Pneumonia: killing more children than malaria, measles, diarrhea combined

For two days, especially at night, twoyear-old Maryam Bako cried endlessly as her mother, Maimuna, 37, frantically tried to calm her. Maimuna said, she initially thought the child was hungry but she kept rejecting the food and the cries and tantrums didn’t stop.

She said, “She wanted me to carry her standing all through. I couldn’t sleep. It was exhausting and I was very irritable myself.

“When I noticed the rise in her temperature and the situation continued, I took her to hospital, where she was diagnosed with pneumonia,” - a disease she couldn’t afford to vaccinate her daughter against with the required four courses. The hospital had exhausted what was available. Thankfully, Maryam recovered after about a week.

The World Health Organisation (WHO) describes pneumonia as a form of acute respiratory infection that affects the lungs and is the single largest infectious cause of death in children worldwide.

According to UNICEF, “Pneumonia remains the leading infectious cause of death among children under five, killing approximately 2,400 children a day. Pneumonia accounted for approximately 16 per cent of the 5.6 million under-five deaths, killing around 880,000 children in 2016. Most of its victims were less than two years old.”

Dr. Dalhatu Afegbua further explained that, “the infection is usually caused by microorganisms following inhalation through the nostrils to the lungs. These microorganisms can be bacteria, viruses, fungi, etc. But the commonest causes are viruses, (both in adults and children) which may start as catarrh and progress down the airways to the lungs, if the body’s immune system does not check their progression.”

According to Afegbua, a Senior Registrar at the Department of Paediatrics, Federal Medical Centre, Azare, Bauchi State, pneumonia caused by viruses are usually milder except for a few nasty viruses or when it happens to in individuals whose immune system is weak. Pneumonia caused by bacteria is more serious.

While in developed countries, pneumonia is a disease affecting mostly the elderly, in developing climes like Nigeria, it is children who bear the brunt of the disease which is the biggest infectious killer for children. It kills them more than malaria, diarrhea and measles combined.

Speaking on the how children could react to the disease, Afegbua, said, “depending on whether an appropriate treatment is sought, complications may arise with appropriate or early treatment. It all depends on the virulence of the offending organisms.

“Children especially under-5s react to this infection differently. Their symptoms may start as non-specific (like symptoms of any common childhood illness) e.g. loss of appetite, catarrh, vomiting and diarrhea, listlessness and some may convulse as their temperature go higher. These symptoms are in addition to cough and fast breathing mentioned earlier.”

Ahead of the world pneumonia day on November 12, findings from a global study on the disease were released at the Johns Hopkins University in collaboration with Save The Children (STC) an organisation promoting children’s rights, providing relief and support for children in developing countries. Researchers developed the Lives Saved Tool (LiST) model which showed that approximately 11 million (10,865,728) children will die by 2030 on current trends. By 2030, Nigeria would have PHOTO: the highest burden of deaths at 1,730,000. India will follow at 1,710,000; Pakistan at 706,000; the Democratic Republic of Congo at 635,000 and Ethiopia at 407,000.

Treatment of pneumonia is based on isolation or identification of the infecting organism.

While the advent of evidence-based medicine has contributed to curbing pneumonia in the West, Afegbua said, “it is not easy in developing countries like Nigeria where facilities for investigations are far-fetched.

“Investigation is particularly difficult in children because the bodily fluid required to identify the offending organism is not easy to get, at least, reliably.”

The investigation process in Nigeria involves sputum samples coughed up from down the airways. It is then sent for microscopy, culture and sensitivity test.

Afegbua explained that, “at other times the infection could have resulted from blood infection (sepsis) in which case a blood culture could clinch the identification of the offending organism.

“But the world has moved far beyond these conventional ways. There are rapid tests that indicate the probable causative agents. But you would hardly get these in government hospitals [in Nigeria]. Some state of the act hospitals are available all over where these rapid diagnostic tests exist but you know the deal, beyond the reach of the common man who is most affected by the disease.”

He advises that, “Bottomline is that treatment is best done at the hospital by a doctor who, barring the obstacles listed above can make an intelligent decision on the probable causative agents-based history of illness and examination findings before the long-awaited- conventionalculture-results comes out.

“Notwithstanding, first aid involved treating symptoms before seeing the doctor. Treat fever and chest pain with paracetamol.”

The Sustainable Development Goals (SDGs), target date to “end preventable child deaths” and achieve Universal Health Coverage is 2030. To achieve this, where pneumonia is concerned, STC is advocating a scaling up of vaccination coverage to 90 percent of children under the age of five. It says this could save 610,000 lives. Adding that, “providing cheap antibiotics could save 1.9 million; and ensuring children have good nutrition could save 2.5 million.”

With more enlightenment about the disease, mothers like Maimuna are adding their voices to the global call for the availability of pneumonia vaccine like the pentavalent vaccine, which the country recently added to the routine immunization schedule. They also call for a cost reduction so that more children will be vaccinated against the disease.