25/02/2022
๐๐ฒ๐'๐ ๐ง๐ฎ๐น๐ธ ๐๐ฏ๐ผ๐๐ ๐ฌ๐ผ๐๐ฟ ๐ฆ๐ถ๐ฐ๐ธ ๐๐ต๐ถ๐น๐ฑ
So, I was going to post about our new and upcoming clinic (The Children's Clinic Najjera) opening next week, but with so many anxious parents in my inbox, and an avalanche of sick children presenting to health centres in Uganda (and Rwanda and Kenya), I felt it was important to provide guidance and hope to scared and frustrated parents.
For those not in the know, health centres have been experiencing a surge of patients from the middle of December 2021.
We at The Children's Clinic Naalya have been struggling -and almost buckling- to cope with the surge in patient numbers.
We are currently seeing up to four times our usual numbers.
We've spent the last weeks recruiting staff including extra paediatricians... I suspect we may now have more paediatricians in Uganda anywhere outside a university hospital!
So, this surge in patient numbers initially coincided with the arrival of Omicron variant into Uganda.
Indeed, most of the children we saw had classic signs of Covid. Mostly fever, cough, flu and some with chest pain, abdominal pain and diarrhoea.
We tested those who would allow to be tested, and many did test positive for covid. More were negative though.
We managed the the children symptomatically, and many improved.
On opening of schools in the second week of January, our numbers rose further.
This time, many children had mostly fevers, flu, cough and, in some cases, vomiting. Many of those who got really, really ill were wheezing, and some had signs of severe pneumonia.
Signs of severe pneumonia include; fast breathing, difficulty in breathing, and tiredness.
Almost all had a fever, and on checking would either have a sore throat, inflamed eardrums, or both.
The illneses had other unique features:
The labs almost always showed a normal picture. So you had nothing on malaria test, nothing on covid test, nothing on CBC (complete blood count). However, a few had raised CRP (C-Reative Protein) a test that may be raised if you had inflammation or a serious illness due to bacteria.
Kids would start slowly with mild symptoms, and if not managed, fall more ill.
Many would have repeat infections.
The kids in my own household have experienced this; all other paediatricians (we have paediatricians watsapp groups where we discuss the health care of children in uganda) have experienced this (both at work and at home)...
No household appears to be spared.
There are many theories on what is going on;
-Low Immunty in Children:
First, when lockdown came because of Covid, we saw a drastic reduction in children falling ill. At The Children's Clinic Naalya for example, our numbers dropped by 95%.
This is was not unexpected. With children being at home, and not being exposed within the community, many other viruses and infectious diseases were not able to spread.
Even the diarrhoeas and vomiting decreased with washing of hands.
This was a good thing.
Even asthma levels dropped as less vehicles went on the road to pollute the air, but also germs that trigger asthma attacks also couldn't spread.
A side effect of this has been that children developed less immunity to the germs.
Studies upon studies have shown that children who get repeated childhood viral (not bacterial) infections end up as healthier adults, with less cancers due to their more robust immune system.
It must be viral, not bacterial.
A child who gets repeated bacterial infections will most likely be a sicker child and hence will need closer follow up.
Anyway, as our children got healthier, they paradoxically got more vulnerable to disease.
We have seen this in malaria.
As we moved to reduce malaria, fewer and fewer children got malaria. And as a result fewer children developed immunity to malaria.
Now most Kampala (with an incident malaria rate of 0.4%) children are at higher risk of getting severe malaria when they do get malaria. We can't wait for the malaria vaccine.
So now, we have children falling really ill at the slightest contact with germs.
From discussions with my colleagues (almost all paeds), we think the majority of children may be having respiratory syncytial virus, mycoplasma (a fungi) or any of the numerous viruses that they would have just brushed off before covid.
A large proportion of the illneses are "stubborn", rarely responding to conventional treatment.
The majority of kids do get better though on symptomatic treatment. They may take up to 4 weeks to get well.
As a result, we have seen patients move from one paed to another in desperate search of a solution (yes, the paediatric community is small, and are extremely close knit)
My advice is that you stick to your paediatrician or doctor, let them follow you up, and treat you.
Manage the stubborn fevers with anti fever medications. Get guidance from your paediatrician or doctor for the optimum and safest way to do this.
Don't just give cough and flu syrups to your kids. These may be dangerous if given incorrectly, and to the wrong age group.
Do not give steroids, especially on your own. Some steroids may relieve some symptoms, but depending on what the cause is, may make some conditions worse.
Steroids already are relatively dangerous drugs if given by a non-clinician.
Some children may require nebulisation (medicine through a mask) or IV medication. So it is important you visit your paediatrician or doctor early on.
I hope this helps.
I will talk about both The Children's Clinic Najjera and The Children's Clinic Gayaza, our two upcoming clinics next time.
Internet Pic of a child being nebulised
By Daniel Tumwine
