Pneumonia: An outcome of preventable mistakes

Dr Amitava Acharyya, CNS Correspondent, India 
Photo credit: CNS
“That men do not learn very much from the lessons of history is the most important of all the lessons of history”--Aldous Huxley
During the early 1900s, pneumonia was the third leading cause of death. Still now it is in endemic condition among under 5 years old children (responsible for 15% of all deaths in children < 5 years old) and geriatric population. The preventive and curative aspects of pneumonia are well established. But, the failure of implementation of proper health care structure, inadequate health promotion and health education among the masses and inadequate supply of anti-biotics remain the causes of this preventable burden.

It is unfortunate that 99% of all childhood deaths from pneumonia occur in developing countries like India, Pakistan, and Nigeria. These countries have huge problems of poverty, illiteracy, malnutrition, population over growth, maternal deaths and non communicable diseases. All these factors are inter-related. Malnutrition is one of preventable risk factors of pneumonia. Still today, India is one of the highest ranking countries in the world for the number of children suffering from malnutrition. 44% of Indian children under the age of 5 are underweight; 72% of infants and 52% of married women have anaemia; 25% of the hungry people worldwide live in India; and only 46.4% of women exclusivley breast feed their babies during the first 6 months.

The simple act of hand washing with soap can reduce the number of pneumonia-related infections in children by more than 50%, according to a study published in The Lancet. But even this common and basic hygiene practice of hand washing is much below optimum level in India, where a large number of mothers are uneducated and tap water supply is unsatisfactory. Most people are still unaware of this easiest tool for prevention of not only pneumonia but also other deadly diseases diarrhoea like deadly under 5.

Indoor house air pollution is another causative factor, strongly related with onset of pneumonia. Most of the pneumonia affected children belong to low socio-economic status where a large family may live in a one roomed tenement with poor ventilation. Very often the same room or an adjoining area doubles up as a kitchen using biomass fuels for cooking. Then again, the smoke from bidis/ cigarettes used by adults in the family escalates the problem.

The World Health Organization (WHO) has stressed upon the importance immunization for prevention of pneumonia. Indian Association for Paediatrics has been recommending the inclusion of the pneumococcal conjugate vaccine in the government's immunisation programme since the last few years, but it has not yet materialised. Even in countries like Pakistan and Bangladesh, these vaccines are available at a subsidised rate.

Community acquired pneumonia (CAP) is another leading cause of hospital admission among geriatric population. It is an increasing problem among the elderly, who are particularly susceptible to this infection because of their impaired gag reflex, decreased mucociliary function, waning immunity, and various degrees of cardiopulmonary dysfunctions. CAP represents the third most frequent hospital diagnosis among patients aged 65 years or older. In hospitals, pneumonia caused by artificial life supporting ventilation (ventilation induced pneumonia) and by entering of food in respirative system (aspirate pneumonia) are major causes of mortality among the aged. Through proper nursing care, sterility, hand washing and hospital de-humidification we can minimize hospital acquired pneumonia. Immunization among COPD and asthma patients against influenza is also a good option to implement in our society to prevent pneumonia among our elderly population.

We know the causes of pneumonia, and we also know how to prevent it. Yet we are unable to control it. It is high time we put our act together to ensure that no child dies of pneumonia.

Dr Amitava Acharyya, Citizen News Service - CNS
13 December 2015

2 comments:

  1. Dr Amitava Acharya, Congratulations for this eye opener and as public health researcher I have make a fewpoints that control of Pneumonia in children is beyond vaccines and also have tolook at various other interventions like nutrition support, Breast feeding, Hygiene and clothing requiring a upheaval in their socio economic status.

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