Severe measles in the tropics. II.

Management of the Child with MeaslesAn understanding of the attitude of the local people towards measles and their methods of managing the disease is essential.Information needs to be collected on whether the child with measles is hidden away, what foods or fluids are given or not given, how the people believe the disease is caused and spread, and what treatment, if any, they believe to be effective.Because of fear that they will spread infection, children with measles do not gain admission easily to many children's wards; frequently only those who are very sick are admitted.However, the infectivity of children with measles declines rapidly after the appearance of the rash.Within 24 hours it is negligible, and non-existent after 48 hours, at a time when most of the dangerous "complications " occur.At this stage children can be admitted without risk of passing on measles to others.The study of 2,164 and 2,376 children admitted respectively to children's wards in West and East Africa offered an oppor- tunity to determine the clinical features on admission most frequently associated with death.These have been considered in detail elsewhere2 3 and are presented in summarized form below: At all ages.-Darkening of the rash, or a rash desquamating in large plaques; signs of laryngeal obstruction; evidence of dehydration, blood and mucus in the stool, or a frequency of more than five stools per day; convulsions or loss of conscious- ness; and a weight below the tenth percentile.In the child under 3 years of age.-Soreness of the mouth, particularly if it interferes with sucking; dyspnoea, or other evidence of pneumonia.These findings may be used in areas where measles is severe in order to decide which of the many children with measles require admission to hospital. TreatmentNo drug is known which influences the course of the virus disease.A priority in treatment must be to maintain the child's intake of food and fluid at a satisfactory level.Milk, if available, is the food most acceptable, and if skimmed milk only can be obtained this should be converted into a " filled " milk by mixing with oil, as described in King's37 book.This book also gives practical advice on the management of the dehydration so frequently experienced.No study of the routine prophylactic use of antibiotics in severe measles has been undertaken.In the U.S.A., Weinstein43 showed that antibiotics did not prevent bacterial complications of measles, nor was the decline in mortality from measles in that country related to the introduction of antibiotics (Fig. 2).