The Union's approach to child pneumonia cuts deaths by more than half

WORLD PNEUMONIA DAY, 12 November 2010
Every 20 seconds pneumonia causes a preventable tragedy somewhere in the world. That's how often a child under five dies of a disease that is preventable, treatable and curable with existing vaccines and antibiotics. World Pneumonia Day, to be held this year on Friday, 12 November, was established in 2009 by the Global Coalition Against Child Pneumonia to increase awareness and gain commitment to ending this waste of young lives. Read more


The International Union Against Tuberculosis and Lung Disease (The Union) established its Child Lung Health Division in 1995 to address the problem of child pneumonia, as well as tuberculosis in children and other lung diseases in low- and middle-income countries.

In 2000, the Child Lung Health Programme (CLHP) was launched in Malawi using an approach to child pneumonia based on The Union's successful model for tuberculosis treatment. Elements of this approach included standardised treatment, rational use of antibiotics and a stable supply of medicines, government commitment to funding, careful recording and reporting and ongoing training and supervision. Between 2000 and 2005, the case fatality rate for children under five with severe/very severe pneumonia dropped by more than 50%.

In 2005, the CLHP was absorbed into the Malawi health services, where it has proved to be a sustainable intervention. The case fatality rate has continued to decline to 66% below the 2000 baseline.

"The Child Lung Health Programme demonstrates clearly the fact that children are dying of pneumonia is because of priorities, not because of capability or opportunity," says Dr Nils E Billo, Executive Director of The Union.

Last year New York Times columnist Nicholas D. Kristof called pneumonia "the orphan of global health" in his widely read 9 May column titled "The Killer No One Suspects."

One reason for the neglect of pneumonia is that it is a problem that falls more heavily on low-income countries. For every one child who dies of pneumonia in an industrialised country, 2,000 die in low-income countries.

The Global Coalition Against Child Pneumonia estimates that one million lives could be saved annually by widespread use of vaccines and improved access to antibiotics.

"2010 has been the Year of the Lung," says Dr Billo, "so this is a perfect opportunity to make our governments and health services aware that pneumonia is one of our most solvable public health problems. We have safe, effective and affordable tools to prevent and treat pneumonia, and this neglect is not acceptable." (CNS)

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Stop The Child From Turning Blue: Fight Pneumonia

World Pneumonia Day, 12 November 2010
The second World Pneumonia Day is being held on November 12, 2010. World Pneumonia Day was launched in 2009 by a broad coalition of public and non profit organizations, the Global Coalition Against Child Pneumonia, to mobilize efforts to fight a neglected disease. This day seeks to bring focus on pneumonia as a public health issue and to prevent the millions of avoidable deaths that occur each year. Read more

Pneumonia is an infection of the lungs, filling them with fluid. It causes cough and fever and can make breathing difficult. It is the leading cause of death among children under 5 years of age worldwide, killing 1.6 million of them every year . This means that one child dies from pneumonia every 20 seconds. Pneumonia alone accounts for 20% of all pediatric deaths around the world. By contrast, 732,000 children die from malaria and 200,000 from HIV/AIDS each year.

Most children (about 98%) who die of pneumonia live in developing countries. 43 million cases of pneumonia occur every year in India.

Dr Nils Billo, Executive Director of The Union, feels that "better management of the problem, with low cost prevention and treatment strategies, is the key to its solution. Governments need to be convinced to invest in vaccination and treatment which is available. An integrated approach, especially at the peripheral level, can be a great help."

The death rate from pneumonia is 215 times higher in low-income countries than in high-income countries. And yet,  we can protect from pneumonia. Exclusive breastfeeding during the first six months of life is an easy way to help protect children from pneumonia and many other diseases. Other strategies, like good nutrition  and reducing indoor air pollution from cook stoves and tobacco smoke also help. Vaccines are a safe and effective tool for preventing pneumonia before it occurs. But once it occurs,the treatment for most types of serious pneumonia is usually antibiotics.

India did establish a program for case management of pneumonia with anti microbial agents in 1990. This has had some effect on child mortality, bringing it down from 116 deaths, in 1990 to 69 deaths in 2008, per 1000 children under the age of 5 years. But the magnitude of problem continues. Immunization coverage is still low at 44% of all children below the age of 5 years. The coverage is lower in urban slum and rural areas. Researchers estimate that even if 87% of Indian households (especially in rural areas) could gain access to clean stoves, 240,000 fewer children under age 5 would die from acute respiratory infections.

