The study was carried out to determine the prevalence of measles amongst children in Abia State University Teaching Hospital (ABSUTH) Aba. The aim of the study is to provide data on the prevalence of measles amongst children (0 – 5 years) in ABSUTH, to determine the most affected age group, and to identify the most prevalent complications.
Worldwide, among the burden of vaccine-preventable diseases, measles ranks the first with an 8% disease burden (Durbey and Choudhury, 2010). In developing countries, measles is a major cause of childhood morbidity and mortality due to underlying malnutrition and living in overcrowded homes (Levin and Weinberg, 2011). A rapid increase in measles immunization coverage is known to produce changes in the epidemiology of the disease, indicating that strategies for the control of measles may also require constant review (Onyiriuka, 2011).
Measles is an acute and highly contagious disease that is characterized by fever, rashes, coryza, conjunctivitis, and generalized maculopapular, erythematous rash. It has high morbidity, mortality, and ease fatality rate of about 5% (Obioma, 2010). A larger proportion occurs in tropical and developing countries. The disease affects mainly the younger age group and is the cause of about 1,5 million death per year in the world. These have been attributed to poor nutritional standards, secondary bacterial infections, poor environmental conditions, inadequate medical care, and lack of immunization.
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According to Onyiriuka (2011), measles is spread by droplet infection or through person-to-person contact. These facts have been implicated in the increased number of people infected in an overpopulated area where most individuals are not immunized. Also, there can be a history of the disease in a previously immunized individual and this can be due to primary immunization failure. The infection is rarely found in infants less than 6 months old (who are exclusively breastfed) because; they possess an increased number of maternal antibodies. Since measles is one of the leading causes of death among children in the tropics, it is a devastating relationship with the health of the Nigerian child that cannot be over-emphasized.
Aba, being a large metropolis, suffers from overcrowding and indiscriminate dumping of refuse. It has all the factors that promote the measles outbreak and its spread. This study is carried out in Aba and data is gotten from Abia State University Teaching Hospital located in town. This study seeks to know the prevalence of measles in children attending Abia State University Teaching Hospital, Aba (ABSUTH).
Statement of Problem
Although the population-based prevalence of measles in Nigeria is not known, tertiary hospital-based studies have shown that measles accounted for 1.3 to 5.1% of all pediatrics admissions. The reported case-fatality rates for measles varied from 1.9 to 12.4% (Onyiriuka, 2011).
Measles is known to affect both immunized and non-immunized children, although the prognosis is better in the former than in the latter. This study, therefore, seeks to retrospectively measure the demographic data of children who presented in Abia State University Teaching Hospital, Aba (ABSUTH) between January 2014 to December 2018, and also the number that was vaccinated and still suffered the disease.
With the high incidence rate of measles in ABSUTH Aba, the researcher was motivated to carry out research on the prevalence of measles amongst children in ABSUTH.
- What the number of children with measles affected in ABSUTH from 2014 to 2018?
- What is the demographic distribution of measles?
- Which month records the highest occurrence from 2014 to 2018?
Objectives of the Study
The general objective is to identify the prevalence of measles amongst children attending ABSUTH, Aba against other pediatric cases.
The specific objectives are to:
- Identify the number of children diagnosed from 2014 to 2018
- Determine the months with the highest incidence of measles
- Identify the demographic distribution of measles at ABSUTH
Significance of the Study
Measles, being a childhood disease, is seen mainly in preschool-aged children and most times due to its presentation (fever, rash) it’s misdiagnosed by parents as a mere rash either due to drug or skin hypersensitivity reaction. As a result of this wrong diagnosis or oversight, complications can occur.
This study hopes to achieve the following:
- This study will be a good reference for mothers to understand the signs and symptoms of measles and also the importance of immunization.
- It will aid nurses especially those in pediatric wards and under 5 years clinics to understand the concept and severity of the disease.
- It act as a source of information to other health officials.
- It will serve as a source of literature to researchers who might need this study for reference.
- The information gathered will be used by government and non-governmental organizations in Aba in developing viable possible policies and measures aimed at developing the town.
Scope of the Study
This study investigates the prevalence of measles in children (0 – 5) attending Abia State University Teaching Hospital, aba was chosen because it has all the characteristics of a host town (overcrowding, indiscriminate refuse disposal). It has a big tertiary hospital (ABSUTH) and also for its proximity to the researcher.
Measles – It is also known as Rubeola. It is a highly contagious infectious disease caused by the measles virus, specifically a paramyxovirus of the genus morbillivirus.
Prevalence – A measure of morbidity based on current sickness estimated either at a particular time (point prevalent) or over a stated period (period prevalence).
Conceptual Review on Prevalence of Measles
Measles is one of the leading causes of death among young children even though a safe and cost-effective measles vaccine is available. More than 95% of measles death occurs in low-income countries with weak health infrastructure. Measles is a human disease and is not known to occur in animals (WHO, 2011).
According to Wikipedia (2018), estimates based on modern molecular biology place the emergency of measles as a human disease sometime after 500AD. This discounts the former speculation that the Antoine plague of 165 – 180 AD was caused by measles. The first systematic description of measles and its distinction from smallpox and chickenpox is credited to the Persian physician Rhazes (860 – 932) who published the book of smallpox and measles. Given what is now known about the evolution of measles, Rhazes’ account is remarkably timely.
Measles is an endemic disease, meaning, it has been continually present in a community and many people develop resistance. In populations not exposed to measles, exposure to the new disease can be devastating. In 1529, a measles outbreak in Cuba killed two-thirds of the natives who had previously survived smallpox. Two years later, measles was responsible for the death of half the population of Honduras and had ravaged Mexico, Central America, and Indian civilization (Bryne J.P., 2008).
