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Of all the preventable illnesses that threaten children under five in northern Nigeria, pneumonia is one of the deadliest. It is also one of the easiest to miss. The World Health Organization (WHO) defines childhood pneumonia as an acute respiratory infection that affects a child’s lungs, yet in many homes it is mistaken for an ordinary cough or cold until it is too late.
Research shows how widespread, and how hidden, the problem is. In a community screening study of 9,171 children in Kiyawa Local Government Area, Jigawa State, 1.3% were found to have pneumonia, and nearly half of those cases were severe. When the researchers applied an alternative diagnostic definition to the same children, the figure rose to 2.8%. Conventional approaches, in other words, are likely to overlook many sick children. Nationally, the Nigeria Demographic and Health Survey found that 2.2% of children under five had shown symptoms of acute respiratory infection in the two weeks before they were surveyed.
As the world marked World Pneumonia Day on 12 November under the theme “A New Era of Pneumonia Control,” the question for northern Nigeria is what that new era should look like here.
Dr Rabiu Adamu Isa, a paediatrician at a state hospital in Katsina, sees the answer begin with honesty about the scale of the problem. Severe pneumonia remains highly prevalent across the region, he says, and many families do not recognise how serious it is. In his hospital’s paediatric department, weekly morbidity and mortality reviews show that severe bronchopneumonia and severe malaria together account for more than half of all admissions.
He also describes a cycle between malnutrition and pneumonia. “Malnourished children already have weak immune systems,” he explains. “A weak child is more susceptible to pneumonia, and an infected child, with higher metabolic demands and difficulty breathing, finds it hard to feed, which makes the situation worse.”
The deeper challenge, however, is systemic. Many tertiary hospitals lack the equipment to manage large numbers of children with pneumonia at once, while staff shortages and the cost of care push families into impossible choices.
“Families must pay out of pocket for treatment, including oxygen cylinders that cost ₦4,000 each and blood bags that cost ₦7,000,” Dr Rabiu says. “Long waits to see a doctor, and the need to choose between treatments when money is limited, are major reasons children do not get adequate care in time.”
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If the problem is systemic, so is the solution, and it must put prevention and early care first. Primary health care centres are central to this. Many simple pneumonia cases can be managed there, without going to a tertiary hospital.
“I tell mothers that once they see symptoms like a cough, a runny nose or any change in their child’s breathing, they should visit the primary health care centre, because those centres are equipped to manage simple pneumonia,” Dr Rabiu says. He considers immunisation the most effective and cost-effective protection, noting that fully vaccinated children usually develop only mild forms that can be treated without admission. Cleaner cooking also helps, by switching to gas or moving cooking fires away from where children sleep and play, and so does exclusive breastfeeding for the first six months of life.
No single intervention can end childhood pneumonia, and northern Nigeria is adding new tools to the fight. One of them is SARMAAN, the Safety and Antimicrobial Resistance of Mass Administration of Azithromycin in Children project, led by the Nigerian Institute of Medical Research with the Federal Trained health workers go door to door, giving supervised, approved doses of azithromycin, an antibiotic widely used to treat respiratory and other childhood infections, to children aged 1 to 59 months in high-mortality communities.
The approach builds on international evidence such as the MORDOR trial, which found that twice-yearly doses reduced deaths among children under five by 13.5% in high-mortality settings. SARMAAN has now reached more than 16 million children across 11 northern states, with close monitoring for safety and antimicrobial resistance. It is not a vaccine and does not replace immunisation, breastfeeding or prompt care. It reinforces them where children are most at risk.
Building trust has been just as important as delivering medicine. Parents understandably ask why a healthy child should take medicine, and myths have long slowed vaccine uptake too. A recent SARMAAN community survey found that 84% of caregivers now trust the health workers delivering the medicine, up from 37% at the start of the year. That change came from answering questions patiently, in local languages, and involving fathers in household decisions. Harmful practices persist, however. Dr Rabiu warns against giving infants water or other pre-lacteal feeds in the first six months instead of exclusive breastfeeding, which can introduce bacteria and weaken immunity.
A new era of pneumonia control will come from many tools working together, not from one breakthrough. It means stronger primary health care, better pay and welfare for health workers, and sustained investment in vaccines, oxygen, early diagnosis and child survival interventions like SARMAAN. For parents, it means never dismissing a cough or a change in breathing, seeking care early, and staying open to the interventions that protect children before illness takes hold.
