Pneumonia: Why vaccine-preventable child-disease still kills thousands in Nigeria

Alisa Umar, a middle-aged woman, lost her baby two years ago.

“Fatima was my ninth child and she would have been seven this year,” she told PREMIUM TIMES with a forced smile.

Mrs Umar fled the insurgency in her home Borno State and now lives at an unofficial Internal Displaced Peoples (IDP) camps at Damangaza on the outskirts of the Federal Capital Territory (FCT).

Her narrative in Hausa language was translated to Pidgin English by her husband, Muhammed.

Sitting beside a pot of water on a firewood stove, she was preparing a meal of corn pap for her one-year-old son, Abdullamis.

Fatima died from pneumonia shortly after the family arrived at the IDPs camp.

Mrs Umar was delivered of babies 11 times but lost five of them. She had no idea what killed her babies before their sixth birthdays.

The babies died when the family was in Borno State where they had no access to medical attention, but Fatima made it to the hospital. Unfortunately, however, health workers said her case was presented late.

The family only got to know Fatima had pneumonia after officials of the ministry of health visited Damangaza on a medical outreach.

“The people tested the kids in the camp and said my child and some other children had pneumonia,” she recalled.

“We took her to the primary healthcare centre in Damangaza but they rejected her. We then took her to a private hospital at Durumi 2. But after a few days, the child died. She was the sixth child I have lost,” Mrs Umar said with misty eyes.

Low Immunisation Coverage

India and Nigeria top in the global ranking of infant deaths from pneumonia.

Statistics show that over 1.6 million people die from pneumonia globally every year, with under-five children most affected.

Pneumonia is the number one killer-disease of children under the age of five. It has overtaking malaria, diarrhoea, malnutrition as the top child-killer disease.

According to the World Health Organisation (WHO), a child somewhere in the world dies of pneumonia every 20 seconds. Most of the deaths are in underdeveloped countries, many of which are in Africa.

The pneumococcal conjugate vaccine (PCV-10 or PCV-13) is efficacious against severe cases of the disease. But low immunisation rate in Africa, including Nigeria, means a high infant mortality rate continues to be recorded from the disease.

Immunisation coverage in Nigeria is 32 per cent.

The United Nations Children Fund (UNICEF) says infant and under-five mortality rates in Nigeria have remained steady at 74 and 117 deaths per 1,000 live births respectively over the past five years.

One in every 13 children born in the country die before their first birthday. One in eight do not survive to their fifth birthday.

Statistics show many of the infant deaths in Nigeria is from pneumonia, a vaccine-preventable disease.

Fatima Umar is just one of the many cases of death from pneumonia in the country.

A recent statistics from UNICEF shows that an estimated 6.7 million cases of childhood pneumonia are recorded in Nigeria every year, with about 200,000 under-five deaths annually.

Too Poor To Go To Hospital

According to Mr Umar, one of his surviving children had been diagnosed with pneumonia.

But he was yet to take the child to the hospital due to lack of funds.

“At least, you must have N5,000 to go to the hospital. The health centre in Damangaza cannot treat all these problems,” the distraught father said.

Mr Umar said his children never had vaccines until the family relocated to Abuja.

Pneumonia is an infection that inflames the air sac in one or both lung. The disease if not diagnosed early and treated is serious and life-threatening.

The disease is spread by airborne droplets caused by viral, bacterial or fungal infections. It causes inflammation in the lungs, wherein the tiny air sacs inside the lungs get filled with liquid, making it difficult for the patient to breath.

William Osler, one of the founding fathers of modern medicine, in one of his writings in 1901 described pneumonia as “the captain of the men of death.”

Mr Osler was writing about the USA, where the disease was a major killer of children and a source of fear for their parents.

Over a century later, the deadly disease continues to ravage the world.

Nigeria’s Vaccination Schedule

According to Nigerian childhood vaccination schedule, a child is expected to receive four dosages of pneumococcal vaccine before age two.

The first shot of the vaccine is given six weeks after birth, the second at 10 weeks, third at 14 weeks and the fourth or last shot between 12 to 15 weeks.

There are two types of vaccine: PPSV23 (Pneumovax), a pneumococcal polysaccharide vaccine against 23 types of the bacteria, and PCV13 which protects against 13 types of pneumococcal bacteria (which cause the most common pneumococcal infections in kids).