Pneumonia, along with influenza, and respiratory syncytial virus (RSV), forms a disease group commonly known as Acute respiratory infections (ARIs), group that, are responsible for 4.25 million deaths each year, according to the first-ever Acute Respiratory Infections Atlas, launched during the 41st Union World Conference on Lung Health, Berlin, Germany (11-15 November 2010)  by World Lung Foundation. Out of these, one million deaths occur in India alone, which is about one quarter of the world total. The death toll from ARIs among Indians is more than all deaths from HIV/AIDS, malaria and tuberculosis combined.

The main drivers of ARIs (as also of tuberculosis) are malnutrition (one billion people around the world are malnourished), indoor and outdoor air pollution, overcrowding/cramped living conditions, and tobacco use.

In an exclusive interview given to CNS (Citizen News Service) at the launch of this Atlas, Dr Neil Schluger, author of this Atlas said that "there were basically three problem areas in controlling ARIs, especially in the developing countries --- awareness of the disease, proper distribution of vaccines, and developing newer treatments. According to him, “Parents should be able to recognize the symptoms of the disease understand when the child is sick and seek treatment before it is too late. Then there should be support from government and donor organizations to ensure availability and distribution of the vaccines and antibiotics. As of now only about two and a half percent of the donor funds are used for acute respiratory infections. Pharmaceutical companies will have to be encouraged to more invest in research.”

Dr Schluger thinks that it would be worthwhile to involve schools in this fight against ARIs, especially for vaccination programs, as well as to help identify the symptoms in school going kids at an early stage.     

Pneumonia has been neglected for too long, perhaps because it affects children and old people more than others – who are unable to draw attention of the authorities and compel them to take appropriate action. It is time for others to come out and speak on behalf of them. We need to make a lot of noise to draw the attention of the authorities towards this neglected disease.

Shobha Shukla - CNS
(The author is the Editor of Citizen News Service (CNS) and also serves as the Director of CNS Diabetes Media Initiative (CNS-DMI). She has worked earlier with State Planning Institute, UP. She is supported by the Stop TB Partnership to write from the 41st Union World Conference on Lung Health, Berlin, Germany (11-15 November 2010). Email: shobha@citizen-news.org, website: www.citizen-news.org) 


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Pneumonia kills more children than any other disease

Pneumonia kills more children than any other disease
Reinforce smoke-free laws to reduce pneumonia deaths in children

W o r l d P n e u m o n i a D a y
2 November 2009

Pneumonia kills more children than any other disease. Every 15 seconds it claims another child. Two million (twenty lakhs) children (less than 5 years) die of pneumonia every year. This is when diagnosis and treatment of pneumonia is widely available and affordable, says experts on the first-ever World Pneumonia Day on 2nd of November 2009.

"Pneumonia is the leading cause of death in children worldwide. Pneumonia kills an estimated 2 million children every year – more than AIDS, malaria and measles combined" says Professor (Dr) Rama Kant, the World Health Organization (WHO)'s International Awardee 2005 and Head of the Department of Surgery, CSM Medical University (upgraded King George's Medical College - KGMC).

Pneumonia is a form of acute respiratory infection that affects the lungs. The lungs are made up of small sacs called alveoli, which fill with air when a healthy person breathes. When an individual has pneumonia, the alveoli are filled with pus and fluid, which makes breathing painful and limits oxygen intake.

"Pneumonia can be caused by viruses, bacteria, fungi or chemicals. Pneumonia can be prevented by immunization, adequate nutrition and by addressing environmental factors such as enforcing smoke-free laws and patient-safety practices. Pneumonia can be treated with antibiotics, but according to the WHO, less than 20% of children with pneumonia receive the antibiotics they need" says Prof Kant. "Recently Ventilator Associated Pneumonia (VAP), Pneumonia in immuno-compromised states like diabetes mellitus and AIDS, has caused resurgence of this serious problem" adds Prof Kant. "This can occur at any age and is irrespective of gender. Nosocomial infections (hospital born) are most of the times resistant to antibiotics and have a high mortality. The infections in early stage in such situations might respond to recent, much broad-spectrum and expensive antibiotics but late Pneumonia are commonly resistant and have high mortality. Use of infected endo-tracheal tubes, oxygen masks and anaesthesia gas tubes can also be responsible for such grave situations. Here only patient safety practices can save patients" cautions Prof Kant, who is the former Chief Medical Superintendent of Gandhi Memorial & Associated Hospitals, CSMMU.

"VAP has become important because of use of ventilator in serious patients of trauma, burn, neuro-surgical problems and surgery for instance" says Prof Rama Kant.

