Investigation of a measles outbreak in a Rural Nigerian community ??? The Aladura experience

Abstract


I. A. Adeoye1, M. D. Dairo1, L. V. Adekunle1, H. O. Adedokun2and J. Makanjuola2

The global burden of measles has remained a public health challenge. Worldwide, measles is the fifth leading cause of death among under-five children with an estimate of 197,000 deaths in 2007. In Nigeria, measles is an important cause of childhood morbidity and mortality. Measles outbreaks have been increasingly common in the country with 30, 194 and 256 outbreaks reported in 2006, 2007 and 2008 respectively. This paper describes the investigation, findings and mitigation efforts of a measles outbreak in Ogunmakin, a rural community in South-western Nigeria from 7 th January to 15 th February 2009. The study design was descriptive and cross-sectional in nature. The investigation was multidisciplinary in nature performed based on the national guidelines for investigating a measles outbreak. This involved data and blood sample collection from the initial cases, notification of the local government health authority, active search and line listing of cases from other health facilities. A household survey was conducted to find additional cases as well as to define the extent of the outbreak. Qualitative techniques were also employed to explore the issues associated with the uptake of immunization in the community. A total of 29 measles cases were identified, all were less than five years old. There were two deaths giving a case fatality rate of 6.9%. Majority of the cases (96.5%) were not immunized against measles. The epidemic spanned 5 weeks with majority of the cases occurring in the 2 nd week. There was a clustering of cases in one of the five quarters/settlement – Otesile. The measles immunization coverage for the community was estimated as 22.9%. The stated reasons for the poor uptake of immunization were lack of time, not regarding it as important. A total of 432 children aged 9 months to 15 years received measles antigen during the response vaccination campaign. The measles outbreak in Ogunmakin village was due to low routine immunization coverage resulting in an accumulation of susceptible children. Socio-cultural factors and weak health infrastructure contribute significantly to the low uptake of immunization. There is the need mobilized the entire community on the importance of immunization as well as strengthen the provision of routine immunization.

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