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Saturday, September 27, 2008

Pneumonia kills more children than malaria

New evidence shows that pneumonia kills more children than malaria, measles and HIV/Aids combined. Though preventable, the disease remains neglected mainly due to ignorance of its causes and immediate symptoms, writes Dennis D. Muhumuza

A child suffering from pneumonia at Mulago hospital
In the acute child care unit of Mulago Hospital on Thursday mid-morning, a child of about five years lay in a slanted little bed; eyes sunken, pain all over his face, lungs visibly stiff. He was using a lot of energy to breath in what the doctor called “in-breathing.” Every time he did, his skeletal lungs expanded and contracted in a violent and alarming manner. A tube run from a container fixed to his bedpost, into his nose and directly into the blood vessel on his wrist. He was on oxygen which if removed, would make breathing difficult: “The oxygen is piped and must pass through water because if you don’t make it a little bit humid, it becomes dry and it dries up the chest,” explained the doctor.

Like tens of others packed in health centres countrywide, this child was battling a very painful case of pneumonia and would stay up to three days on oxygen depending on the severity of the disease. Unknown to many, pneumonia kills more children than measles, HIV/Aids, and malaria combined, according to a report, Progress For Children on

According to estimates from the United Nations children’s fund (Unicef), pneumonia kills over two million children in the world under the age of five every year. That is about the population of Kampala.

“Pneumonia is actually the leading infectious cause of death in children, contributing to about 20 percent of all under-five mortality rates. That translates to about 20,000 Ugandan children dying of pneumonia per year,” says Dr Eric Wobudeya, a paediatrician at Mulago Hospital Complex. “It’s a severe disease yet it has not been given the priority it deserves.”

This is because there has been little input to understand the grim disease. In fact, the first study, what Dr Jessica Nsungwa Sabiiti of Ministry of Health, called “A verbal autopsy” was only recently conducted around the country to determine the number of children the disease kills annually. The report is yet to be released.

As a paediatrician heading the ministry’s programme for the management of childhood illnesses, Sabiiti agrees that pneumonia has not been given enough emphasis because of the push given to malaria – long viewed as the number one cause of death in Africa. So malaria monopolised nearly all medical attention but all that is changing because with the help of the Global Fund, the effectiveness of the interventions put in place (mosquito nets and the new drugs) have weakened the severity of, and significantly reduced the proportion of patients dying of malaria.

After the examination of 2,080 children under the age of five in Mulago Hospital, it has been established that pneumonia is more common than malaria and needs to be dealt with before it wipes infants of the face of Uganda.

Things have not been helped by ignorance and the misconceptions surrounding the disease. Many times people say pneumonia is caused by cold – that if you don’t wrap your child in as much warmth it gets infected. Others are known to get painkillers and to administer all sorts of syrup or cough mixtures when a child begins to cry and cough and the temperature shoots off. The truth is that pneumonia is an infectious disease caused by bacteria and sometimes viruses.

Signs of pneumonia
Cough, fast breathing and high fever are signs of pneumonia and your child should be taken to the nearest health unit for proper treatment. These symptoms defer from those of the elderly where headache, chest pain, lung congestion and sometimes nausea and vomiting are symptoms.

Health experts say indoor pollution caused by smoke from firewood, congestion, poverty, poor ventilation, malnutrition and staying in a poor place like slums are some of the factors that influence infection.

Although a big problem among children under five and the elderly, with the spate of HIV/Aids, not even the youths can be spared.

“Pneumocystis Carinii Pneumonia (PCP) is the common cause of death in people with HIV/Aids but can be prevented with Septrine,” says Dr Wobudeya. He was quick to add that all forms of pneumonia, however fatal, are preventable when the disease is detected early and proper medication sought.

“Viral pneumonia is dangerous but the bacterial ones cause more deaths. And most of these are caused by two types of bacteria: Haemophilus Influenzae and Streptococcus Pneumoniae and both of these bacteria have vaccines and beyond the vaccines are other important preventable methods, for instance, if children develop measles, those children are more likely to get severe pneumonia, so if we immunise all our children against only measles we reduce the amount of mortality in pneumonia by about 10 percent,” says Dr Wobudeya.

“And in addition to drug treatment, a patient with pneumonia should stay in bed, eat healthy meals, and drink large amounts of liquids. With good treatment, it usually takes three days for patients to get better.”

Getting better is essential if Millennium Development Goal Four, which aims at reducing by two thirds the mortality rate among children under five by 2015, is to be achieved. There is however fear that it may take long to subdue this contagious disease especially with the fist of poverty dealing cruel blows in many households.

More troubling, according to Dr Wobudeya, is that pneumonia has become resistant to our simple drugs and yet chemotherapy which has helped combat the disease in the developed world are unavailable in government hospitals and poor clinics because they are expensive. While this poses no danger to the affluent who can rush their children to well-oiled clinics, the poor are left in despair because they cannot afford expensive treatment.

Kitagata Hospital, one of the biggest government hospitals in western Uganda, admits about 150 children suffering from pneumonia every month, according to its medical superintendent Dr Wilberforce Owembabazi, but the majority are those who don’t get to hospital.

This is a dire situation that the Uganda Paediatricians Association, whose major aim is to take care of the country’s children by ensuring they get good health care, may not handle on its own although it has rolled out an awareness campaign on child pneumonia throughout the country.

“We are working together with the Ministry of Health to prevent early neonatal death” [of babies aged 1-7months], says Dr Sabrina Bakeera Kitaka of the Department of Paediatrics Makerere Medical School, and the general secretary of the association. “Our aim really is to make pneumonia visible, do more advocacy and educate the communities but we are still limited by resources.”

The call by World Health Organisation (WHO) to have pneumonia managed at the community level has been heard by the Ministry of Health which is training nurses, nursing aides, lay workers and other volunteers in northern Uganda to become what Dr Sabiiti calls “mini-paediatricians.”

“You don’t need to be a paediatrician to manage pneumonia,” she said. “We are training them in using a respiratory timer developed by Unicef; we have taught them to examine the child and count the respiratory rate; and to ask the right questions from mother, and if the child is breathing faster than normal, has a cough then that child has pneumonia.”

The pain on the face of that Mulago child on oxygen is a haunting scene. Whatever means are used to scale up effective interventions; preventing death is all that matters.

--Daily Monitor, August 21, 2008