Economy

Hope for children with pneumonia as new drug is unveiled

child

Treatment of pneumonia in children has been problematic in Kenya for a long time due to costly but largely ineffective syrup medicines. PHOTO | FOTOSEARCH

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Summary

  • The introduction of Amoxicillin Dispersible Tablets (Amoxyl DT) — a cheaper and more effective option — into the local market could however bring relief to families facing huge costs to treat the disease.
  • The Health ministry, on recommendations of the World Health Organisation (WHO), has revised its treatment guidelines to include the child-friendly Amoxyl DT as a first line treatment for pneumonia in children.
  • The United Nations Children’s Fund (Unicef) introduced Amoxyl DT in its supply catalogue in 2011. The drug has been available in other countries but remained low in many low-and middle-income countries including Kenya.

Treatment of pneumonia in children has been problematic in Kenya for a long time due to costly but largely ineffective syrup medicines.

The introduction of Amoxicillin Dispersible Tablets (Amoxyl DT) — a cheaper and more effective option — into the local market could however bring relief to families facing huge costs to treat the disease.

Dr Warfa Osman, the Head of the Neonatal, Child and Adolescent Health Unit at the Health ministry, said the drug — which was introduced in the country for the first time last Monday — would help curb deaths.

“Amoxyl DT dissolves in liquid and disintegrates within three minutes when put in water or in a small amount of breast milk before administration to allow for uniform diffusion, making it more effective,” Dr Osman told the Business Daily.

“It is also cheaper. A pack of 100 tablets will cost Sh145, attributable to the lower shipping and storage costs.” An original Amoxyl syrup 50ml costs upwards of Sh400.

The Health ministry, on recommendations of the World Health Organisation (WHO), has revised its treatment guidelines to include the child-friendly Amoxyl DT as a first line treatment for pneumonia in children.

The United Nations Children’s Fund (Unicef) introduced Amoxyl DT in its supply catalogue in 2011. The drug has been available in other countries but remained low in many low-and middle-income countries including Kenya.

This is despite a Unicef report showing that 60 per cent of the over 1.2 million pneumonia deaths in under-five-year-olds globally occurs in 10 countries; Kenya, Uganda, Tanzania, Bangladesh, DR Congo, Ethiopia, India, Niger, Nigeria and Pakistan. About 19,000 Kenyan children die every year from pneumonia, translating to one death in every 20 seconds.

Pneumonia — a form of acute respiratory infection that affects lungs — is the number one killer of children under the age of five years and accounts for 16 per cent of deaths in Kenya and 18 per cent globally.

“In order to further increase accessibility and use of Amoxyl DT, advocacy efforts are required to support changes to national treatment guidelines and inclusion in the national essential medicines list,” the report says.

“Despite affordable diagnostics and inexpensive antibiotics availability, only a third of pneumonia cases receive antibiotics as part of their treatment regimens.”

The report further says that healthcare workers face difficulty administering appropriate drug dosages to children.

Paediatric formulations are often approximated by breaking up adult doses.

“For instance, tablets are often cut, crushed and then mixed into a liquid; concentrated capsules are diluted; or injectable are taken orally. These adaptations compromise effectiveness,” says the report
Amoxyl DT replaces the Amoxyl syrup, which doctors say is cumbersome to dispense as the spoon size used in administering could change dosage accuracy.

“Unlike the syrup which requires refrigeration in high temperatures, Amoxyl DT does not require refrigeration and is easy to dispense thus convenient dosing,” said Dr Osman.

Pneumonia presents itself as a cough with fast breathing, fever, wheezing and drawing in of the chest.

A child with pneumonia would be unable to eat or drink and may experience unconsciousness, hypothermia and convulsions if treatment is not given immediately.

Pneumonia dislodged malaria in 2015 to become the top killer of Kenyans with deaths from HIV, tuberculosis (TB) and meningitis declining.

Official data shows that pneumonia killed 22,473 Kenyans in 2015, up from 21,640 the previous year, while casualties from malaria — which has for years been the top killer — declined by 2,267 to 20,691 in the same period.

Data from the Ministry of Health shows children in western Kenya are more likely to die from pneumonia compared to other parts of the country due to high prevalence of malaria, diarrhoea and underlying causes such as malnutrition and HIV/Aids. “Nyanza region has the highest under-five mortality rate at 82/1,000 live births followed by Nairobi at 72/1,000 live births,” said Dr Osman.

The new drug has many advantages over the syrup and could go a long way in fighting pneumonia, he said.

Amoxyl DT also increases patient compliance as it reduces wastage through spillage and does not require refrigeration as compared to the syrup.

It is also easily stored and transported, attracting less shipping and storage costs hence encouraging supply.

“Amoxyl DT has a more convenient dosing schedule as it is administered only two times a day compared to the syrup — four times a day — thus encouraging better compliance,” said Dr Osman.

“It is also pain-free and reduces general health costs as there is no need for injection syringes.”

Dr Osman said the ministry introduced the pneumococcal vaccine (PCV10) for prevention and now Amoxyl DT as treatment.

The Kenya Demographic Health Survey (2014) shows that the uptake of PCV10 is at 85 per cent.

It is important for a child to receive all three doses of PCV10 vaccines before the age of one year — at six, 10 and 14 weeks.

Pneumococcal vaccine protects against severe forms of pneumococcal diseases such as meningitis, pneumonia and bacteraemia, according to Dr Osman.