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Introduction: Public Health Impact and Prevention Strategies for Children Under 5 in Northern Nigeria

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Measles is an extreme disease that is primarily a viral disease and is obtained from a virus name Morbillivirus. This virus is mainly a part of the family of paramyxovirus. The incubation period of this disease is approximately ten days, and the range of this virus is between seven to eighteen days. This virus is mainly featured by a particular type of fever and it has the following symptoms in the body a dry cough along with the identification of conjunctivitis. The mortality rate of this disease falls under various categories (ncbi.nlm.nih.gov/pmc, 2022). Measles has adversely affected people globally of about twenty million people and the infection mostly affected people that are belonging from regions that are underdeveloped. This infection has affected people from Asia and Africa and the North part of Nigeria and mainly children who are under the age of five years. This virus is basically effect the north Nigerian people. It will frequently transmitted for several months. It attacks the child lung and also make infection in throttle. This virus effect the north Nigeria very effectively. According to WHO, it is clear that fifty percent people are affected in the geographical part of north Nigeria by this disease (afro.who.int/news, 2022). This not only affect children it is also affect the middle age strong people also. According to the study, measles is explained as a form of infection in north Nigeria that shows the pressure of the disease in this region. This shows the loophole and the various recommendations along with the preventive measures is done by WHO along with the improvement and control. 

Impact of measles on public health

These measles virus has more impact on the Nigerian people who are lived in the northern part. In the north part of Nigeria has a proper environment for the virus that is why the virus can easily flew in the air and spread out through the air. It affect the people and children to the maximum part. The unhealthy environment for the virus and also the immunity power of the southern parts of Nigerian people, the virus cannot be spread very badly like northern part of Nigeria.  This virus is mainly common in the part of countries that is the mode of developing and particularly in the regions of Nigeria. This virus is a contagious disease that is mainly spread by dry coughing, sneezing and also by contact mainly personally (who.int, 2022).  The mechanism of this virus is that it remains primarily active and is also contagious in the atmosphere that is affected the person when he or she comes in direct contact. This virus spreads that can cause epidemics is the reason for several death to the child in Nigeria who are below the age of five. Children who lack nutrition are more vulnerable to viruses and the occurrence of rash caused to the child after getting infected within four days. The countries where this disease is reduced along with the various cases of import of this virus from the other part of the countries remain the crucial source of this disease.

Cases of Measles in Nigeria

Figure 1: Cases of Measles in Nigeria

This viral outbreak is responsible for the killing of more than ten thousand children of the local population of Nigeria and this keeps on spreading all over the region of the country. Recently the cases began to increase in October 2018 and this virus impacts the local population of regions with various symptoms such as redness in the eyes and pain in the mouth along with rash all over the skin (Baffa et al. 2018).  According to the data of the World Health Organization (WHO), this situation had an outbreak in the regions since the whole country gained the vaccines for measles in 1963.

The large party of these endemic outbreaks affected mainly the children of Nigeria. There is the state named Borno where the people of that are mainly gets affected and the recording of the 15,237 cases wre highly identified (pubmed.ncbi.nlm.nih.gov, 2022). This virus has affected the people of Nigeria by damaging the lungs and creating respiratory problems. Measles had affected the system of the immunity that results in the development of the harmful disease pneumonia (Utulu et al. 2020). This virus causes the death of many children in Nigeria along with the instability that led to the occurrence of this virus. In the past decade countries like Afghanisthan, Ethiopia along with Nigeria gets hugely affected by this virus, measles creates massive havoc among the children of the country during the period of 2022 and the impacted rated is much higher (unicef.org, 2022). This disrupts the system of surveillance that resulted in the inappropriate recording of the number of cases. 

Surveillance data of measles in Northern Nigeria

From the data of the past two years, that is 2019 and 2020, the region of Nigeria is one of the countries where children are not vaccinated. The two major organizations one is WHO and the other one is UNICEF computes the process of immunization nationally and shows the coverage of the vaccines for this disease one is DTP3 and the other part of this is MCV1 that is not processed and improved in recent years (Sato et al. 2022, p.15). The regions of Nothern Nigeria have initiated a passive structure and system of surveillance for the dangerous disease of measles. The results thus indicate that there is an original rise in the various cases that are related to the outbreak of measles (GIRMA 2020). According to the data, there is the symbol of the rising trend of the cases of measles and the primary assessment and evaluation of the cases of this disease in the northern and southern parts of Nigeria. 

