Give child pneumonia the attention it deserves

Diana E Wangari, CNS Special Correspondent
When most people are asked about lung health and infectious diseases, the first condition that probably comes to mind is TB. This is expected as, for decades, TB was regarded as a major killer and it showed no discrimination in choosing its victims, infecting children, women and men; rich and poor alike. Neither was it restrictive in its area of destruction—it could attack different organs--from the lungs to the bones. The fight against TB had to be mounted and the campaigns had to be aggressive to match the evolution of a disease that is seemingly outsmarting all efforts to control by appearing in newer avatars of drug resistant TB.

This effort is equally evident at the 45th Union World Conference on Lung Health, at Barcelona with multiple sessions on issues related to TB attended by over 3000 odd participants.

Dr Keith Klugman
Photo credit: Diana W/CNS
But TB is not the only war that has to be fought when it comes to Lung Health and Infectious diseases. Therefore, in my zest to learn about the other dimensions of lung health, I attended a session organized on childhood pneumonia.

"Welcome to this symposium on Child Pneumonia and what a great turnout," said Dr Keith Klugman, Director of the Pneumonia Programme at the Bill and Melinda Gates Foundation. Looking around the room ,that was half full, I could not help but wonder if the statement was intended to be humorous or if that was the kind of great turnout that was expected from a session on Child Pneumonia in an otherwise predominant TB conference.

And as speaker after speaker took to the podium, I would find my answer.

It was the words of Dr Stephen Graham, however, that stuck with me as he addressed the audience--"Child pneumonia affects those who do not have a voice to speak out-- the very young."

This is evidenced by the fact that pneumonia remains the most common cause of morbidity and mortality in children. Globally it is the number one infectious killer of children under 5 years of age: every year it kills nearly 1 million children accounting for about 15% of the total deaths for children under 5 years, of which 2% are newborns. Almost all deaths from pneumonia occur in poor or rural communities in low-and middle-income countries. The disease is most prevalent in sub-Saharan Africa and South Asia, of which India, Nigeria, Pakistan, DRC, Ethiopia, and China account for 50% of total deaths.
in the global distribution of the primary causes of all under five deaths.
Dr Stephen Graham
Photo credit: Diana W/ CNS

Part of the struggle in raising awareness and generating an interest in childhood pneumonia lies in the fact that it can be caused by several different organisms ranging from bacteria to viruses, Dr Stephen Graham added. In addition, diagnosis is a challenge as the presenting symptoms overlap with several other diseases (like TB) and, keeping in mind that often clinicians have to rely on clinical presentation of the disease, cases of misdiagnosis of pneumonia are quite common. This is a fact that most clinicians in the audience strongly agreed with and in a video showing a child in respiratory distress as a result of severe malaria and another with pneumonia, one could not tell the difference--at least not just by looking at them.

Speaking to Citizen News Service (CNS), Dr Stephen Graham said, "There is need for advocacy for child pneumonia. There are different factions working on pneumonia, for example in vaccine development and cause studies. But we need to integrate these segments together to create a greater and more powerful voice."

Being in this field and trying to focus the spotlight on child pneumonia for over ten years, Dr Graham has definitely seen the need for a combined effort to deal with it and we cannot take his words lightly. It is not just a call to clinicians, researchers and health care workers to unite, but also a message to the public that these are your children, your family members, your neighbours and you too have to speak up and say, "Pneumonia is also claiming our lives. Give it the attention it deserves."

Funding for tackling this preventable disease is not flowing in either-- at least not in the same way that it is washing the shores of the HIV/AIDS and TB camps. The Bill and Melinda Gates Foundation is one of the major contributors, who through projects such PERCH-- a seven site study-- is aiming to identify the causes of pneumonia in order to determine whether the vaccines currently in development will address the need of providing improved pneumonia care and prevention to children.

But more important is to make the existing interventions more widely accessible and properly used. Evidence shows that children are dying from pneumonia because existing effective interventions are not readily available for all. The potential of interventions from pneumococcal vaccines to improved community-based care and management of hypoxia are recognized, but not yet realized. Proper nutrition, vaccinations, hand-washing with soap, low-emission cook stoves and exclusive breastfeeding for newborns, can help protect children and prevent pneumonia. Early access to appropriate, affordable antibiotics and oxygen therapy can be lifesaving.

We must scale up our efforts if we are to meet the global challenge to end these preventable child deaths by the year 2030.

Diana E Wangari, Citizen News Service - CNS 
31 October 2014
(The author is reporting for Citizen News Service (CNS) from 45th Union World Conference on Lung Health in Barcelona, Spain with support from Lilly MDR TB Partnership. Email: