This is how Nigerians are fighting an epidemic with highest number of child pneumonia deaths in the world

Nigerian photographer Yagazie Emezi travels across her home country to document the ongoing epidemic of child pneumonia

Nine-month-old Malik is given oxygen at a health centre in Ikorodu (Yagazie Emezi/Save The Children)

Nigeria has the highest number of child pneumonia deaths worldwide, with as many as 443 succumbing to the infection per day. That’s equivalent to 18 deaths every hour.

The situation is being exacerbated by continuing overpopulation, especially in Lagos state where health centres are seeing a huge number of child pneumonia cases.

At the Ita Elewa centre in downtown Ikorudu in Lagos state, chief nursing officer Olatunji regularly sees up to 200 patients a day and up to 10,000 a month.

From dawn to dusk, mothers arrive with their children on foot at the centre which is on a main road bustling with cars and motorbikes. The air is thick with pollution and the sounds of blaring horns.

Award-winning photographer Yagazie Emezi has captured the ever-worsening healthcare situation facing Nigerians – and what they are doing to tackle it.

Mothers wait to have their children vaccinated at a health centre in Ikorodu (Yagazie Emezi/Save The Children)

Chief nursing officer Olatunji administers a vaccine at the Ita Elewa health centre in Ikorodu (Yagazie Emezi/Save The Children)

Oxygen

Shortages of oxygen supplies were regular in Nigeria even before the Covid-19 pandemic, but today and particularly after a spike of infections in 2021 the healthcare system has struggled to keep up with demand.

Health care providers like Olatunji found themselves with zero oxygen supplies to distribute. Some families are then unwilling to make the additional journey to a hospital after being referred due to the costs of travel and drugs.

Rachel, the clinical officer at Ita Elewa, recalls: “There was a baby we referred, but the mother told me that she could not go through the stress of general hospital. She took her baby home, and unfortunately, she lost the baby.”

Charitable donations from Save the Children and British multinational pharmaceutical company GSK have attempted to help alleviate the situation by providing a supply of oxygen canisters and extra training to help health officers like Rachel identify cases of pneumonia early and administer life-saving treatment.

One critical case of pneumonia was spotted by Rachel early in nine-month-old Malik after his mother noticed he was having difficulty breathing.

Olatunji administers a vaccine to a child (Yagazie Emezi/Save The Children)

Clinical officer Rachel, 26, at one of the health centre she works at in Ikorodu (Yagazie Emezi/Save The Children)

Nine-month-old Malik is breastfed by his mother Olamide (Yagazie Emezi/Save The Children)

By using an oximeter to check Malik’s oxygen saturation levels Rachel was able to see that he was measuring at 88 per cent. A normal count would be between 95-100 per cent. He was immediately administered oxygen and a follow-up appointment was made for the next day.

Malik’s father was reluctant to bring him back to the hospital, and Rachel says: “He told me that ‘there is no money’ – he’s been going through some financial problems, and doesn’t even have the money to bring the baby to the facility.”

She adds: “I took it upon myself that, whatever the financial costs, I will take them upon me. Let’s just take the baby to the facility. These are the challenges I’m facing on a daily basis.”

Indoor air pollution

Nigeria is recorded as having the highest number of air pollution-related child pneumonia deaths in the world, with almost 185 children under the age of five dying each day. Many of the deaths are related to household pollution from open fires or cookstoves in the home.

Many regions of Nigeria are so remote that they have very poor access to healthcare and information. Some areas can also be completely cut off by flooding during the rainy season. People living in regions like Jigawa state are most at risk of having little knowledge of pneumonia prevention or how to treat it.

A men’s group meet in a community in Jigawa state (Yagazie Emezi/Save The Children)

Healthworker Nura Ibrahim administers a vaccine to 22-day-old Rukayya outside his home in Jigawa state (Yagazie Emezi/Save The Children)

Mallam looks on as Aisha, 30, and Hauwa, 15, play with Bashir, one, outside their home (Yagazie Emezi/Save The Children)

Some 200 communities in Jigawa are now benefitting from small groups of well-informed community health workers and citizens to help combat the pneumonia epidemic. These groups are supported and organised by Save the Children and GSK’s Inspiring programme.

One of these group’s members is Mallam, whose own son Bashir was diagnosed with pneumonia. He said: “We’ve learnt not to take children into the kitchen because the smoke in there can make them sick. Where we cook, let it not be dark or block where the smoke escapes. Because when a child inhales the smoke, it causes diseases.”

Hunger

In Jigawa, over 60 per cent of children under five suffer from acute malnutrition. According to Save the Children, this means those children are four times more likely to die from pneumonia.

Food scarcity in the desert region is already a fact of life but it’s further exacerbated by intense conflict over a region where 90 per cent of livelihoods rely on agriculture.

Healthworker Nura Ibrahim prepares to vaccinate (Yagazie Emezi/Save The Children)

Sahura, 20, and her 22-day-old son Rukayya (Yagazie Emezi/Save The Children)

Sahura, 30, lives in a remote village in Jigawa state with eight children and struggles to feed her family. She says: “There is a lack of money. There are numerous children but little resources. The outcome is that there is suffering and hardship.”

She adds: “I feel bad because I don’t have enough to give them. The only food I give them is that which I plant like guinea corn and rice.”

Vaccination

The Jigawa state region also has incredibly low vaccination rates. In 2016 more than 190,000 children aged 12-23 months were not immunised with the pneumococcal conjugate vaccine (PCV), which protects children against pneumonia.

Mobile vaccination teams have been attempting to provide the life-saving treatment to children in the region travelling by motorbikes to the most inaccessible regions.

A mobile vaccination team travelling by motorbike to a remote community (Yagazie Emezi/Save The Children)

A mobile immunisation team walking through a remote community looking for children to vaccinate (Yagazie Emezi/Save The Children)

Suleh, who leads one of these Save the Children and GSK-supported teams, says: “We reach communities by motorbike but during the rainy season it will often take us over an hour because sometimes we have to wait to get access using a canoe. Every child needs to receive three doses of the PCV in an interval of four weeks.”

Battling against rampant pneumonia in Nigeria is clearly an uphill battle, but organisations such as GSK and Save the Children have been working to improve skills and knowledge in the region. They have also been instrumental in providing the tools healthcare providers need to protect the most vulnerable children.

The organisations have also been working to persuade the Nigerian government to fund similar work across the country.