Risk Factors for Measles Deaths in Children: Kyegegwa District, February-September 2015

Introduction: Measles is a highly contagious infection spread by droplet transmission.. In 2013 there were 145,700 measles deaths globally, majority of whom were below 5years [1]. From January – August 2015, Uganda experienced measles outbreaks in several districts in the western region including Kyenjojo, Mubende ,Isingiro and Kamwenge[2]. On 18 August 2015, Kyegegwa District reported a cluster of 8 suspected measles deaths. We went out to investigate the causes and risk factors for deaths in this outbreak.

Methods: We defined a probable measles diagnosis as onset of high fever (≥38OC), generalized maculopapular rash plus any of: conjunctivitis, cough or coryza between 1st February and 15th September in a Rwentuha sub-county Kyegegwa District resident; a case, as a death in a child (<5 years) with a probable measles diagnosis in the same period, and a control

as a child (<5years) with a measles diagnosis in the same period who survived. We rigorously searched for cases and controls by working together with the village health team members. Using standard questionnaires, we interviewed parents/caretakers for both case and control-persons and also reviewed patient’s records. It is scientifically known that prior measles vaccination and vitamin A supplementation during illness reduces the se- verity of illness and thus risk for measles death. Additionally malnutrition, young age and inadequate treatment are risk factors for measles deaths.
We subsequently reviewed vitamin A supplementation during illness, treatment according to standard guidelines and measles vaccination status among 16 cases and 48 controls-persons matched by age and village of residence in a case control study. We collected blood specimen for measles diagnosis from the sick children.

Discussion: Our findings indicated that deaths were under the age of five (>5), indicating great danger of measles to infants as compared older age. These findings are in line with a study conducted in Niger, Nigeria and Chad [3, 4].The study also showed that a big proportion of deaths were not vaccinated. For the small fraction of cases who were vaccinated, it could have been ineffectiveness of vaccine as a result poor storage. For instance, towards the end of 2014, there was a cold chain break down in the district which could have affected the quality of vaccine. Meanwhile, almost a quarter of the cases were below vaccine eligible age (9 months) recommended for measles vaccination in Uganda. A numbers of factors affect the vaccination performance in the study area like in the study conducted in Nigeria [5]. Those identified include; people’s negative perception towards vaccine, distance to the health centers, poor health education and poverty, and inadequate health facilities and personnel in the area of study. It was revealed that that Vitamin A supplementation

during illness plays great role in boosting immunity, lack of vitamin A supplementation was associated with death of measles patients in this investigation and elsewhere [6]. Our findings also revealed that less than 10% among the deceased compared to 92% sought treatment from health facilities.
This was in line with the high numbers of deaths that occurred at home compared to those that took place at health facilities. Similarly, the study done in Niger, Nigeria and Chad, 6% did not report to the any health facility citing reasons such as poverty, distance and ignorance [3].
The high percentage of death that occurred at home suggests that the locals still trust traditional treatment to conventional medicine in the cure of measles. It was noted that the community believed in the myth “ that a measles case would die if at all he/she crossed a road.” Others believe that treating measles with an injection causes death”. Tradition- al behaviors in the study area influence the management of measles as in many other less developed countries [7].