Childhood pneumonia - the forgotten killer

Diana Wangari, CNS Special Correspondent,  Kenya
(First published in The Star, Kenya)
If you were asked what were the leading infectious disease killers of children under the age of five, what would your answer be? Unless you were a health professional or keep abreast with health information regarding that particular population, I am almost certain that pneumonia would not find a place in the top three diseases that came across your mind.

I do not blame you because the truth of the matter is that the amount of attention and funding that this disease receives pales in front of many other diseases like TB. And yet, pneumonia happens to be the number one infectious disease that causes the greatest under five mortality. But most people are bound to forget the statistics, as it does not receive as much attention as other diseases such as TB or HIV/AIDS. And certainly, it is not an epidemic that can cause the panic as Ebola did recently.

A report released on World Pneumonia Day in November 2014 by the Institute for Health Metrics and Evaluation (IHME) found that international development assistance targeting pneumonia represents a very small portion of overall global health financing. The report ‘Pushing the Pace: Progress and Challenges in Fighting Childhood Pneumonia’ found that just 2% ($US670 million) of the estimated $US30.6 billion of international development assistance for health was spent on fighting pneumonia in 2011.

This is despite the fact that pneumonia claimed the lives of 905,059 children in 2013, or, in other words, was responsible for 14% of all under five deaths. Furthermore, the report found that reductions in child pneumonia deaths since 1990 (58%) have not kept pace with those due to other childhood killers like measles (83%) and diarrhea (68%).

Progress has been particularly slow for high-burden countries in sub-Saharan Africa where declines in total child pneumonia deaths averaged just 14%. Nigeria saw only a 4% decline and a number of countries, including Democratic Republic of Congo, Chad, and Cameroon, actually experienced an increase in child lives lost to pneumonia.

The fact that many of the countries that have performed so poorly in reducing child pneumonia deaths, have achieved remarkable reductions in reducing child deaths from other causes not only suggests that there is a lack of integration in managing the major childhood killers in these countries but also implies that the amount of investment and disease prioritization are critical factors.

In contrast, countries like China, India, Iran, Bangladesh, Mozambique and Indonesia have all recorded reductions by 70% in child pneumonia deaths since 1990, an indication that dramatic reductions in child pneumonia deaths are possible. But even with these reductions, India still boasts of the highest number of children (300,000) dying of pneumonia.

The report finds that over 80% of the estimated $US670 million of development assistance for pneumonia in 2011 was invested in vaccine programmes, while other important areas of pneumonia prevention, diagnosis and treatment like breastfeeding, reducing indoor air pollution, improving diagnostics and access to antibiotics and oxygen therapy did not receive the same levels of investment.

Speaking to the CNS team at the 45th Union World Conference on Lung Health held in Barcelona last year, Stephen Graham, a paediatrician and Professor of International Child Health with University of Melbourne with particular interest in pneumonia had said, " It is a sad fact that we continue to neglect pneumonia and do not give it as much attention-- whether in terms of funding or prevention measures. However, it is still the leading infectious disease killer of children under the age of five. This is a situation that we must remedy as the statistics will not change unless we make the changes needed."

And part of that change is increasing the amount of funding directed to pneumonia, as more resources are required not only to increase access to the vaccine, but also to educate people about preventive measures such as breastfeeding and cooking in hygienic conditions. In addition, ensuring that appropriate diagnostic methods are available and subsequently used, followed by prescription of the right antibiotic and treatment, including oxygen therapy.

Even more so, as we know that 7 out of every 10 child pneumonia deaths occur in just 15 countries, new investments need to prioritize the population of children in these countries, with a special focus on sub-Saharan populations where child pneumonia deaths are actually increasing. Commenting on the report, Director of Pneumonia at the Bill and Melinda Gates Foundation, Keith Klugman said, “We need to reach the most vulnerable children with the prevention, diagnostic and treatment technologies that are currently available, while at the same time accelerating the search for better tools, especially diagnostic technologies that can identify the children most at risk of death from pneumonia.

It is essential that the discovery, development and delivery of existing and innovative pneumonia technologies is better integrated with other areas of child survival, especially diarrhea, nutrition, and malaria, as part of integrated community case management of childhood illnesses. For the most vulnerable children who live far from formal health services, and often in fragile settings, we need to find innovative ways of delivering integrated community care close to their doors.”
(First published in The Star, Kenya) 

Diana Wangari, Citizen News Service - CNS
12 February 2015