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Nigeria Progress Slow Against Diarrhoea, Pneumonia

Nigeria failed to meet targets for pneumonia and diarrhoea prevention and treatment, according to a progress report by the International Vaccine Access Centre (IVAC).
IVAC’s 2017 report scored Nigeria 30% overall on interventions to prevent or treat both diseases, which account for one in four deaths of children aged under five years globally.
The report analysed data from 15 countries with the greatest burden of pneumonia and diarrhoea but implementing the integrated Global Action Plan for the Prevention & Control of Pneumonia and Diarrhoea (GAPPD).
Nigeria’s GAPPD score is only one point up from 2016—and puts it ahead of only Chad and Somalia, with 23% and 19% respectively.
Intervention in pneumonia placed Nigeria at 38%, compared with a GAPPD target of 84%. Similarly, intervention in diarrhoea placed the country at 21%, compared with a target 82%.
The report comes months after Nigeria officially launched policy to include amoxicillin dispersible tablets on its essential medicines list—and make it possible for health workers to use the antibiotic for treatment of pneumonia, a move interventions in child and family health have been pushing for years.
The Partnership for Advocacy for Child and Family Health (PaCFAH) has also been pushing for adoption of zinc and low-osmolarity oral rehydration solutions for management of diarrhoea.
It says the ranking Nigeria got for both interventions reflected a lack of political will to mainstream interventions against pneumonia and diarrhoea.
“I even expected it to be worse than what you are seeing now,” said David Akpotor, acting programme director for strategy for an arm of PaCFAH hosted by the Pharmaceutical Society of Nigeria.
“The government is not serious about driving down these numbers. That’s what PaCFAH is saying. The government should mainstream it and take it serious. They way they are going about it is slow.”
Failing indicators
The 15 countries with the highest burden of pneumonia and diarrhoea are India, Nigeria, Pakistan, the Democratic Republic of Congo, Angolo Ethiopia, Indonesia, Chad, Afghanistan, Niger, China, Sudan, Bangladesh, Somalia and Tanzania.
They account for 70% of more than 1.5 million children worldwide from both pneumonia and diarrhoea.
None of the 15 countries reached a target GAPPD score of 86%, when a country meets the minimal target for each of 10 interventions evaluated.
The interventions considered include threshold vaccination that could prevent diseases: a third dose of diphtheria-tetanus pertussis, a first dose of measles-containing vaccine, a third dose of haemophilius influenzae type B, a third dose of pneumococcal conjugate vaccine, and a final dose of rotavirus vaccine.
Treatment interventions include use of antibiotics to treat suspected pneumonia, oral rehydration solution for diarrhoea and zinc supplementation.
The indicator for protection is exclusive breastfeeding for the first months of a child’s life.
Eleven countries met or exceeded an overall GAPPD score of 43%, which is half of that target; four countries did not — Somalia (19%), Chad (23%), Nigeria (30%), and China (38%), researchers wrote in the report.
Of the 15 countries evaluated, only six countries are meeting GAPPD targets for at least one of the interventions. No countries are meeting GAPPD targets for any of the treatment indicators.
Slow start
The study found fewer than four in 10 children aged under five with pneumonia was taken to an appropriate health care provider or was treated with antibiotics.
Nigeria’s 2016 move to include amoxicillin as a first-line drug for pneumonia was meant to place it on “essential medicines list”, making it available for use in health facilities.
Among all 36 states of the country, only Kaduna has had anything to do with the document.
“It should have gone through all the states and procurement started,” said Akpotor. “The south south, south east, south west, north central,  northwest have not had opportunity to see the document, let alone implement.”
“Even the 2018, [the report] will be the same if we continue this way,” said Akpotor. “If we fold our arms, it will continue like that and the report will get worse and worse.
“Health seeking behaviours should increase. Up till now, some persons, when they have pneumonia, don’t go to hospital. They still want to do it themselves.”
The failed rollout of amoxicillin dispersible tablet as first-line treatment leaves hospitals free to use alternatives like erythromycin and septrim.
“They may not have amoxicillin, since it is not on the essential medicines list, but a primary health centre might have other nearest drug for treatment and then refer to where the drug can be had.”
Measles link
Nigeria—alongside Somalia, Angola and Pakistan—failed to reach more than a third of young children with even the first dose of measles vaccine, according to the IVAC report.
Pneumonia and diarrhoea contribute to complications and deaths that result from measles.
The number of children who die from measles each day has dropped from 2,000 to 400 over the past 15 years, due to increasing use of measles vaccine.
But the progress has stagnated, leaving children in hard to reach locations unvaccinated.
At least 33 million Nigerian children are targeted for measles vaccination this November.
Many children born between 2013 and 2016 have never been vaccinated against measles.
The IVAC report calls vaccine coverage is “canary in a coal mine,” indicating weaknesses in a country’s immunization system and, more broadly, its primary health care system.
It warns that children not receiving measles vaccine may not be receiving other critical public health interventions, putting them at risk of both measles and other preventable diseases.
“The consequence is an explosion of illness and disease,” said Declan Okpaleke, president of the African Health Journalists Association.
“Family health budget will increase in a country where there is no health insurance. Families will spend more out of their pocket on diseases.
The impact of vaccine-preventable diseases is crucial in Nigeria, which has one of the world’s highest levels of out-out-pocket spending on medical needs.
“It will impact more families. When that happens, education, housing will suffer. All the basic needs of families will suffer, because they would have had to divert money to take care of their health.”
The Guardian News

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