38 cents. It is also a significant contributor to the Millennium Development Goals, particularly MDG 4—a two-thirds reduction in child mortality by 2015.



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