Measles cases

Figure 2: Measles cases

There is an investigation related to these cases of these diseases along with the data, quality and performance of the sites that are reporting and this is made to assess the information and the data on the side of reliability (Abdulrahman et al. 2022, p.12). This is mainly generated by the system and characteristics of the surveillance and the regions of Nigeria mainly experiencers the outbreaks that are recurrent mainly in the northern region of the country that strengthens the immune and the activities based on immunisation. This was concluded on the basis of analysis of the data that is secondary that collected the information and surveillance between the period 2012 and 2018 (Utazi et al. 2020, p.300). This surveillance data was gathered from the local government of the populations of the region in the state of Zamfara, this is sourced from the Ministry of Health of Zamfara state. The computation of the frequencies and the proportions of the particular data of the statistics are utilized in the analysis of the series. There is a total, of approximately thousand and twenty-three cases of measles that is sourced from the data of January and December in the year 2018. The age of the median is particularly in the segment of 2.3 years (Ige et al. 2019, p.319). It is identified that males are more vulnerable to these diseases because as there is an increase in age this incidence tends to decrease. Recently the cases began to increase in October 2018 and this virus impacts the local population of regions with various symptoms such as redness in the eyes and pain in the mouth along with rash all over the skin. Therefore, the overall rate of fatality is higher than the four per cent in recent years.  The surveillance concluded that the high pressure of this disease among those who are the age of five in the regions of the urban population thus interacts with control and the reduction measurement of this disease (Na'uzo et al. 2021). Therefore the reduction measurement of these diseases is of various strategies and the successful reduction of the viruses strengthened among the children of Northern Nigeria

The southern part of the region has the highest coverage of this vaccination when compared with the Northern part of the state. Due to the high transmission of this disease in the regions of Africa, the WHO thus introduces the plans of strategy for the reduction of this disease and the various target of reduction taken by the local population of Northern Nigeria (Akinbobola and Hamisu, 2018, p. 200)). The various plans of strategy that are developed by the institutions thus take the aim of reduction of this disease in all parts of Nigeria by the end of 2020. 

The surveillance of Measles is passive and mainly depends on the system that is initiated by the  Disease Surveillance Notification Officers and by the doctors and the nurses and the other members of the community. The cases were mainly reported on a weekly basis according to the system of ISDR. This information is also channelled from the various facilities of the health department (Sato et al. 2022). This disease is also surveillance among the ward members who are on the basis of the focal band of the local government (Eze, 2020). There are various feedback relating to this is provided in the direction that is opposite and the cases that are suspected related to this disease can be explained to any person with the symptoms of high fever along with the rash and dry cough and the problem that is related to the eyes. According to the data, this is estimated about the population that is produced from the Commission of the National Population and from the data of 2006 the figures of the census shows the utilization of the grown on the annual basis is approximately 3% from the state of Zamfara.

Preventsion of measle

Vaccines are used for the prevention of measles in both children and adults. The vaccines of the measles are generally given to children as a mixture of the measles-mumps-rubella (MMR) vaccine. Sometimes these types of vaccines also include the vaccine for chickenpox and that are familiar as the MMRV vaccine (O’Donnell et al. 2019, p.311). The healthcare worker suggests that a child should get the MMR vaccine at age of 12 to 15 months and again they have to receive it during the age of 4 to 6 years when they are attending school. The two doses of the MMR vaccine are approximately 97% effective in blocking the measles that protect these small lives (Kauffmann et al. 2021, p.820). After getting measles people children can also be affected by the measles but the signs are very mild.

Around 86% of the children in the world received at least a single dose of the vaccine for measles before their 1st birthday and the figure goes to 72% in the year 2000. In many studies, it is observed that the effectiveness of the combination vaccine MMR is more than the separate vaccination of mumps, measles and rubella (Pittet et al. 2020, p. 138). Small side effects are noticed after the vaccination such as fever and mild sore arm. Among the non-vaccinated children most of them are belongs to Nigeria, Pakistan and India.

Measles is one of the contagious viral diseases that are related to the respiratory. In Nigeria, the morbidity and mortality rates were continuously elevating in children who are under the age of 5 years. The Nigerian government takes many steps for preventing measles in their country (news.un.org, 2022). The National Primary Health Care Development Agency (NPHCDA) with the help of the World Health Organization (WHO) launched a programme to fight against measles. Gavi also supported this campaign as the alliance of vaccines (afro.who.int, 2022). The main goal of this campaign was to arrive at the children that were more than approximately 28 million. This campaign was run across 19 states in the northern part of Nigeria. The states are, Bauchi, Benue, Kano, Katsina, Borno, Plateau, Taraba, Adamawa, Kaduna, Niger and Sokoto. The other states are Kebbi, Gombe Jigawa, Nasarawa, Yobe, Kwara, the Federal Capital Territory and Zamfara.

