Better uptake of the new pneumococcal conjugate vaccine (PCV) in children under five alongside more robust health monitoring systems at community level could help stem pneumonia related-deaths in children in Kenya: 20 percent of deaths in children under five are attributable to the disease, according to the Ministry of Public Health and Sanitation.
Immunization against Hib (Haemophilus influenzae type b), pneumococcus (a bacterium that can cause ear, sinus and bloodstream infections and pneumonia), measles and whooping cough (pertussis) is the most effective way to prevent the disease, says the World Health Organization (WHO).
Globally, pneumonia is the leading cause of death in children under five, killing an estimated 1.1 million each year, according to WHO. Caused by viruses, bacteria or fungi, pneumonia “can be prevented by immunization, adequate nutrition and by addressing environmental factors”, says WHO.
The Kenyan government has been targeting under-five children for PCV vaccination through a partnership with the Global Alliance for Vaccines and Immunizations, GAVI. Since January 2011, scientists have been tracking the vaccine’s coverage versus pneumococcal disease-related hospital admissions among residents of the costal town of Kilifi.
The research, Pneumococcal Conjugate Vaccine Impact Study (PCVIS) compares “the incidence rates of invasive pneumococcal disease, radiologically proven pneumonia, and all-cause admissions to hospital in the period before vaccine introduction and the period after vaccine introduction.” The study is due to be completed by the end of 2015, and uses the PCV10 vaccine, a two-dose vial without preservatives approved by WHO.
The results of PCVIS, which is being carried out by the Kenya Medical Research Institute, KEMRI-Wellcome Trust Research Programme alongside the Division of Vaccines and Immunization (DVI), are expected to help DVI determine future vaccine policy.
Meanwhile, the PCV vaccine seems to be paying off.
“Already, the incidence of the illness in children aged [under] five has gone down by approximately two-thirds in Kilifi since the PCV vaccine was introduced three years ago,” Anthony Scott, the lead researcher with KEMRI, told IRIN.
More data needed…
Alongside the vaccine, better-equipped health monitoring and delivery systems are also needed. According to the GAVI alliance, data-mining electronic medical records are vital at a policy level to understanding the efficacy of medicines.
“With good data, it is very easy to show the minister and the country’s leaders the importance of bringing a new vaccine to Kenya,” said S.K. Sharif, Kenya’s director of public health and sanitation. “Not only do we have senior leaders who are passionate about vaccinations, but another advantage for Kenya is that we are very good at collecting scientific evidence about vaccinations.”
But a lot more needs to be done to digitize more records, especially in rural areas. “Our data are wanting. The Government needs to invest heavily in data collection to improve Kenya’s data system,” Shikanga O-tipo, the head of the integrated disease surveillance department in the Ministry of Public Health and Sanitation, told IRIN.
…and better diagnostic equipment…
Healthcare professionals also lack the equipment and knowledge to diagnose pneumonia early in many parts of Kenya.
“The disease requires specialized clinical attention, but many of Kenya’s health facilities don’t have X-ray equipment to diagnose chests for pneumonia,” said O-tipo. Additionally, “health workers have sometimes failed to identify the disease-causing micro-organisms and would constantly prescribe any other antibiotic that often leads to resistance,” added O-tipo.
Some of these difficulties are a result of how the disease presents itself early-on. “There are many other conditions that come with heavy breathing. This makes pneumonia, which shares similar symptoms, hard to detect at early stages,” said Donald Apat, a health specialist with Millennium Villages.
…and more community awareness
Community awareness about pneumonia is also needed in many parts of Kenya. “A lot of cases have been reported where sick people in the communities would sit back, hoping that the disease would go. And the moment they are taken to the health facilities, the disease would have eaten them up,” said O-tipo.
Globally, nearly half of early childhood deaths as a result of pneumonia are estimated to be as a result of a failure or delay in diagnosing the illness and adequate treatment, according to the Melinda and Bill Gates Foundation, which supports the GAVI alliance.
Health officials now recommend educating communities about personal hygiene, such as covering the mouth when coughing and washing hands properly to curb the spread of the disease.
“More attention should be focused at the community levels, where a lot of infections are community acquired,” said O-tipo.