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Measles outbreak kills more than 1,200 among Madagascar’s poorest

The Associated Press AMBALAVAO, Madagascar (AP) — Babies wail as a nurse tries to reassure mothers who have come to vaccinate their children against a measles outbreak that has killed more than 1,200 people in this island nation where many are desperately poor.

Madagascar faces its largest measles outbreak in history, with cases soaring well beyond 115,000, but resistance to vaccinating children is not the driving force behind the rise.

Measles cases are rising in the United States and elsewhere, in part because of misinformation that makes some parents balk at receiving a vaccine. New York City is trying to halt an outbreak by ordering mandatory vaccinations in one Brooklyn neighborhood.

In Madagascar, parents want to protect their children but face challenges including a lack of resources.

Only 58 percent of people on Madagascar’s main island have been vaccinated against measles, a major factor in the outbreak’s spread. With measles one of the most infectious diseases, immunization rates need to be 90 percent to 95 percent or higher to prevent outbreaks.

On a recent day, the Iarintsena health center’s waiting room was full, with mothers sitting on the floor and others waiting outside in the overwhelming heat. Two volunteer nurses and a midwife tried to meet the demand.

Nifaliana Razaijafisoa had walked 15 kilometers with her 6-month-old baby in her arms. “He has a fever,” she said. “I think it’s measles because there are these little pimples that have appeared on his face.”

The nurse quickly confirmed it.

“I’m so scared for him because in the village everyone says it kills babies,” Razaijafisoa said.

The outbreak has killed mostly children under 15 since it began in September, according to the World Health Organization.

“The epidemic unfortunately continues to expand in size,” though at a slower pace than a month ago, said Dr. Dossou Vincent Sodjinou, a WHO epidemiologist in Madagascar. By mid-March, 117,075 cases had been reported by the health ministry, affecting all regions of the country.

Some cases of resistance to vaccinations exist because of religious influence or traditional health practitioners, but they are isolated ones, he said.

This outbreak is complicated because nearly 50 percent of children in Madagascar are malnourished. Razaijafisoa’s baby weighs just 5 kilograms.

“Malnutrition is the bed of measles,” Sodjinou said.

“This is the case for almost all children with measles who have come here,” said Lantonirina Rasolofoniaina, a volunteer at the health center.

Simply reaching a clinic for help can be a challenge. Many people in Madagascar cannot afford to see a doctor or buy medicine, and health centers often are poorly staffed.

As a result, information about health issues can be unreliable. Some parents are not aware that vaccines are free, at least in public health centers.

Four of Erika Hantriniaina’s five children have had measles. She had wrongly believed that people could not be vaccinated after nine months of age.

“It’s my 6-year-old daughter who had measles first. She had a lot of fever,” she said. “I called the doctor but it was Friday. He had already gone to town. I went to see another doctor who told me that my daughter had an allergy. ... This misdiagnosis was almost fatal.”Speech

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