Janet Ogundepo
Child health experts have said that pneumonia is one of the deadliest childhood diseases in Nigeria, killing more children than malaria and tuberculosis combined, yet many parents are unaware of simple steps they can take to protect their children from this respiratory infection.
The Coordinating Minister of Health and Social Welfare, Prof Ali Pate, said about 850,000 newborns and under-fives die from preventable illnesses.
He further noted that while 280,000 newborns die from prematurity, the country records 162,000 childhood pneumonia-related deaths annually.
Pate warned that the country was not yet on track to achieve the Sustainable Development Goal target of less than 25 per 1,000 live births by 2030.
Data from the National Demographic Health Survey 2024 shows that under-five mortality was 110 deaths per 1,000 live births, yet childhood pneumonia, also referred to as the ‘forgotten killer’ of the under-fives, has not received priority attention.
The United Nations Children’s Fund says pneumonia is a preventable disease that kills more children globally than any other infection. It is caused by bacteria, viruses or fungi, and leaves children fighting for breath as their lungs fill with pus and fluid.
UNICEF reports that the disease is the leading killer of children in Nigeria, causing 19 per cent of under-five deaths, adding that pneumonia killed one Nigerian child every three minutes in 2019.
In exclusive interviews with PUNCH Healthwise, the paediatricians revealed practical measures that can significantly reduce children’s risk of contracting pneumonia.
Understanding the spread
Pneumonia is an infection of the lungs caused primarily by bacteria and viruses. For a child to develop pneumonia, these organisms must succeed in overwhelming the protective immune system in the lungs and the body as a whole.
“Whenever a child has pneumonia, what it means is that those organisms, bacteria and viruses, have succeeded in overwhelming the immune system,” Ubuane said.
Children under five years are particularly vulnerable because their immunity is still developing. Newborns in the first four months of life are the most susceptible, with their immune systems not reaching peak strength until well beyond age five.
A paediatrician, Dr Ayodele Renner, explained that prevention begins with understanding how the disease spreads and the risk factors that make children vulnerable.
Pneumonia is usually caused by viruses, though bacteria and fungi can also trigger the lung infection. The disease spreads through airborne droplets when an infected person coughs or sneezes.
“If a person coughs or sneezes and they have the organism that can cause pneumonia, and a child is in the vicinity of those cough droplets, then they can actually catch pneumonia,” Renner said.
Children can also contract the infection by touching contaminated surfaces and subsequently putting their hands into their eyes or nose, making hand hygiene crucial.
Prioritise exclusive breastfeeding
One of the most effective ways parents can protect their children is through proper breastfeeding practices. Renner emphasised that while Nigeria is a society that breastfeeds, many mothers introduce water and pap too early during the exclusive breastfeeding period.
“We add in lots of other things like water, pap, and we add them very early. That does have its own consequences for long-term health for the child,” she said.
Exclusive breastfeeding for the first six months strengthens a child’s immune system and provides natural protection against infections.
Ensure complete immunisation
Vaccination remains a critical defence against pneumonia. However, Nigeria has one of the highest numbers of zero-dose children in the world.
Ubuane identified incomplete immunisation as a major driver of high pneumonia deaths in Nigeria.
“One major contributor to high pneumonia deaths in Nigeria is that the additional immunity we ought to give them through vaccination, many children, for one reason or the other, are not getting,” he said.
Key vaccines that protect against pneumonia include the pneumococcal vaccine, influenza vaccine, BCG for tuberculosis, and measles vaccine.
However, vaccine hesitancy driven by misinformation has significantly reduced vaccination coverage in Nigeria.
The paediatrician emphasised that partial immunisation, whilst better than none, falls short of providing optimal protection. Every child must not only start but also complete their vaccination schedule.
Renner also said, “These children are not protected and are susceptible to some of the most dangerous organisms causing meningitis, pneumonia and diarrhoeal disease.”
Parents should ensure their children receive all recommended vaccines according to the national immunisation schedule, including catch-up immunisations if any doses were missed.
Improve home environment
The physical environment where children live plays a significant role in their susceptibility to pneumonia. Renner identified overcrowding and poor ventilation as major risk factors.
Parents should ensure proper ventilation in rooms and avoid overcrowding, particularly in sleeping areas. Good air circulation helps reduce the concentration of airborne pathogens.
Maintain strict hygiene practices
Poor hygiene, particularly inadequate handwashing, significantly increases pneumonia risk. Parents should teach children to wash their hands regularly with soap and clean water, especially before eating and after using the toilet.
Ensure access to potable water and maintain clean cooking utensils and food preparation surfaces. Where shared toilet facilities exist, regular cleaning and disinfection are essential.
Address malnutrition
Adequate nutrition is crucial for building a child’s immune system. Nigeria has the highest number of stunted children below the age of five years globally, making them more susceptible to falling ill and struggling to recover without significant healthcare intervention.
“When the child is malnourished, that little building immunity is further compromised, and it gives room for germs to overwhelm the immune system in the lungs and the general immune system in the blood,” Ubuane explained.
Parents should provide children with balanced, nutritious meals to build strong immune systems. Where resources are limited, seek assistance from community health programmes that offer nutritional support.
Recognise warning signs early
Despite prevention efforts, parents must know when to seek medical help. Ubuane identified delayed hospital presentation as a major factor contributing to pneumonia deaths in Nigeria.
“We see children with very severe pneumonia arriving late to the hospital. Parents have tried one thing or the other,” he said.
Early diagnosis and treatment can prevent complications and significantly improve survival rates. Parents should immediately take children showing signs of respiratory distress to the nearest health facility rather than attempting home remedies.
Renner urged parents to watch for symptoms such as difficulty breathing, persistent cough, high fever, chest pain and rapid breathing.
Reduce exposure to sick individuals
Since pneumonia is communicable, parents should limit children’s exposure to people with respiratory infections. When family members have colds or coughs, they should cover their mouths when coughing or sneezing and wash their hands frequently.
Children who are unwell should be kept home from school or childcare facilities to prevent spreading infections to other vulnerable children.
Why prevention matters
Renner stressed that whilst pneumonia is treatable with antibiotics or antivirals and supportive care, prevention remains the best approach.
“The best case scenario is actually that the children never come down with this disease in the first place,” he said.
The paediatricians called on policymakers, governments and civil society groups to prioritise children’s health through adequate funding and legislation that ensures easier access to healthcare facilities.
“We should be advocating for children to make sure that they have the best outcomes by preventing these illnesses,” Renner counselled.
They urged continuous public health education through professional societies, integration of health education into school curricula, support for vulnerable families with nutrition programmes, expansion of vaccination coverage, regulation of housing standards and control of outdoor air pollution.
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