According to the World Health Organization (WHO), Pneumonia is the single largest cause of death in children worldwide. "Every year, it kills an estimated 1.8 million children under the age of five years, accounting for 20% of all deaths of children under five years old worldwide. There are some 155 million cases of childhood pneumonia every year in the world. Pneumonia affects children and families everywhere, but is most prevalent in South Asia and sub-Saharan Africa. It can be prevented with simple interventions, and treated with low-cost, low-tech medication and care" says WHO site.

Pneumonia can be spread in a number of ways. The viruses and bacteria that are commonly found in a child's nose or throat, can infect the lungs if they are inhaled. They may also spread via air-borne droplets from a cough or sneeze. In addition, pneumonia may spread through blood, especially during and shortly after birth. More research needs to be done on the different pathogens causing pneumonia and the ways they are transmitted, as this has critical importance for treatment and prevention.

The symptoms of viral and bacterial pneumonia are similar. However, the symptoms of viral pneumonia may be more numerous than the symptoms of bacterial pneumonia.

When pneumonia becomes severe, children may experience lower chest wall indrawing, where their chests move in or retract during inhalation (in a healthy person, the chest expands during inhalation). Infants may be unable to feed or drink and may also experience unconsciousness, hypothermia and convulsions.

While most healthy children can fight the infection with their natural defences, children whose immune systems are compromised are at higher risk of developing pneumonia. A child's immune system may be weakened by malnutrition or undernourishment, especially in infants who are not exclusively breastfed.

Pre-existing illnesses, such as symptomatic HIV infections and measles, also increase a child's risk of contracting pneumonia.

The following environmental factors also increase a child's susceptibility to pneumonia:
* indoor air pollution caused by cooking and heating with biomass fuels (such as wood or dung)
* living in crowded homes
* parental smoking.

"In India, on 2nd October 2008, the smoke-free laws were implemented country-wide, in line with the Cigarette and Other Tobacco Products Act (2003) and also the global tobacco treaty (Famework Convention on Tobacco Control - FCTC) which India has ratified in 2005. The implementation of smoke-free laws has been far from ideal - and this needs to be implemented strictly - not only to harness tobacco control outcomes but also broader public health, environmental and social justice outcomes this law aims to deliver" says WHO's Director-General's Awardee on tobacco control for the year 2005 Professor (Dr) Rama Kant. Parental smoking is one of the key factors to increase child's susceptibility to pneumonia, says Professor (Dr) Rama Kant.

Pneumonia can be treated with antibiotics. These are usually prescribed at a health centre or hospital, but the vast majority of cases of childhood pneumonia can be administered effectively within the home. Hospitalization is recommended in infants aged two months and younger, and also in very severe cases.

Preventing pneumonia in children is an essential component of a strategy to reduce child mortality. Immunization against Hib, pneumococcus, measles and whooping cough (pertussis) is the most effective way to prevent pneumonia.

Adequate nutrition is key to improving children's natural defences, starting with exclusive breastfeeding for the first six months of life. This is also effective in preventing pneumonia and reducing the length of the illness.

Addressing environmental factors such as indoor air pollution (by providing affordable clean indoor stoves, for example) and encouraging good hygiene in crowded homes also reduces the number of children who fall ill with pneumonia.

In children infected with HIV, the antibiotic cotrimoxazole is given daily to decrease the risk of contracting pneumonia.

A very effective and important preventive method for pneumonia and other conditions too is proper hand washing, informs Prof Kant.

Published in:
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Pneumonia kills more children than any other disease

Pneumonia kills more children than any other disease
Reinforce smoke-free laws to reduce pneumonia deaths in children

W o r l d P n e u m o n i a D a y
2 November 2009

Pneumonia kills more children than any other disease. Every 15 seconds it claims another child. Two million (twenty lakhs) children (less than 5 years) die of pneumonia every year. This is when diagnosis and treatment of pneumonia is widely available and affordable, says experts on the first-ever World Pneumonia Day on 2nd of November 2009.

"Pneumonia is the leading cause of death in children worldwide. Pneumonia kills an estimated 2 million children every year – more than AIDS, malaria and measles combined" says Professor (Dr) Rama Kant, the World Health Organization (WHO)'s International Awardee 2005 and Head of the Department of Surgery, CSM Medical University (upgraded King George's Medical College - KGMC).

Pneumonia is a form of acute respiratory infection that affects the lungs. The lungs are made up of small sacs called alveoli, which fill with air when a healthy person breathes. When an individual has pneumonia, the alveoli are filled with pus and fluid, which makes breathing painful and limits oxygen intake.