In about 150 years, measles has been estimated to have killed about 200 million people worldwide with seven to eight million children thought to have died from measles each year before the vaccine was introduced (Wikipedia, 2018).
Measles has been defined by many authors. According to Steadman (2008), measles is an acute exanthematous disease caused by a virus of genus morbillivirus, a member of the family paramyxoviridac and marked by fever, and other constitutional disturbances. Measles is also known as rubeola. Measles is a highly communicable disease that occurs worldwide (Kumar and Cark, 2009).
Measles is a highly contagious infectious disease caused by the measles virus. It is one of the most contagious but vaccine-preventable of childhood (Wikipedia).
Measles is a respiratory disease caused by the measles virus. The diseases and the virus that causes it to share the same name. measles virus normally grows in cells that line the back of the throat and lungs (CDC, 2011).
Measles is caused by the measles virus; the measles virus is spread through the respiratory route. The virus is contained in the millions of tiny droplets that come out of the nose and mouth when a measles carrier coughs or sneezes. One can contract measles by breathing in these droplets or, if the droplets have settled on a surface, by touching the surface and then placing the hand near the nose or mouth. The measles virus can survive on surfaces for several hours. In fact, it is one of the most contagious viruses known to man. As a result, it can be spread rapidly in a susceptible population. Infected persons carry the virus in their respiratory tract before they get sick so, they can spread the disease without even being aware of it (Netheman, 2008).
Symptoms do not appear immediately after a person becomes infected with the measles virus, it begins to multiply within the cells that line the lungs and back of the throats. The virus can also spread to the lymph nodes, bone marrow, liver eyes, thymus tonsils, spleen, skin, and brain.
The symptoms typically appear ten to fourteen days after a person is infected with the measles virus. The period between measles transmission and the onset of symptoms is called the incubation period. During this period, the virus multiplies symptoms includes, including hyperthermia (raised body temperature), sore throat, coryza, malaise, anorexia, red, watery eyes, koplik’s spots are a small white area that may have bluish-colored centers. The skin rash appears within three to five days of onset of symptoms. The rash often begins on the face and spreads downwards all over the body till it gets to the feet. A very high fever may develop when the rash starts to disappear after a few days and the fever resolves. It is better to leave the rashes alone as scratching leaves the patient in worse condition (Nettleman, 2008).
The best way to prevent measles is to get the measles vaccine. Measles antibodies are transferred from mothers who have been vaccinated against measles or who have been previously infected with measles to their children while they are still in the womb. Such antibodies will usually give newborn infants some immunity against measles but over the first nine months of life, such antibodies are gradually lost (Leuridan, Sabbe and Van Damme, 2012). In developing countries where measles is common; like in Nigeria, the World Health Organization recommends that the measles vaccine be given at nine months and another dose at fifteen (15) months because of its high morbidity and mortality rates. Vitamin A supplement is also recommended for every child to enable them to develop a strong immunity.
There is no treatment that can kill the measles virus so treatment focus on supportive care to relieve the symptoms. Supportive care includes the following:
- Get plenty of rest,
- Baths with tepid water may reduce discomfort,
- Medications to control pain and
- Antibiotics to treat secondary infections
- Drink plenty of fluid to help avoid dehydration
- A humidifier may ease the cough.
Vitamin A supplements (particularly for children aged 6 – 24 months) 100,000 111 daily for 2 days and repeated on day 14, that is the days, 1, 2, and 14 (Nettleman, 2008).
The measles vaccine and the combined measles mumps rubella (MMR) vaccine are very safe and effective, they generally have few side effects, mild reactions such as fever, redness, or swelling of the injection site have been reported. As with any medicine, there is a slim chance that side effects could occur after getting the vaccine however, the potential risks associated with getting the vaccine much greater than that should not be given to persons who are pregnant or severely immune-suppressed (WHO, 2011).
The success of immunization in the reduction of the incidence of measles has been duly observed. In the works of Krusinki and Burnett (2007), it was observed that 80% of the world population (especially, children) were immunized by one year of age and that an estimated one million lives were saved annually.
Unvaccinated populations are at risk for the disease. The low vaccination rates in northern Nigeria dropped further in the early 2000s when radical preachers promoted a rumor that polio vaccines were a western plot to sterilize Muslims and infect them with HIV. The number of cases of measles rose significantly and a hundred died (Wikipedia, 2018).
By 2008 in the United States, the number of measles cases grew to 131. Of these, about half involved children whose parents rejected vaccination. There were 20 deaths and 15 hospitalizations. 11 of these cases had received at least one dose of the vaccine. Children who were unvaccinated or those whose vaccination status was unknown accounted for 122 cases. The measles vaccine reduced all case mortality by 43% (29 – 54), Vitamin A and measles vaccines are effective interventions to prevent measles mortality in children (Sudfield Naver Halsey, 2010).
Outbreaks of measles occur within a certain period. Studies in various areas in Nigeria show the highest incidence between January and May which coincides with the period of the dry season when the hot, dry, and dense weather is likely to aid transmission of infected droplets (Azubuike and Nkaginieme, 2008).
Sporadic outbreaks in Nigerian communities were found to have occurred at the end of the rainy season and the beginning of the dry season when many rural populations begin seasonal migration pattern, especially, in Niger State (Berman, 2008).
Measles is usually uncomplicated but complications occur more in children under 5 years who are undernourished or immune-compromised (Sabella, 2010).
Complications include Otitis Media, diarrhea. Pneumonia, Seizures blindness, and encephalitis (inflammation of the brain) this is rare but can cause permanent brain damage or death. Measles during pregnancy increases the risk of miscarriages, premature labor, and low birth weight babies.