Pneumonia In Nigeria Research Articles

Integrated community case management of childhood pneumonia in Nigeria highly cost effective

Integrated community case management of childhood pneumonia in Nigeria highly cost effective

Management of childhood pneumonia in Nigeria.

Management of childhood pneumonia in Nigeria.

'Everybody in Nigeria is a doctor…': a qualitative study of stakeholder perspectives on lay diagnosis of malaria and pneumonia in Nigeria.

Lay diagnosis is a widely used diagnostic approach for home management of common illnesses in Nigeria. This study aimed to explore the perspectives of caregivers and healthcare professionals on lay diagnosis of childhood malaria and pneumonia. Aligned to this, the study sought to explore the feasibility of training caregivers in the Integrated Management of Childhood Illness (IMCI) guidelines for improved recognition and treatment of these diseases. A qualitative study using individual face-to-face semi-structured interviews was conducted in Benin City, Nigeria. Participants included 13 caregivers with children under 5 years and 17 healthcare professionals (HPs). An inductive approach to thematic analysis was used to generate themes and analyses. Caregivers relied on lay diagnosis but recognised its limitations. The perceived severity of malaria and pneumonia significantly influenced caregivers' preference for reliance on lay diagnosis practices, health-seeking behaviour and willingness to undertake training in IMCI guidelines for home management of diseases. Safety and potential unintended misuse of medications were recognised by caregivers and HPs as the main challenges. The high level of acceptance among caregivers to receive IMCI training could help improve effective management of childhood malaria and pneumonia at the community level through early recognition and prompt treatment.

Health system challenges for improved childhood pneumonia case management in Lagos and Jigawa, Nigeria.

Case fatality rates for childhood pneumonia in Nigeria remain high. There is a clear need for improved case management of pneumonia, through the sustainable implementation of the Integrated Management of Childhood Illnesses (IMCI) diagnostic and treatment algorithms. We explored barriers and opportunities for improved case management of childhood pneumonia in Lagos and Jigawa states, Nigeria. A mixed-method analysis was conducted to assess the current health system capacity to deliver quality care. This was done through audits of 16 facilities in Jigawa and 14 facilities in Lagos, questionnaires (n = 164) and 13 focus group discussions with providers. Field observations provided context for data analysis and triangulation. There were more private providers in Lagos (4/8 secondary facilities) and more government providers in Jigawa (4/8 primary, 3/3 secondary, and 1/1 tertiary facilities). Oxygen and pulse oximeters were available in two of three in Jigawa and six of eight in Lagos of the sampled secondary care facilities. None of the eight primary facilities surveyed in Jigawa had oxygen or pulse oximetry available while in Lagos two of three primary facilities had oxygen and one of three had pulse oximeters. Other IMCI and emergency equipment were also lacking including respiratory rate timers, particularly in Jigawa state. Health care providers scored poorly on knowledge of IMCI, though previous IMCI training was associated with better knowledge. Key enabling factors in delivering pediatric care highlighted by health care providers included accountability procedures and feedback loops, the provision of free medication for children, and philanthropic acts. Common barriers to provide care included the burden of out-of-pocket payments, challenges in effective communication with caregivers, delayed presentation, and lack of clear diagnosis, and case management guidelines. There is an urgent need to improve how the prevention and treatment of pediatric pneumonia is directed in both Lagos and Jigawa. Priority areas for reducing pediatric pneumonia burden are training and mentoring of health care providers, community health education, and introduction of oximeters and oxygen supply.

The burden and risks of pediatric pneumonia in Nigeria: A desk-based review of existing literature and data.

