Frangeline is aged two, but weighs no more than a four-month-old — the terrible result of her battle with measles, which is cutting a deadly swathe through Madagascar.
Widespread malnutrition and low rates of immunization on the Indian Ocean island have ramped up the killing power of the highly infectious virus.
In the past six months, nearly 1,000 children have been killed by a resurgent disease that vaccination once appeared to have tamed.
Now on a drip, the scrawny infant was only saved because her mother Soa Robertine, 32, made the 25km trek from her home to the Anivorano-nord health center, in the island’s far north.
Without her timely action, respiratory or neurological complications arising from the virus would have proved fatal, doctors said.
“Frangeline is suffering severe malnutrition and she wasn’t vaccinated against measles,” the clinic’s head of medicine Hollande Robisoa said. “She contracted a complicated form of measles and she would have died if she hadn’t been brought here.”
Many other children have not been so lucky.
Between September last year and last month, there were more than 79,000 cases of measles in Madagascar, 926 of which were fatal, the WHO said.
The Anivorano-nord clinic has had 510 patients suffering from kitrotro and kisaosy — the local names for measles.
About 100 patients were hospitalized, but only four lost their lives, official statistics showed.
However, many local people dispute the numbers in a community where rumors are common.
“I heard that hundreds of children have already died,” said Sylvain Randriamaro, 46, sitting in the hospital waiting room.
“I was alarmed, so I decided to vaccinate my two children,” aged five and six, he said.
Measles has hit Madagascar barely a year after it was gripped by an outbreak of plague that claimed 200 lives.
“It’s a major epidemic,” WHO representative Vincent Sodjinou said. “It’s down to the fact that for almost a decade the rate of vaccine coverage was not high enough and, over generations, the numbers of unvaccinated people have increased.”
Measles can be relatively benign if symptoms like fever and cough are handled promptly.
If not, there is a risk of “opportunistic” illness such as pneumonia or diarrhoea — diseases that can fatally attack patients with weak immune systems.
In Madagascar, where 47 percent of children under five are malnourished, the disease has proved particularly dangerous.
“It’s often said that malnutrition makes a bed for measles,” Sodjinou said. “The most serious cases are often reported in malnourished children.”
The pediatric ward at Antsiranana’s military hospital, north of Anivorano, has been overwhelmed.
“Normally we only treat one measles case here every two months,” head of medicine Ravohavy Setriny Mahatsangy said. “We’ve had 444 just since December.”
Mahatsangy blamed physical contact between patients, their “reluctance to go to hospital and opposition to vaccinations.”
The combination of factors has wrought a tragic toll on his patients.
One example is Marie Lydia Zafisoa, aged eight, whose “mother took her to a witch doctor ... and then a traditional healer who prescribed six baths,” her aunt, Bana Tombo, said.
When that failed, Zafisoa’s father carried her to the clinic.
“It was too late — she died on the way, on her father’s shoulders,” Tombo said.
Seven-month-old Adriano Luc Rakototsioharana was more fortunate.
Her grandmother Catherine had also turned to traditional medicine before taking her to hospital.
She barely survived the ordeal — but even so, Catherine remained adamant that traditional medicine held the key.
“For measles, you need a cow dung infusion or a tea with bark from the lazalaza tree,” she said.
Doctors said that such beliefs are frustrating their efforts to roll back the disease.
“It’s the culture,” Ravohavy said, with a resigned smile. “Changing people’s mentality is far more difficult than treating measles.”
They also complained that the situation is worsening, despite the state paying for most measles treatment.
“But the people prefer traditional healers who often advise them to refuse any hospitalization,” health ministry official Said Borohany said. “And most villages are hours away from basic medical centers.”
The other viable solution, vaccinations, has been complicated by the lack of funds available for such a program.
Until now, the nation’s vaccination program has administered only a single dose when the WHO recommends two.
The UN agency has estimated that 5.6 million doses would be needed to contain the epidemic.
However, Madagascar is US$1.6 million short of the US$11.2 million needed to fund such an operation.
Newly elected Malagasy President Andry Rajoelina has promised to vaccinate all children aged between six months and nine years.
“Our goal is to eradicate measles,” he said.
However, the fight will be long and difficult.
“Madagascar put in place a routine vaccination program,” Sodjinou said. “But it remains inadequate to reach the furthest reaches of the country.”
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