It’s about to rain pneumonia on children

Children may be facing the worst pneumonia season in years as the nation-wide curfew and fear of coronavirus infection keep patients away from hospitals.

“With most emergencies happening at night, many parents are unable to bring sick children to hospital,” says Dr Elizabeth Gitau, the CEO of the Kenya Medical Association.

Last week, Nakuru County Health Executive Kariuki Gichuki said a lot of people could be silently suffering in their houses.

“We are afraid many people could be wrongly treating some illnesses at home.”

April to June is one of the two peak pneumonia seasons in Kenya when thousands of children are hospitalised. Last year 21,383 children under age five were admitted with pneumonia.

Pneumonia has stubbornly remained the top killer disease in the country in the last decade, and the single-biggest cause of child hospitalisation in the last three years.

Data published last month in the 2020 Economic Survey and collected from hospitals showed cases of pneumonia have been rising every consecutive year.

The number of pneumonia hospital visits rose from 1.5 million in 2015 to almost two million last year.

“Pneumonia remained the leading cause of infants and children under-five admissions to health facilities for the period 2017 to 2019,” says the survey.

Previous surveys have also shown pneumonia as persistently being the major cause of death in children despite a vaccine introduced in 2011.

The pneumonia situation is likely to worsen this year as parents keep their children away from hospitals over Covid-19 fears.

“We are aware many sick people may be keeping away from hospitals but encourage them to visit our facilities” said Health Director General Partick Amoth.

This, however, is complicated by directives issued by the Ministry of Health in March asking patients with non-urgent matters to stay away from hospitals as the pandemic rages.

The Guidelines on the Management of Paediatric Patients during Covid-19 Pandemic advises caregivers of paediatric patients to reduce contact with hospitals.

“Routine paediatric outpatient clinics should be postponed … and clinicians should spend minimal time with patients.”

The situation is muddied further because most symptoms of pneumonia are similar to those of Covid-19.

“Children with indrawing pneumonia ...should be prioritised for Covid-19 testing,” say the guidelines.

This may further scare parents and families who face mandatory quarantine, which has created an element of dread among the public.

Does the pneumonia vaccine work?

But even without the coronavirus pandemic, a section of medical experts are worried over increasing cases of pneumonia despite many of the children having been vaccinated.

In 2018, a team from Aga Khan University Hospital, Kenyatta University and the University of Embu published an explosive study carried out at Gertrude’s Children’s Hospital, Nairobi, concluding that the vaccine does not work.

“Kenyan children receiving PCV-10 pneumonia vaccine are not protected,” the study concluded.

But soon after the findings were highlighted in The Standard, the study authors softened their conclusions.

“After receiving reviews, I changed the previous wording from ‘Kenyan children currently using PCV-10 vaccine are not protected’ to ‘these results, therefore, highlight the importance of monitoring and evaluation to provide information to determine the effectiveness of PCV-10 in Kenya’s public health services’,” wrote the lead author in a revised report.

On the other hand, evaluations published by the Health ministry, donors and industry stakeholders report the vaccine to be highly effective and recommend the government continue purchasing it after the donor pulls out in 2022.

Some of the evaluations had been funded by GAVI Alliance, the Bill and Melinda Gates Foundation, and drug manufacturers including Pfizer, GlaxoSmithKline and Merck.

One of the evaluations says, for example, that in Kilifi, pneumonia had reduced by 68 per cent in children aged under five since the vaccine was introduced.

But early this month, data published in Nature Communications by international researchers and the government of Malawi says the vaccine has largely been a disappointment.

The study says seven years since the vaccine was introduced in Malawi, pneumonia cases are still high, and suggests new approaches be investigated.

In fact, the researchers intimate the vaccine has been a disappointment in Africa.

“There are concerns that pneumococcal conjugate vaccines (PCVs) in sub-Saharan Africa sub-optimally interrupt pneumonia.”

Similarly, a report presented in February at the annual scientific conference of the Kenya Medical Research Institute showed pneumonia strains covered by the vaccine are still persistent in their study areas of Nairobi and Siaya counties.

April to June

is one of the two peak pneumonia seasons in Kenya when thousands of children are hospitalised.

Keep pneumonia at bay

·         Besides the recommended vaccinations, smoking or putting your child in an environment where they inhale smoke makes them more susceptible to pneumonia.

·         Keep them away from infected persons, and if infected, keep the child away from the healthy children.

·         Frequent handwashing will reduce chances of infection when child touches mouth or nose.

Signs to look out for

Pneumonia can be caused by a virus or bacteria. The one brought on by virus is less serious while one brought on by bacteria develops fast and is treated using antibiotics.

Look out for:

·         Sudden fever

·         Unusually fast breathing

·         Chest pains

·         Fatigue

·         Shaking chills

·         Muscle aches

·         Cough