Pneumonia is a leading killer of children under-5 years, with a high burden in Nigeria. We aimed to quantify the regional burden and risks of pediatric pneumonia in Nigeria, and specifically the states of Lagos and Jigawa. We conducted a scoping literature search for studies of pneumonia morbidity and mortality in under-5 children in Nigeria from 10th December 2018 to 26th April 2019, searching: Cochrane, PubMed, and Web of Science. We included grey literature from stakeholders' websites and information shared by organizations working in Nigeria. We conducted multivariable logistic regression using the 2016 to 2017 Multiple Cluster Indicators Survey data set to explore factors associated with pneumonia. Descriptive analyses of datasets from 2010 to 2019 was done to estimate trends in mortality, morbidity, and vaccination coverage. We identified 25 relevant papers (10 from Jigawa, 8 from Lagos, and 14 national data). None included data on pneumonia or acute respiratory tract infection burden in the health system, inpatient case-fatality rates, severity, or age-specific pneumonia mortality rates at state level. Secondary data analysis found that no household or caregiver socioeconomic indicators were consistently associated with self-reported symptoms of cough and/or difficulty breathing, and seasonality was inconsistently associated, dependant on region. There is a clear evidence gap around the burden of pediatric pneumonia in Nigeria, and challenges with the interpretation of existing household survey data. Improved survey approaches are needed to understand the risks of pediatric pneumonia in Nigeria, alongside the need for investment in reliable routine data systems to provide data on the clinical pneumonia burden in Nigeria.

A mixed-methods evaluation of stakeholder perspectives on pediatric pneumonia in Nigeria-priorities, challenges, and champions.

Interventions to reduce pneumonia mortality exist; however, stakeholder engagement is needed to prioritize these. We explored diverse stakeholder opinions on current policy challenges and priorities for pediatric pneumonia in Nigeria. We conducted a mixed-methods study, with a web-survey and semi-structured interviews, to explore stakeholder roles, policy barriers, opportunities, and priorities. Web-survey participants were identified through stakeholder mapping, including researchers' networks, academic and grey literature, and "Every Breath Counts" coalition membership. Stakeholders included actors involved in pediatric pneumonia in Nigeria from non-governmental, government, academic, civil society, private, and professional organizations. Stakeholder interviews were conducted with local government, healthcare managers, professional associations, and local leaders in Lagos and Jigawa states. Quantitative data were analyzed descriptively; qualitative data were analyzed using a thematic framework. Of 111 stakeholders, 38 (34%) participated in the web-survey and 18 stakeholder interviews were conducted. Four thematic areas emerged: current policy, systems barriers, intervention priorities, and champions. Interviewees reported a lack of pneumonia-specific policies, despite acknowledging guidelines had been adopted in their settings. Barriers to effective pneumonia management were seen at all levels of the system, from the community to healthcare to policy, with key issues of resourcing and infrastructure. Intervention priorities were the strengthening of community knowledge and improving case management, focused on primary care. While stakeholders identified several key actors for pediatric pneumonia, they also highlighted a lack of champions. Consistent messages emerged to prioritize community and primary care initiatives, alongside improved access to oxygen, and pulse oximetry. There is a need for clear pneumonia policies, and support for adoption at a state level.

Protective effect of intranasal peste des petits ruminants virus and bacterin vaccinations: Clinical, hematological, serological, and serum oxidative stress changes in challenged goats.

Background and Aim:The current vaccination for peste des petits ruminants virus (PPRV) is stalled by myriad challenges and continuous endemicity of pneumonia due to fulminant bacterial complication in goats. The present study evaluated the protective effect of intranasal PPRV linage 1 and bacterine vaccinations.Materials and Methods:Twelve West African Dwarf (WAD) goats aged 6 months were randomly grouped and vaccinated within 2 weeks using a combination of PPRV lineage 1 vaccine (Nig/75), and bacterin from Mannheimia haemolytica (Mh) or Pasteurella multocida intranasally. The goats were observed for 3 weeks post-vaccination before comingled with a known infected WAD goat with apparent clinical signs of peste des petits ruminants and further observed clinically for 5 weeks post-infection (PI). Blood samples were taken for hematology while sera were assayed for antioxidants (glutathione peroxidase, glutathione transferase, and superoxide dismutase) activities and pro-oxidants (malondialdehyde content, reduced glutathione, hydrogen peroxide generation, and myeloperoxidase) using spectrophotometric methods. Data were subjected to parametric statistics at α=0.05 using GraphPad Prism version 21.Results:Clinically, there were pyrexia, oculonasal discharge, diarrhea, anemia, leukopenia, and increased pro-oxidants in the unvaccinated goats, while moderate neutrophilia and leukocytosis were observed in PPRV and bacterin vaccinated goats. Two unvaccinated goats were weak and euthanized at 13 and 28 days PI. The goats vaccinated with PPRV and Mh showed better response clinically and biochemically.Conclusion:The mucosal vaccination of goats with PPRV vaccine and bacterine will protect against exposure and culminate in the development of protective mucosal, humoral, and cell-mediated immune responses. This vaccination strategy will provide framework needed in the prevention and control of endemic caprine pneumonia in Nigeria.

