Background

Pneumonia is the single largest infectious cause of death in children worldwide.  It accounts for 16% of all deaths of children according to the WHO.

In Nigeria, pneumonia has replaced malaria as the number one killer of children under five, claiming 18% of all under-five deaths. According to the WHO, there were 148,772 under-five deaths due to pneumonia in Nigeria in 2004, falling slightly to 132,556 in 2015.

Diarrhea is also a leading killer of children, accounting for approximately 8 per cent of all deaths among children under age 5 worldwide in 2016. Diarrheal diseases, such as cholera and rotavirus, kill 1.5 million kids each year, mostly under 2 years old.

In 2018, Kano State recorded 31,477 cases of diarrhea in under – 5 children and 3,488 cases of pneumonia in the same category of children.

Trend of Some Child Killer Diseases in Kano

Source: State IDSR Reports

Lack of release of budgetary allocation hinders the supply of basic drugs to reduce the death of 0-5 years children that occur due to preventable diseases such as diarrhea and pneumonia. WHO recommended that use of Zinc-ORS and Amoxicillin DT as the First line of treatment which is very critical to achieving a significant reduction in child mortality.

Current Status

KNSG adopted 2013 the National Policy on the use of ZN-ORS for the management of diarrheal diseases and the State has included activities for childhood killer diseases in the 2019 AOP. For pneumonia activities in the State, only 20 SHFs have been covered with trained personnel and equipment. Thus, pneumonia services are covered in about 50% of SHFs in the State. Recently, HMB has distributed oxygen equipment to 3 additional secondary facilities (HBPH, Tiga GH and Kwankwaso Cottage) and will roll out the training on identification and management of pneumonia any time soon.

Achievements

KNSG amended its treatment guideline to include Zinc-ORS and Amoxicillin as the first line treatment for diarrhea and pneumonia. Following the revision of the essential drug list in 2016, the State included Zn/ORS and Amoxicillin DT into DRF scheme.

Rationale for Advocacy

There is poor coordination and low capacity of staff at the State IMCI unit under the Ministry. Examination and drug administration are very critical elements in addressing childhood killer diseases. However, despite the availability of ORS-Zinc and Amoxicillin, many frontline health workers lack the required skills to attend to children suffering from diarrhea or pneumonia.

There is need for demand generation of amoxicillin DT across SHFs and high burden PHCs; HCWs need to know the use of Amoxicilin DT in the State; community need to know danger signs and identification; HCWs need to know symptoms and first line treatments.

Unavailability of treatment protocol for child killer diseases at primary and some secondary health facilities is one major of concern that could be addressed by awareness creation and sensitization of healthcare workers.

Despite the adoption of task shifting and sharing policy, diarrhea and pneumonia are serious diseases that shall always be handled by well-trained health personnel who are inadequately available in our health facilities.

Recommendations

• The need to reactivate and strengthen the State’s IMCI unit for proper planning and implementation of childhood killer diseases in Kano
• Training of HCWs in the remaining SHFs and the 18 high burden PHCs on management of childhood killer diseases.
• Print and distribute treatment protocol documents on diarrhea and pneumonia diseases for the health workers reference
• Facilitate effective coordination between three tiers/levels of health facilities/care in the state.
• There is need for community awareness creation on the signs and symptoms of pneumonia

Benefits of the ORS-Zinc and Amoxicillin

Public Health Benefits

• Avert unnecessary child deaths
• Increase child development index
• Value for money in purchase of drugs

Socio-Political Benefits

• Improved human development index for the state
• A healthy population that could add value to the state’s socio-economic development
• Effective public health system at the grass-root level will reduce general health care spending and thus, other state critical health infrastructural needs can be met.

The Kano PAS Advocacy Coalition This Policy Brief is a product of the Kano State PAS Advocacy Project. The Partnership for Advocacy in Child and Family Health at Scale (PACFaH@Scale) project Nigeria, referred to as PAS is a health advocacy project anchored by the Nigeria non-profit, the dRPC and implemented directly by local NGOs and health professional associations. The project is not service delivery and it is not awareness creation. Its focus is limited to evidence-based advocacy.  The project’s timeline is 2018 to 2022 and the issue areas of the project are: Routine Immunization, Family Planning, Child Killer Diseases, and Primary Health Care Under One Roof. Focal states of the project are Anambra, Enugu, Kaduna, Kano, Niger, Rivers, Taraba and Lagos States. In Kano State, the PAS Advocacy Coalition is made up of various civil society organisations led by Medical Women Association (MWAN), Women in Media Communication Initiative (WIM), National Association of Nurses and Mid-wives Kano State Branch (NANNM), Federation of Muslim Women Association of Nigeria (FOMWAN), Kano Emirate Council Committee on Health & Human Development (KECCoHD), Society of Gynaecologists and Obstetricians in Nigeria (SOGON), The Challenge Initiative (TCI), Accountability Mechanism for Maternal and Child health in Kano State (AMMKaS), Youth Environmental Development Association (YEDA) and Facility Health Committee Alliance (FHCA)