Measles in Nigerian children. A study of the disease in West Africa, and its manifestations in England and other countries during different epochs

Abstract

1. An investigation of measles was made in Nigeria as part of a longitudinal study of 405 village children, supplemented by observations on 1,283 children admitted to a Mission Hospital with the disease.2. Measles was found to be the most serious of the acute infectious diseases of Nigerian children. During the Imesi village study measles played a major part in the death of 15, or 7% of the 222 children who were seen with measles. The overall case mortality in Nigeria is believed to be in the region of 5%. For children admitted to hospital with the complications of measles, a mortality in excess of 20% is not infrequent. This contrasts with the present situation in Northern Europe and America, where measles is of relatively minor public health importance.3. Bronchopneumonia was present in nearly half the children needing admission to hospital. Of those with bronchopneumonia, 28% died.4. Diarrhoea occurred in all stages of the disease, but was most common and severe during and following the period of desquamation. Treatment by parenteral fluid to combat dehydration was required in 55% of children admitted with this complication.5. Extensive loss of weight was associated with the disease in the majority of children. In the village study nearly one child in four lost 10% of his former weight. The mean time taken to recover former weight was 7·2 weeks.6. Children frequently developed marasmus and kwashiorkor after an attack of measles.7. Striking appearances were observed in the rash and subsequently in the skin. In some children the rash darkened in colour in the manner described by Rhazes and other early writers. Extensive desquamation often appeared after the rash. The desquamation was most severe when the rash darkened.8. The picture of measles in this study resembles descriptions of the disease to be found in the older literature. Accounts of the incidence and severity of bronchopneumonia, laryngitis, diarrhoea and weight loss before 1920 are presented to illustrate this similarity.9. Possible reasons for differences in the frequency and severity of measles in different places and epochs are discussed. Differences in strains of the virus and host immunity seem unlikely factors, but liability to secondary infections may be of some importance. It is concluded that the severity of the disease is related to the manifestations of the rash. A dark rash, followed by profuse desquamation, is associated with equivalent changes in the larynx, bronchus, and intestines, which are likely to be responsible for the occurrence of bronchopneumonia, laryngitis and diarrhoea. Defective nutrition is a possible cause of the ‘vulnerability’ of the epithelium.The analysis of the data from Nigeria was made possible by the payment of expenses to Dr Morley by the London School of Hygiene and Tropical Medicine from July 1960 to December 1961. Subsequently the work was supported by a grant from the Medical Research Council to Prof. B. S. Platt, Head of the Department of Human Nutrition, London School of Hygiene and Tropical Medicine.The authors wish to thank Dr W. R. Aykroyd, Senior Lecturer, Department of Human Nutrition, for his encouragement and assistance in preparing the text, and Miss Allen and Miss Wise for secretarial help. They must also thank Professor Court of the Department of Child Health in the University of Durham for helpful criticism.