Pathology and bronchoalveolar lavage fluid cellular and oxidative stress changes in canine pneumonia in Nigeria

Studies on canine respiratory diseases are scant in the literature especially in Africa, unlike the situation on ruminants. This study is on the pathology and bronchoalveolar cellular and oxidative stress changes in naturally occurring canine pneumonia in Nigeria. The dogs used were collected from cases submitted for necropsy in the institutional Department of Veterinary Pathology. Gross examination, bronchoalveolar lavage (BAL) cytology, oxidative biochemical assay of BAL fluid (BALf) supernatant and histology of sections from all the lung lobes were done using standard procedures. Grossly, 22 (31%) were normal while 48 (69%) were congested, haemorrhagic and/or pneumonic out of the 70 canine lungs examined. Microscopically, there were pulmonary congestion (4%), pulmonary oedema (20%), pulmonary haemorrhages (7%), atelectasis (4%), interstitial pneumonia (10%), bronchointerstitial pneumonia (14%) and bronchopneumonia (9%). The BALf cytology of pneumonic lungs showed increases in neutrophils, alveolar macrophages, lymphocytes and haemosiderophages including free and phagocytosed bacteria, and fungal hyphae. Glutathione peroxidase (GPx) and glutathione transferase (GST) activities increased in congested and bronchointerstitial pneumonic lungs but were reduced in other pneumonic lungs. The superoxide dismutase (SOD) activity was significantly reduced in the pneumonic canine lungs. Hydrogen peroxide generation increased in congestion and oedema, bronchopneumonia and bronchointerstitial pneumonia. Malondialdehyde (MDA) level increased in other congested and pneumonic lungs. There was also significant positive correlation of BALf pro-oxidant assay to the type and severity of pneumonia (+ 0.75, P < 0.05). Pneumonias account for 57.2% of the respiratory conditions of which bronchointerstitial and interstitial pneumonias are the prevalent types. The study also showed that oxidative stress markers in BALf may serve as predictors of pneumonia especially in the early stages. Since treatment recommendations for pneumonia often centre primarily on supportive care and anti-oxidant and antibiotic administration, further studies on causal agents, treatment and prevention strategies for canine pneumonia in Nigeria are warranted.

Immunohistochemical Evidence of Multiple Viral and Bacterial Associations in Caprine Pneumonia in Nigeria: Implications for Vaccines

DOI : 10.26650/actavet.2019.409009 Caprine pneumonia is a major cause of economic loss and the conventional vaccines are not optimal in protecting goats. A better understanding of the associations of respiratory pathogens may help improve our knowledge for vaccination to effectively control caprine pneumonia. One hundred and fifty goats (140 pneumonic and 10 normal) were examined for various lung pathologies using standard gross and histologic techniques. Antigens of parainfluenza 3 virus (PI3V), respiratory syncytial virus (RSV) and peste des petits ruminants virus (PPRV) and bacterial antigens of Mannheimia haemolytica (M.haemolytica) and Pasteurella multocida (P. multocida) were demonstrated immunohistochemically in the lungs. The data of goats positive and negative for the viral and bacterial antigens were analysed using descriptive statistics. Viral antigens were detected in 113 (81%) of the pneumonic lungs (100 as single, 11 dual and 2 triple). Bacterial antigens were detected in 120 (86%), M. haemolytica in 47 (34%), P. multocida in 59 (42%) and combined bacterial antigens in 14 (10%) of the pneumonic lungs. Multiple agents were detected in 108/140 positive cases; virus-bacterium association was observed in 106/108. PPRV antigens alone were observed in 15 cases. PPRV coexisted most frequently with M. haemolytica (n=20), P. multocida (n=13), PI3V with P. multocida (n=18), and RSV with M. haemolytica (n=9). The lesions corresponded to cranioventral (n=45), diffuse (n=75), and lobar consolidations (n=20) manifested as fibrinous bronchopneumonia (n=22), suppurative bronchopneumonia (n=20), bronchointerstitial pneumonia (n=61), interstitial pneumonia (n=25) and bronchiolitis (n=12). Thus, multiple infections are involved in pneumonia, hence we must consider combined vaccination strategies incorporating multiple antigens for adequate control of caprine pneumonia.

