pneumonia in Nigeria

What is Pneumonia?

Pneumonia is a form of acute respiratory infection that affects the lungs. The lungs are made up of small sacs called alveoli, which fill with air when a healthy person breathes. When an individual has pneumonia, the alveoli are filled with pus and fluid, which makes breathing painful and limits oxygen intake.

Pneumonia is the single largest infectious cause of death in children worldwide. Pneumonia killed 808 694 children under the age of 5 in 2017, accounting for 15% of all deaths of children under five years old. In Nigeria, 19% of child deaths were due to pneumonia in 2018, and it was the biggest killer of children under-five in 2017. There  are  an  estimated  56  million  episodes  of lung  infections  among  Nigerian children  every year.  Although,  not  all  episodes  will  lead  to death,  these  infections  nevertheless  cause suffering and require treatment. Pneumonia  is  an  economic  burden  for  families and  communities,  contributing  to  the  cycle  of poverty. Pneumonia affects children and families everywhere, but is most prevalent in South Asia and sub-Saharan Africa. Children can be protected from pneumonia, it can be prevented with simple interventions, and treated with low-cost, low-tech medication and care. READ: Is Peak 123 Milk Good for Babies ?

 

What Causes Pneumonia

Pneumonia is caused by a number of infectious agents, including viruses, bacteria and fungi. The most common are:

 

  • Streptococcus pneumoniae – the most common cause of bacterial pneumonia in children;

 

  • Haemophilus influenzae type b (Hib) – the second most common cause of bacterial pneumonia;

 

  • respiratory syncytial virus is the most common viral cause of pneumonia;

 

  • in infants infected with HIV, Pneumocystis jiroveci is one of the most common causes of pneumonia, responsible for at least one quarter of all pneumonia deaths in HIV-infected infants.

 

How Pneumonia is Transmission

Pneumonia can be spread in a number of ways. The viruses and bacteria that are commonly found in a child’s nose or throat, can infect the lungs if they are inhaled. They may also spread via air-borne droplets from a cough or sneeze. In addition, pneumonia may spread through blood, especially during and shortly after birth. More research needs to be done on the different pathogens causing pneumonia and the ways they are transmitted, as this is of critical importance for treatment and prevention.

 

Presenting features of Pneumonia

The presenting features of viral and bacterial pneumonia are similar. However, the symptoms of viral pneumonia may be more numerous than the symptoms of bacterial pneumonia. In children under 5 years of age, who have cough and/or difficult breathing, with or without fever, pneumonia is diagnosed by the presence of either fast breathing or lower chest wall indrawing where their chest moves in or retracts during inhalation (in a healthy person, the chest expands during inhalation). Wheezing is more common in viral infections. Very severely ill infants may be unable to feed or drink and may also experience unconsciousness, hypothermia and convulsions.

 

Symptoms of pneumonia in Adult
  • a cough – which may be dry, or produce thick yellow, green, brown or blood-stained mucus (phlegm)

 

  • difficulty breathing – your breathing may be rapid and shallow, and you may feel breathless, even when resting.

 

  • rapid heartbeat.

 

  • high temperature.

 

  • feeling generally unwell.

 

  • sweating and shivering.

 

Risk factors

While most healthy children can fight the infection with their natural defences, children whose immune systems are compromised are at higher risk of developing pneumonia. A child’s immune system may be weakened by malnutrition or undernourishment, especially in infants who are not exclusively breastfed.

Pre-existing illnesses, such as symptomatic HIV infections and measles, also increase a child’s risk of contracting pneumonia.

The following environmental factors also increase a child’s susceptibility to pneumonia:

  • indoor air pollution caused by cooking and heating with biomass fuels (such as wood or dung)

 

  • living in crowded homes

 

  • parental smoking.

 

How Pneumonia is treated

Pneumonia is treated with antibiotics. The antibiotic of choice is amoxicillin dispersible tablets. Most cases of pneumonia require oral antibiotics, which are often prescribed at a health centre. These cases can also be diagnosed and treated with inexpensive oral antibiotics at the community level by trained community health workers. Hospitalization is recommended only for severe cases of pneumonia.

 

How to prevent Pneumonia

Preventing pneumonia in children is an essential component of a strategy to reduce child mortality. Immunization against Hib, pneumococcus, measles and whooping cough (pertussis) is the most effective way to prevent pneumonia.

Adequate nutrition is key to improving children’s natural defences, starting with exclusive breastfeeding for the first 6 months of life. In addition to being effective in preventing pneumonia, it also helps to reduce the length of the illness if a child does become ill.

Addressing environmental factors such as indoor air pollution (by providing affordable clean indoor stoves, for example) and encouraging good hygiene in crowded homes also reduces the number of children who fall ill with pneumonia.

In children infected with HIV, the antibiotic cotrimoxazole is given daily to decrease the risk of contracting pneumonia.

 

What is the economic costs of Pneumonia?

The cost of antibiotic treatment for all children with pneumonia in 66 of the countdown to 2015 countries for maternal, newborn and child survival is estimated at around US$ 109 million per year. The price includes the antibiotics and diagnostics for pneumonia management.

 

Pneumonia is a problem with solutions

We  can protect children  from  pneumonia  and  many  other  diseases  through exclusive  breastfeeding  during  the  first  6  months  of  life.

In  Nigeria,  only  20%  of  babies  are  exclusively  breastfed,  this  needs  to  be  improved.  Other strategies  to  protect  include:  good  nutrition, hand‐washing, and reduced indoor air pollution.

We  can  prevent  pneumonia  with  new  and  effective  vaccines  against  HiB  and  pneumococcus. With  help  from  GAVI,  many  countries  in  Africa now provide or will soon provide the HiB vaccine.   A  pneumococcal  conjugate  vaccine  has  already  been  introduced  in  Rwanda, The  Gambia,  and  South Africa.

Thanks  to a  new and  clever way  to  fund  vaccines called  the  Advance  Market  Commitment  (AMC),  more  low‐income  countries  will  soon  have  access  to  this  new  generation  vaccine. The Nigerian government is striving to include HiB and  pneumococcal  vaccines  into  the  national  immunization program with GAVI’s support.

Other  preventive  strategies  include:  vaccination  against  measles  and  pertussis  (i.e.  whooping  cough),  zinc  supplementation, HIV  prevention,  and  antibiotic  prophylaxis  for  people  with  or  exposed to HIV

Children  should  have  access  to  effective  and  affordable treatment. Treatment for most types of serious pneumonia is  usually  antibiotics,  which  typically  cost  less  than  150 Naira  per  dose.

Effective  case management strategies can help to ensure that children receive  the right treatment for pneumonia quickly.

In Nigeria, only an estimated 1 of every 5 children  with  pneumonia  receives  appropriate  antibiotics.

Health  policies and  services  should  be  designed  to  provide  children  prompt  and  effective treatment for pneumonia.

Raise awareness about pneumonia among leaders  and health providers  Educate  the  public  to  recognize  pneumonia  and  seek proper treatment

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