Sudan

Keys to reducing child mortality in Sudan

By Alastair Beach

The recent measles outbreak in Sudan demonstrates that reducing child mortality requires not just better immunization coverage, but also broader public awareness of the importance of proper medical treatment. 

EL GENEINA, West Darfur, Sudan, 4 December 2015 – In a small concrete hospital ward in El Geneina, a tiny girl lies next to her mother beneath a striped yellow and white sheet. The temperature outside is at least 40° C (104° F). On the ceiling, a single fan rotates slowly in the gloom, but it makes little difference. The room, lit by two white lightbulbs, is hot and stuffy.

UNICEF Image
© UNICEF Sudan/2015/Omer
Sa’diya Adam and her 24-month-old daughter Nawadir sit on a hospital bed in El Geneina, in Sudan's West Darfur state, where Nawadir is being treated for measles.

The girl, a recent victim of the ongoing measles outbreak, lies motionless next to her mother. Her eyes are closed, but she is not sleeping. Occasionally she grunts or moans, then twists and turns as if to try and make herself more comfortable. 

“Enough, enough,” says the girl’s mother tenderly, patting her gently on the back. But the child keeps wailing, her eyes screwed tightly shut.

Seven other beds are packed into this small, sweltering ward. On four of them lie other children, all accompanied by their mothers. All are victims of the measles outbreak that has swept through Sudan this year, leading to 3,438 confirmed cases in 72 localities across all 18 states in the country with 71 deaths, as of November. With 667 cases reported, West Darfur state has the highest number in Sudan; overall, the majority of cases – 73 per cent – are among children under 15 years old.

Missed campaign

“I knew about the measles immunization outreach,” says Sa’diya Adam, the mother of the young girl writhing beneath the striped sheet. “But when the most recent outreach happened, I was not in the area, so we missed it.”

Her daughter, 24-month-old Nawadir, subsequently caught measles. The symptoms started with a high fever, and later developed into coughing and the appearance of a rash. But Sa’diya, 35, did not immediately take Nawadir to hospital. Like other mothers in from her village, she turned instead to one of the traditional remedies that families use to treat sick relatives.

In her case it was ‘millet water’, a drink created by soaking seeded grass until the liquid turns yellow.

But Nawadir’s fever only became worse, and spots began to appear all over the young girl’s body. Eventually Sa’diya decided to take Nawadir to hospital.

“I became very worried,” she says. “I had measles when I was younger and I know how difficult it can be for a child.”

Now, with Nawadir tossing and turning on her hospital bed, Sa’diya says she is determined to make sure none of her relatives or friends ever experience the distress that she has suffered while waiting for her daughter to recover.

“When I return home, I will tell people that every child who has reached the age of nine months must be vaccinated. If not, then there is a danger they will get ill.”

UNICEF Image
© UNICEF Sudan/2015/Omer
Nafisa al-Bagr, 25, with her son Nour, two-and-half years old. She says she was not aware that children should be immunized against measles. He is now being treated in the same ward as Nawadir.

Her thoughts are echoed by Nafisa al-Bagr, a 25-year-old mother sitting in the same ward two beds away.

She says she had no idea that she had to get her children immunized against measles. As a result, her son Nour, 2-and-a-half years old, had contracted the virus.

Village traditions

Perched on a hospital bed next to the sick boy, she says, “When I return home, I will tell all the mothers to have a vaccination. Now I know that every child who is vaccinated will be protected against measles.”

According to Joda Naeem, a nursing supervisor at the measles ward, one of the major problems for health workers is the prevalence of “traditional” medicines and treatments, such as broths made using grass and onions and placing children in hot tubs of water mixed with leaves from local neem trees.

“Sometimes using traditional treatments causes further complications,” Mr. Naeem says. “When the remedies fail, then the families come to the hospital.”

Upon reaching the ward, the children are put on different kinds of medication. Vitamin A tablets are provided, along with saline drips, intravenous antibiotics and Paracetamol syrup.

But sometimes it is simply too late.

Although routine vaccination coverage in Sudan for measles first dose has gradually increased from 58 per cent in 2000 to to 86 per cent in 2014, it is still below the 95 per cent coverage target needed to achieve elimination of the disease. As a result, repeated outbreaks of preventable childhood diseases continue to threaten the lives of thousands of children in Sudan.

If Sudan is to sustain and improve upon the gains made in reducing child mortality, continued commitment to and investment in strengthening the routine immunization systems is crucial.


 

 

UNICEF Photography: Ending measles

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