ASSESSMENT OF FACTORS ASSOCIATED WITH MEASLES OUTBREAKS IN ZARIA LOCAL GOVERNMENT AREA (LGA) KADUNA STATE, NIGERIA
ASSESSMENT OF FACTORS ASSOCIATED WITH MEASLES OUTBREAKS IN ZARIA LOCAL GOVERNMENT AREA (LGA) KADUNA STATE, NIGERIA
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Date
2012-09
Authors
DALHAT, MAHMOOD MUAZU
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Abstract
Measles is a highly contagious vaccine preventable viral infection. Immunisation coverage as
low as 20% were reported in Nigeria. Consequently, 30, 194 and 256 outbreaks of measles
were reported in 2006, 2007 and 2008, respectively. Identifying socio-demographic factors
predisposing to measles could provide strategies for measles control at community level. We
conducted a community survey to determine factors related to measles disease in households
in Zaria LGA.
An unmatched, case-control study was conducted. A case was defined as any child who was
diagnosed by a health worker in a health centre, between June, 2006 and June, 2011. Controls
were children from the same neighborhood who did not have a child with past history of
illness suggestive of measles (fever and rash). A multi-stage sampling technique was used to
select 140 cases and 140 controls. An interviewer-administered questionnaire was used to
collect demographic information and risk factors for measles. Anthropometric measurements
of assenting children were taken. Malnutrition was defined as ≤ 2 standard deviation away
from the WHO recommended Z-score table of weight for height. Independent risk factors for
measles was determined by bivariate and multivariate analyses. The study was complemented
with a KII with the persons in charge of routine immunization (RI) in all the 12 health care
facilities in Zaria LGA that received RI antigens from local authorities. An observation
checklist was completed by interviewers to assess availability of required facilities for RI
delivery.
A total of 72 cases (51%) and 60 controls (43%) were females. Median ages for cases and
controls were 42 months (range: 10 – 156) and 36 months (range: 9 – 108), respectively. Of
the 216 children assessed, 95(44%) were malnourished. Malnourished children [OR =1.9;
95% CI: 1.1 - 3.3)], failure to achieve DPT3 coverage [OR =2.3; (95% CI: 1.4 - 3.7)], lack of
formal education [OR =1.9; (95% CI: 1.1- 3.1)], maternal age >35yrs [OR =1.9; (95% CI: 1.1
XIII
- 3.2)], spending <150 naira on transport per vaccination visit [OR =2.3; (95% CI: 1.3- 4.1)]
and mother’s income <1000 naira ($7.0) per month [OR =2.1; (95% CI: 1.3 - 3.5)] were
statistically significant risk factors for measles disease on bivariate analysis. Multivariate
analysis revealed failure to vaccinate for measles [AOR =2.3; (95% CI: 1.1 – 4.7)], failure to
achieve DPT3 coverage [AOR =3.3; (95% CI: 1.7 – 6.4)], mothers earning <1000 naira
($7.0) per month [AOR =2.1; (95% CI: 1.3 – 3.5)], spending <150 naira ($1.0) per
vaccination visit [AOR =2.4; (95% CI: 1.2 - 4.6)] as independent risk factors for measles
disease.
A total of 12 KII were conducted. At least 7 respondents agreed that measles outbreaks were
frequent (≥1/year). All health facilities reported stock outs within the previous 6 months prior
to the study. Measles vaccine was among the vaccines unavailable during stock out in 4 of
the facilities. No measles vaccine was available in half the facilities during the evaluation. All
the facilities cited as major challenges to RI frequent stock outs of vaccine and poor parents’
awareness on importance of vaccination. Other challenges cited were poor facilities for cold
chain maintenance, absence of feedback from reports sent to local authorities, and lack of
staff training on RI delivery. All the respondents recommended maintaining a consistent
supply of RI antigens, improving public awareness on importance of immunization, provision
of cold chain maintenance facilities and regular training of staff.
Poor public health infrastructures, financial limitations among mothers and lack of awareness
by parents in the study area could lead to poor RI delivery. Effective RI delivery, improved
Health education and improving the socio-economic status of women could prevent measles
outbreaks.
Key words: Case-control, Measles, Nigeria, Risk factors, Vaccination.
Description
A THESIS SUBMITTED TO THE POSTGRADUATE SCHOOL,
AHMADU BELLO UNIVERSITY, ZARIA, NIGERIA
IN PARTIAL FULFILLMENT FOR THE AWARD OF
MPH – FIELD EPIDEMIOLOGY
DEPARTMENT OF COMMUNITY MEDICINE,
FACULTY OF MEDICINE,
AHMADU BELLO UNIVERSITY, ZARIA, NIGERIA
SEPTEMBER, 2012.
Keywords
ASSESSMENT,, FACTORS,, MEASLES,, ZARIA LOCAL GOVERNMENT,, KADUNA STATE,, NIGERIA.