|Reducing by one third the deaths due to pneumonia|
Pneumonia: a leading killer of children
Pneumonia is the leading killer of children. Of the estimated 6.9 million child deaths each year, 18 per cent or 1.2 million are due to pneumonia.
This toll is highly concentrated in the poorest regions and countries and among the most disadvantaged children within these societies. Nearly 90 per cent of deaths due to pneumonia as well as diarrhoea occur in sub-Saharan Africa and South Asia.
Mortality due to childhood pneumonia is strongly linked to poverty-related factors including undernutrition, lack of access to safe water and adequate sanitation, indoor air pollution and inadequate access to health care. Therefore an integrative approach to tackle this important public health issue is an urgent need.
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: Suspected pneumonia refers to children with a combination of respiratory symptoms for which they should seek clinical assessment for pneumonia by an appropriate provider. These respiratory symptoms include ‘cough and fast or difficult breathing due to a chest-related problem’. Not all children with suspected pneumonia should receive antibiotic treatment, only those with pneumonia as classified by the Integrated Management of Child Illness guidelines (based on a rapid respiratory rate counted by a health worker). It is not possible to measure such pneumonia prevalence among children under age 5 during a household survey interview or to ascertain underlying pneumonia illness for children with these respiratory symptoms. Thus, 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 these children 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, primarily exclusive breastfeeding during the first six months of life, as well as zinc and vitamin A intake.
• 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.
The UN Inter-agency Group for Child Mortality Estimation (IGME), Levels and Trends in Child Mortality: Report 2012, UNICEF, New York, 2012.
UNICEF, Committing to Child Survival: A Promise Renewed – Progress Report 2012, New York, 2012.
Liu L, Johnson HL, Cousens S, et al, for the Child Health Epidemiology Reference Group of WHO and UNICEF. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet 2012; 379: 2151–61.
UNICEF, Pneumonia and Diarrhoea: Tackling the deadliest diseases for the world’s poorest children, UNICEF, New York, 2012.
UNICEF, Pneumonia: The forgotten killer of children, UNICEF and WHO, New York and Geneva, 2006.
WHO and UNICEF, Global Action Plan for Prevention and Control of Pneumonia (GAPP): Report of an informal consultation, WHO, Geneva, 2008.