key: cord-1000636-412ihjzy
authors: Uwishema, Olivier; Onyeaka, Helen; Alshareif, Baha Aldeen Abdalaziz; Omer, Mohammed Eltahier Abdalla; Sablay, Alfredo Lorenzo Recio; Tariq, Rabeet; Mohamed, Rayan Ibrahim Hamid; Zahabioun, Amirsaman; Yousif, Mohamed Yousif Elamin; Chalhoub, Elie; Tovani‐Palone, Marcos Roberto
title: Pneumonia amidst the COVID‐19 pandemic in Africa: Challenges and possible solutions
date: 2022-01-10
journal: Health Sci Rep
DOI: 10.1002/hsr2.493
sha: 5445c216762668deb4a632f4dd58a17bec0cb765
doc_id: 1000636
cord_uid: 412ihjzy

nan

tific journals have published much literature on the topic; however, among the research articles published from June to December 2020, only 1.5% mentioned Africa in their titles or abstracts. Moreover, data from Sub-Saharan Africa underestimates the pandemic due to several factors, such as the overall low testing capacity and lack of laboratories, limited access to and weakness of health services, and political constraints, all of which suggest an imperative need for better reporting and further research on COVID-19 in Africa. 2 Pneumonia is the leading global cause of mortality in children under 5 years old. However, this disease still occurs frequently in working-age immunocompromised individuals and older adults (>70 y/o) with prior chronic conditions. [3] [4] [5] For decades, pneumonia has been the secondleading cause of admission to adult medical wards in Africa, behind only malaria. 6 Recently, although improved conjugate vaccines, such as the pneumococcal conjugate vaccine (PCV) and Haemophilus influenzae type b (HiB), have contributed to a decrease in the incidence and severity of pneumonia in infants and adults, 7 the occurrence of secondary bacterial pneumonia, and fungal and viral pulmonary co-infections on top of COVID-19 pneumonia has worsened the situation. 8, 9 Co-infection with viral pneumonia is not rare 10 and often results in hypoxia, acute respiratory distress syndrome, and multiple organ failure, with significant morbidity and mortality rates. 11,12 Despite this, no prevalence studies of pneumonia as a comorbidity of COVID-19 or non-COVID pneumonia have been conducted in Africa during the pandemic. Coinfection with bacteria or fungi may complicate existing viral pneumonia, especially in critically ill patients. 13 These infections may vary according to the local endemic/epidemic infections, suggesting that results may differ in Africa. Therefore, the continent's response to the pandemic should always consider the epidemiology of comorbidities and co-infections. 14 Currently, there is also a need for prevalence studies to define the significance of different types of pneumonia as a comorbidity of COVID-19 or as individual infections apart from COVID-19, followed by their respective morbidity and mortality status. Defining the significance of the problem would be only the first step in taking significant steps moving forward for its solution.

In addition to pneumonia, some African countries have faced other infectious diseases outbreaks. 9 In light of this, new strategies to address risk factors for pneumonia and severe COVID-19, such as child, maternal, environmental, pathogen, and health system factors, Another critical point is that Pneumococcal conjugate vaccine (PCV) and Haemophilus influenzae type b (HiB) vaccination were shown to significantly decrease the incidence and severity of pneumonia-related mortality in children. 4, 16 With PCV vaccination specifically, it was estimated that pneumonia mortality was reduced by 23% to 33% in children less than 19 years old, preventing approximately 18 000 deaths between 2009 and 2016 in South Africa. 16 Moreover, a significant decrease in pneumococcal pneumonia in adults has been achieved by the process of immunizing children, given that it interrupts the transmission of disease-causing serotypes from the pediatric nasopharynx to susceptible adult populations. 4 In this connection, it is beneficial to countries with high incidence and mortality of pneumonia to strengthen immunization programs for HiB, PCV, diphtheria, pertussis, measles, as well as Influenza, in line with the World Health Organization's Expanded Program on Immunization (EPI) programs, and thus to prevent pneumonia in relation to the capacity of each country.

Along with immunization, the inclusion of nutritional rehabilitation, zinc supplementation, exclusive breastfeeding, availability of drinking water and basic sanitation, and hygiene strategies will strengthen public health intervention for pneumonia prevention, especially amidst the COVID-19 pandemic. [17] [18] [19] In the settings that bear an additional burden of the pandemic, there must be availability and access to necessary antimicrobials and other medications in health care centers and hospitals, while simultaneously increasing the capacity and knowledge of community health workers and medical professionals. 7 Intervention for respiratory care of severe COVID-19 pneumonia patients as well as postintensive care programs must also be considered in this context. 20 

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