Halting measles outbreak hampered by religious sects

An outbreak of measles this month in all four of Swaziland's regions has health organisations scrambling to immunise children in populous urban townships. "We are searching for the origin of the outbreaks, but we know the conditions that can lead to an epidemic, and we saw them coming. A problem we have is certain religious groups who refuse to immunise their children," Dr John Kunene, principal secretary at the Ministry of Health and Social Welfare, told IRIN. In 2000, Swaziland had achieved a 98 percent immunisation rate against measles among children. The remaining 2 percent who were not immunised were mainly children of Christian Zionists, who refuse both modern and traditional medical treatment. "These cults are proliferating, particularly in the Manzini region. The parents won't take their children to hospitals when they are ill. They refuse child inoculations. We foresaw a problem, and it was just a matter of time before a crisis occurred," said a senior nurse at Raleigh Fitkin Memorial Hospital in Manzini, Swaziland's second city. Measles is a highly contagious disease, with children particularly susceptible. If left untreated, it can lead to pneumonia and death. Inflammation associated with measles can cause permanent deafness. Kunene said the health ministry was notified by the World Health Organisation that cases of measles had appeared over the border in the South African provinces of Mpumalanga and Gauteng. "We are trying to trace our outbreaks back to their source, and cannot say now if it is South Africa. But we knew conditions were in place for an epidemic because of pockets of susceptibility," he added. Along with urban slums, the fundamentalist Christian sects are classified among the "pockets of susceptibility". Combining traditional Swazi ancestral worship with evangelical Christianity, believers are known by the colours of their garments, such as the Red Gown sect and the Blue Gown sect. Forty percent of Swazis belong to these sects, though only a relative few disallow medical treatment for themselves and their families. King Mswati and Queen Mother Ntombi are practitioners, though neither belongs to a particular sect. Several splinter sects follow a belief grounded in their interpretation of the bible, that only God may cure the ill, and it is impious to seek medical treatment. "Measles is a highly contagious disease, but treatable if swiftly addressed, and preventable through immunisation. But the 'religious refusers' are making things difficult. We may be speaking of quarantine before long," said a source at King Sobhuza clinic, which serves the poor Manzini township KaKhoza. A legal flap ensued earlier this year when the father of a seven-year-old boy suffering from tuberculosis refused health workers' pleas to treat his son. A court order permitted a health clinic to administer life-saving treatment, but when the boy was returned home, his father refused to administer the boy's medication. The child died. The first week of the measles outbreak this month saw 42 suspected cases nationwide, with 17 confirmed after testing. The latest figures, released on Thursday, record a decline in suspected cases to 26 during the second week. Of these, only two cases were confirmed, but testing is still underway. All the infected persons were children. Health officials noted that the number of infections waxed and waned in the early phases of an epidemic. "When we have a case, we are hospitalising children until the critical stage of the disease has passed," said Kunene. Health workers cautioned that informal settlements ringing urban centres were particularly susceptible to a measles outbreak because of overcrowding and poverty. "Nutrition determines how well a child survives serious illnesses like measles. Immunity is a big factor in survival, and immunity is affected by nutrition," said Kunene. Swaziland is facing a fifth year of declining harvests - about 25 percent of Swazis will be dependant on food aid by January. Also concerned about measles are HIV/AIDS groups, who are tracking a rise in deaths attributable to AIDS among children under five. "These children are HIV-positive from mother-to-child transmission of the virus. The mother, and probably the father, fall ill, and cannot adequately look after a child's health. Chances are they are also poor, because of the link between poverty and AIDS in Swaziland. The child is more vulnerable to contracting measles," said Phefeni Vilakati of the AIDS Information and Support Centre in Manzini. The government has begun a public awareness campaign to get parents to arrange inoculations for their children. In KaKhoza, a poor township on the fringes of Manzini, and in Skoom, an informal settlement along the city's riverbank, social welfare workers are canvassing the tin-roof shacks and stick and mud dwellings to find sick children. Similar census-taking has been done in search of cases of tuberculosis, cholera and HIV/AIDS. This week, health workers are on the lookout for measles cases.