Childhood respiratory illnesses contribute significantly to under five-year mortality and morbidity in lower-middle-income countries more than the above five years across the world.
Dr Precious Champiti-Binauli, a cardiothoracic surgeon with a speciality in radiology at Ongwediva Medipark shared this during an information sharing session on respiratory diseases.
He said: “Despite declining mortality and morbidity associated with childhood pneumonia during the Millennium Development Goal period 2000–2015, 0.9 million children younger than five years died of pneumonia in 2015, and in 2018, less than 802 000 with half of these deaths occurring in Africa and Southeast Asia. Namibia as a country is not spared as the same disease burden affects us.”
According to the Pan African Thoracic Society (PATS) in partnership with the British Thoracic Society (BTS), the ‘Big Five’ respiratory illnesses are mostly communicable as compared to non-communicable ones. Champiti-Binauli added these include pneumonia (viral, bacterial), TB and post TB lung disease, Air pollution and respiratory diseases, Upper airway disease and, Asthma/ COPD.
He said: “Pneumonia remains the commonest cause of death in children under five years outside the neonatal period, with almost 800 000 deaths in 2018, with the burden skewed toward LMICs, especially in Africa. In Namibia, the same applies and is evident mostly in the public sector than the private sector.
Pneumonia usually results from the interaction of several organisms, with multiple organisms co-occurring. Viral pathogens are common, with a respiratory syncytial virus, being the most common viral pathogen.”
Champiti-Binauli hinted that children with severe pneumonia, or those with ambulatory pneumonia who are malnourished, HIV infected or have a household TB contact should be carefully evaluated for TB.
“Children may present with uncomplicated lymph node disease, complicated lymph node disease with airway compression and lobar collapse, bronchopneumonia, miliary tuberculosis, adult-type cavitary disease, pleural effusion, or a peripheral opacity with associated lymph node enlargement. Infants are particularly at risk for severe intrathoracic and disseminated tuberculosis associated with increased morbidity and mortality, while adolescents present like adults, with destructive pulmonary disease,” he detailed.
“In Namibia, similar statistics also exist but in the pediatric population, it is the communicable diseases compared to the non-communicable diseases that predominate. This trend is seasonal and also depends on location,” stated Champiti-Binauli.
The World Health Organisation (WHO) states that communicable, or infectious diseases are caused by microorganisms such as bacteria, viruses, parasites and fungi that can be spread, directly or indirectly, from one person to another. Some are transmitted through bites from insects while others are caused by ingesting contaminated food or water.
Non-communicable diseases (NCDs), also known as chronic diseases, tend to be of long duration and are the result of a combination of genetic, physiological, environmental and behavioural factors. Common non-communicable include asthma, biomass (wood) poisoning and congenital.
“Asthma is less common in children living in rural areas than those living in large urban areas. There are seasonal variations. In Namibia, asthma is more a disease of affluence especially as our children are now more exposed to urban life compared to the rural setting,” noted Champiti-Binauli.
When it comes to asthma, Christophe von Garnier from the Lausanne Hospital University in Switzerland said when parents or guardians are doubting diagnosis; it is advisable to refer children aged six to 11 to specialists.
“Suspected occupational asthma, persistent uncontrolled asthma or frequent exacerbations, risk factors for asthma-related death, significant side-effects (or risk of side-effects), symptoms suggesting complications or sub-types of asthma can be referred to specialists,” he said.
The Centres for Disease Control and Prevention (CDC) states that those at greatest risk for severe illness from Respiratory Syncytial Virus Infection RSV include premature infants, very young infants, especially six months and younger, children younger than two years old with chronic lung disease or congenital (present from birth) heart disease.
CDC adds that children with weakened immune systems and those who have neuromuscular disorders, including those who have difficulty swallowing or clearing mucus secretions are also at risk of getting severely sick.
“Virtually all children get an RSV infection by the time they are two years old. Most of the time RSV will cause a mild, cold-like illness, but it can also cause severe illnesses such as bronchiolitis (inflammation of the small airways in the lung), pneumonia (infection of the lungs),” CDC states on its website.
One to two out of every 100 children younger than six months of age with RSV infection may need to be hospitalised adding those hospitalised may require oxygen, intubation, and/or mechanical ventilation (help with breathing). Most improve with this type of supportive care and are discharged in a few days.