Like our counterparts in the Americas, Nigeria will be joined the rest of Africa to mark Africa Vaccination Week which began on the 24th April to end 30th of April. In an article written by Ndidi Chukwu for Health Reporters, The National Primary Health Care Development Agency, (NPHCDA) has said it will leverage on the gains of Africa Vaccination Week (AVW) and reach out to Internally Displaced Persons (IDP) in Nigeria with the goal to boost ‘population immunity’ among vulnerable groups, mainly targeted at the internally displaced persons. “The strategy for boosting the population immunity in IDPs is through outreach services using health camps where integrated health services will be provided” NPHCDA Executive Director, Dr Ado Mohammad told a press conference in Abuja.
In an article written by Ndidi Chukwu for Health Reporters, The World Bank Group’s Board of Executive Directors have approved a US$500 million International Development Association (IDA) credit to significantly improve maternal, child, and nutrition health services for women and children in Nigeria. By improving access to higher quality health services, the new development financing will help Nigeria to achieve its “Saving One Million Lives (SOML) Initiative,” which was launched by the Federal Ministry of Health in October 2012 to save the lives of the more than 900,000 women and children who die every year in Nigeria from largely preventable causes. “Saving One Million Lives is a bold response from the Nigerian government to improve the health of the country’s mothers and children so they can survive illness and thrive. This, in turn, will also contribute to the social and economic development of Africa’s largest economy,” said Benjamin Loevinsohn, a Lead Health Specialist and Task Team Leader for the new project.
It’s World Malaria Day today. A day marked down by the world to take a look at the successes achieved so far in the fight to rollback Malaria.
Responsible for over 300,000 deaths yearly in Nigeria where 25% accounts for infant mortality (children under age 1), 30% for childhood mortality (children under age 5) and 11% for maternal mortality; Malaria is highly endemic affecting particularly young children and pregnant mothers. With majority of the deaths in children ubder-5 and a high percentage of miscarriages, stillbirths, low birth weight, anaemia in pregnancy and maternal mortality caused by malaria, it makes one wonder what successes we have achieved in the fight against Malaria. Looking from the outside, one would think that Malaria was winning the fight and not the other way around with about 50% of the population having at least one of episode of malaria in a year. Continue reading
In 2015 alone, it was estimated that nearly a million children worldwide, died before their fifth birthday. One out of nine of these children (121,000) died in Nigeria. It is estimated that there are 6.7 million cases of childhood pneumonia annually. Nigeria thus has the second largest burden of the disease after India which has about ten times our population. In addition, pneumonia is estimated to constitute 15% of all causes of death in children below the age of 5.
One of the key highlights of the 2014 World Pneumonia Day was the release of a new report by the Institute for Health Metrics and Evaluation (IHME) titled “Pushing the Pace: Progress and Challenges in Fighting Childhood Pneumonia”. This report found that there had been a reduction in child pneumonia deaths over the last fifteen years of about 58%, but that this had not kept pace with reductions in deaths from other childhood killers such as measles and diarrhoea whose reduction stood at 83% and 68% respectively. In addition, funding remained an issue; illustrated by the fact that in 2011 only 2% ($US670 million) of the estimated $US30.6 billion of international development aid for health, was spent on fighting pneumonia, the leading cause of death among children under-five years! The IHME report has attracted a lot of comments from major actors in the pneumonia landscape worldwide. My good friend Ms. Leith Greenslade, Vice Chair at the MDG Health Alliance, clearly articulated my own take on the report:
“ …There is an opportunity to achieve a better alignment between the major causes of child death and the allocation of development assistance. The fact that many of the countries that have performed so poorly in reducing child pneumonia deaths have achieved remarkable reductions in reducing child deaths from other causes (e.g. diarrhea and measles) suggests that disease prioritization and level of investment are critical factors. If we want to achieve MDG4 by 2015 and end preventable child deaths by 2030 we need to make sure that our spending tracks disease burden more closely than it has to date.”
It comes as no surprise that the report further confirmed the relative neglect of pneumonia disease among the top five causes of child mortality. This neglect has consequences on the institutional response to tackling the problem and even the health literacy of the population. A simple random chat with people in Nigeria clearly highlights that strong myths largely affect people’s understanding of the disease. Whenever I explain to people that Nigeria carries a significant chunk of the global burden of the disease, it has often been greeted by surprise…and even incredulity.
Sadly, a significant number of people still think pneumonia is a disease of “cold environments”, rather than as a result of disease causing organisms. It is also not surprising that in the same report, Nigeria has showed only 4% reduction in pneumonia deaths among children under five years in the time reviewed.
During the course of a discussion on pneumonia with a senior legislator in the Nigerian National Assembly two months ago, she had asked me two questions:
What can we do to change this state of affairs?
What has been done so far in Nigeria?
