Measles is a preventable disease yet when it strikes in Nigeria it finds a ready pool of victims most of whom are children.

In June more than 50 children died while another 400 were hospitalised in Nigeria’s northeast Borno state following a measles outbreak.

The viral disease, transmitted both by air and by bodily fluids, was first reported on 19 June in the village of Njimtilo in the outskirts of the Borno state capital Maiduguri, and then quickly spread to five adjoining local areas including Konduga, Jere, Damboa, Bama and metropolitan Maiduguri.

Health officials have frequently blamed low immunisation rates for such outbreaks, as well as outbreaks of polio, diphtheria and tuberculosis. A 2005 World Health Organisation (WHO) survey found that 72 percent of measles cases in Nigeria occurred in children under five years old, three-quarters of whom had not been immunised.

Measles can strike as much as 90 percent of an un-immunised population.

Despite Nigeria’s oil wealth only 12.7 percent of children under five years old are fully immunised against childhood diseases. That rate is among the lowest rates anywhere in the world, according to WHO.

One reason for the low coverage, WHO says, is the decrepit health services sector which lacks funding and proper infrastructure and management.

Emeka Iwobi, a paediatric doctor based in Nigeria’s largest city, Lagos, told IRIN that poverty and ignorance also play a part. “Most of those who need [vaccines] are too poor to afford them or may not know they need them,”

Some 70 percent of the population of 140 million lives on less than US $1 a day, many in unhygienic conditions that favour the spread of disease.

Most people often lack access to basic medical care. Nigeria was 187th out of 191 countries in a WHO global ranking of performance of health systems, coming ahead of only DR Congo, Central African Republic, Myanmar and Sierra Leone.

The worst affected states in Nigeria are those in the Muslim north. Immunisation efforts in the region have suffered major setbacks because some radical Muslim preachers there are suspicious of Western medicine. The preachers have claimed that the polio vaccination programme was part of plot to reduce the Muslim population.

In 2004 authorities in the mostly Muslim state of Kano suspended polio vaccination for 10 months to conduct tests to determine if the vaccines contained sterilising agents or the AIDS virus, as critics had alleged.

In other parts of northern Nigeria communities systematically boycotted efforts to immunise their children.

“The polio boycott has had a ripple effect on immunisation efforts of other childhood diseases,” said a senior official of the National Programme on Immunisation who spoke on condition of anonymity.

“We can't make much progress unless we overcome the negative perception,” he said.