For a long time, physicians have thought bacteria causes pneumonia — Kenya’s number one child killer that claimed 21,584 in 2017 alone.
But a study spanning more than 30 years shows that 61 percent of the disease is caused by viruses, once again triggering a debate among experts on whether the Health ministry needs to revise its policy and treatment of pneumonia.
The Pneumonia Etiology Research for Child Health (PERCH) study, a million-dollar research conducted in Kenya and six other countries with a high burden of the disease, found that viruses caused most of the severe cases.
The respiratory syncytial virus was the leading pathogen (31 per cent) at all sites in the 30 pathogens. Bacteria, which are eliminated from the body by antibiotics, only cause 27 per cent of pneumonia, the study showed. Yet, Kenya’s World Health Organisation-approved guidelines recommend the use of antibiotics to treat pneumonia
The study enrolled 4,232 children between one month and 5 years old, who were hospitalised with severe pneumonia as well as another 5,325 from the same communities who were not sick.
Kenya, Mali, the Gambia, South Africa, Thailand, Zambia and Bangladesh were chosen because they have differing characteristics that might influence the causes of pneumonia.
Dr Ambrose Agweyu, a researcher and pneumonia expert from Kenya Medical Research Institute (Kemri-Wellcome Trust told the Nation: “I do not foresee Kenya abandoning the use of antibiotics on children with pneumonia despite this study.”
Dr Agweyu said the diagnosis of pneumonia makes it extremely difficult for healthcare workers to know what causes it, and know for sure whether to administer antibiotics or not.
Pneumonia manifests through a cough that is accompanied by short laboured breathing as a result of a problem in the chest.
Dr Agweyu added: “Unlike the PERCH study that had high technology to isolate and know ‘this is the pathogen that is causing this disease’, many health facilities do not have this equipment, and the healthcare worker is not going to deny a severely sick child antibiotics knowing there is a 30 per cent chance it could have been caused by bacteria.”
The expert added there were pneumonia cases caused by viruses that worsened to include bacterial complications. Besides the complexity of the disease, the current guidelines used by hospitals in Kenya are also not helping. Kenya revised its WHO-approved guidelines on pneumonia last year, after 30 years since their development.
A paediatrician, who had worked on the data analysis at the London School of Hygiene and Tropical Medicine, Prof Kim Mulholland, had expressed concern over WHO’s simplification of managing children with pneumonia into those two categories of “low risk” — to be treated at home — and “high risk” — to be treated in hospital.
The Health ministry did not respond to the Nation’s questions about the guidelines.