Haematology, bronchoalveolar cellular changes and pathology of swine pneumonia in Nigeria

Respiratory diseases are of considerable economic importance in pigs, and less emphasis is on the diagnostic approaches in porcine health in our environment. The aim of this study was to compare the diagnostic accuracy of haematology, gross, bronchoalveolar lavage (BAL) and histopathological changes of pneumonia in pigs. The study was conducted at a municipal abattoir for over three months. A total of 146 finished pigs were clinically examined. Blood samples were taken, while the plucks were examined for lung lesions. Lavage samples and lung sections were taken for BAL and histological examinations. Six breeds were slaughtered comprising Large White 112 (76.7%), Mixed Breed 15 (10.3%), Duroc 7 (4.8%), Local 6 (4.1%), Hampshire 4 (2.7%), and Large Black 2 (1.4%). Based on sex, 71 (48.6%) were males while, 75 (51.4%) were female. Grossly, there was pneumonia in 92 (63.0%) of the pigs and the mean pulmonary consolidation score was 9.6±1.2. The large white breed had the highest consolidation score. Also, the right and left caudal lobes had the highest consolidation scores. Clinically, there was mild anaemia and leukocytosis, and BAL fluid cellular differential showed increased lymphocytic and neutrophilic counts in the pigs with pneumonia (p&lt;0.05). Histologically, 91 (62.2%) of samples were normal, bronchointerstitial pneumonia was 31 (21.4%), bronchopneumonia was 18 (12.4%), granulomatous pneumonia was 1 (0.7%), bronchiolitis was 4 (2.7%), and verminous pneumonia was 1 (0.7%). Bronchointerstitial pneumonia was the most prevalent pattern. Porcine pneumonia is still important in our environment; the roles of different causal agents need to be elucidated for production of vaccines and control in Nigeria and other parts of West Africa.Keywords: Bronchoalveolar lavage, Cytology, Swine, Pneumonia, Diagnostics

Cultural and immunohistochemical evaluation of bacterial agents in caprine pneumonia in Nigeria

Goats are important protein-producing animals but pneumonia, in spite of the huge investments in small ruminant production, remains a major limitation. This study evaluates the prevalence of important bacterial pathogens associated with caprine pneumonia in Nigeria using cultural and immunohistochemical techniques. One hundred and fifty goat lungs were randomly examined from macroscopic, cultural isolation and microscopic changes using standard techniques. The common bacteria identified were formalin inactivated for bacterine and polyclonal antibody production. Immunohistochemical staining was performed against the bacteria antigens using the avidin-biotin peroxidase complex technique. The data were presented in frequencies and percentages, and compared using non-parametric statistics at α = 0.05. The pathology in the caprine lungs included broncho-interstitial pneumonia (41), interstitial pneumonia (27), and bronchopneumonia (72). Ten of the lungs were normal. Bacterial isolation yielded Mannheimia haemolytica (40%), Pasteurella multocida (20%), Escherichia coli (13%), Klebsiella pneumoniae (10%), Streptococcus sp. (8%), Baccillus sp. (5%), and Pseudomonas sp. (3%). Mannheimia haemolytica (Mh) and Pasturella multocida (Pm) were the most common isolated bacteria. The bacterial antigens were detected on the surface of respiratory bronchiolar, and alveolar epithelia, within inflammatory exudate and in cytoplasm of alveolar macrophages. One hundred twenty (80%) of the caprine lungs were positive for the Mh and Pm antigens; 47 for Mh, 59 for Pm, 14 for both, and 30 negative for either antigens. Significant differences were observed in the staining intensities of the antigens. This study validated Mannheimia haemolytica and Pasteurella multocida as most important bacterial pathogens in caprine pneumonia in Nigeria. Thus, adequate control of caprine pneumonia should consider bacterine or multivalent vaccines incorporating these important bacteria to curb morbidity and mortality of goats.

