For a disease that has infected not less than six million killing another 200, 000 (two hundred thousand) every year, the toga of a serial killer might just be the right phrase. Incidentally, this is what pneumonia does in Nigeria.
The above statistics are from the United Nations Children Fund (UNICEF) and World Health Organisation (WHO) as disclosed by Public Health Physician, Dr. Chizoba Wonodi, of the Johns Hopkins Bloomberg School of Public Health at a press briefing in Ibadan to herald the 40th edition of the Paediatrics Association of Nigeria Conference (PANCOF).
In Nigeria, pneumonia is regarded as one of the most potent childhood killer diseases that caused many families emotional pains, loss of finances and productive hours just as it has millions of children annoying pains and trauma.
The child health statistics in Nigeria is far from pleasant as Wonodi pointed out, over one million children, less than five years old, die every year in Nigeria. Nigeria currently ranks third in the list of countries with the worst records deaths among children. Recent records show that in Nigeria, 93.93 deaths per 1,000 live births are recorded among children. The records for males is 100.87 deaths per 1,000 live births while females is 86.79 deaths per1,000 live births. Pneumonia is a major contributor to this grim statistics.
According to Wonodi most children who die from pneumonia are under five years old, from causes directly linked to Pneumococcus and Haemophilus Influennsa type B (HIB) bacteria infections. Pneumonia that is caused by a bacterial infection commonly affects one lobe (or section) of the lung. This can affect children of any age, and can develop very quickly. It is most likely to be associated with a very high fever and a cough that is productive of sputum (phlegm), although children tend to swallow sputum rather than cough it up.
The most common type of bacteria responsible for bacterial pneumonia in children is Streptococcus pneumoniae (or pneumococcus), with toddlers being the most at risk. However, with the introduction of Prevenar, a vaccine that protects against pneumococcus, into the childhood immunisation schedule, the number of cases of pneumococcal pneumonia has dropped. There is also pneumonia that is caused by virus. This is probably the most common type of pneumonia affecting children of any age, although it tends to affect infants and preschool-aged children most frequently. Viruses tend not to confine themselves to a single lobe of the lungs, but have a more widespread, patchy effect. Symptoms can be more variable than with bacterial pneumonia, in terms of whether the illness comes on quickly or gradually, and whether or not there is an associated fever. Antibiotics will not help viral pneumonia. Usually, children with viral pneumonia will get better by themselves over a period of time that can range from days to weeks. Most children will have a cough that lasts for some weeks after the infection.
Consultant Paediatrician and Head of Paeditrics Department at the University College Hospital, Ibadan, Professor Adegoke Falade, said although the signs of the disease and the symptoms they experience will depend on their age, most children with pneumonia usually show common signs like cough and rapid breathing. The child may also show signs that they are having trouble breathing, including: flaring of the nostrils; grunting when breathing out; and using their abdominal and neck muscles when breathing.
Other signs and symptoms of pneumonia may include a general feeling of being unwell, restlessness, irritability, fever and headache. Sometimes a child with pneumonia will develop abdominal pain, nausea and vomiting (especially after coughing). Chest pain may occur, but it is probably less common than in adults with pneumonia. Falade, however, said that the ultimate way of determining whether a child has pneumonia or not is through physical examination, and chest X-ray results. Falade, said, "I am deeply concerned by the toll that childhood pneumonia exact on Nigeria."
He said deaths from the disease are more tragic, despite being largely preventable through use of vaccines and other important approaches. Wonodi said, "Pneumonia is a devastating disease for Nigerians. It has caused untimely death for too many children and crippled their families emotionally and financially," Wonodi said.
She, however, said that morbidity and death from the HIB and Pneumococcus Bacteria are preventable using various strategies.
"Many cases of pneuomonia are preventable. Established prevention techniques, such as improving nutrition, exclusive breast feeding, reducing indoor air pollution and vaccination against measles and pertusis have successfully lowered pneumonia risk among children," she said. She said two of the most effective interventions for reducing pneumonia are vaccines that protect against HIB and pneumococcus.
Vaccine offers hope
Kenya and 14 other African countries that have incorporated the use of the HIB vaccine into their routing immunisation programmes, have witnessed significant reduction in infant deaths. A bitter reality, however, is that Nigeria is yet to adopt the use of a vaccine against the disease, despite overt move by various bodies to make it popular as a veritable means of reducing under-five deaths in the country.
A recent study showed that pneuomococcal vaccine prevented 16 percent of child deaths when given routinely in a clinical trial in Gambia. Also, a number of studies in Africa have shown virtual elimination of HIB meningitis and pneumonia in countries that use the vaccine. Worldwide, HIB disease is estimated to cause three million episodes of serious disease each year, leading to 400,000 childhood deaths.
Epidemiologist and Paediatrician at Centre for Disease Control and Prevention (CDC), Atlanta, U.S.A., Dr. Adam Cohen, noted that if countries, donors and industries can be mobilised to introduce HIB vaccine, deaths and sufferings due to HIB would become a thing of the past.
He said it is gladdening that Nigeria has included use of HIB vaccine in its multi-year programme for child health. WHO estimates that vaccines against HIB and pneumococcus can prevent more than one million child deaths per year. HIB vaccine is a conjugate vaccine developed for the prevention of invasive disease caused by Haemophilus influenzae type B bacteria.
Cohen disclosed that Nigeria has the opportunity of getting help from The Global Alliance for Vaccines and Immunisation (GAVI) to ensure that the vaccine comes to Nigerians at no cost. According to him, the cost of the HIB vaccine is as low as N28 per dose and a child requires not more than three doses. If the cost for Nigeria is put beside the fact that the vaccines reduces the risk of deaths from pneumonia by 10-20 percent and the potential of eliminating deaths, then there should be no reason to wait
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