These vaccines may not always prevent pneumococcal pneumonia, but they prevent serious complications of pneumonia if it does occur.

There is low immunisation coverage in Nigeria and cases of children missing immunisation schedule. Some start the dosage but do not complete them. These contribute to the high death statistics.

Like the Umars, there are many families in the country whose children do not receive vaccines.

A 2018 Pneumonia and Diarrhoea report by the John Hopkins Bloomberg School of public health and International Vaccine Aces Center shows that globally, two diseases led to nearly one of every four deaths of children under five years of age in 2016.

According to the report, between 19 and 10 per cent of under-five deaths in Nigeria are caused by pneumonia and diarrhoea.

UNICEF recently estimated that Nigeria records 6.7 million cases of childhood pneumonia every year, with about 200,000 under-five deaths recorded annually.

On the chat of child killer diseases, pneumonia has toppled malaria, a common disease often perceived as the number one killer of children globally.

Save the Children, a non-governmental organisation, said if the world continues with the current trends, about 735,000 deaths will occur in 2030.

In a report titled “Fighting for Breath, A Call to Action in Childhood Pneumonia”, the international NGO said fast and decisive action to tackle the killer disease could save about 5.3million lives by 2030.

Bill and Melinda Gates in their annual letter of 2017, said immunisation is the only acceptable way of preventing pneumonia and other child-killer diseases.

The philanthropic couple, who have been spending on immunisation campaigns and vaccines production through their health foundation, pointed out that immunisation saves lives, contributing to about 122 million children’s lives saved since 1990.

Late Presentation Of Cases

A Nigerian paediatrician who identified himself simply as Dr Francis said many children die from pneumonia due to late presentation at the hospitals.

He said many children are at the risk of the disease due to factors such as lack of exclusive breastfeeding, premature birth, living in overcrowded rooms, indoor smoking, and high pollution rate, among others.

“I am not saying infant formula is bad, but lack of exclusive breastfeeding is bad. A newborn should be given breast milk exclusively for the first six months of life. Premature birth also predisposes a child to the risk of the disease; when babies are born in less than 37 weeks (nine months) they have more risk.

“Low birth weight is another predisposing risk to pneumonia. The normal birth weight is 2.5 to 3.999 kg. But when a child is less than those weights, they have higher risk of contacting pneumonia than other children of average age.”

To curb the risk, he said immunisation is important and it is the reason a lot of efforts is being geared towards immunising a child.

Mr Francis suggested constant enlightenment on how to recognise pneumonia.

“There is a need to educate people and community health givers on symptoms of the disease. When you see a child coughing, having running nose and breathing fast they should suspect pneumonia until proven otherwise. The child should immediately be referred to the hospital because if not, the child’s heart can fail and it dies.

“Unfortunately, the shortage of doctors in the rural areas and the distance to the nearest health centre is also a contributory factor to high death rate in the country. Even if the health centres are near the people, do they have enough skilled manpower and equipment to detect and treat those cases?

“These are some of the problems causing late presentation. Some of the cases presented come in late with complications, heart failure, and before you know the child will die. That is why pneumonia is number one child killer now worldwide,” he said.

“A lot of interventions have been put in place in terms of vaccines for pneumonia, which is included in the national routine immunisation programme,” Chika Offor, the Chief Executive Officer of Vaccine Network, a non-governmental organisation, said.

“When a child is born and the child goes through the routine immunisation from age 0 to 9 months, the child has some form of cover especially in the area of pneumonia.

“However, the vaccines alone are not enough as the lifestyle of the people also matters. Preventive measures like good ventilation, good diet put together will aid to kick pneumonia out.

“The government has done a lot by providing vaccines; the problem is the people going to access it? Most parents do not take the complete routine immunization programme,” she said.

Symptoms Of Pneumonia

The symptoms associated with pneumonia include:

*Excessive sweating and clammy skin

*Fever (sometimes new-borns and old or very weak persons have severe pneumonia with little or no fever).

*Cough (often with yellow, greenish, rust coloured, or slightly bloody mucus).

*Loss of appetite, low energy, and fatigue

*Sharp chest pain

*Cold sores often appear on the face or lips

*Rapid, shallow breathing, with little grunts or sometimes wheezing. The nostrils may spread with each breath.

*Sudden chills and then high fever