2023-09-22 11:36:45
Habib, Sikirat Sa’id’s baby, was only six months old when her mother, already of a certain age, fell ill. Sikirat was called to Ilorin, western Nigeria, to assist her. She packed a small bag, put Habib on her back and left Lagos by bus for a journey of more than 300 kilometers.
The small bag contained, among other things, Habib’s vaccination record. He hadn’t missed any vaccinations so far and Sikirat didn’t want to miss a vaccination because of the trip.
“When the doctors told me that my son would not see, I was so desperate that I started crying and no one might console me. I blamed myself terribly. My son lost his sight because of me.”
“On the day he was scheduled for his measles vaccination, I took him to one of the health centers in Ilorin, but they told me they did not have any vaccine,” she recalls. “They gave me an appointment for another date. I went to the hospital on the scheduled day, but was told there was still no vaccine, so I gave up.”
The grandmother died a few months later. Sikirat returned home to Lagos with Habib, who was 10 months old at the time, and took her to the nearest health clinic. It was mid-to-late 2012, at the end of a season of intense rains. “I still remember the nurses’ anger. They were furious with me for letting the measles vaccination date slip. They told me it was too late. This is how my son was ultimately not vaccinated once morest measles,” says Sikirat.
It is unclear why nurses at the Lagos health center told Sikirat it was “too late” to vaccinate the child. The Nigerian health system specifies that the two-dose measles vaccine should ideally be given at nine months and fifteen months – but catch-up vaccination is recommended up to the age of 15 for all children who do not have not been vaccinated or have only received one dose. This mistake will have terrible consequences for Habib.
Less than a year later, he fell ill: high fever, rash all over his body, red, watery eyes, glued together with discharge.
Measles commonly causes inflammation of the conjunctiva and cornea, making the eyes red and painful and sensitive to light. Most often, the inflammation disappears without a trace. But corneal ulceration can sometimes lead to permanent scarring, particularly in malnourished children who have a vitamin A deficiency or a bacterial or viral co-infection. In the absence of treatment, this keratomalacia can, in the most serious cases, lead to perforation of the cornea. At this stage, death is often near.
Sikirat took her son to Alimosho General Hospital in Lagos. From there, Habib was transferred to Lagos University Teaching Hospital (LUTH) and then to Lagos State University Teaching Hospital (LASUTH). When he was able to open his eyes slightly, Sikirat saw that they were “very red.”
The situation was much worse than it seemed. “The doctors told us that he would no longer be able to see because the measles had affected both of his eyes,” Sikirat recalls.
“When the doctors told me that my son would not see, I was so desperate that I started crying, and no one might console me. I blamed myself terribly. My son lost his sight because of me.”
The resurgence of danger
Already in 2004, measles and vitamin A deficiency were recognized as the main causes of blindness among children in developing countries. These two diseases are linked. Vitamin A deficiency is dangerous for the eyes because it dries them out, which can damage the retina and cornea. Infection with the measles virus, which can in turn attack certain parts of the eye, leads to a collapse in vitamin A levels, a real disaster in children who already have a borderline level.
Measles – the most contagious of vaccine-preventable diseases, known to epidemiologists as “the canary in the coal mine” for its ability to spot flaws in health systems – is making a comeback. In the first three months of 2022, Nigeria alone reported 12,241 measles cases.
In the 1990s and early 2000s, estimates of the global incidence of measles varied widely, ranging from 15,000 to 100,000 new cases annually with respect to measles-related blindness. Improving vaccination coverage once morest measles and the distribution of vitamin A have since brings down these rates.
But where vaccination coverage is patchy, and especially where it is difficult to get a good diet, children still face significant risks.
What is alarming is that these areas of vulnerability have expanded since COVID-19 disrupted health systems and people’s lives around the world. In 2021, nearly 40 million children across the world were deprived of their dose of measles vaccine, representing a huge breach in the collective safety net of herd immunity.
Measles – the most contagious of vaccine-preventable diseases, known to epidemiologists as “the canary in the coal mine” for its ability to highlight weak health systems – is making a comeback. During the first three months of 2022, Nigeria alone reported 12 241 case of measles.
It is not known how many of these cases resulted in blindness. But during our interview, Dr. Dupe Ademola-Popoola, a pediatric ophthalmologist and professor of ophthalmology at the University of Ilorin, told us at least one: a little girl, who arrived at the hospital with aggravated keratomalacia. by measles.
” And [les patients] arrive early enough, we can hope for a rapid recovery, by addressing the dryness of the cornea right away,” explains Dr. Ademola-Popoola. The eye can be cleaned and moisturized, vitamin A administered, and antibiotics administered to prevent secondary infections that might cause scarring. The goal is to save at least 50% of the child’s cornea. If you can’t do this, you have to find a place in one of the specialized schools, but they are rare.
Habib cannot watch Ben 10 for long, his favorite comic strip, or play Ludo with his sisters; It tires his eyes too much. If he plays football with his friends, he risks getting injured. “The doctor told me to be careful, so I’m careful,” he admits.
“Once this stage [d’intervention précoce] past, it’s really difficult, especially if there is already ulceration. In the case of the little girl in question, the eye had already emptied of its contents.”
At five months, she was still too young to have received her first dose of measles vaccine. Only collective immunity resulting from a high vaccination rate in the community might protect it. Too weak, this collective shield did not work.
