Addressing the challenge of pneumonia

Nigeria’s health indices are a source of major concern to health experts as many Nigerian children aged five and below continue to die through preventable childhood diseases including pneumonia and other pneumococcal diseases. It is estimated that 130,000 Nigerian children die annually from pneumonia, the second highest number of childhood pneumonia deaths in the globe and highest in Africa.

The disease is a severe form of acute lower respiratory infection that specifically affects the lungs, and accounts for a significant proportion of respiratory disease burden. With the disease, pus and fluid fill the alveoli in one or both lungs, and this interferes with oxygen absorption, making breathing difficult.

Nigeria lies within the Pneumococcal Meningitis belt of Africa where infant mortality has remained high, yet this disease has not attracted huge attention over the past decade. It has received limited funding and reportage when compared to diseases like malaria, Acquired Immune Deficiency Syndrome, (AIDS), etc.The burden that pneumonia places on families and the health system in resource-constrained countries in turn exacerbates inequalities. The coverage rate for interventions is consistently lowest.

A cursory look at pneumococcal disease show that poor environmental hygiene, poor nutrition worsened by dwindling economic fortunes of families and communities, poor ventilation worsened by over-crowding and unwholesome building construction practices and ignorance are reasons that predispose Nigerians, especially children to the deadly disease.

The introduction of Pentavalent vaccine (which includes the Haemophilus influenzae type B (Hib) antigen) into the routine immunization schedule of infants by the federal government is commendable. Currently, Ghana has implemented with the inclusion of PCV into its national immunization schedule in April 2012. Since its introduction, this has drastically reduced pneumonia-related deaths in Ghana which until now remained one of the leading causes of death among infant mortality and under-five deaths.

Prevention of pneumococcal diseases through vaccination will result in significant cost savings while also improving patient care and indirectly reducing overall mortality. The benefits of extensive vaccination in NPI plan extend beyond an immediate public health impact. The prospect of realising these positive outcomes through widespread vaccination should provide enough incentive for the government to issue a call to action.

Since preventing children from developing pneumonia is critical to reducing deaths, basic interventions everyone should undertake include ensuring adequate nutrition, primarily exclusive breastfeeding during the first six months of life, as well as zinc and vitamin A intake for infants.

Other interventions include reducing indoor air pollution, promoting basic hygiene practices, such as washing hands with soap and proper disposing of children’s faeces. Since access to health services is limited in some communities, prompt treatment may require training health workers to diagnose and treat children with pneumonia in the community.

While the predominance of pneumococcal pneumonia as a proportion of overall pneumonia is evident regionally in Africa, the Global Action Plan for Prevention and Control of Pneumonia (GAPP), developed by the World Health Organisation and UNICEF in May 2010 needs to be implemented. These include preventing children from contracting pneumonia through increasing awareness on pneumonia and controlling the disease through protection, prevention and treatment.