Despite the comprehensive World Health Organization (WHO)/United Nations Children's Fund (UNICEF) measles mortality–reduction strategy and the Measles Initiative, a partnership of international organizations supporting measles mortality reduction in Africa, certain high-burden countries continue to face recurrent epidemics. To our knowledge, few recent studies have documented measles mortality in sub-Saharan Africa. The objective of our study was to investigate measles mortality in three recent epidemics in Niamey (Niger), N'Djamena (Chad), and Adamawa State (Nigeria).
Methods and Findings
We conducted three exhaustive household retrospective mortality surveys in one neighbourhood of each of the three affected areas: Boukoki, Niamey, Niger (April 2004, n = 26,795); Moursal, N'Djamena, Chad (June 2005, n = 21,812); and Dong District, Adamawa State, Nigeria (April 2005, n = 16,249), where n is the total surveyed population in each of the respective areas. Study populations included all persons resident for at least 2 wk prior to the study, a duration encompassing the measles incubation period. Heads of households provided information on measles cases, clinical outcomes up to 30 d after rash onset, and health-seeking behaviour during the epidemic. Measles cases and deaths were ascertained using standard WHO surveillance-case definitions. Our main outcome measures were measles attack rates (ARs) and case fatality ratios (CFRs) by age group, and descriptions of measles complications and health-seeking behaviour. Measles ARs were the highest in children under 5 y old (under 5 y): 17.1% in Boukoki, 17.2% in Moursal, and 24.3% in Dong District. CFRs in under 5-y-olds were 4.6%, 4.0%, and 10.8% in Boukoki, Moursal, and Dong District, respectively. In all sites, more than half of measles cases in children aged under 5 y experienced acute respiratory infection and/or diarrhoea in the 30 d following rash onset. Of measles cases, it was reported that 85.7% (979/1,142) of patients visited a health-care facility within 30 d after rash onset in Boukoki, 73.5% (519/706) in Moursal, and 52.8% (603/1,142) in Dong District.
Children in these countries still face unacceptably high mortality from a completely preventable disease. While the successes of measles mortality–reduction strategies and progress observed in measles control in other countries of the region are laudable and evident, they should not overshadow the need for intensive efforts in countries that have just begun implementation of the WHO/UNICEF comprehensive strategy.
Three household retrospective mortality surveys in parts of West Africa affected by recent measles epidemics found that, despite progress made elsewhere, mortality rates remain unacceptably high.
In most developed countries, measles is often now regarded as an uncommon and not very serious childhood illness. The situation in developing countries is totally different; many children get measles, and the consequences can be severe. The main factor accounting for this difference is the much greater availability of vaccination against measles in developed countries. Globally, approximately 410,000 children under the age of 5 y die of measles each year. In developing countries, the death rate among children with measles is 1%–5%, but in refugee situations and among malnourished children, it may reach 10%–30%. The complications of the disease include pneumonia, diarrhea, encephalitis, and corneal scarring, which can lead to blindness. It costs less than US$1 to vaccinate a child against measles but, tragically, it remains the leading cause of vaccine-preventable death among children.
Why Was This Study Done?
There are many national and international initiatives intended to improve measles vaccination rates, and in many developing countries things are improving; measles death rates in Africa as a whole are believed to be less than half of what they were 10 y ago. However, in certain countries—for example in West Africa—serious measles epidemics do still occur. It has been some years since any major studies have been conducted to try to establish how many children die during these epidemics. It is important to know this in order to help with efforts to improve the situation.
What Did the Researchers Do and Find?
They focused on three epidemics of measles in West Africa and their impact on one neighborhood in each of three countries that were severely affected: Chad, Niger, and Nigeria. The total population of these neighborhoods was more than 64,000. The researchers spoke to the heads of households and asked for information about measles cases. They recorded details of symptoms of children who were taken ill during the epidemic and the outcome, including deaths. They also noted what action families took when children had measles. The percentage of children who developed measles was around 17% in the neighborhoods in Chad and Niger, and 24% in the Nigerian neighborhood. The death rate among the children who had measles was around 4% in Chad and Niger, and 11% in Nigeria. Most parents took their children to a health-care facility within 30 d of a rash appearing but this varied: 86% did so in Chad, 74% in Niger, and 53% in Nigeria.
What Do These Findings Mean?
Children in these countries still face an unacceptably high risk of death from a completely preventable disease. Much more needs to be done to increase the number of children who are vaccinated.
Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0040016
Wikipedia information on measles (note that Wikipedia is an online encyclopedia that anyone can edit)
More detailed information on measles may be obtained from MedlinePlus and the World Health Organization
Information about the Measles Initiative
For information about the three countries in this study, consult their country profiles on the BBC website: Chad, Niger, and Nigeria.