“The parents initially thought it was malaria,” explains Dr. Ademola-Popoola. But, as his mother recounted, her baby quickly developed rashes, his eyes became opaque and closed, and his cornea immediately began to melt,” explains the doctor.
Sadly, the little girl died shortly following. But even for children who survive the initial acute phase of this blinding infection, survival doesn’t mean much. Research indicates that in developing countries, 60 % children who become blind, whatever the cause, die within two years. “Some of them die from the same problem [qui les a rendus aveugles]or they die due to lack of care, or simply because their parents cannot cope with the situation,” explains Dr. Ademola-Popoola.
For the remaining 40%, the future narrows considerably. It is estimated that 90% of blind children never go to school.
Habib at the crossroads
Habib Sa’id turned 11 in October this year and implored Allah to allow him to see clearly – at least with the eye that still works.
Habib
Crédit : Royal Ibeh
He is small for his age and speaks softly. He moves slowly and carefully, out of habit and necessity. He wants to preserve his autonomy. He politely refuses to be held by the hand to help him navigate a public space, for example. Since the age of 7, he has refused his parents’ help with bathing, he tells VaccinesWork. “I manage on my own, but it’s not easy,” he admits.
He’s not blind, well not entirely. His right eye is irreparably lost: the cornea is damaged but, more seriously, the optic nerve is destroyed. The left eye, for its part, although opacified by the scarring of the cornea, retains vision corresponding to 20% of normal vision.
Sikirat never stopped seeking specialist help for her son. This is why Dr. Faderin counts Habib among the three children she will help to benefit from a corneal transplant.
With this reduced vision, the world appears to Habib, not blurry, but “vanishing”. He tilts his head in relation to the objects he is looking at, places his left cheek almost parallel to the page he is reading: “By moving my eye, I see more clearly”. He is grateful to Allah, he says, for allowing him to still see so much.
However, his vision problems hamper him and limit him in his activities. He cannot read Ben 10, his favorite comic strip, for long or play Ludo with his sisters; It tires his eyes too much. If he plays football with his friends, he risks getting injured. “The doctor told me to be careful, so I’m careful,” he admits.
“It’s more difficult for reading, because my eye starts to water when I ask too much of it. I try to read only for a few hours – but I have to read every day to pass my exams,” says Habib. Despite his visual impairment, he attends an ordinary school: “In class, I compete with children who can see and read with both eyes,” he says. He is nevertheless a good student: he is especially good at mathematics and English, but he is, according to his family, excellent in all subjects. He likes his teachers and they like him. One day he would like to be a teacher himself.
Habib at school. Credit: Royal Ibeh
But for now, Habib’s destiny is at a crossroads. It can lead to total darkness: doctors fear that he may suffer from a cataract in his left eye, the least affected, which might compromise what remains of his vision.
The other outcome is undoubtedly more promising. Indeed, the left eye might, according to ophthalmologists, lend itself to surgical intervention capable of restoring up to 80% of its vision. This path is, however, fraught with pitfalls.
A second chance?
Dr. Mosunmade Faderin, medical director of the Eye Bank for Restoring Sight, whose premises are on the LASUTH campus in Lagos, has met “many” children blinded by measles, but she prefers not to specify them. the number.
Often, she explains, these children lose their sight in several episodes. This tragedy might firstly have been avoided by vaccination, then by appropriate care. The healing which leads to permanent loss of sight is often accelerated, she says, by the application of traditional remedies (for example woman’s milk or other ointments placed on irritated eyes), outside of any medical supervision, instead of calling a healthcare professional.
This is obviously not what happened for Habib. Sikirat never stopped seeking specialist help for her son. This is why Dr. Faderin counts the boy among the three children she will help to benefit from a corneal transplant.
“Measles caused damage to both eyes,” explains Dr. Faderin, summarizing Habib’s case. “The right eye was more seriously damaged, which explains why he cannot see. As for the left eye, whose cornea was partially damaged, it can still see partially. According to our diagnosis, we believe that he can benefit from a penetrating keratoplasty ».
The success rate depends on several factors, including the surface area of adhesion of the iris to the cornea, but one can reasonably expect recovery of 80% vision in that eye, she says.
Without prejudging the outcome of the operation, we can say that Habib is part of a small minority. According to Dr Ademola-Popoola, corneal transplantation is still in the “early stage of development” in Nigeria, and operations of this type are far from common.
One of the limiting factors, explains Dr. Faderin, is cultural. “There are deaths every day in Nigeria, but the families of the deceased do not allow us to remove the cornea, due to their cultural and religious beliefs: if they donate the eyes of their deceased to us, with what will we see- them when they resurrect? “, she explains.
This local shortage makes the operation much more expensive. Let’s imagine that Nigeria receives a usable cornea; “Habib would only have to pay for the operation, regarding 500,000 naira (US$1,121).” Currently, the cost of the procedure is estimated to be double that, or regarding $2,500. However, they do not have to buy the cornea: “It cannot be sold,” emphasizes Dr. Faderin, but they must pay for its transport from the donor to Nigeria.
Either way, it’s way too expensive. The operation might have been carried out in 2019 – a donor cornea was available – but Habib’s family simply might not afford it. In the meantime, time is running out. According to Dr. Faderin, if Habib’s eye continues to deteriorate, the chances of a successful transplant will diminish. Sikirat seems resigned. “The only thing I can give him now is my unconditional love and attention, and the best education possible.”
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