Minister of Health Sibongile Ndlela-Simelane
Just like in Nigeria, the recent demise of children due to a diarrhoea outbreak is a result of delays by government in rolling out a national immunisation programme, as recommended by the WHO, to immunise children against rotavirus.
Rotavirus, according to the Centre for Disease Control and Prevention, is the leading cause of severe diarrhoea and dehydration in young infants worldwide. In Swaziland, a majority of the children who have died are below the age of two.
Speaking to the Sunday Observer, a local medical doctor, who preferred to remain anonymous for fear of reprisal, said the presence of rotavirus was discovered in all the 32 children who have died so far as a result of the diarrhoea outbreak.
In Nigeria, it was reported in February that 160 000 yearly deaths of children under five years was a result of the West African country’s government failing to rollout the rotavirus vaccine. The World Health Organisation (WHO) recommended in 2009 that rotavirus vaccines be included in all countries’ national immunisation programmes.
Yesterday, Minister of Health Sibongile Ndlela-Simelane told this publication that the rotavirus vaccine would only be introduced in the country next year and claimed that this would make Swaziland the second country in Africa, after South Africa, to achieve this.
However, information from the Rotavirus Organisation of Technical Allies (ROTA) Council shows that the minister’s comment was either a lie or she is ignorant of the facts.
The ROTA Council website reflects that as of July 2014, 21 African countries had introduced rotavirus vaccines into their national immunisation programmes. These countries include Botswana, South Africa, Angola, Zambia, Zimbabwe, Burkina Faso, Burundi, Cameroon, Ethiopia, Ghana, Kenya, Libya, Madagascar, Malawi, Mali, DRC, Rwanda, Sierra Leone, Tanzania and Gambia. The doctor who spoke to the Sunday Observer said government, through the ministry of health, should stop blaming parents for the outbreak.
“Parents are now being blamed for failing to practise hygienic standards and taking too long to bring their children to hospital after exhibiting signs of diarrhoea. Someone within the ministry of health must be held accountable.
“They never took the WHO advice seriously. There is just no reason or justification why so many children were left to die. It is not acceptable that every year there must be people dying but no action taken against those responsible. The vaccine is widely available but Swaziland chose not to vaccinate the children. We need mass immunisation of children against the virus,” said the doctor.
The minister, conceded that rolling out the rotavirus vaccine was not top but second priority.
“Our first priority was pneumonia vaccine for children which we rolled out this year when we sent text messages to parents to bring their children for immunisation. The second priority is diarrhoea and next year we will become the second country in Africa to introduce rotavirus vaccine,” she said.
The minister said the rotavirus, vaccine was expensive; therefore rolling out the immunisation programme cannot not be done overnight since “it is a process and a strong budget is needed”.
It has been gathered that the ministry of health has put July 2015 as the tentative date for the vaccine rollout.
Dr. Simon Zwane, the principal secretary in the ministry of Health, said government should not be blamed for the diarrhoea outbreak. He argued that even if the rotavirus vaccine had been introduced there would still be no guarantee that an outbreak would not take place.
“The outbreak can still occur even after vaccination,” he said. Zwane said the availability of funds was a key factor in introducing the vaccine because sustaining the process has to be considered. “Even after vaccination, you still have to take the necessary precautions such as hygiene. As a ministry we have done our assessment and other necessities but the process is not yet complete. Once everything is in place, the vaccine will be introduced,” said the PS.
Following the diarrhoea outbreak, the ministry has set up a team of experts to assess the cause and bring the situation under control. As a result the number of cases has drastically declined and no cases have been reported since Wednesday.
Situation needs to be contained - UNICEF
A technical team from the United Nations Children Emergency Fund (UNICEF-Swaziland) has joined government in assessing the deadly outbreak of diarrhoea amongst Swazi children.
The focus now, according to UNICEF Country Representative Rachel Odede, is on management of the outbreak.
