Childhood measles in a south eastern state university teaching hospital

Background: The disease burden from measles, a vaccine preventable disease remains high despite decades of interventions by World Health Organization, Nigeria and other agencies. Objective: To assess the prevalence and pattern of childhood measles among children presenting at Imo State University Teaching Hospital, Orlu, Imo State. Design: Retrospective descriptive. Methods: A retrospective descriptive study of children who had measles infection in Imo state university teaching hospital within the given time frame (June 2009 - June 2014). Data was abstracted from the hospital records using a proforma, and analysed with SPSS at a statistical significance level of 0.05. Results: Within the study period, 12,216 patients attended the paediatrics clinic. Of these, 115(0.9%) were diagnosed with measles infection. The peak age was in infancy 30 (26.1%). Of the total infants 15(50%) were less than 9 months of age. The age group 37-42 months had the lowest frequency 9(7 7%). Males, 80(69.6%) were statistically significantly more than females 35(30.4%) giving a female : male ratio of 1:2.3 with a P value is < 0.0001,Chi-square statistic (with Yates correction) = 33.670, Odds ratio= 5.224, 95% Confidence Interval: 2.979 to 9.164. most of the patients 112(97.4%) were Ibos. Rural dwellers 108(94%)were statistically significantly more affected than urban dwellers7(6%). Most of the parents of these children 50(43.5%) were farmers; 28(24.5%) were housewives. 60(52.1%) of these parents had only primary school education while 15(13.3%) had junior secondary and 15(13%) had no formal education. 109(94.8%) were Christians. All the 115 patients presented with both skin rash and fever; 100(87%) presented with cough; 52 (45.2%) presented with poor appetite and 30(26%) presented with weight loss. Complications from the measles infection were bronchopneumonia 40(34,8%), otitis media 32(28%), protein-energy malnutrition 25(21.7%), tonsillitis 15(13%) and blindness 3(2.6%). Majority 77(67.0%) had not received measles vaccine while 38(33%) had received the vaccine. The major reason given for failure to receive the vaccine was that the mother forgot 28(36.4%), child not due for immunization 21(27.3%), no vaccine at the health centre 14(18.2%) while 14(18.2%) had no excuses. The children who died were aged 5months, 7months, 8months, 14 months and 24months respectively with a female to male ratio of 1:2.5. None of the dead children had received the measles vaccines before the onset of the illness. All of them had complications which included bronchopneumonia 5(100%), otitis media 5(100%) and encephalitis 4 (80%). Complications occurred more in the malnourished and the unvaccinated. Of the 80 children who were admitted, there was a case fatality rate of 6.3%. Mortality was associated with bronchopneumonia, otitis media, encephalitis and age under 2years. Conclusion: Measles remains a burden in our environment affecting mostly infants, the unvaccinated, rural dwellers, and children whose parents were of low educational and socio – economic status.