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| Reducing by one third the deaths due to pneumonia |
The challenge
Pneumonia: a leading killer of children
Pneumonia is one of the leading killers of children. Nearly 1 million children under five die from the disease each year, accounting for nearly one in eight child deaths globally.
Currently, 13 per cent of under-five deaths are due to pneumonia, not including deaths during the neonatal period (the first four weeks of life).
Mortality due to childhood pneumonia is strongly linked to other factors including malnutrition, poverty, hygiene, pollution and inadequate access to health care. Therefore an integrative approach to tackle this important public health issue is an urgent need.
Pneumonia remains among the leading causes of child deaths worldwide
Major causes of death in neonates and children under five, global distribution 2008 (revised)
Deaths among children under-five Neonatal deaths
Source: World Health Organization (WHO), World Health Statistics 2011; for undernutrition, Black. S. et al., The Lancet, 2008.
Terminology: Acute respiratory infections, pneumonia and suspected pneumonia
Acute respiratory infection (ARI): This includes any infection of the upper or lower respiratory system, as defined by the International Classification of Diseases. Acute lower respiratory infections (ALRI) affect the airways below the epiglottis and include severe infections, such as pneumonia.
Pneumonia: Pneumonia is a severe form of acute lower respiratory infection that specifically affects the lungs, and accounts for a significant proportion of the ALRI disease burden. The lungs are composed of thousands of tubes (bronchi) that subdivide into smaller airways (bronchioles), which end in small sacs (alveoli). The alveoli contain capillaries where oxygen is added to the blood and carbon dioxide is removed. With pneumonia, pus and fluid fill the alveoli in one or both lungs, and this interferes with oxygen absorption, making breathing difficult.
Suspected pneumonia: Since radiography and laboratory tests are largely unavailable in poor areas, childhood pneumonia is diagnosed by its clinical symptoms – coughing, and fast or difficult breathing that is chest related (not due to a blocked nose). Therefore, the term 'suspected pneumonia' better describes a large proportion of children diagnosed with pneumonia in developing countries. In addition, data collected through national household surveys, such as Multiple Indicator Cluster Surveys (MICS) and Demographic and Health Surveys (DHS), report pneumonia prevalence based on information regarding whether children have experienced coughing and fast or difficult breathing (due to a problem in the chest) in the two weeks prior to the survey, and thus have not necessarily been diagnosed by a health professional.
Prevention and case management can reduce childhood pneumonia deaths
Preventing children from developing pneumonia is critical to reducing deaths. Efforts include basic child survival interventions such as:
• Immunizing children (especially with measles, Hib and pneumococcal conjugate vaccines)
• Ensuring adequate nutrition, including zinc intake and breastfeeding
• Reducing indoor air pollution
• Promoting basic hygiene practices, such as washing hands with soap and proper disposing of children’s faeces
But once a child develops pneumonia, prompt treatment with a full course of effective antibiotics is lifesaving because most severe cases are caused by bacterial pathogens. And since access to health services is limited in many developing countries, prompt treatment may also require training health workers to diagnose and treat children with pneumonia in the community.
Studies show that community health workers can effectively manage uncomplicated pneumonia. Case management includes classifying suspected cases, based on breathing rates and lower chest wall indrawing (where the chest retracts during inhalation), treating non-severe pneumonia cases with antibiotics and referring severe pneumonia cases to health facilities, where possible.
Related report
Pneumonia: The forgotten killer of children
References
WHO, World Health Statistics 2011, WHO, Geneva, 2011.
WHO and UNICEF, Global Action Plan for Prevention and Control of Pneumonia (GAPP): Report of an informal consultation, WHO, Geneva, 2008.
UNICEF, Pneumonia: The forgotten killer of children, UNICEF and WHO, New York and Geneva, 2006.
Black, S. et al. for the Child Health Epidemiology Reference Group of WHO and UNICEF, ‘Global, regional, and national causes of child mortality in 2008: A systematic analysis’, in The Lancet, vol. 375, no. 9730, 5 June 2010, pp. 1969-1987.