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AMBALAVAO, MADAGASCAR – Babies groan when a nurse tries to rebadure mothers who have come to vaccinate their children. They fear a measles epidemic that has killed more than 1,200 people in this island nation where many are desperately poor.
While Madagascar faces the largest measles epidemic in its history and the number of cases far exceeds 115,000, resistance to childhood immunization is not the driving force.
Measles cases are on the rise in the United States and in other parts of the world, partly because of the misinformation that some parents are reluctant to see a crucial vaccine. New York City is now trying to end a measles epidemic by ordering mandatory vaccinations in a Brooklyn neighborhood.
In Madagascar, many parents want to protect their children but face huge challenges, including lack of resources.
Only 58% of the inhabitants of the main island of Madagascar have been vaccinated against measles, a major factor in the spread of the disease. Since measles is one of the most infectious diseases, the vaccination rate must be 90 to 95% or more to prevent epidemics.
On a recent day, the waiting room at the Iarintsena Health Center was full, with mothers sitting on the floor and others waiting outside in the oppressive heat. Two volunteer nurses and a midwife tried to respond to the request.
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 those 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 measles outbreak has killed most children under the age of 15 since its debut in September, according to the World Health Organization.
"The epidemic unfortunately continues to grow," but at a slower pace than a month ago, said Dr. Dossou Vincent Sodjinou, an epidemiologist at WHO in Madagascar. By mid-March, the Ministry of Health had reported 117,075 cases, affecting all regions of the country.
Some cases of resistance to vaccination exist because of the influence of religion or traditional health practitioners, but they are isolated, he said.
This epidemic is complicated by the fact that nearly 50% of Malagasy children are malnourished.
"Malnutrition is the bed of measles," said Sodjinou.
The baby from Razaijafisoa weighs only 5 kilograms.
"This is the case for almost all children with measles who have come here," said Lantonirina Rasolofoniaina, a health center volunteer.
It can be difficult to contact a help center for help. Many people in Madagascar can not afford to see a doctor or buy drugs, and health centers often lack staff or have low-skilled workers.
As a result, information on health issues may not be reliable. Some parents do not know that vaccines are free, at least in public health centers.
Four of Erika Hantriniaina's five children had measles. She had mistakenly thought that people could not be vaccinated after the age of nine months.
"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 been to town. I went to see another doctor who told me that my daughter was allergic. . . . This misdiagnosis was almost fatal. "
The girl had diarrhea and vomiting and could not eat, Hantriniaina said, adding that she had nearly survived.
Measles, a highly infectious disease transmitted by coughing, sneezing, close contact or infected surfaces, is not the subject of any specific treatment. The symptoms are treated instead.
"Vitamin A is given to children to boost their immunity. We try to reduce the fever. In case of cough, we administer antibiotics, "said Dr. Boniface Maronko, sent by the WHO to Madagascar to oversee efforts to contain the epidemic. If the disease is not treated early enough, complications appear, such as diarrhea, bronchitis, pneumonia and convulsions.
Madagascar's Ministry of Health has sent free medicines to areas most affected by the epidemic. Maronko reminded health center officials in the Ambalavao region not to charge parents, claiming that he had seen doctors asking for money. He said he feared the drugs would not be enough.
The country's capital, Antananarivo, a city of about 1.3 million people, has not been spared by the epidemic.
Lalatiana Ravonjisoa, a vegetable seller in a poor neighborhood, cries for her 5-month-old baby.
"I had 5 children. They all had measles. For the last one, I did not go to the doctor because I did not have money, "she said. "I gave my baby the leftover medicine from his big brother to bring down the fever."
For a few days she did not worry, "I felt like he was healed." But one morning, she noticed that it was hard to breathe. Later, she found that he was cold feet.
"Look at my baby," she said to her mother.
"She hugged her for a long time and she said nothing. Then she asked me to be strong. He was gone."
Ravonjisoa said that she was angry, "but I did not think for a moment that he was going to die." At the hospital, a doctor confirmed that his baby had died of respiratory complications related to measles.
At the end of last month, WHO launched a third mbad measles immunization campaign in Madagascar with the overall goal of reaching 7.2 million children aged 6 months to 9 years.
"But vaccination is not the only response strategy to this epidemic. We still need resources for care, monitoring and social mobilization, "said Sodjinou, epidemiologist of WHO.
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