Closing the Gap on Pneumonia in Kenya

Neema Kalama, now 14, is pictured in front of her house in Kenya. Photo courtesy of WHO/M Pflanz

Soon after the birth of her second child, a daughter she named Neema, Tabu Kalama found herself homeless and with no regular income. Kalama had no option but to sleep with her newborn daughter and her 18-month old son in the meager shelter of palm trees near the beach in Kilifi, in eastern Kenya. It was June, among the coolest and wettest months there. “I was so worried that the baby would fall sick, and there was nothing that I could do,” Kalama says.

Neema developed a temperature high enough to be fatal for a 3-month-old baby. Kalama had heard about pneumonia and worried that Neema might have this illness. Pneumonia is the leading infectious cause of death in children worldwide. This disease killed an estimated 935 000 children under the age of 5 in 2013. Kalama brought Neema to the hospital. After more than a week, including periods when Neema lost consciousness, her baby overcame the illness and was discharged. Three months later, friends and well-wishers joined together to build the Kalama family a small hut in Kilifi. Today, Kalama ekes out a living by watching over a neighbor’s herd of goats and from additional odd jobs.

When Neema, now 14 years old, fell sick, Kenyan children were not immunized against bacteria that cause pneumonia. In January 2011, following recommendations by the World Health Organization (WHO) and with the organization’s technical assistance -- plus financial support from Gavi, the Vaccine Alliance -- Kenya’s health ministry introduced PCV-10. This “10-valent” vaccine targets 10 bacteria that cause invasive pneumococcal disease, a form of the illness that is frequently fatal. 
  
Kenya was among the first countries in the African Region to introduce PCV, and the first low-income country to use the 10-valent vaccine. Today, newborns nationwide receive the vaccine in three doses at 6, 10 and 14 weeks. Neema’s youngest siblings have all received PCV-10.

Kenya’s push to immunize babies against pneumonia is helping the country advance on the 2025 targets of the Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhea (GAPPD), released by WHO and UNICEF in 2013. The two agencies have recognized that it is not effective to try to prevent and control pneumonia and diarrhea separately. Pneumococcal vaccine – a key element of the new integrated strategy- had been introduced in 102 countries by the end of 2013, and global coverage was estimated at 25 percent.

Since PCV-10 was introduced in Kenya, scientists at the Kenya Medical Research Institute (KEMRI) have been studying the impact of the vaccine on child health. Their research, which is supported by the Wellcome Trust and Gavi, found that introduction of PCV-10 in Kenya resulted in an estimated 42.7 percent reduction in pneumococcal disease episodes and a 6.1 percent reduction in childhood deaths.(1)

Unlike Neema and her siblings, many Kenyan children do not live in towns close to clinics or health centers. This means health workers must travel to distant rural areas for immunization drives.

“The key thing is to sensitize the community about the importance of these immunizations,” says Judy Kinya, a clinical officer at the Vipingo Health Centre, an hour’s drive along the coast road south of Kilifi.

Painted in foot-high letters on the wall outside is the center’s vision: “A nation free from preventable diseases and ill health.” In the shade of the half-walled waiting area, mothers gather with their babies and young children for general health check-ups and new rounds of immunizations.

“These are the ones here who heard the message, and it is true that there are many of them,” says Kinya. “But there are many more out there in the more remote areas, and really to succeed fully with immunization coverage, we need to be able to reach every last one of them.”

“We know that reaching children in remote rural areas and urban slums is the biggest challenge we face as we move forward on closing the immunization gap and giving all children the opportunity to be fully immunized,” says Dr. Custodia Mandlhate, WHO representative for Kenya. “Working closely with WHO, Kenya’s health authorities are striving to meet this challenge.”

Back in Kilifi, Neema has run home from school as the Easter holidays begin. "She and her brother are enrolled in the local primary school, where they trade places at the top of the class," Kalama says with pride. After the most recent exams, Neema was once again in first place as the school’s top student.

Reference: 1. Ayieko P et al. Assessment of Health Benefits and Cost-Effectiveness of 10-Valent and 13-Valent Pneumococcal Conjugate Vaccination in Kenyan Children. Plos One.

Source: WHO