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© 1995 Faculty of Public Health Medicine of the Royal Colleges of Physicians of the United Kingdom

research-article

Assessment and possible control of endemic measles in urban Nigeria


P. Byass, Senior Lecturer
M. D. Adedeji, Assistant Director, EPI Unit
J. G. Mongdem, Director, Disease Control
A. C. Zwandor, Director General
S. H. Brew-Graves, WHO Representative
C. J. Clements, Medical Officer

Nottingham School of Public Health, Queen's Medical Centre Nottingham NG7 2UH
Federal Ministry of Health Lagos, Nigeria
Ministry of Health Plateau State, Nigeria
World Health Organization Lagos, Nigeria
Expanded Programme for Immunization, World Health Organization Geneva, Switzerland


Address corrrespondence to Dr P. Byass

BACKGROUND: Measles remains as a serious problem of infancy and childhood in the developing world, despite the availability of a vaccine. Increasing urbanization is changing patterns of endemicity.

METHODS: A survey of measles in an urban area of Nigeria, using a rapid assessment approach, was carried out to characterize measles in this community.

RESULTS: An annual incidence rate of 11.8% among underfives was found, associated with an acute case fatality rate of 3.3%. This level of endemicity was two orders of magnitude greater than that suggested by official case reports. An endemic, rather than epidemic, pattern was found over the six-month period of the study. Vaccine efficacy was estimated at 26%. Risk factor analyses showed the major risks for measles to be clinic at tendance in the month preceding disease, households with more than one mother, and having under-five siblings. Measles itself was the principal risk factor for malnutrition and against survival.

CONCLUSIONS: Improved understanding of measles epidemiology and risk factors are prerequisites for effective control. Possible strategies should include vertical vaccination efforts in addition to routine programmes.


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