Madagascar battles to contain measles outbreak

AS Madagascar faces its largest measles outbreak in history and cases soar well beyond 115 000, resistance to vaccinating children is not the driving force.

In Madagascar, many parents would like to protect their children, but face immense challenges, including the lack of resources. Just 58% of people on Madagascar’s main island have been vaccinated against measles, a major factor in the outbreak’s spread.

Recently the Iarintsena health centre’s waiting room was full, with mothers sitting on the floor and others waiting outside.

Nifaliana Razaijafisoa had walked 15km with her 6-month-old baby.

“He has a fever,” she said. “I think it’s measles because there are these little pimples that have appeared on his face.” The nurse quickly confirmed it.

“I’m so scared for him because in the village everyone says it kills babies,” Razaijafisoa adds.

The measles outbreak has killed mostly children under age 15 since it began in September, according to the World Health Organisation.

“The epidemic unfortunately continues to expand in size”, though at a slower pace than a month ago, said Dr Dossou Vincent Sodjinou, a WHO epidemiologist in Madagascar.

By mid-March, 117 075 cases had been reported by the health ministry.

This epidemic is complicated by the fact that nearly 50% of children in Madagascar are malnourished.

“Malnutrition is the bed of measles,” Sodjinou said. Razaijafisoa’s baby weighs 5kg. “This is the case for almost all children with measles who’ve come here,” said Lantonirina Rasolofoniaina, a volunteer at the health centre.

Four of Erika Hantriniaina’s five children have had measles. She had wrongly believed that people could not be vaccinated after nine months.

“It’s my 6-year-old daughter who had measles first. She had a lot of fever,” she said. “I called the doctor, but it was Friday.

“He had already gone to town. I went to see another doctor who told me that my daughter had an allergy… this misdiagnosis was almost fatal.”

The girl had diarrhoea and was vomiting, Hantriniaina said, adding that she narrowly survived.

Measles, a highly infectious disease spread by coughing, sneezing, close contact or infected surfaces, has no specific treatment. The symptoms are treated instead.

“Vitamin A is given to children to increase their immunity. We try to reduce the fever. If there is a cough, we give antibiotics,” said Dr Boniface Maronko, sent by WHO to Madagascar to supervise efforts to contain the outbreak. If the disease is not treated early enough, complications appear including diarrhoea, bronchitis, pneumonia and convulsions.

The country’s capital, Antananarivo, a city of some 1.3 million people, has not been spared by the epidemic.

Last month, WHO started a third mass measles vaccination campaign in Madagascar with the overall goal of reaching 7.2 million children aged 6 months to 9 years.

“But immunisation is not the only strategy for the response to this epidemic. We still need resources for care, monitoring and social mobilisation,” said Sodjinou.