If one were to hazard a guess as to the
leading cause of child mortality in the developing world, it is perhaps unlikely
that pneumonia would be the first illness to spring to mind. Yet, pneumonia kills
one out of every five children who die under the age of five every year1, and is alone responsible
for more children’s deaths than malaria, AIDS and measles combined.2

This relatively unspoken-about killer in the
western world, wreaks havoc in those 68 countries where under-five mortality is
most critical (previously known the “countdown to 2015” countries in reference to
the Millennium Development Goals)3, where 98% of all cases of
childhood pneumonia occur4.

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Why are children in low-income settings more susceptible
to pneumonia than their wealthier counterparts? Pneumonia preys on the weak.
Healthy well-nourished children have natural defenses to defend against pneumonia-inducing
pathogens.5 More vulnerable are the dangerously
undernourished children with compromised immune systems (stemming from malnourishment
or cases of measles or HIV). Germ-friendly living conditions also play a role; over-crowded
households and polluted indoor breathing spaces render children more
susceptible to the deadly lung-infecting bacteria.6

To make matters worse, a major obstacle in identifying
pneumonia cases is that the symptoms (wheezing, coughing, high fever) tend to
closely resemble those of malaria7, leading to confusion and often
well-intended but inappropriate medical treatment. One medical study showed
that in a clinic in Malawi, of 471 children whose symptoms matched the WHo’s clinical
definition of pneumonia, 449 (95%) also met the clinical definition of malaria8.

However, hope is on
the horizon. First, with the correct knowledge, the majority of childhood 

pneumonia cases could be avoided through relatively
simple gestures such as more regular handwashing to prevent the spread of germs
and better ventilation in the home.

Second, the respiratory illness has become a major
priority for global health powerhouses, the WHO and Unicef, who have joined
forces to design and develop the Global Action Plan for Prevention and control
of Pneumonia (GaPP) with the goal of increasing awareness of childhood
pneumonia as a major cause of child death. Together, they are calling for the scaling-up
of life-saving interventions.1

The GaPP advocates for a three-pronged
approach to tackling pneumonia; protect children by providing a safe
environment, prevent children from contracting the bacteria and treat infected children
swiftly and efficiently.

More specifically, the GaPP recommends the following
strategy2:

1.     To protect:

Ø Promote exclusive
breastfeeding of newborn infants for the first six months

Ø Provide adequate nutrition
to children under-five, including the correct micronutrients

Ø Reduce indoor air-pollution
by smoking outside the home and providing appropriate ventilation for stove
cookers

Ø Promote regular hand-washing
to reduce the spread of germs

2.     To prevent:

Ø Increase immunization rates
against measles, pertussis and HIB (infections which often lead to the
development of pneumonia)

Ø Prevent HIV contraction
and contamination from mother to child

Ø Provide zinc supplements
to children with cases of severe diarrhea

3.     To treat:

Ø Increase access to care
through community-based case management

Most cases of pneumonia require inexpensive
antibiotics which can be administered in the home. With the above conditions in
place and the right advice provided to caregivers from healthcare
professionals, communities could be empowered to tackle the situation themselves.
In fact, research from nine studies investigating the impact of community-based
case-management across seven affected regions showed that pneumonia mortality
and child morality more generally could be reduced by 37% and 26% respectively
through this type of community-focused approach.3 A glimmer of light then,
in a smoky room.

1 Who & and Unicef. Global Action Plan for
Prevention and control of Pneumonia (GaPP), February 2008

2 Who & and Unicef. Global Action Plan for
Prevention and control of Pneumonia (GaPP), February 2008

3 Unicef. The under-five mortality rate: The
indispensable gauge of child health, https://www.unicef.org/sowc08/docs/sowc08_panels.pdf