DP is a 4 year old girl. She had been admitted twice in the year on account of fever, cough, difficulty with breathing, and weakness. She had similar complaints later in the year for which her parents sought care in the hospital. She was managed for recurrent pneumonia. In addition to medications, a review of her home and immediate environment revealed pollution of her bedroom with generator fumes. Also discovered was the fact that she lived in an overcrowded household.
What is Pneumonia?
It is an infection in the lungs. It is often typically referred to as ‘chest infection.’ It is responsible for absence in school, loss of play, and loss of family income. It is one of the top 5 causes of death among children below the age of 5 years.
How common is it?
In countries with very good health systems, the proportion of children who have the infection is very low. In developing countries, due to several reasons- inaccessibility to vaccines, ignorance, poor potency of available vaccines, etc– many children suffer from pneumonia.
(why do some children have the infection and others do not?): Aside the lack of vaccination against microorganisms that cause infections generally, malnourishment, living in polluted environments, overcrowded households, presence of immunodeficient conditions like HIV/AIDS, use of immunity suppressing medications like steroids; congenital heart diseases (heart disease present from birth), all increase the risk of having pneumonia. These children may have many episodes of infection in a year.
The infection is caused by several microorganisms. Common ones include bacteria, viruses, and fungi. Typical bacterium that causes pneumonia is Streptococcus pneumoniae. As children get older, their immunity (defence system) matures, hence, may have fewer or no infection.
How does it manifest?
Caregivers need to be observant else, a child with pneumonia may not be identified early. Manifestations of the infection include a combination of any of these
- Fast breathing
- Difficulty with breathing
- Reduced appetite
- Chest examination reveals impairment with air flow in the lungs.
The care of a child with chest infection is comprehensive in approach. Investigations include
- Blood check to identify presence of infection in the body and possibly the particular microorganism causing pneumonia.
- Chest X ray to identify changes in the lungs from the infection.
- Other investigations depend on suspicion of other conditions that predispose to pneumonia.
Medications are given to cure the ongoing infection and also to ensure that spread of the infection to other individuals is prevented. This explains why appropriate treatment of a patient helps protect the community.
In ideal situation, the living environment and school environment should be evaluated for possible risk factors that make the child sick from pneumonia. Children who live or attend schools in unhealthy environments may have recurrent infections. Other sick children in these environments who were not taken to the hospital MUST be treated, otherwise, the child who had been treated would be reinfected. In countries with good health system, a sick child is advised to stay off school in order to protect other pupils.
Counseling of caregivers on the importance of completion of medications prescribed to the child is important. To guarantee full recovery, the dose of medication MUST be completed even when the child feels well. This will ensure eradication of the bacteria or other microorganisms causing the chest infection.
Completed doses of Pneumococcal vaccine in addition to other vaccines available in the National Programme on Immunization (NPI) help reduce the proportion of children with pneumonia. In addition, good household and environmental hygiene helps to reduce the number of children with pneumonia infection. A sick child must be taken to a hospital immediately to prevent death.
Dr Ademola Orolu is a Consultant Family Physician. He holds the Fellowship of The West African College of Physicians. He is also an Associate Fellow of The National Postgraduate Medical College of Nigeria. He is in active clinical practice. He is a writer, a patient advocate, and has a passion for health education. He is the chief editor of The Family Doctors. He can be contacted via firstname.lastname@example.org