"Pneumonia can be caused by viruses, bacteria, fungi or chemicals. Pneumonia can be prevented by immunization, adequate nutrition and by addressing environmental factors such as enforcing smoke-free laws and patient-safety practices. Pneumonia can be treated with antibiotics, but according to the WHO, less than 20% of children with pneumonia receive the antibiotics they need" says Prof Kant. "Recently Ventilator Associated Pneumonia (VAP), Pneumonia in immuno-compromised states like diabetes mellitus and AIDS, has caused resurgence of this serious problem" adds Prof Kant. "This can occur at any age and is irrespective of gender. Nosocomial infections (hospital born) are most of the times resistant to antibiotics and have a high mortality. The infections in early stage in such situations might respond to recent, much broad-spectrum and expensive antibiotics but late Pneumonia are commonly resistant and have high mortality. Use of infected endo-tracheal tubes, oxygen masks and anaesthesia gas tubes can also be responsible for such grave situations. Here only patient safety practices can save patients" cautions Prof Kant, who is the former Chief Medical Superintendent of Gandhi Memorial & Associated Hospitals, CSMMU.

"VAP has become important because of use of ventilator in serious patients of trauma, burn, neuro-surgical problems and surgery for instance" says Prof Rama Kant.

According to the World Health Organization (WHO), Pneumonia is the single largest cause of death in children worldwide. "Every year, it kills an estimated 1.8 million children under the age of five years, accounting for 20% of all deaths of children under five years old worldwide. There are some 155 million cases of childhood pneumonia every year in the world. Pneumonia affects children and families everywhere, but is most prevalent in South Asia and sub-Saharan Africa. It can be prevented with simple interventions, and treated with low-cost, low-tech medication and care" says WHO site.

Pneumonia can be spread in a number of ways. The viruses and bacteria that are commonly found in a child's nose or throat, can infect the lungs if they are inhaled. They may also spread via air-borne droplets from a cough or sneeze. In addition, pneumonia may spread through blood, especially during and shortly after birth. More research needs to be done on the different pathogens causing pneumonia and the ways they are transmitted, as this has critical importance for treatment and prevention.

The symptoms of viral and bacterial pneumonia are similar. However, the symptoms of viral pneumonia may be more numerous than the symptoms of bacterial pneumonia.

When pneumonia becomes severe, children may experience lower chest wall indrawing, where their chests move in or retract during inhalation (in a healthy person, the chest expands during inhalation). Infants may be unable to feed or drink and may also experience unconsciousness, hypothermia and convulsions.

While most healthy children can fight the infection with their natural defences, children whose immune systems are compromised are at higher risk of developing pneumonia. A child's immune system may be weakened by malnutrition or undernourishment, especially in infants who are not exclusively breastfed.

Pre-existing illnesses, such as symptomatic HIV infections and measles, also increase a child's risk of contracting pneumonia.

The following environmental factors also increase a child's susceptibility to pneumonia:
* indoor air pollution caused by cooking and heating with biomass fuels (such as wood or dung)
* living in crowded homes
* parental smoking.

"In India, on 2nd October 2008, the smoke-free laws were implemented country-wide, in line with the Cigarette and Other Tobacco Products Act (2003) and also the global tobacco treaty (Famework Convention on Tobacco Control - FCTC) which India has ratified in 2005. The implementation of smoke-free laws has been far from ideal - and this needs to be implemented strictly - not only to harness tobacco control outcomes but also broader public health, environmental and social justice outcomes this law aims to deliver" says WHO's Director-General's Awardee on tobacco control for the year 2005 Professor (Dr) Rama Kant. Parental smoking is one of the key factors to increase child's susceptibility to pneumonia, says Professor (Dr) Rama Kant.

Pneumonia can be treated with antibiotics. These are usually prescribed at a health centre or hospital, but the vast majority of cases of childhood pneumonia can be administered effectively within the home. Hospitalization is recommended in infants aged two months and younger, and also in very severe cases.

Preventing pneumonia in children is an essential component of a strategy to reduce child mortality. Immunization against Hib, pneumococcus, measles and whooping cough (pertussis) is the most effective way to prevent pneumonia.

Adequate nutrition is key to improving children's natural defences, starting with exclusive breastfeeding for the first six months of life. This is also effective in preventing pneumonia and reducing the length of the illness.

Addressing environmental factors such as indoor air pollution (by providing affordable clean indoor stoves, for example) and encouraging good hygiene in crowded homes also reduces the number of children who fall ill with pneumonia.

In children infected with HIV, the antibiotic cotrimoxazole is given daily to decrease the risk of contracting pneumonia.

A very effective and important preventive method for pneumonia and other conditions too is proper hand washing, informs Prof Kant.