I replied to her questions as follows:
There is urgent need to mobilise resources to move against this disease if we want to achieve MDG 4, because it would enable the rollout of vaccines to prevent infection, strengthen programmes around health information, breastfeeding and access to clean cooking stoves. It would enhance the early recognition and treatment of children with pneumonia with the appropriate antibiotics such as the dispersible amoxicillin tablet and access to oxygen therapy where it is needed.
In response to her second question, I explained that despite many challenges, Nigeria was on the road to rolling out the pneumococcal conjugate vaccine at the end of the year, which would serve as the cornerstone of prevention.
The country’s partners at the last United Nations General Assembly week 2014 side meetings, had agreed to strengthen partnerships around breastfeeding including early initiation of breastfeeding due to the poor indices, as poorly breastfed babies are at a fifteen times greater risk of death from pneumonia when compared to babies who are exclusively breastfed for the first six months of life. (Children with malnutrition are also more likely to die of pneumonia). On the side of treatment, following compelling case profiles of several countries across Africa, Nigeria had started the process of rolling out the integrated community case management (ICCM) for malaria, pneumonia and diarrhoeal diseases. The country had also achieved local production of dispersible Amoxicillin tablets which is the first line drug for treatment of community-acquired pneumonia, a landmark achievement on the continent.
Because of the large human resource for health gap at the frontlines of Nigerian health system, the ICCM programme would use community assets by riding on the back of community-based health volunteers (CBHV) also called Community Oriented Resource Persons (CORPs) in underserved communities. Such structures are not new and have done well in Sokoto and Bauchi states in community-based distribution of misoprostol and chlorhexidine to reduce maternal mortality, with the support of USAID’s Targeted States High Impact Project (TSHIP). However, certain enabling policies need to be reviewed for pneumonia to be treated at the frontlines by such volunteers. Among the groups also being considered in this category to expand access to ICCM treatment for children are the ubiquitous patent and proprietary medicine vendors (PPMVs) found in every community in Nigeria.
One of the major challenges in ramping up pneumonia programmes has been around the diagnostic conundrum. Unlike its counterpart malaria, pneumonia diagnosis is mostly based on the clinical acumen of the provider for recognising signs in a child, because confirmation by X-ray is almost impossible at the lowest level of health care. New diagnostic technologies such as pulse-oximeters, mobile applications and other forms of tools to enhance quick, reliable and cost-effective diagnosis are being developed and tried. The inability to deliver compact and cost-effective oxygen therapy at primary care centers has also been a challenge at the frontlines that requires investment.
To end preventable child deaths by 2030 in Nigeria, we must move pneumonia to the centre stage of our child health programme strategies. The level of investment and disease prioritization we give to our strategies are critical factors, and require good integration at community level in managing the major childhood killers, namely, pneumonia, malaria and diarrhea. We must focus on pneumonia if we want to reduce preventable child deaths in Nigeria.
Currently, children visiting hospitals to update their immunisation shots will get an extra shot. A new vaccine targeting at least 10 diseases related to pneumonia is set to become part of routine immunisation for children aged one year and below in hopes of averting nearly half a million deaths, the National Primary Health Care Development Agency says.
The Pneumococcal Conjugate Vaccine, PCV, rolled out in 12 states on Monday December 15 in the first phase of introduction and could avert an additional 486,957 deaths of children over the next six years. It is called “conjugate” because it targets more than one disease.
Children aged one will get at three doses of PCV every four weeks as part of their routine immunisation schedule in health facilities.
Pneumococcal diseases, caused by the bacterium Streptococcus pneumoniae, are leading causes of morbidity and nearly 1.6 million annual global death in adults and children from pneumonia, meningitis and sepsis, experts say.
The bacterium normally lives in the throat and nose of healthy people but has potential to cause infections, which differ by geographic region and age. Children are most affected—one dies every two minutes from pneumonia around the world. One of every 20 children dying from pneumonia is in Nigeria, where 13% of all child deaths—nearly 200,000 each year—are from pneumonia, second only to India’s burden, says World Health Organisation.
The vaccine helps children produce antibodies against pneumococcal bacteria and PCV10—one of two available PCVs Nigeria proposes to use—will protect against 10 common types of pneumococcal diseases.
At least four million doses of PCV are expected in the first phase of rollout in Adamawa, Anambra, Ebonyi, Edo, Kaduna, Katsina, Kogi, Osun, Ondo, Plateau, Rivers and Yobe.
An additional 45.9 million doses of the vaccine are expected from the early quarter of 2015 to 2017. A second phase by April 2015 will cover Ogun, Oyo, Sokoto, Imo, Bayelsa, Cross River, Benue, Taraba and Abia.
A third phase planned for April 2017 will cover remaining states country wide. PCV introduction, earlier planned for last year, was delayed due to global vaccine shortage. It is the next vaccine to be introduced after last year compounding five routine antigens into a pentavalent form (five vaccines in a single shot) and another for rotavirus is planned as soon as next September.
Source: Health Reporters