Short term outcome of measles at Kenyatta National Hospital

Abstract

Two hundred patients aged from 4 months to 10 years admitted with measles at the Infectious Disease Hospital (IDH) between 15th April 1986 and 15th September 1986 were studied. Their mean age was 23.5 months and there were no significant sex differences. Sixty one percent of children resided in Nairobi while 39% came from other provinces. The ma i,n complications seen included: con junct.iv.iti s 62% diarrhoea & vomiting 60%, bronchopneumonia 53.5%, oral thrush 20% and laryngotracheobronchitis 28.5%. There was associated urinary tract infection in 18.8% of them with Klebsiella as the commonest pathogen. Fourteen percent of patients with bronchopneumonia had unresolving pneumonia with bacterial isolation from lung puncture, obtained in 53.3%of them. Encephalitis was observed more commonly in this study than found in other studies, but was rarely associated with a fatal outcome. Epistaxis and haematemesis was an interesting complication observed exclusively in those above 24 months of age. Age was found to be a significant factor in the outcome of measles, as has been reported previously, influencing both morbidity and mortality. T'ne younger age groups tended to develop more severe measles complications; except for conjunctivitis observed more amongat. the older children. Although 57.2% of patients were underweight at onset of study, precipitation of acute kwashiorkor was seen only ln 2.5% after a mean duration of hospitalization of 7.3 days. Malnutrition was found to playa significant role in the complication rate, with t.he malnourished being commonly adversely affected. The case fatality rate was 4%, and ocourredmainly among the infants; majority of who (7 out of 8) were malnourished.

The immunization status did not appear to affect outcome of measles here; but those immunized were only 28.57%. Similarly prior contact with a health facility did not appear to influence outcome significantly except for oral thrush, which was seen more commonly amongst those with prior contact with a health facility .