‘Children In Crèches Are Highly Vulnerable To Respiratory Infections’

Former President of the Association of Resident Doctors (ARD), Lagos University Teaching Hospital (LUTH) chapter, Dr Emeka Ugwu, is of the opinion   that parents’ sociological behaviour can make their children vulnerable to acute respiratory tract infections like pneumonia. The paediatrician stated that aside malnourished children, children who go to crèches are more likely to have pneumonia than those who do not. 

We have noticed that a number of children are coming down with symptoms of cough, diarrhoea and vomiting. What could be responsible for this? 

If one looks at the epidemiology of diseases in children, even in our country, diarrhoea disease and acute respiratory infection are the commonest killer diseases in children.  The top five killer diseases of children   below the age of five are pneumonia, diarrhoea, malaria, measles and malnutrition. You can see that pneumonia, which can manifest as cough, is a big issue (though there are other respiratory tract infections, which we regarded as cough, that are not necessarily pneumonia).  

   Pneumonia manifests in the lower part of the respiratory tract. The respiratory infection, even in abroad, you have up to eight infections per year for a child. So you expect every child, even in Nigeria, to have between three and eight respiratory tract infections, which may include cough, in a year. Diarrhoea disease, the one people refer to as purging, should not be that common. 

  Pneumonia is not necessarily new.  Efforts are in place to reduce the prevalence. But it is expected more in some seasons. During the rainy season, for example, you are likely to have pneumonia. But during the dry season when there is dust, you are going to have more   diseases like croup, characterised by a loud cough that resembles the barking of a seal and difficulty breathing. 

It, therefore, means that if we are talking about children having up to eight times of these infections, it means that in less than two months, a child will have respiratory tract infection like catarrh and cough.  Most of them are viral though; just a few of them may   progress to pneumonia.  

 But in our environment, pneumonia is the most    important cause of death among children. Studies have shown that pneumonia is the most important cause of deaths in children, causing up to 25 per cent of deaths. Pneumonia makes children to breathe with difficulty, and these children can die as result of heart failure. The children may not even cough, but they may have pneumonia.

  As I said earlier on, the commonest cause of respiratory tract infection is the virus. Many of the infections do go on for a week and then resolve on their own. They can be bacteria from the beginning, or viral at the beginning with bacteria super infection.  The two commonest causes are haemophilus influenzae and strepneumonia. 

Are there things parents and children are doing that may predispose children to these infections?

There are predisposing factors for acute respiratory infection. Take malnutrition for instance. More than half of the children that have the infection are already malnourished. So, if a child is not feeding well, the child is more likely to have respiratory tract infection, including pneumonia. 

 Also, our people are no longer doing exclusive breastfeeding. But exclusive breastfeeding has been shown to reduce the incidence of acute respiratory tract infection, including pneumonia in children. So, if you breastfed your child for six months, your child is less likely to be suffering from these respiratory tract infections.  But we have seen over the years that our rate of exclusive breastfeeding is dropping in Nigeria. That could be a contributory factor. 

 Poverty is also an issue.  More than 70 per cent of Nigerians are poor. Poverty contributes to poor housing, overcrowding and poor nutrition. Because of poverty, many families are more likely to live in an overcrowded environment. Overcrowding increases incidence of acute respiratory tract infection and diarrhoea.  If generator fumes enter into rooms and pollute the rooms, a child may be at risk of respiratory infection. 

 The way parents seek healthcare is also a challenge. Some parents do not take their children to the hospital, when the children are sick.  For instance, if a child is quickly identified to have respiratory infection, and is treated quickly before it progresses to pneumonia, the incidence of death from pneumonia would be reduced. 

 Because many mothers work, they take their children to crèches. A child who goes to crèche will have respiratory infection about two times more than children who do not go to crèche.  So, if we say that a child who does not go to crèche would have respiratory infection about eight times in a year, it means that a child who goes to crèche may have it up to 10 to 12 times in a year, which is on the average of every month.   

  The reason is that most of these infections are viral, and they are highly infectious. These children play together in crèches. The ideal thing is that if a child comes down with flu-like symptoms like catarrh, he should be sent home, or be separated from other children, until it is resolved. This is because if the child comes to crèche, he would infect the ones who had recovered. So, having children in crèche early in life also contributes to the increased rate of acute respiratory infection. 

 What is the preventive measure for these infections?

Every child should be exclusively breastfed. It significantly reduces acute respiratory tract infection. A child should be fed properly, because malnutrition reduces immunity of a child. So, if a child were well-fed and nourished, he would have a better defence against disease; he is unlikely to come down every now and then. Furthermore, there should not be overcrowding in a home. There should be proper ventilation in a home, so that these children can breathe in better air. If air is stagnated, children would breathe in germs.  But if there is free flow of air and there are not too many people who are causing overcrowding, children are likely to do better. 

  If one is using generator, one should make sure that the fumes from the generator are kept away from   living rooms, so that the fumes do not enter the nose of these children and irritate their airways. Immunisation is very important. Parents should make sure that children get routine immunisation. 

  Parents should clean their environment properly so that children are not exposed to dust. And when a child has respiratory tract infection, parents should not take the child to crèche. Or if they feel that the child is having recurrent respiratory tract infection, they can inform the crèche so that the crèche can review its policy to control these infections.

 Some parents clothe children heavily during the cold season. Cold period has been associated with acute respiratory tract infection, but it not because the cold gets into the chest to the lungs. Cold does not cause pneumonia. Sometimes, even when everybody is crowded into a room because there is cold, it could also predispose children to respiratory tract infection.