Exclusive breastfeeding, Immunisation reduce cases of pneumonia
The report of a research conducted by University College London, University College Hospital Ibadan, University of Melbourne and Johns, Hopkins University, covering November 2018 to June 2019, revealed that more than six million children under the age of five die yearly of pneumonia. It stated that the disease is the second leading cause of such deaths, with 880, 000 deaths recorded in 2016. Half of these deaths happened in five countries, which include Nigeria.
Prof. Adegoke Falade of University College Hospital Ibadan said exclusive breastfeeding and immunisation practices would reduce the risk of pneumonia morbidity and mortality among infants. He said despite renewed commitments to prevent childhood deaths from common infections, mortality rates of children under the age of five are still unacceptably high.
Falade in an interview with The Guardian pointed out that priority areas for reducing pneumonia morbidity and mortality should focus on training, community education, provision of oximeters and oxygen, increasing the number of healthcare providers and making provision for universal free healthcare.
He noted that the mortality rate of under-five Nigerian children was 120/1,000 live births in 2017, considerably higher than the Sustainable Development Goal target of 25/2,000 live births, which needs to be achieved by 2030.
He said: “The mortality rate, due to pneumonia specifically, was reported as 19/1,000 in 2016. Nigeria is not moving to reach these goals. Therefore, there is a clear need for evidence-based and sustainable approaches to targeted childhood infections, specifically pneumonia.
“The overall aim of this situational analysis was to generate gender-sensitive evidence on the current state of pneumonia in children aged 0 to 59 months, using Jigawa and Lagos States.”
Falade explained that vaccine coverage for pneumonia was high in Lagos, but low in Jigawa, though there is evidence of an upward trend in Jigawa.
He said: “Other environmental risks, for instance, solid fuel for cooking, were low in Lagos, but high in Jigawa. Overall, the published evidence available for both Lagos and Jigawa was based predominantly on large national surveys, which have several limitations. Therefore, our finding was that there are still major evidence gaps regarding the epidemiology of pediatric pneumonia in Nigeria.
“There were clear differences in the types of facilities available in Lagos and Jigawa, with more private providers in Lagos and more primary providers in Jigawa. Oxygen and pulse oximeter was not universally available across secondary care and were less available along with other equipment in Jigawa.
“Interestingly, oxygen was more widely available than pulse oximeter in Lagos, suggesting the introduction of oximeters could improve how the treatment is directed. The availability of essential medicines was mixed across both states, with amoxicillin available in all, but with low stocks in many. The availability of second-line IV antibiotics was more varied…”
He said overall healthcare providers scored poorly on Integrated Management of Childhood Illness (IMCI) and Emergency Triage Assessment and Treatment (ETAT), knowledge. Having been trained in either of these was associated with some improvement in knowledge.
“Key enabling factors in delivering paediatric pneumonia care highlighted by healthcare providers included accountability procedures and feedback loops, the provision of free medication for under-five children and philanthropic acts,” he said. “On the other hand, common barriers to providing care included the burden of out of pocket payments, challenges in effective communication with caregivers, delayed presentation and the lack of clear diagnosis and case management guidelines…”
Falade disclosed that extended families play a role in the provision of care and therefore, interventions will need to be mindful of the roles of mothers-in-law, grandmothers, and aunties, as well as the child’s parents.
Child Health and Immunisation Specialist, Dr. Opeyemi Odedere, said children can be protected from pneumonia with simple interventions, low-cost treatment, low-tech medication, and care.
He explained that childhood pneumonia is preventable and treatable. He urged parents to make their children available for immunisation given in the first 12 months of a baby’s life to protect the child from being infected with pneumonia. Preventive measures include going for antibiotic treatment, improved hygiene and using clean cooking fuel, among others.
He said: “Pneumonia claims the lives of more children around the world than any other infectious disease. Most of these deaths resulting from pneumonia occur in developing countries and about three-quarters takes place in just 15 countries. More than half of the world’s annual incident cases occur in India, China, Bangladesh, Pakistan, and Nigeria, according to the World Health Organisation (WHO).
“Pneumonia is an inflammation of the lungs caused by bacteria, viruses, and fungi. In pneumonia infection, the lungs, which are made up of small sac-like features called alveoli, usually filled with air, when a healthy individual breathes, are now filled with pus and fluid, making breathing painful and reducing intake of oxygen.”
The Chief of Party, Inspiring Project at Save the Children International, Dr. Adamu Isah, said: “There are priority areas that need action to reduce the rate of pneumonia in Nigeria. These include focusing on community and primary care, improving case management through sustainable training approaches, implementation of oximetry and oxygen, and advocacy for pneumonia.”
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