Pneumonia: Why preventable killer disease is still an epidemic in Nigeria

Health worker Grace Felix uses a Mid-Upper Arm Circumference band (MUAC) to examine Mojes Morris, 3, as he sits on his mother's lap in a village near Yola[PHOTO CREDIT: UNICEF/UNI279424/Modola]
Health worker Grace Felix uses a Mid-Upper Arm Circumference band (MUAC) to examine Mojes Morris, 3, as he sits on his mother's lap in a village near Yola[PHOTO CREDIT: UNICEF/UNI279424/Modola]

Count to 39; a child just died from pneumonia somewhere in the world; that child is most likely a Nigerian!

According to recent information released by the United Nations Children’s Fund (UNICEF), Nigeria is one of the countries still battling pneumonia. Thousands have died and more will continue to die of pneumonia if the health sector does not take immediate action.

UNICEF brands the disease, a “forgotten epidemic” in Nigeria. This news of the impact of pneumonia comes despite the availability of preventive measures and existing treatments, a privilege we did not have in the past.

Bacteria, viruses and fungi are the usual suspects for pneumonia. However, Streptococcus pneumoniae bacterium is the most common cause of the respiratory disease; it affects the lungs and reduces oxygen intake. It is principally these respiratory and systemic complications associated with the disease that eventually leads to death, as is often the case in Nigeria.

The World Health Organisation Child Health Epidemiology Reference Group estimates over 150.7 million new pneumonia incidences annually. While the evaluation appears troubling, it compares favourably, considering the history of the disease. As a matter of fact, since 2000, global pneumonia-associated deaths have reduced by 54 per cent. However, in all the advancements, Nigeria still lags, as evidenced by recent statements from UNICEF.

“Despite progress over the last two decades, children in poor communities have been left behind,” UNICEF said.

A child dies every 39 seconds from pneumonia.

“Pneumonia kills more children than any other infectious disease,” says UNICEF.

In examining the age group most affected by this infectious disease, children and especially children under five years are always disproportionately affected. Children under five are not only particularly at risk of contracting pneumonia but are also more at risk of dying from it.

A child dies from pneumonia every 39 seconds; 2,200 children, every day and 800,00 children, every year in the world.

Globally, evaluation for the causes of death for children under five places pneumonia at 15 per cent of the casualty rate. This estimation is especially significant as it is an indicator of the health and development of a nation.

Generally, impoverished children are most at risk of this disease; the reason being that these children are often not vaccinated. Further, their environment also contributes to their chance of getting pneumonia; as many reside in unsanitary environments with unsafe drinking water and air pollution.

Also, the World Health Organisation (WHO) notes that children under five are more at risk because of their low immune defences. It is also worth noting that developing African nations’ challenge of undernourishment also contribute to this ease of contraction.

HIV is yet another reason a child could have a compromised immune system and thus be more susceptible to contracting pneumonia.

Pneumonia kills more children in Nigeria than anywhere else

“In Nigeria, more children under the age of five died from pneumonia in 2018 than from any disease – 443 deaths per day,” UNICEF states.

The state of the disease in Nigeria is particularly dire. Pneumonia is a leading childhood killer disease in Nigeria. In 2018 alone, 162,000 children died from pneumonia, making Nigeria the country with the highest number of pneumonia-related deaths in the world. Yet, these deaths were entirely preventable with vaccines and adequate treatments in the form of low-cost antibiotics such as Amoxicillin Dispersible Tablet.

Preventing child deaths

According to UNICEF, 71 million children around the world do not receive the life-saving and recommended vaccine for pneumonia – pneumococcal conjugate vaccine (PCV). Also one in three children do not receive the necessary antibiotic treatment to ensure their survival.

READ ALSO: Two Million Children Risk Dying Of Pneumonia In Nigeria – Report

With regard to the former, data shows that not enough children are vaccinated in Nigeria, much less for pneumonia. Just recently, a publication entitled ‘Nigeria Strategy for Immunisation and PHC System Strengthening [NSIPSS] 2018 – 2028’ estimated that four million children were still unvaccinated in the country. The implications of this are evident in the number of preventable deaths occurring in Nigeria.

Treatment for pneumonia and barriers

The symptoms often present as classic cough and fever along with shortness of breath, chest pains, nausea or vomiting. Recognising these symptoms is essential to classifying the ailment appropriately – regular or severe. Generally, lower level facilities ought to refer in cases of severe pneumonia (more than two weeks of pneumonia symptoms) for reasons of equipment and skill.

According to the most recent WHO and UNICEF treatment guidelines, the broad-spectrum antibiotic – amoxicillin DT (Dispersible Tablet) is recommended as the first line of treatment for a child with pneumonia. This suggestion was adopted by the Nigerian Government in 2016. These recommendations were made in light of findings that amoxicillin DT is easy to use for children and has proved to be more effective than existing antibiotic treatments.

In Nigeria, data from an ongoing Development Research and Project Centre (dRPC) project showed that factors which affected amoxicillin DT usage included supply and the training and knowledge of relevant authorities and clinicians on proper guidelines and treatment protocols. About 86 per cent of doctors in a pediatric ward in Niger State reported poor knowledge on treatment protocols. dRPC’s findings further revealed that from the supply end, hospitals experienced delays in procuring amoxicillin DT. And in some PHCs, the medicine was completely unavailable altogether.

Further, the organisation also found that children in Niger State consistently arrived too late when oral medication would not be appropriate as the first line of treatment. Moreover, the lack of amoxicillin DT usage might also be attributed to cost; as out-of-pocket payments are still how many Nigerians navigate the health systems of their country. Parents of the patients in Niger State, for example, demanded the cheapest alternative to amoxicillin DT even when offered this first-line treatment.

“It is important to note that this recommendation holds for treating children from home or admitting them into the clinic/hospital. The only exceptions we noted are in cases where there may be other causes of pneumonia; such as pneumonia of viral or fungal origin, and perhaps children exposed to HIV infection,” the report stated.

Future recommendations

Before now, a much more focused policy was lacking. The WHO subsumed pneumonia management strategies into the Integrated Management of Childhood Illnesses (IMCHI) developed for low resource settings. However, following the high recommendation by global health authorities, the Federal Ministry of Health (FMoH) together with partners of the Every Breath Counts Coalition (EBCC), presented Nigeria’s first National Integrated Pneumonia Control Strategy and Implementation Plan at the first-ever global forum on pneumonia held in Spain, early this year.

Through the EBCC, it is hopeful that Nigeria would fulfil this goal of reducing childhood pneumonia by 2030 through its ambitious pneumonia control strategy, a call the coalition made to the governments of the 10 countries with the highest burden of pneumonia in children.

Yet, despite health authorities recommendation of amoxicillin DT as a first-line treatment of childhood pneumonia, examples from Niger State show that many factors are restricting adherence to the new treatment protocol. Health authorities are seldom going to see improvements until they address existing shortfalls through advocacy, domestication of guidelines and capacity building of health care professionals.

Where pneumonia is rampant, experts also observe a strong correlation with underdevelopment. It is, therefore, safe to say that recent news from UNICEF is indicative of a more significant issue linked to development and a consequence of an underperforming health system.

Perhaps then, this news can serve as a glaring reminder for the need for an all-inclusive development plan by the government.

It is also worth noting that the projections paint an even more grim picture. With the current trends in Nigeria, UNICEF says that 1.4 million children under five could die from pneumonia over the next decade.


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