Pneumonia is the deadliest infectious disease among children under the age of 5 worldwide — more than HIV, tuberculosis, Zika, Ebola, and malaria combined.
Annually, the disease claims 921,000 deaths, or 16 percent of all deaths among children under 5 years old globally. A disproportionate amount of all childhood deaths from pneumonia occurs in countries marked by conflict, poverty, and weak health systems.
Shockingly, these deaths can be largely prevented as the disease can be easily detected and treated.
Despite recent mobilization of funding and targeted interventions by donors, nongovernmental organisations, and the private and public sectors between 2005 and 2015, much more needs to be done to end preventable child deaths by 2030. What do we need to do?
There are still 170 million children that have not been vaccinated against pneumonia in the world today. In low-income countries, rates of exclusive breastfeeding are as low as 50 percent. To continue reducing the number of pneumonia deaths and of children falling ill, it will be essential to scale up the use of vaccines and to encourage breastfeeding and good sanitation practices such as handwashing.
Other interventions include improving indoor air quality — for example, by increasing the use of clean-burning cooking fuels — and treating children for malnutrition, as this can boost their immune system and reduce their risk of infection. In a recent study in Myanmar, we found that teaching community health workers about pneumonia, malnutrition, and referring children with severe acute malnutrition to hospitals was successful, as their knowledge about malnutrition increased substantially, resulting in quick referral when needed.
Another way to reduce pneumonia deaths is early detection. Since 2009 several organisations, including the Malaria Consortium, Save the Children, and UNICEF, have been undertaking research into the most effective methods of evaluating pneumonia diagnostic tools to find innovative solutions for diagnosing pneumonia.
It is of utmost importance to identify the most accurate and acceptable diagnostic tools for health workers living in remote and hard-to-reach places so they can easily identify children with symptoms of pneumonia, including increased respiratory rates (by using respiratory rate timers) and hypoxemia, a condition of insufficient oxygen in the blood (with pulse oximeters used for monitoring oxygen saturation). Community health workers corroborate this, as documented in our recent research. They perceived the new diagnostic tools as highly scalable and easy to use.
It is crucial to collaborate with technological innovators, researchers, and companies worldwide to encourage development of more accurate diagnostic tools in order to treat children appropriately and reduce the unnecessary use of antibiotics. These innovations will strengthen our ability to protect young lives. We hope to see two new automated respiratory rate devices introduced in 2018.
There is considerable evidence to show that pneumonia can be diagnosed and treated successfully at the community level — for example, in remote villages — whether by providing health services in places without any formal health staff or by relieving the burden on overstretched health facilities. Providing health services within these communities can be lifesaving, especially during the critical 24 hours after the onset of illness symptoms.
Bacterial pneumococcal pneumonia is responsible for the largest proportion of pneumonia deaths — 55 percent — and can be easily treated with oral antibiotics. By training community health workers to provide quality health care, prescribe antibiotics correctly, and use pneumonia diagnostic tools appropriately, and by scaling up diagnosis and treatment of pneumonia at the community level, thousands of children’s lives have been saved.
This is thanks to an approach called integrated community case management (iCCM). As pneumonia, diarrhea, and malaria account for almost a third of deaths among children under the age of 5 worldwide, it makes sense to combine the management of these diseases within the hard-to-reach communities.
Moreover, the advantages of including digital innovation in community health are significant. For our work in Mozambique, we use an interactive mobile phone application that covers all community health services. The app supports community health workers to screen newborns and children for signs of pneumonia, prompts them to check the child’s vaccination status, and offers them treatment and referral recommendations as appropriate. Data is reported in near-real time to health officials, informing them of disease outbreaks and low stock levels.
We are implementing iCCM programs in Nigeria, Myanmar, Ethiopia, Uganda, and South Sudan and are committed to continuing this work, as we see this is an effective way to prevent children dying from pneumonia.
Lastly, training community health workers to refer severe pneumonia cases to the hospital is essential, as hypoxemia can be fatal if oxygen is not immediately available. Some 2 million children are admitted to hospital each year with the condition. Access to oxygen in hospitals needs to be improved to save the lives of children who are referred from the community. As a member of the United4Oxygen coalition, we continue to work to ensure better access to oxygen in Ethiopia and Nigeria.
The Global Goals for Sustainable Development can be met, but only if we stop pneumonia now. Investing in child health by preventing, detecting, and treating pneumonia will not only support the achievement of the global goal for good health and wellbeing. It will also have knock-on effects on other goals for clean air and water, economic stability, equality, clean energy, and eliminating poverty and hunger.
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