Published in:
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Actions, not answers, needed to reduce pneumonia deaths

Actions, not answers, needed to reduce pneumonia deaths
1st World Pneumonia Day, 2 November 2009

Pneumonia claims two million children under five each year, yet no new drug, vaccine or special diagnostic test is needed to save their lives. The answers are at hand, and effective treatment is both inexpensive and widely available.

So why are children dying? This question is the driving force behind the first World Pneumonia Day (2 November 2009). The Global Coalition Against Child Pneumonia led by Save the Children has organised a Global Summit on Pneumonia in New York and other events around the world to mobilise efforts to stop a disease that kills one child every 15 seconds.

Actions, not answers, are needed to solve the problem, according to Penny Enarson, head of the Child Lung Health Division for the Paris-based International Union Against Tuberculosis and Lung Disease (The Union).

In an editorial “Who Speaks for the Children?” published this month in the International Journal of Tuberculosis and Lung Disease, Enarson et al point out that “recent data from 68 high-mortality countries showed that only 32% of children with suspected pneumonia receive antibiotics”. Other lapses in the delivery of care range from lack of trained staff and poor case management to inadequate stocks of drugs and faulty equipment.

Over the past decade, The Union has developed a service delivery model that addresses the key challenges in providing effective care for children with pneumonia. Based on the widely used Union model for tuberculosis control known as DOTS, the Child Lung Health Programme (CLHP) is based on government commitment, standard diagnostic and treatment guidelines, staff training, a purchasing and distribution system that ensures an uninterrupted supply of drugs, recording and reporting mechanisms, and supervision and evaluation.

The CLHP was first implemented by The Union in partnership with the Malawi Ministry of Health and Population. Between 2000 and 2005, the case fatality rate for children under five with severe and very severe pneumonia dropped 54.8%. By 2008, the rate had declined by 60%, demonstrating the sustainability of the model. The CLHP has also been implemented with good results in pilot programmes in Benin, China, Sudan and Tanzania.

“If we’re committed to reaching the Millennium Development Goal of reducing child mortality by 50% by 2015, we have to improve the way pneumonia is managed”, says Enarson. “The tools for saving these children exist. It is the political will to act and resources to support effective action that have been lacking”.

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Actions, not answers, needed to reduce pneumonia deaths

Actions, not answers, needed to reduce pneumonia deaths
1st World Pneumonia Day, 2 November 2009

Pneumonia claims two million children under five each year, yet no new drug, vaccine or special diagnostic test is needed to save their lives. The answers are at hand, and effective treatment is both inexpensive and widely available.

So why are children dying? This question is the driving force behind the first World Pneumonia Day (2 November 2009). The Global Coalition Against Child Pneumonia led by Save the Children has organised a Global Summit on Pneumonia in New York and other events around the world to mobilise efforts to stop a disease that kills one child every 15 seconds.

Actions, not answers, are needed to solve the problem, according to Penny Enarson, head of the Child Lung Health Division for the Paris-based International Union Against Tuberculosis and Lung Disease (The Union).

In an editorial “Who Speaks for the Children?” published this month in the International Journal of Tuberculosis and Lung Disease, Enarson et al point out that “recent data from 68 high-mortality countries showed that only 32% of children with suspected pneumonia receive antibiotics”. Other lapses in the delivery of care range from lack of trained staff and poor case management to inadequate stocks of drugs and faulty equipment.

Over the past decade, The Union has developed a service delivery model that addresses the key challenges in providing effective care for children with pneumonia. Based on the widely used Union model for tuberculosis control known as DOTS, the Child Lung Health Programme (CLHP) is based on government commitment, standard diagnostic and treatment guidelines, staff training, a purchasing and distribution system that ensures an uninterrupted supply of drugs, recording and reporting mechanisms, and supervision and evaluation.

The CLHP was first implemented by The Union in partnership with the Malawi Ministry of Health and Population. Between 2000 and 2005, the case fatality rate for children under five with severe and very severe pneumonia dropped 54.8%. By 2008, the rate had declined by 60%, demonstrating the sustainability of the model. The CLHP has also been implemented with good results in pilot programmes in Benin, China, Sudan and Tanzania.

“If we’re committed to reaching the Millennium Development Goal of reducing child mortality by 50% by 2015, we have to improve the way pneumonia is managed”, says Enarson. “The tools for saving these children exist. It is the political will to act and resources to support effective action that have been lacking”.

Published in:
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The Colombo Times, Colombo, Sri Lanka
Elites TV News, USA
Banderas News, Mexico
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World News Network, USA
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The Liberian Times, Liberia
Bihar and Jharkhand News Service (BJNS)
The Ghanaian Chronicle, Accra, Ghana
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