First report of immunohistochemical detection of Peste des petit ruminants, parainfluenza 3 and respiratory syncytial viral antigens in lungs of Nigerian goats

ABSTRACTThis study determined the of involvement of PPR, PI3, and RS viruses in the pathology of caprine pneumonia across Nigeria. 150 goats were selected randomly. PI3 and RSV monoclonal antibodies and PPR polyclonal antibody were used for the immunolocalization of the antigens. Histologically, 61 of the goats had broncho-interstitial pneumonia, 25 had interstitial pneumonia, 42 had bronchopneumonia, 12 had bronchiolitis, and 10 were normal. PPR, PI3, and RS viral antigens were demonstrated in: intact and desquamated bronchial, bronchiolar epithelial cells, macrophages, leukocytes, pneumocytes, and giant cells. 23% of the caprine lungs had positive immuno-staining to PI3 viral antigen, 10% were positive for RSV antigen while 34% were positive for PPR viral antigen. 8% showed immunostaining for the two and or three respiratory viral antigens in the goats. PI3 and RSV antigens were more in the young goats, red sokoto breed and during the dry season. This is the first report of immunohistochemical detection of PPR, PI3 and RS viral antigens in caprine lungs in Nigeria. These findings underscore the importance of PI3 and RSV viruses in the control of caprine pneumonia in Nigeria.

PUB143 Environmental Tobacco Smoke as a Risk Factor to Increasing Respiratory Childhood Infection and Pneumonia in South West Regionn Nigeria

There is consistent evidence that children exposed to environmental tobacco smoke (ETS) have higher incidence of asthma, ear- and throat disease, worsening of asthma symptoms and lung symptoms as cough, wheezing and pneumonia. A child exposed to ETS has about 30% higher risk of absence from school due to illness. Evidence clearly implicates (ETS) as a cause of lung cancer, excess respiratory disease, and cardiovascular disease mortality in nonsmokers. Few studies have looked at the interaction of tobacco use or ETS exposure with occupational and ambient air pollution (both indoor and outdoor) in contributing to chronic obstructive pulmonary disorders in developing countries, or the importance of ETS as a risk factor for the already high burden of childhood respiratory infections. A descriptive cross sectional study was carried out in 5 states (Ogun, Lagos, Akure, Oyo and Ekiti). A multistage cluster random sampling was employed to select 450 families in each state. Data was collected using structured questionnaires by trained interviewers. About 2113 records were available for analysis. There were 1298 (60.7%) males and 815 (38.1%) females aged 10 and below. A Majority, 807 (38.0%) live with both parents, 213 (10.0%) live with mother alone while 265 (12.5%) live with relatives. The prevalence of children exposed to ETS in the southwest region Nigeria was 73.2%, the study further revealed that 28.5% of children in this region with respiratory childhood infection are exposed to environmental tobacco smoke and 18.4% pneumonia cases are attributed to ETS. However, (122, 14.7%) parents or relatives don’t see a problem with using tobacco products. It is also clearly stated that about 46.9% cases of respiratory childhood infection and pneumonia combined are caused by ETS in the south west region Nigeria. Since Environmental Tobacco Smoke has this much negative effects on children in the south west region Nigeria. Efforts should be tailored towards protecting children from ETS to reduce the rate of children exposed to ETS, thereby curbing or reducing respiratory childhood infection and pneumonia in Nigeria.