“What I can say though is that government is doing a great deal of effort to deal with the outbreak. In the last week, government has been doing its best to contain the outbreak but there is always room for improvement based on lessons learnt,” she said.
Odede said in her two years in Swaziland, she had never witnessed such as it was occurring for the first time in her presence. “The most important thing now is for the situation to be contained. Schools have to be provided with information and communities strengthened to act quickly on suspicious cases,” said the country representative, who however referred further inquiries to government.
Private doctors come in to help
Former Minister of Health Dr. Phetsile Dlamini, who runs a private practice known as Philani Clinic, has made herself available to government in the fight against the diarrhoea outbreak.
Dlamini is a paediatrician – a doctor who deals with medical care of infants, children and adolescents. She said as private practitioners they worked hand in hand with government and this time was not an exception.
“As a child specialist, we work together with government. The situation of the outbreak will get better as long as there is cooperation from parents who should prepare water with salt and sugar for their children who look sickly.
“They should stop assuming that the children are teething. What is killing the children is dehydration, so the rehydration water is important,” she said.
Dlamini said she first had patients coming from South Africa who were exhibiting symptoms of rotavirus and was able to treat them. “But it was not brought into the country by them because it is not transmitted in this manner,” she said.
She stated that rolling out the rotavirus vaccine has been on the table for quite some time but it also has to be taken into account that once the rollout begins there should be no break, thus the availability of sufficient funds should be ensured.
“The specifications also have to be checked. WHO and UNICEF are also assisting and the ministry is consulting us for help, so they are not doing things in isolation,” added Dlamini.
‘Lack of child doctors
also to blame’
The shortage of paediatricians is one aspect cited by a medical doctor as having contributed to late detection of the deadly diarrhoea. The doctor said the ministry of health failed to handle the cases because of lack of expertise since government has only two paediatricians.
“Swaziland does have specialists who need to be brought back under government employ. Currently the expertise is in the private sector,” said the doctor.
Principal Secretary Dr. Simon Zwane agreed that they were short of paediatricians, with only one at the Mbabane Government Hospital and another at Good Shepherd. “Ideally, every regional hospital should have at least one paediatrician but we don’t have them as they don’t come cheap. However, we have doctors in all the hospitals, who are trained in handling paediatrics even though they’re not specialists,” he said.
WHO experts coming
Following an outbreak of the deadly diarrhoea, a group of experts from the World Health Organisation (WHO) are expected in the country to assess the situation.
Principal Secretary Dr. Simon Zwane said the specialists would work with a government team in assessing whether government’s response to the outbreak was proper or not. “They are coming with technical know-how. After their assessment we will then be in a position to say how our response has been,” Zwane said.
He said they were expecting at least three experts.
The South African situation
In South Africa, most children will catch a rotavirus infection between 6 and 11 months of age and the rotavirus season is typically between April and August every year.
Prior to the introduction of the rotavirus vaccine into the national immunisation programme since 2009, it was estimated that between 17 644 and 25 630 South African children less than two years old are admitted to hospitals annually for the treatment of rotavirus diarrhoea and approximately 500 children may have died annually.
Subsequent to the introduction of rotavirus vaccine into the public immunisation programme since 2009 in South Africa, there has been approximately 40-50% reduction in diarrhoea hospitalisations among children, including 60-70% reduction for rotavirus associated hospitalisation among vaccinated children.
Situation in Botswana
Acute respiratory infections and diarrhoea remain the major causes of morbidity and mortality amongst children under five years old in Botswana.
The vaccines were introduced as part of routine immunisation in an effort to reduce the Infant Mortality Rate (IMR) and Under 5 mortality Rate (U5MR) in line with Botswana’s commitment as signatory to the Child Survival: A Promise Renewed Initiative.
The 2011 diarrhoea outbreak in Botswana claimed the lives of over 124 children. It is hoped that with the introduction of the Rotavirus vaccine morbidity and mortality amongst children under-five years old due to diarrhoea will be significantly reduced.