LARKANA, Feb 4: The Sindh health department in its preliminary report on measles outbreak has revealed that a total of 88 children have died of the disease in Sindh over the past five weeks.

The report was submitted to Health Minister Dr Sagheer Ahmed by Dr Ashfaque Memon, former additional health secretary (technical) who was tasked with supervising the crash immunisation programme in the wake of a sudden rise in measles-related deaths in the province.

Poor routine immunisation coverage at primary health facilities is one of the reasons behind the outbreak, according to the report, which indicates that 70 per cent of such health facilities are under the administrative control of the People’s Primary Healthcare Initiatives (PPHI), Sindh.

The report observes that the PPHI focused only on providing curative services and there is a lack of communication and coordination between it and health department functionaries.

The report says that in 2012 the measles coverage was claimed to be 81 per cent but the claim is not reliable or authentic because of a lack of interest witnessed in the implementation of routine immunisation.

Dr Memon, who currently holds the office of the Director-General of Health Services, Sindh, told Dawn on Monday that the initial report had been submitted to the health minister and would be finalized along with the minister’s input.

He said heavy rains and floods in Sindh had internally displaced a big population over the past four years and most of the affected families had missed routine immunisation. Children belonging to these families also suffered from malnutrition and effect of other harmful environmental conditions.

Regarding the measles-related deaths, the report suggests that most fatalities occurred due to post-measles complications like pneumonia, encephalitis, diarrhoea and poor nutrition. The myths related to measles also accounted for the deaths, as parents of the affected children would prefer to see faith-healers instead of doctors. The report attributed the trend to belief, misconception and a lack of confidence in government hospitals.

Dr Memon said that malnutrition underlying immune deficiency paired with vitamin A deficiency and travel through the endemic areas appeared to be the risk factors that aggravated the situation.

The report suggests that unless the level of immunisation in pre-school age children is increased, the outbreak is likely to reoccur. During the crash vaccination programme kicked off in eight districts — Ghotki, Jacobabad, Sukkur, Khairpur Mir’s, Shikarpur, Kashmore, Larkana and Kambar-Shahdadkot, a total of 3,482,621 children were vaccinated till Jan 29, 2013. The number of suspected cases of measles till Jan 31, 2013 in the province stood at 3,041 while blood samples of 1,601 children were obtained and sent to the National Institute of Health, Islamabad, for verification, Dr Memon said.

He noted that 5,667,478 children were vaccinated against measles in the province till Jan 31, 2013 and 855 measles patients were admitted to various hospitals.

The report called for improvement in cold chain management of measles vaccine, undertaking urgent training of vaccination staff at all levels, and efforts to increase the nutritional status of children under the age of five years. The routine immunisation at district level should also be enhanced, it suggested.

The report recommended observance of ‘national immuinsation days for measles’ on the pattern of polio campaigns at six months interval during which targeted children should also be given vitamin A supplement. It called for efforts to cover the displaced population in the Expanded Programme of Immunisation (EPI).

In reply to a question that would the health department, as proposed earlier, arrange a second dose of measles vaccine next week, Dr Memon said negotiations on the proposal were under way.

However, he said, the World Health Organisation (WHO) saw no need for a second dose and regarded it as wastage of vaccine. However, sources say that the health department had already requisitioned three million vials from the federal EPI to launch the campaign for a second dose.