Pneumonia: The Silent Killer in Nigeria

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As pneumonia continues to ravage lives in Nigeria, killing at least 20 children every hour, more than the malaria scourge, with 6.7 million cases recorded yearly, Martins Ifijeh writes on need for stakeholders to step up preventive measures and efforts to manage the silent killer disease

While Nigeria battles high maternal and child deaths, malnutrition, malaria, diarrhoea, and other lethal health issues, another silent killer is slowly sending an increasing number of children to their early graves. Often referred to as one of Nigeria’s most misunderstood diseases, pneumonia is now killing children more than malaria in the country, going by the report of the International Vaccines Access Centre (IVAC).

The report shows that in 2015, about 17 per cent and 10 per cent of under-five deaths were caused by pneumonia and diarrhoea, respectively, suggesting that malaria is now third placed among child killer diseases in the country.

Ignorance
With most Nigerians wrongly believing that pneumonia is caused by exposure to cold weather, food, and water, experts say ignorance may be a major part of the factors fuelling the prevalence of under-five deaths in the country caused by pneumonia.
Available statistics show that pneumonia kills a staggering 1.6 million people globally every year with children under the age of five bearing the brunt of the crisis, especially in underdeveloped and developing countries like Nigeria.

According to the World Health Organisation, even though pneumonia is preventable and treatable, a child somewhere in the world still dies of pneumonia every 20 seconds, making it the number one infectious killer of children across the globe, especially in Africa where even malaria is known to be the commonest of diseases.

Statistics

Africa is known to be badly affected by pneumonia. According to reports, Nigeria takes the lead in the prevalence rate on the continent. Reports say among five children in Nigeria that die of childhood killer diseases, two die from pneumonia.
Statistics from the United Nations Education Fund (UNICEF) also shows that an estimated 6.7 million cases of childhood pneumonia are recorded in Nigeria every year, with about 200,000 under-five deaths recorded annually; which means every hour, 20 children die from pneumonia in Nigeria.

Stakeholders
Experts say stakeholders and the governments at local, state and national levels must scale up awareness campaign about the disease, as is currently being done for malaria, polio and HIV/AIDS. They are also calling on Nigerians to put measures in place to prevent the disease from taking away their loved ones.

Symptoms
Project Head, Perfect Health Initiative, Dr. Omons Okumale, says most people do not know about pneumonia and how it can be prevented, adding that the lack of awareness is largely responsible for its prevalence, especially among children whose immunity is not as strong as that of adults.

“Pneumonia is a severe disease, because the body gets oxygen through the lungs and once the brain does not get oxygen in three minutes, death occurs. That is why it is a very fatal disease,” Okumale explained.
He said although pneumonia was more prevalent in the Western world, “It is not the most common cause of death for them, because they know how to deal with their issues, they have preventive measures in place to tackle it, unlike us over here where it is a growing concern.”

On why children are more prone to the disease, Okumale said it was because their immune system is very low. “Apart from children, others also at high risk are the immune compromised people. I mean persons with Human Immuno Virus (HIV) and those on drugs like corticosteroids. Also prone to it is the elderly because at their age their immunity is low,” he said.
He said pneumonia was caused by bacteria, fungi, and virus infections, as well as other types of germs. “Chemical causes should not be left out also. Assuming one mistakenly drinks kerosene, a quantity of it could go into the lungs causing chemical pneumonia,” he said.

“The cause of pneumonia determines the treatment. Before treatment, one must first do a diagnosis to know which of the germs is the remote cause, so that the physician can know exactly which medication to use.”

On the symptoms of pneumonia and how they manifest, Okumale said the most common symptom included cough, fever and shortness of breath. “God gave everyone cough as a defence mechanism to push out foreign bodies from the respiratory tract. Also, shortness of breath is understandable because since there is infection in the alveoli, there definitely will be difficulty in exchanging gases with the blood, vice versa,” he said.

To compensate for the inadequate oxygen to the blood, he said the lung breathes faster and shorter so as to make up for the fact that each breathing during pneumonia does not deliver enough oxygen to the blood. “There could be loss of appetite as well as weakness. Even when the person eats, there is not enough oxygen to metabolise the food, hence the body becomes weak. There could sometime be chest pain,” he added.

Myths

Okumale said regarding the misconception that cold weather caused pneumonia that the disease was caused by germs. According to him, “If it was due to cold, all the children in cold regions abroad would have contracted it by now. When this bacteria or virus gets into the body either through the mouth or other openings in the body, it goes to the gut and contaminates the blood and goes into the respiratory apparatus to cause problem there. That is pneumonia.

“People should understand that the most viable way pneumonia is transmitted is through germs contracted under poor sanitation and hygiene. It is not prevented or treated by wearing clothes that cover every part of the body or being in a warm environment.”

He said children exposed to cigarette smoke, those who do not participate in routine pneumonia programmes and those exposed to smoke from charcoal or firewood were more at risk of the disease.

Okumale, however, said the myth about cold being a causal factor may not be totally discarded, as the assumption could have an element of fact, adding that the germs causing the disease thrives more in cold weather. But he noted that because the disease thrives more in cold environment does not mean cold is the source of the disease.
“That is why it is a very common disease abroad. Even at that, it is not the most common cause of death over there because they sure know how to take care of themselves. They have vaccines against it. The reason people are still dying of malaria today is because it is an African problem. If it was the advanced countries’ problem, they would have developed vaccines against it. Warm environment is a little bit not conducive for pneumonia virus to thrive,” he stated.

Tackling Causative Agents
Okumale said there were different bacteria or viruses responsible for pneumonia; hence the need to identify which kind of germ causes a particular pneumonia before treatment can be initiated.

He stated, “There are anti-bacterial drugs for the pneumonia caused by bacteria, which usually is administered over a long period of time. But with the new drugs developed, the medication might last just few days. If the pneumonia is severe and the person is having fast and short breathe, it is necessary to put the person on oxygen as a temporary measure before treatment.

Vaccine
Consultant Paediatrician, Dr. Odom Ebizimo, believes most Nigerians do not know there are vaccines available against pneumonia, stressing that it is necessary they take advantage of it to prevent undue illnesses and deaths in the country. According to him, awareness is the major factor that can reduce the high number of deaths due to childhood pneumonia.

Ebizimo said, “In advanced countries, there are a lot of vaccines for various respiratory infections and their citizens know about them. So it’s easy to access such facilities, unlike here in Nigeria where most people may not be aware. The prevalence of pneumonia is not as high in western countries compared to ours.

“Recently, the Nigerian government added two new respiratory vaccines to the one they give to children at six weeks or 10 weeks. Even on individual basis, these vaccines can be sourced from private hospitals, but they will be of course more expensive. Pneumonia is preventable in Nigeria if vaccines are taken.”

Ebizimo who said clean environment had a major role to play in the prevention of pneumonia, stressing that a situation where over 10 people sleep in one room, especially in cities like Lagos, presents a breeding ground for pneumonia.

“Government has been doing awareness for Nigerians to immunise themselves against diseases like polio, measles and tuberculosis, but more awareness should be created, especially for pneumonia. Nigerians should be encouraged to immunise themselves against pneumonia. People should also live in a well-ventilated place. Offices and other closed rooms should be well ventilated as well,” he added.