Measles cases in Bayelsa state

Figure 3: Measles cases in Bayelsa state

The WHO, Gavi and NPHCDA executed their vaccine centre in different places of the northern states such as schools, markets, mosques, churches and every possible area to reach their targeted population. The Gavi provided funding through the vaccines for measles to run the programme not only in those 19 states but also in 5 states of the southern part of Nigeria (Ige et al. 2019, p.11). WHO’s Nigerian section trained more than 44000 healthcare providers and approximately 17000 teams were mobilised for the vaccination to give support in those campaigns.

The campaign for the vaccine of measles was very effective in Nigeria. The government as first stage of the campaign started to educate the people through different visual aids, such as television, radio and many more. The government in its campaign told that isolate the affected children because of its contagious property. They also suggested that vaccinated person also stay away from them. The government strategically put the centre of the campaign in those people where people could easily get access to it.  The government is continuously trying to educate the parents on the positive side of the vaccine. The coverage of vaccines reduces death by 73% by the year 2018 that is claimed by the WHO

Reduction of the Impact on Public Health

Measles is a communicable disease and acute respiratory disease that are viral. It can affect any person of any age. These diseases can be very fatal and serious for a small child whose age is under five. The common symptoms are fever, coryza cough, conjunctiva and malaise. Nowadays measles is under control because of the vaccination that prevents it and therefore the death rate also decreases.

A single case of measles should get greater priority for public health. Investigation and prompt identification are crucial for controlling the acceleration of the outbreak strategies. The response to the outbreak of measles is a wide logistical procedure that needed reasonable preemptive, planning or the gathering of the committee to control the outbreak (Aladejebi, 2020, p30). The members of this committee should be experts from the health departments. The committee go through regular routine training and planning activities that are required for the emergency outbreak. This committee also helps to determine the requirement for extra resources.

After the detection of a case, further transmission risk is also required to be determined. It is important to identify the individual who came to close contact with a measle-affected person and is at very high risk to get affected. A factors rapid assessment that could give to a virus outbreak at the level of local, an evaluation of coverage data of vaccination that is available in the contagious population, must be completed.

Surveillance must be increased to look for more cases and make sure of a timely measles diagnosis. The first approach to elevate surveillance is to rise the between the locals about the transmission. The school, laboratories, physicians and others are encouraged to report any further new cases of measles and take part in active surveillance (ncbi.nlm.nih.gov, 2022). Unreported cases can be recognized by reviewing the attendance log of the emergency room and laboratory records.

Communication with health authorities and the public is necessary to increase awareness of the measles’ risk. In case the exposure happens in a big area then it is best to not trace the individual contact (Matthew et al. 2018, p.45). In that place, it is best to inform the potential exposure to the public that may help in finding the cases. Then the public will be up-to-date about the outbreak status and the potential exposure in different ways such as through media releases, press briefings and many more.

The caregiver of the measle affected person should be knowledgeable about the transmission mode of the virus, the period of infection and the minimization of the measles spread. Generally, this advice can be provided through printed materials. Phone lines only for measles can also be set up for providing guidelines (Adekoya, 2018, p.5). The persons who are exposed towards measles should get counsel to be observant of the symptoms of measles and to obey the provided steps in case the disease developed.

The clinical specimens must be collected for the confirmation of the measles and for the detection of the viral molecular and genotyping. This is very important because epidemiology can aid in the identification of the source of the outbreak.

Measures to reduce the measles’ spread that includes vaccination offered towards non-immune persons. This will help to decrease the outbreak of measles. Patient's clinical, epidemiological, and demographic data should be collected at the time of the case interview (Khan et al, 2020, p. 835). It is recommended to complete the interview in the first 48 hours after identification of a case. At the last of the outbreak, an analysis of the notification of the outbreak and data on the response must be done.

Conclusion

The measles virus is responsible for measles disease and they affect the respiratory system of human. This illness is very fatal for small children and it can cause death. Conjunctiva, fever and cough are the common symptoms of this illness. This illness is spread through coughing and sneezing. There are only two ways to prevent this kind of illness that is isolation and vaccination. The main purpose of this study is to understand the outbreak of measles in Nigeria and how to combat it. Steps are further needed to prevent further outbreaks of measles. 

The number of measles was continuously increased in Nigeria, especially in the northern part of it. Children who are under the age of five were getting affected by measles and the death rate was increasing very rapidly at that time. The government of Nigeria started a campaign to fight against measles with the help of WHO, Giva and NPHCDA. All of these organizations help the Nigerian government in different ways as Giva provided the required vaccine that is needed for measles. WHO trained many workers the help in the campaign, after these campaigns, they succeeded to reduce the mortality rate of children. Most of the children got at least one dose of the vaccine by a year. The government of Nigeria further takes some steps that stop the outbreak such as making committees, collecting data, surveillance and many more. The public of the Nigeria must also take part in this programmed very positively.

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