As many as 210 children have tragically lost their lives to a measles outbreak in Sindh during 2012, with no signs of a let up in sight. The outbreak is not an overnight phenomenon. An upward trend in measles cases was noticed in the in the southern districts of the province including Karachi city in March 2012. Later in the year, another escalation was noticed from October onwards, reaching its peak in December. This time, the highest number of cases and deaths were reported from districts in the northern parts of Sindh. District Qamber Shahdadkot reported maximum number of measles cases (777) while district Sukkur remained conspicuous for maximum deaths (33).
An update released by the World Health Organization on January 1, 2013 informs that 2,222 suspected measles alerts were reported from various districts of Sindh during the period between January 1 and December 25, 2012. Of these, 502 alerts were confirmed as outbreaks. The total number of suspected cases investigated by the Disease Early Warning System (DEWS) teams in 23 districts of Sindh stood at 7,274. Of these, 291 (4%) children were less than 9 months of age and were not eligible for vaccination; the number of eligible children stood at 6,983 (96%). Investigations have revealed that 18% of the eligible children had received one dose of measles vaccine, 4% had received two doses, and a staggering 78% had remained unvaccinated for measles.
The WHO attributes a majority of the deaths to post-measles complications such as pneumonia, post-measles encephalitis and diarrhea. About 20% of the deceased children were malnourished too. The disease has hit areas marked by poverty, unhygienic living conditions, lack of clean drinking water, non-availability of appropriate medical facilities as well as paramedics and doctors, and most importantly, poor routine immunization coverage.
An emergency measles and Vitamin A campaign targeting 2.9 million children aged between 9 months to 10 years has teed off in 8 districts of Sindh (Sukkur, Khairpur, Larkana, Qamber-Shadadkot, Shikarpur, Jacobabad, Ghotki and Kashmore), effective January 1-9, 2013. While this is a step in the right direction, media reports reveal that over 400 social and Lady Health Workers in Dharki city have announced to halt all work relating to the anti-measles campaign until improvement in their service structure. The LHWs are reported to have boycotted the drive to convey their sentiments against non-payment of dues for an earlier anti-polio campaign. While it is crucial to maintain high immunity levels and immunize all children at recommended ages to prevent resurgence of measles outbreaks, issues like non-payment of dues to LHWs also need to be resolved for the conduct of an effective and comprehensive immunization campaign.
Measles, a respiratory infection caused by a virus, is a major killer of children worldwide. The infection can spread via contact with droplets from the nose, mouth, or throat of an infected person. Sneezing and coughing can release contaminated droplets into the air. Routine immunization is highly effective in preventing measles.
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Mariam Malik (Blog moderator)
Senior Research and Communications Associate
Heartfile