One late night in 2016, Virginia Manalo, mother of two, found herself on the receiving end of a frantic call from a relative. She was told that her 7-year-old son, Julian, had fallen ill to a high grade fever. A fever that almost triggered a convulsion. Julian was quickly rushed to the hospital for emergency care.
Manalo had assumed that her son was only suffering from a fever brought about by the common cold and cough for the past days. However, she found herself in shock when the doctor advised her to immediately have Julian confined because her son already has acquired the deadly lung infection – pneumonia.
RITM-ARI Co-Principal Investigator Dr. Vernoni Dulalia examines a child.
“Natakot ako kasi hindi ko alam na pwede palang ikamatay ng anak ko yun, kung hindi naagapan (I was scared, because I did not know that I could lose my son if I didn’t bring him to the hospital),” said Manalo as she recalled the experience.
According to the World Health Organization (WHO), pneumonia is an acute respiratory infection in which viruses, bacteria, or fungi affect the lungs. It is characterized by fast breathing, lower chest indrawing, flaring of the nostrils, grunting, and sometimes wheezing.
In 2015 alone, WHO accounted 920,136 pneumonia-related deaths for children aged 5 years and below. The recorded data corresponds to 16% of all deaths of children, a statistic higher than that of AIDS, malaria, and measles combined. With a mortality rate of 23.4 per 100,000 people, the Philippines is among the 15 countries that make up 75% of the world’s childhood pneumonia cases.
Research Institute for Tropical Medicine (RITM) Director and Acute Respiratory Infection (ARI) Research Group member Dr. Socorro P. Lupisan also confirmed that although “not many are aware, [but] pneumonia is the number one killer of children. It remains to be one of the top five causes of deaths among children, worldwide and also here in the Philippines.”
With the thrust to control childhood pneumonia in the country, the RITM-ARI Research Group through its Science and Technology Research Partnership for Sustainable Development (SATREPS) project conducted studies to evaluate strategies on effective management measures to reduce the mortality and prevent pneumonia.
Based on the recommendations of the ARI Research Group studies, pneumonia can be prevented by reinforcing appropriate health-seeking behaviors, improving healthcare practice and access, and strategizing health immunization programs.
Manalo admitted that she was administering medications for Julian without the proper prescription from a doctor. With the hopes of improving Julian’s condition, the self-prescribed medications actually made Julian’s condition worse.
“Akala ko kasi talaga normal na ubo’t sipon lang siya, kaya pinainom ko siya ng mga gamot na para sa ubo’t sipon. Pero nung sobrang taas na ng lagnat niya, at di na kaya pababain nung gamot, dun na namin siya dineretso sa ospital (At first, I really thought it was just the common cold and cough, so I gave Julian over-the-counter medications. However, when his fever got really high and the medications weren’t helping, that was when we rushed him to the nearest hospital),” said Manalo.
When asked if she noticed any probable symptom of pneumonia, Manalo mentioned fast breathing. However, since was not aware of pneumonia, Manalo quickly associated the fast breathing to asthma which Julian has.
The gap in the knowledge level and health-seeking behavior of mothers is one of the greatest obstacles in eliminating childhood pneumonia in the Philippines.
Former ARI Research Group Head and the immediate Past President of the Pediatric Infectious Disease Society of the Philippines Dr. Salvacion Gatchalian explained that “there is increased mortality in pneumonia, because children are only brought to the hospital when it’s already too late. It is because some people do not know, they do not realize the gravity of the situation.”
Socio-economic status played a role as well in hindering Manalo to seek professional advice when her son felt ill.
“Naisip ko kasi na yung gagastusin ko para maipacheck up si Julian, pwede ko na rin magamit na pambili niya ng gamot (I thought to myself that the money I would spend to get Julian checked could also be the money I can use to buy his medicines),” said Manalo.
Still, Dr. Gatchalian urges parents to bring in patients early since health care centers and public hospitals offer free consultation.
“Pneumonia is preventable. It is actually the late consult that increases the risk for mortality and morbity,” Dr. Gatchalian emphasized.
Striving to improve healthcare
One of the co-investigators of the SATREPS project from Tohoku University Dr. Mariko Saito-Obata shared that lower socioeconomic status, and maternal reasons were major risk factors. She also mentioned that cost distance was slightly associated to an increased incidence of pneumonia.
A significant update on the etiology of childhood pneumonia in the Philippines was found as well. On a national level, the scientists from Japan and the Philippines through the RITM-ARI SATREPS project managed to disprove the long-held belief that pneumonia is largely caused by bacteria. The group found that viruses were more common etiologic agents of childhood pneumonia with the respiratory syncytial virus (RSV) as the most common cause.
“RSV was the most common pathogen observed in children with pneumonia. It was not causing significant mortality compared to other viruses, but it was causing illnesses and admissions to hospitals,” explained Dr. Lupisan.
She then added that the group is currently studying the transmission of RSV and hopes to come up with a recommendation for control – “an RSV vaccine maybe, so we can decrease hospital admissions of children,” said Dr. Lupisan.
Health professionals continue to play an important and critical role in the control of pneumonia in the country, as Dr. Gatchalian cited.
She stated that health professionals need to constantly be aware of the early symptoms of pneumonia, particularly fast breathing. But more importantly, she emphasized that doctors should use drugs rationally and appropriately to avoid the development of antibiotic resistance.
“The rising antibiotic resistance is the challenge to treatment these days, even among adults,” Dr. Gatchalian underscored.
Vaccination saves you all the trouble
Dr. Gatchalian mentioned that non-immunization is one of the definite risk factors that makes any child more vulnerable to pneumonia, so she highlighted that this should really be taken into consideration.
In 2013, the Department of Health introduced the Pneumococcal Conjugate Vaccine (PCV) as an addition to its free basic immunization program for children in the health centers across the country.
The RITM-ARI Research Group conducted trials that assessed the efficacy of PCV and found that areas within the country with poor access to healthcare have the highest vaccine efficacy (Lupisan, 2013).
Thus, the group recommended an alternative strategy to universal vaccination which is to target vaccination to areas where children are most likely to benefit.
“High mortality in pneumonia is not just because of the socioeconomic status,” noted Dr. Gatchalian as she cited that local health strategies are in place to reduce the number of child deaths linked to pneumonia.
On the other hand, Dr. Gatchalian also mentioned that risk factors for pneumonia is really a “spectrum of everything”.
She pointed out that “there should be increased immunization coverage, and most importantly health education for mothers and health care providers, so that patients can be treated as early as possible.”
As for the case of Manalo, it was all lessons learned for her and her son’s experience in battling and surviving the dreaded pneumonia. Ever since Julian’s recovery, Manalo made it a point to keep her son’s health in tiptop shape.
“Dapat pala huwag na nating hintayin lumala ang nararamdaman ng mga anak natin, bago tayo magpatingin at makinig sa mga payo ng mga doktor (We should not wait for our children’s illness to worsen, before we visit doctors and follow their instructions),” Manalo ended.
Meanwhile, the RITM-ARI and SATREPS partnership was nothing short of fruitful for both Japan and the Philippines. Various technologies were introduced to the Philippines, including the use of the pulse oximeter that helped diagnose and categorize pneumonia. Data collected in the project sites also gave way for a plethora of research papers to be published by Japanese and Filipino researchers.
While the project has already been concluded last year, clearly the hope to see the prevention and control of the disease that inflicts death on many Filipino children is still very much alive.
by Eunice Brito, Project Matyag [RITM Web Team]