Averting the rising under-5 mortality in Nigeria

By Abubakar Jimoh

In Nigeria, pneumonia and diarrhoea remain major killers of children under 5 years, accounting for about 400,000 preventable deaths, annually.

While an estimated 6.7 million cases of childhood pneumonia are reported annually, Nigeria reportedly has the second largest burden of the disease after India which has about ten times Nigeria population. Pneumonia and diarrhoea are estimated to constitute 16% and 19% respectively of all causes of death in children below the age of 5.

In 2010, in a report titled Integrated Management of Childhood Illness by World Health Organization (WHO), diarrheal diseases were observed amongst the most frequent childhood illnesses and leading cause of preventable death, especially among children under five in developing countries with Nigeria included.

According to WHO, “acute diarrheal diseases are one of the main problems affecting children in the world, reducing their well-being and creating considerable demand for health services.”

A study conducted by the United States National Center for Biotechnology Information (NCBI) in 2014 to develop context-specific strategies to improve care-seeking for childhood illness, Nigeria was identified as a high burden country with low rate of related treatment coverage, particularly in the grassroots.

The study concluded that while simple, inexpensive treatments are available for pneumonia and diarrhoea, yet too few children receive appropriate and timely care, particularly in high burden country like Nigeria and in the most deprived settings due to a range of interrelated factors—insufficient supply of life-saving commodities and trained health workers, poor geographic access to services, poor quality of care, as well as user-related financial and non-financial barriers.

In 2015, 5.9 million children around the world were projected would die before reaching their fifth birthday by WHO. 1 Of these 5.9 million deaths, pneumonia was responsible for 16% and diarrhea was responsible for 9%, making them two of the leading killers of children worldwide. Together, these diseases claimed the lives of nearly 1.5 million children under the age of five in a single year.

In another 2015 Progress Report on Pneumonia and Diarrhoea report published by the International Vaccine Access Center (IVAC) in collaboration with Johns Hopkins Bloomberg School of Public Health, it was revealed that lives of six children are lost with each passing minute. The report observes that although the number of child deaths in 2015 decreased compared to 2013 (6.4 million), the overall contribution of pneumonia and diarrhea to those deaths has remained rather steady (15-16% for pneumonia and 9% for diarrhea) over those two years.

In addition, the report bemoans pneumonia and diarrhea mortality in young children as they continue to be disproportionately concentrated in a few countries, year after year with 72% of the global burden of pneumonia and diarrhea child deaths occur in just 15 countries, even though they are home to only 55% of the world’s under-five population.

It is on the above premise that the Pharmaceutical Society of Nigeria (PSN) under the aegis of Partnership for Advocacy in Child and Family Health in Nigeria (PACFaH) notes that the global drive to halt unfavorable and preventable under-5 death statistics led to the inauguration of the United Nations Commission on Life-Saving Commodities (UNCoLSC) for Women and Children in 2010 with overall goal to increase access to essential life-saving commodities in 50 of the World’s poorest and high burdened countries across the world.

As the UNCoLSC recommends effective guidelines (such as the adoption of Amoxicillin Dispersible Tablets and Zinc/Lo-ORS) as first line treatment of pneumonia and diarrhoea respectively to prevent the death of children under-5, PSN-PACFaH is seriously worried over impending challenges confronting effort to successfully combat the childhood killer diseases such as lack of budget line item by governments at all levels for the procurement and administration of life-saving commodities, poor political commitment and awareness.

Also, WHO in 2010, recommended ‘Flexible Solid Oral Dosage’ forms as the optimum formulation for Children’s medicines administered orally, as they have proven effective and durable than liquids/paediatric suspensions, in addition to being less bulky to ship and store, especially in the grassroots.
It has become imperative for Nigerian Government to institutionalise the UNCoLSC recommendations especially the Pneumonia and Diarrhoea component that she co-chaired and signed in 2012.

According PSN-PACFaH, while preventive measures against pneumonia and Diarrhoea like vaccinations, exclusive breastfeeding, regular handwashing, vitamin A supplementation and proper nutrition are encouraged, however, these may not be sufficient to stop the rising under mortality in the country. Hence, full implementation of the UNCoLSC recommendations on Childhood Pneumonia and Diarrhoea has become imperative.

Similarly, training and retraining programmes for the Front Line Health workers to acquire the current knowledge and skills to effectively manage childhood Pneumonia and Diarrhoea using Amoxicillin DT, and Zinc/ORS respectively are paramount to successfully win battle against the diseases.

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