ISLAND MEASLES OUTBREAK KILLS 1,200
Lack of resources fuels spread in Madagascar
AMBALAVAO, MADAGASCAR • Babies wail as a nurse tries to reassure mothers who have come to vaccinate their children against a measles outbreak that has killed more than 1,200 people in this island nation where many are desperately poor.
Madagascar faces its largest measles outbreak in history, with cases soaring well beyond 115,000, but resistance to vaccinating children is not the driving force behind the rise.
Measles cases are rising around the world, in part because of misinformation that makes some parents balk at vaccinating their children.
In Madagascar, many parents want to protect their children but face immense challenges, including the lack of resources.
Only 58 per cent of people on Madagascar’s main island have been vaccinated against measles, a major factor in the outbreak’s spread. With measles one of the most infectious diseases, immunization rates need to be 90 per cent to 95 per cent or higher to prevent outbreaks.
On a recent day, the Iarintsena health centre’s waiting room was full, with mothers sitting on the floor and others waiting outside in the overwhelming heat. Two volunteer nurses and a midwife tried to meet the demand.
Nifaliana Razaijafisoa had walked 15 kilometres with her six-month-old baby in her arms.
“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 said.
The outbreak has killed mostly children under 15 since it began in September, according to the World Health Organization.
“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, affecting all regions of the country.
The outbreak is complicated by the fact that nearly 50 per cent of children in Madagascar are malnourished.
“Malnutrition is the bed of measles,” Sodjinou said.
Razaijafisoa’s baby weighs just 5 kilograms.
“This is the case for almost all children with measles who have come here,” said Lantonirina Rasolofoniaina, a volunteer at the health centre.
Simply reaching a clinic for help can be a challenge. Many people in Madagascar cannot afford to see a doctor or buy medicine, and health centres often are understaffed or have poorly qualified workers.
As a result, information about health issues can be unreliable. Some parents are not aware that vaccines are free, at least in public health centres.
Four of Erika Hantriniaina’s five children have had measles. She had wrongly believed that people could not be vaccinated after nine months of age.
“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 narrowly survived, Hantriniaina said.
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 diarrhea, bronchitis, pneumonia and convulsions.
Madagascar’s health ministry has sent free medication to regions most affected by the outbreak. Maronko reminded heads of health centres in the Ambalavao region not to make parents pay, saying he had seen some doctors asking for money. He told The Associated Press that he feared the medicines wouldn’t be enough.
Late last month, WHO started a third mass vaccination campaign in Madagascar with the overall goal of reaching 7.2 million children aged six months to nine years.
“But immunization is not the only strategy for the response to this epidemic. We still need resources for care, monitoring and social mobilization,” said Sodjinou, the WHO epidemiologist.