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Alarm over dramatic rise in pneumonia cases in Kenya

Tuesday March 31 2020

Prof Ruth Nduati,

Prof Ruth Nduati, a consultant paediatrician, wears a mask during the launch of ‘Break the Chain Initiative’ at Apple Wood Park in Nairobi on March 30, 2020. PHOTO | EVANS HABIL| NATION MEDIA GROUP 

VERAH OKEYO
By VERAH OKEYO
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WINNIE ATIENO
By WINNIE ATIENO
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Data from the National Registry of Diseases shows that when Kenya reported the first case of coronavirus on March 13, there was a spike in pneumonia, one of the complications of severe Covid-19.

From January up until early February, the number of pneumonia cases were 137,667 before a dramatic increase to 195,504. While the data for March is not complete, a source at the Ministry of Health suspects that the numbers are still increasing.

The pattern — an increase from January and then a plateau — is not similar for the same period in 2019.

BACTERIAL PNEUMONIA

Experts are murmuring about it, careful not to link it to coronavirus. However, they suspect three scenarios — it could be people dying of Covid-19 pneumonia while on medication for bacterial pneumonia, and this may have occurred even earlier before the first case was reported, with the rains that came at the beginning of the year having led to the increase.

Further, all attention has been given to coronavirus, leaving little focus on pneumonia and other infectious diseases in hospitals.

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In the light of children who recently died in Kilifi County, the Respiratory Society of Kenya has cautioned clinicians that any case of pneumonia should be treated as suspected Covid-19 until proven to be “ordinary pneumonia”.

SHORTNESS OF BREATH
Dr Jeremiah Chakaya, a practising respiratory physician allied to the society, told the Nation that it is very difficult to differentiate between Covid-19 and pneumonia.

He said any respiratory infection, including coronavirus, is going to present with the same telltale signs when it becomes severe — cough, fever, difficulty in breathing and shortness of breath.

Pneumonia, Kenya’s number one child killer that claimed 21,584 in 2017 alone, was long thought to be caused by bacteria, but the Pneumonia Etiology Research for Child Health study found that viruses caused most of the severe pneumonia cases (61 per cent).

The study, which was conducted in Kenya and six other countries with a high burden of pneumonia, showed that the Respiratory Syncytial Virus was the leading pathogen (31 per cent) in all the sites. Bacteria, which are eliminated from the body by antibiotics, only causes 27 per cent of pneumonia.

It is too early to say whether the scientific community will add the virus that causes Covid-19 (Sars-CoV-2) to the list but coronavirus started in late 2019 as a cluster of pneumonia cases with an unknown cause.

SCREENING
So far, there are few cases to distinguish whether pneumonia is caused by a virus or bacteria in Kenya’s public hospitals, where the majority of the population seek medical services.
An expert who requested anonymity said parents should not be quick to label any pneumonia as Covid-19. It’s possible that there could be more deaths in children because pneumonia is being given little attention, he added.

The caution comes after Kilifi government urged parents to take children exhibiting respiratory illnesses, especially pneumonia, to hospitals. This is after the six children died of severe pneumonia in a span of three weeks.

The Kilifi Hospital Medical Superintendent, Eddie Nzomo, said the county is working with the Kenya Medical Research Institute Wellcome Trust to increase screening for the disease.