If one were to hazard a guess as to theleading cause of child mortality in the developing world, it is perhaps unlikelythat pneumonia would be the first illness to spring to mind. Yet, pneumonia killsone out of every five children who die under the age of five every year1, and is alone responsiblefor more children’s deaths than malaria, AIDS and measles combined.
2This relatively unspoken-about killer in thewestern world, wreaks havoc in those 68 countries where under-five mortality ismost critical (previously known the “countdown to 2015” countries in reference tothe Millennium Development Goals)3, where 98% of all cases ofchildhood pneumonia occur4.Why are children in low-income settings more susceptibleto pneumonia than their wealthier counterparts? Pneumonia preys on the weak.Healthy well-nourished children have natural defenses to defend against pneumonia-inducingpathogens.5 More vulnerable are the dangerouslyundernourished children with compromised immune systems (stemming from malnourishmentor cases of measles or HIV). Germ-friendly living conditions also play a role; over-crowdedhouseholds and polluted indoor breathing spaces render children moresusceptible to the deadly lung-infecting bacteria.
6 To make matters worse, a major obstacle in identifyingpneumonia cases is that the symptoms (wheezing, coughing, high fever) tend toclosely resemble those of malaria7, leading to confusion and oftenwell-intended but inappropriate medical treatment. One medical study showedthat in a clinic in Malawi, of 471 children whose symptoms matched the WHo’s clinicaldefinition of pneumonia, 449 (95%) also met the clinical definition of malaria8.However, hope is onthe horizon.
First, with the correct knowledge, the majority of childhood pneumonia cases could be avoided through relativelysimple gestures such as more regular handwashing to prevent the spread of germsand better ventilation in the home. Second, the respiratory illness has become a majorpriority for global health powerhouses, the WHO and Unicef, who have joinedforces to design and develop the Global Action Plan for Prevention and controlof Pneumonia (GaPP) with the goal of increasing awareness of childhoodpneumonia as a major cause of child death. Together, they are calling for the scaling-upof life-saving interventions.1 The GaPP advocates for a three-prongedapproach to tackling pneumonia; protect children by providing a safeenvironment, prevent children from contracting the bacteria and treat infected childrenswiftly and efficiently. More specifically, the GaPP recommends the followingstrategy2: 1. To protect: Ø Promote exclusivebreastfeeding of newborn infants for the first six months Ø Provide adequate nutritionto children under-five, including the correct micronutrientsØ Reduce indoor air-pollutionby smoking outside the home and providing appropriate ventilation for stovecookersØ Promote regular hand-washingto reduce the spread of germs2.
To prevent:Ø Increase immunization ratesagainst measles, pertussis and HIB (infections which often lead to thedevelopment of pneumonia)Ø Prevent HIV contractionand contamination from mother to childØ Provide zinc supplementsto children with cases of severe diarrhea3. To treat:Ø Increase access to carethrough community-based case management Most cases of pneumonia require inexpensiveantibiotics which can be administered in the home. With the above conditions inplace and the right advice provided to caregivers from healthcareprofessionals, communities could be empowered to tackle the situation themselves.In fact, research from nine studies investigating the impact of community-basedcase-management across seven affected regions showed that pneumonia mortalityand child morality more generally could be reduced by 37% and 26% respectivelythrough this type of community-focused approach.3 A glimmer of light then,in a smoky room.1 Who & and Unicef.
Global Action Plan forPrevention and control of Pneumonia (GaPP), February 20082 Who & and Unicef. Global Action Plan forPrevention and control of Pneumonia (GaPP), February 20083 Unicef. The under-five mortality rate: Theindispensable gauge of child health, https://www.unicef.org/sowc08/docs/sowc08_panels.pdf