Boda bodas linked to pneumonia cases

When Irene Nabuyoga’s three-year-old daughter contracted a cough and flu, she had no idea that the illness would lead to death.
Nabuyoga, a farmer from Hangaraba in Butaleja District remembers calling a boda boda rider to rush her and her daughter to hospital because this was the only reliable and affordable means of transport.
She says by the time they reached the hospital, the child had developed breathing problems and became unconscious. “I had stayed home because I expected the flu to heal in a few days. At Busolwe District Hospital, doctors said my daughter had developed severe pneumonia which eventually claimed her life.
Dr John Matovu, the hospital’s medical superintendent, says the condition was worsened by the nearly 30-minute boda boda ride,” says Nabuyoga.
Nabuyoga is not alone but represents many mothers in the villages and urban centres who use boda bodas especially in the morning to ferry their children to school.
Dr Matovu says sitting on a boda boda without a helmet or any other protection such as warm clothes exposes children to Pneumonia - a disease that affects the lungs and one of the leading causes of death particularly among children under five.

At risk
According to the UN children’s agency UNICEF, pneumonia, a severe lung infection kills up to 24,000 Ugandan children under the age of five per year, many of whom are misdiagnosed as having malaria.
He says pneumonia infection that causes inflammation in the lungs, affects millions of Ugandans, is life threatening for children below five years, the elderly and people with chronic conditions.
During the World pneumonia Day celebrations [November 12, 2016], the Ministry of Health revealed that Pneumonia was annually responsible for the death of 24,000 children under the age of five.
UNICEF says pneumonia remains the leading infectious cause of death among children under five, killing 2,500 children worldwide a day and accounts for 15 per cent of all under-five deaths.
Dr Julian Abeso, a pediatrician at Mbale Regional Referral Hospital, warns that if strategic measures are not taken to address the high infection rate of pneumonia among children under five years, it may become Uganda’s leading killer disease.
“In Uganda it has been the second highest cause of death in children after malaria but it will soon take over as the leading killer disease,” says Dr Abeso.
She explains that evidence shows that children are dying from the disease due to the unavailability of effective interventions such as proper nutrition, vaccination, hand washing with soap and low emission cooking stoves.
“And lack of access to laboratory testing and infrastructure in poor communities means as health workers we often have to rely on simple clinical examinations to make their diagnoses,” said Dr Abeso.

Misdiagnosis
Dr Abeso says many of the deaths are because of misdiagnosis especially in the villages and remote areas where children get sick and the first reaction is to treat them for malaria. “Most people are aware of malaria, and the signs for malaria and pneumonia are similar, so it is difficult for some health professionals to differentiate between the two,” adds Dr Abeso.
She says once pneumonia-causing organisms invade lung tissues, air sacs in the lungs called alveoli fill up with fluid and pus, making it hard to breathe and that the symptoms here may include cough, fever, fatigue, and nausea.

Vaccination
The 2014 Pneumonia Fact sheet ranks Uganda as 8th in the number of pneumonia deaths in the world and another report from UNICEF also indicates that all deaths occurring as a result of pneumonia happen in rural and poor communities.
Dr Abeso says parents should cover their children with warm clothing in the evenings and early mornings when travelling using motorcycles or buy for them helmets.
Dr Muhammed Mulongo, the Bulambuli District Health Officer, advises that children younger than five years and adults 65 above should get vaccinated against pneumococcal pneumonia, a common form of bacterial pneumonia. He also calls for action to improve the early identification and treatment of childhood pneumonia at community and outpatient level to reduce deaths.

Early intervention
The Director Health Services at the ministry of Health, Prof Anthony Mbonye, says in the absence of early intervention, pneumonia progresses to a state where even intravenous antibiotics have limited impact, leading to the high hospital case–fatality rates for children. “Delayed care-seeking behaviour or poor access to hospital care, or both, explains the high number of severe pneumonia cases observed in hospitals today in Uganda,” says Prof Mbonye.

Statistics
A recent World Health Organisation report says acute diarrhoeal and respiratory infections are the most frequent childhood illnesses and causes of attendance at health services in low-income and middle-income countries and despite large reductions in child mortality between 2000 and 2010, these diseases remain major causes of avoidable deaths and account for about 30 per cent of all child deaths worldwide.

Facts about pneumonia

• Streptococcus pneumonia is the most common cause of bacterial pneumonia in children, followed by Haemophilus influenza type B (Hib)
• in infants infected with HIV, Pneumocystis jiroveci is one of the commonest causes of pneumonia, responsible for at least one quarter of all pneumonia deaths in HIV-infected infants.

Causes
• Pneumonia is caused by a number of infectious agents, including viruses, bacteria and fungi.
• Respiratory syncytial virus is the most common viral cause of pneumonia.

Transmission
• Pneumonia can be spread in a number of ways; the viruses and bacteria that are commonly found in a child’s nose or throat can infect the lungs if they are inhaled.
• They may also spread via air-borne droplets from a cough or sneeze. In addition, pneumonia may spread through blood, especially during and shortly after birth.

Symptoms
Children with walking pneumonia may not feel sick enough to stay home, but they could have the following symptoms:
• Dry cough
• Low-grade fever
• Headache
• Tiredness