ViewpointChildhood pneumonia mortality—a permanent global emergency
Section snippets
Evidence for the burden of pneumonia
WHO is undertaking another analysis of the worldwide pneumonia burden that will estimate the contribution of the main bacterial causes. The analysis will not change the conclusion that pneumonia is responsible for about 20% of the overall child mortality burden. However, it is worth considering the limitations of the underlying global estimates. Of the 10·5 million yearly child deaths, almost half (4·9 million) occur in malarious areas, mainly in sub-Saharan Africa. Data from Kenya and Malawi
Historical perspective
Throughout history, child mortality rates have been high. The leading causes of child death after the neonatal period have been pneumonia and diarrhoeal disease, with variable contributions from diseases such as malaria and measles. In the USA at the beginning of the 20th century the infant mortality rate was high (over 150 per 1000 livebirths) and 19% of deaths were estimated to be due to pneumonia, a similar proportion to that in developing countries today.8 At that time there was a major
What progress has been made?
After 20 years of case-management-based approaches to pneumonia control, little objective evaluation has taken place. A group of large field trials was done in the 1980s and, with one exception, an impressive fall in pneumonia mortality was associated with introduction of an approach based on community case management.13 However, these studies usually incorporated co-interventions that might themselves have contributed to mortality reduction; the interventions were quite intensive, and were
The way forward
It is time for the international health community to adopt a balanced and unified approach to child survival in general and the control of pneumonia mortality in particular. The first step has been achieved by the Child Health Epidemiology Reference Group with the development of a set of cause-specific mortality estimates that are agreed by all groups within WHO and UNICEF.17 The breakdown of mortality estimates for pneumonia and diarrhoeal disease by cause has produced controversial results in
Conclusion
Of the available strategies to prevent pneumonia, Hib and pneumococcal vaccines are the most likely to attract support from international donors. This support is welcome, but a risk remains that increasing support for vaccines will be accompanied by a decline in support for other strategies, particularly case management—even though some of these strategies might be highly cost effective. In the near future we might see communities in poor countries in which the introduction of pneumococcal and
References (36)
- et al.
Pneumonia: the leading killer of children
Lancet
(2006) - et al.
Overlap in the clinical features of pneumonia and malaria in African children
Trans R Soc Trop Med Hyg
(1993) - et al.
Childhood pneumonia and diarrhoea: setting our priorities right
Lancet Infect Dis
(2007) Clinical care for seriously ill children in district hospitals: a global public-health issue
Lancet
(2004)- et al.
WHO estimates of the causes of death in children
Lancet
(2005) - et al.
Effect of handwashing on child health: a randomised controlled trial
Lancet
(2005) Zinc and pneumonia
Am J Clin Nutr
(2006)- et al.
Countdown to 2015: tracking donor assistance to maternal, newborn, and child health
Lancet
(2006) - et al.
Quality of hospital care for seriously ill children in less-developed countries
Lancet
(2001) - et al.
Incidences of vaccine-preventable Haemophilus influenzae type b pneumonia and meningitis in Indonesian children: hamlet-randomised vaccine-probe trial
Lancet
(2005)
Efficacy of nine-valent pneumococcal conjugate vaccine against pneumonia and invasive pneumococcal disease in The Gambia: randomised, double-blind, placebo-controlled trial
Lancet
Effectiveness of seven-valent pneumococcal conjugate vaccine against invasive pneumococcal disease: a matched case-control study
Lancet
Respiratory illness after severe respiratory syncytial virus disease in infancy in The Gambia
J Pediatr
Integrated approach to child health in developing countries
Lancet
Impact of a chimney wood stove on risk of pneumonia in children aged less than 18 months in rural Guatemala: results from a randomized controlled trial. Symposium MS3 at the ISEE/ISEA Annual Conference, Paris, September 2006
Epidemiology
Differentiating the pathologies of cerebral malaria by postmortem parasite counts
Nat Med
Bacterial infections—a major cause of death among children in Africa
N Engl J Med
Infant and child mortality in the Indian subcontinent, 1881–1947
Cited by (96)
Perception of mothers about Acute Respiratory Infections (ARIs) and risk factors affecting children Under 5 Years (U5Ys) in Fiji
2022, Journal of Pediatric NursingCitation Excerpt :Most of the deaths from ARIs in children occur at home where the families are not able to recognize the danger and life threatening signs and therefore they may not seek appropriate health care (Caballero et al., 2019). A large proportion of deaths caused by ARIs occurred in the developing countries and is a major burden of disease on child health (Mulholland, 2007; Ujunwa & Ezeonu, 2014; The UN Inter-agency Group for Child Mortality Estimation, 2014). The quality of life was markedly impaired for the child when the child presented to hospital with ARIs, whereby parents who identified cough severity and financial concerns had the highest impact (Banda et al., 2016; Goel et al., 2012; Lovie-Toon et al., 2018).
Deterministic epidemic model for (SVC<inf>Sy</inf>C<inf>Asy</inf>IR) pneumonia dynamics, with vaccination and temporal immunity
2020, Infectious Disease ModellingCitation Excerpt :Newborn babies can again, be protected from pneumonia infection through early recognition and treatment at the level of the community or the primary-care health facility, testing of pregnant mothers for streptococcus and giving antibiotic treatment and vaccination with PPV that has a proven record of safety in pregnant and breastfeeding mothers for pneumococcal pneumonia prevention in infants. Suctioning the mouth and throat of babies with meconium-stained amniotic fluid decreases the rate of aspiration pneumonia (Mulholland, 2007(Ngari et al., 2014)). Environmental measures for pneumonia prevention include reduction of indoor air pollution by encouraging good hygiene in crowded homes and smoking cessation that reduces risks of pneumonia infections among children and adults.
Safety of a nasal vaccine against Streptococcus pneumoniae using heat-killed Lactobacillus casei as adjuvant
2015, ImmunobiologyCitation Excerpt :Streptococcus pneumoniae is a highly important respiratory pathogen and it is considered one of the primary causes of pneumonia and meningitis in children under 5 years old and adults over 65 years old in both developed and developing countries (Scott, 2008; Mulholland, 2007).
Barriers and Challenges of Treatment for Pneumonia in Children: A Systematic Review
2022, Malaysian Journal of Medicine and Health Sciences