ASSESSMENT ON MEASLES INFECTION AMONGSTCHILDREND UNDER FIVE YEARS IN NIGERIA

CHAPTER ONE INTRODUCTION 1.1 Background to the Study Globally, significant progress has been made in reducing child mortality due to socioeconomic development and the implementation of targeted child survival interventions. Despite these advances, the World Health Organization (WHO, 2021) reported that approximately 5.2 million children under the age of five died in 2019. Although this reflects a notable decline from previous decades, the burden remains disproportionately high in low- and middle-income countries (LMICs). Measles remains one of the leading vaccine-preventable causes of death among children, particularly in sub-Saharan Africa (UNICEF, 2022). The Sustainable Development Goals (SDG 3.2) aim to end preventable deaths of newborns and children under five by 2030, yet progress remains uneven across countries. WHO and the Child Health Epidemiology Reference Group (CHERG) identified measles as a major contributor to under-five mortality, with its fatal outcomes commonly exacerbated by complications such as pneumonia, diarrhea, and malnutrition (WHO, 2023). Measles is an acute viral illness characterized by high contagion and severe complications. According to Adepoju and Ezechi (2021), outbreaks are more frequent in impoverished, densely populated regions with low vaccination coverage. Although preventable through immunization, measles causes approximately 140,000 deaths annually, mostly among unvaccinated children under five (Gavi, the Vaccine Alliance, 2022). Factors such as poor nutrition, weak health infrastructure, and limited maternal education further intensify the risk of infection and fatality. Transmission occurs primarily via respiratory droplets and direct contact. Onyiriuka et al. (2020) emphasized that while maternal antibodies often protect infants below six months, primary vaccine failure or missed immunization windows heightens susceptibility in older infants. In Nigeria, the disease continues to exert substantial pressure on child health outcomes, as routine immunization coverage remains below global recommendations. Although countries such as the United Kingdom have successfully interrupted endemic measles transmission through high immunization coverage (WHO/Europe, 2020), Nigeria continues to struggle. With national measles vaccine coverage stagnating at approximately 62% (UNICEF, 2022), regional disparities exacerbate the problem. In states like Abia, infrastructural and behavioural barriers hinder consistent access and adherence to immunization schedules. In Nigeria, the case fatality rate for measles ranges from 3% to 5% in clinical settings and up to 10% during large-scale outbreaks (Africa CDC, 2021). The high disease burden, particularly in rural areas, necessitates localized data to guide policy and public health responses. This study is motivated by the limited available epidemiological data on measles infection in Umuahia North Local Government Area (LGA), Abia State, despite periodic outbreaks and persistent under-immunization. 1.2 Statement of the Problem Measles, despite being vaccine-preventable, remains a leading cause of child morbidity and mortality in Nigeria. According to Ushie, Fayehun, and Ugal (2020), high rates of infection persist due to undernutrition, overcrowding, and weak health systems. While global efforts—such as the Measles & Rubella Initiative launched in 2001 and revised in 2012—have aimed to eliminate the disease, Nigeria is still one of the 47 countries with the highest measles burden (WHO, 2023). Obiajuru, Ibebuike, and Vincent (2022) noted that vaccine uptake in Nigeria remains suboptimal due to factors like misinformation, maternal illiteracy, and logistical barriers. Despite periodic mass immunization campaigns, millions of children remain unvaccinated or partially vaccinated. In 2020 alone, the National Primary Health Care Development Agency (NPHCDA) reported significant outbreaks across Northern and South-Eastern states, including Abia. In Umuahia North LGA, little localized epidemiological research exists to assess measles prevalence and immunization gaps. Previous studies often generalized findings across broader geopolitical zones, overlooking local dynamics. Moreover, misinterpretation of measles as benign rashes by caregivers leads to underreporting and delayed healthcare-seeking. These challenges underscore the need for this study, which aims to analyze measles incidence among infants and identify key barriers to vaccine compliance within the LGA. 1.3 Aim and Objectives of the Study The broad aim of this study is to examine the prevalence of measles infection among infants in Umuahia North LGA, Abia State. The specific objectives are 1. To identify the number of infants diagnosed with measles in Umuahia North, Abia State. 2. To assess the age-related prevalence of measles among infants in the study area. 3. To determine the prevalence of measles infection in immunized versus non-immunized children. 4. To identify the factors associated with non-compliance to measles vaccination among unvaccinated infants. 1.4 Research Questions 1. What is the number of infants diagnosed with measles in Umuahia North, Abia State between 2016 and 2021? 2. What is the age-related prevalence of measles among infants in the area? 3. What is the comparative prevalence of measles infection between immunized and non-immunized children? 4. What factors contribute to non-compliance with measles vaccination among unvaccinated infants? 1.5 Significance of the Study The study holds both theoretical and practical significance. Its findings will inform stakeholders on local epidemiological trends and support evidence-based planning to improve immunization strategies. It will aid health policymakers in refining outreach models and address systemic gaps in routine immunization. Specifically, data from this study can be used by Federal Medical Centre (FMC) Umuahia and the Abia State Ministry of Health to evaluate and strengthen their immunization programs.By identifying barriers to vaccine uptake and the differential burden of measles across demographics, the study contributes to broader efforts toward measles elimination in Nigeria. Furthermore, its findings will add to existing literature and serve as a reference for future academic research. 1.4 Scope of the Study This study focuses on the prevalence and distribution of measles infections among infants in Umuahia North LGA, Abia State, covering a six-year period (2016–2021). It explores diagnosed cases, age-related patterns, immunization status, and socio-behavioral determinants of vaccine uptake. The research is limited to data obtainable from local health facilities and caregivers within the LGA. 1.7 Limitations of the Study The study may be constrained by limited access to complete health records, especially retrospective data from 2016–2021. There may also be challenges related to the accuracy of parental recall regarding vaccination status. Additionally, social desirability bias might affect caregiver responses during interviews. Lastly, the study is geographically restricted to Umuahia North LGA, which may limit the generalizability of the findings. 1.8 Operational Definition of Terms Measles Infection: A highly contagious viral illness in infants characterized by fever, rash, cough, and conjunctivitis, confirmed through clinical diagnosis or laboratory testing. Immunization Coverage: The percentage of infants who have received the recommended measles-containing vaccine (MCV) within the appropriate age bracket. Vaccine Non-Compliance: Failure or refusal to receive measles vaccination according to national immunization schedules due to various behavioral, cultural, or systemic factors.