An analysis of national data on care-seeking behaviour by parents of children with suspected pneumonia in Nigeria

Background. Pneumonia is responsible for 940 000 under-5 deaths annually. Most of these deaths result from delays in instituting effective treatment. Objectives. To determine care-seeking behaviour by parents of children with pneumonia and sociodemographic factors that influence decisions to seek appropriate care. Methods. The study was an analysis of the Nigeria Demographic and Health Survey 2013, which was a nationwide cross-sectional survey using a stratified cluster design of 40 680 households. All children under-5 living in the surveyed households with suspected pneumonia in the preceding 2 weeks were recruited along with their mothers. Sociodemographic characteristics of the parents and where they sought care for their child were obtained. Binomial logistic regression analysis was used to determine the contribution of various sociodemographic variables to the decision on seeking appropriate medical care. Results. Of the 28 950 children surveyed, 565 had suspected pneumonia, which equates to an occurrence rate of 19.5 per 1 000 children. About 36% of parents were judged to have sought appropriate care when their children had pneumonia. High paternal education, health decision-making by both husband and wife, and belonging to the higher quintiles on a wealth index were factors that positively influenced care-seeking behaviour. Conclusion. Care-seeking behaviour for pneumonia is poor. Paternal education and joint decision-making are key determinants of parents seeking appropriate care for their children with suspected pneumonia in Nigeria.

Pattern and associated risk factors of caprine pneumonia complex in Nigeria

ObjectiveTo investigate the pattern of lung consolidation in natural infections and identify the risk factors associated with caprine pneumonia in Nigeria so as to elucidate and aid the understanding of caprine respiratory disease complex in Nigeria. MethodsA total of 700 goats were examined before slaughtering between March 2014 and July 2015. Ante mortem evaluation for physical characteristics, body condition, breed and sex, gross morphometry for estimation of the percentage of lung consolidation and histopathology was performed according to standard techniques. Data were presented in percentages, mean ± SEM and subjected to non-parametric analysis. ResultsThe results showed that 30.3% of goats belonged to the breed of West African Dwarf, 55.4% Red Sokoto (RS) and 14.3% Sahelan. As for the age distribution, 3.7% of them were one year old, 30.7% were two years old and 65.6% were above two years old. The overall prevalence of pneumonia was 59.7%. The mean lung consolidation score was 8.1 ± 0.5, consolidation for male was 7.8 ± 0.5 and 21.4 ± 7.7 for female (P < 0.05). There was more consolidation on the right lung and caudal lobes, and RS showed the highest prevalence of consolidation. There was a positive correlation of contralateral lobar consolidation in the pneumonic animals, while significant effect of sex and body scores on the lung consolidation was observed (P < 0.05). The types of pneumonia observed were bronchopneumonia (41.6%), bronchointerstitial pneumonia (8.7%), interstitial pneumonia (7.9%), verminous pneumonia (0.3%), granulomatous pneumonia (0.9%) and normal lungs (40.7%). ConclusionsSex, breed and body scores were observed to be risk factors associated with caprine pneumonia in Nigerian goats. In this study, transport stress may be responsible for the high consolidation in RS. This information will help to increase the knowledge on the pathogenesis and the risk factors that often aggravate the prevalence of pneumonia in goats.

Camel pneumonia in Nigeria: epidemiology and bacterial flora in normal and diseased lung.

Respiratory disease is an emerging problem in camels, although information of the normal bacterial flora and bacterial agents implicated in pneumonia is rare in Nigeria. Five hundred lung samples were collected at random from two randomly selected camel slaughter house in Nigeria. Swabs samples were cultured and identified. Arcanobacterium pyogenes, Mannheimia haemolytica and Pasteurella multocida were recovered from pulmonary lesions, however Staphylococcus aureusand other Staphylococcus spp. were the most commonly isolated. Others agents isolated includes: Corynebacterium spp., Streptococcus spp., Klebsiella pneumonia, Micrococcus spp., Bacillus spp. and Proteus spp. It was concluded that, camels harbour in their lower respiratory tract potentially pathogenic agents, that may pose threat to other camels, domestic animals and/or livestock or even human populations. Therefore we suggest transboundary movements of animals be instituted and the camel herd health programme in Nigeria be maintained. Key words: Bacterial flora, camel, epidemiology, Nigeria, pneumonia.

Caprine pneumonia in Nigeria. I. Epidemiology and bacterial flora of normal and diseased respiratory tracts.

The prevalence of caprine pneumonia in Nigeria is high during the rainy and "harmattan" seasons. In this investigation the important bacteria isolated both from normal and diseased respiratory tracts of goats were pasteurellae and mycoplasmata.