Health care: The measles muddle
With sinking hearts one watched as every day of December brought with it news of children falling prey to measles — an infection of the respiratory system caused by Mobilliviruses. One hundred children died in the month of December 2012 alone.
Pakistanis were left aghast as 14,587 children were affected from the preventable disease of measles in the country during the year out of which 7,145 children were affected from Sindh only. The World Health Organisation (WHO) reported that a staggering number of over 300 innocent children lost their lives to measles in the country in the year 2012 which is a five-fold increase from 2011.
The brunt of these casualties rests on the province of Sindh alone where three quarters of these deaths were reported. To counter this, the Health Minister of Sindh declared a crash programme for administering the measles vaccine in January 2013 which claims to have reached some 2.9 million children in the eight worst hit districts of Sindh through 425 fixed centres and 997 mobile teams. The next booster is due to be administered in February.
It is a sad state of affairs that while health care expenditure in the other provinces has increased, Sindh’s expenses have actually declined by 6.4 per cent. When the provincial healthcare authorities will not make healthcare a priority, what is one to expect.
Measles — also referred to as Rubeola, morbilli, or English measles — is highly contagious and can spread through contact with fluids from an infected person’s nose and mouth, coughing or sneezing. Research shows that 90 per cent of people without immunity to this virus who live in close proximity with an infected person are sure to fall victim to it. A person should be concerned if he/she has a history of fever of at least three days, with at least one of the three C’s (cough, coryza, conjunctivitis). Its telltale rash is accompanied with fever, runny nose, cough and redness in the eyes. Symptoms begin eight to 12 days after one is exposed to the virus — this being the incubation period.
Any website will tell you that it is common for children in developed countries to be immunised against measles by the age of 18 months, as part of a three-part MMR vaccine (measles, mumps, and rubella). Children younger than 18 months possess anti-measles antibodies transmitted from the mother during pregnancy. A second dose is usually given to children between the ages of four and five, to boost immunity. According to Dr Musa Khan at WHO Pakistan, routine immunisation against measles is at nine and 15 months.
Sindh People’s Commission on Disaster Prevention & Management holds the provincial government’s health department responsible for their failure to carry out the routine immunisation under Expanded Programme on Immunisation (EPI).
Reports also reveal that the United Nations agencies like Unicef and WHO have fallen short in providing the vaccines and in adequate quantities resulting in a shortage of these lifesaving vaccines in most health facilities in Sindh.
The clear culprit is the state immunisation machinery which has failed to administer the measles vaccine and thus this distressing resurgence of the disease, especially in the flood affected districts of Sindh. Routine immunisation coverage was at a drastic low where interior Sindh’s coverage stood at 22-25 per cent and even coverage in the metropolis of Karachi remained at 55 per cent. The state machinery claims an 80 per cent coverage of the measles vaccine in Karachi which experts deem a gross miscalculation and exaggeration.
Clearly the standing water since the terrible monsoon rains in September 2012 in the flood affected areas of Ghotki, Shikarpur, Jacobabad, Sukkur, Larkana, Qambar-Shahdadkot, Khairpur and Kashmore-Kandhkot has accentuated the measles outbreak. Malnourishment in young children in these flood stricken areas adds to this mounting problem making these innocent ones easy preys to this contagious disease.
Dr Musa Khan claims that after the emergency was declared as a result of the floods in Sindh, WHO in coordination with the health department and related NGOs rushed to the area to handle the provision of proper healthcare material. This included providing medicines along with the establishment of Acute Respiratory Tract Infection Centres where medical personnel were trained.
Dr Musa adds, “WHO also supports in surveillance, investigation and response. Whenever there is a report of a measles case and more than five cases are identified we visit the area, we request the provincial health department for reinforcement of outreach vaccination activities and provide Vitamin A to the patients which is necessary for recovery”.
When asked what one can do to prevent the measles scenario from worsening in 2013 he was prompt to answer, “We require strong routine immunisation programmes. There should also be careful monitoring of vaccine cold chain maintenance to ensure the vaccines are stored at the proper temperature. It is also imperative to mobilise community education regarding the benefits and importance of measles immunisation and other vaccinations.”
Countries like USA and Canada hardly have cases of measles. It is frightful that innocent children are losing their lives in our country to a disease which can be curbed easily through proper prevention and education.