There’s a nip in the air and mercury has dipped a few degrees. The onset of winter is a welcome respite from the heat, but it brings with it a host of diseases. Pneumonia is one of the foremost of these, claiming lives of children, adults and elderly alike. Pneumonia is in fact the leading infectious killer of children under 5 years of age worldwide, killing 1 child every 3 minutes in India.
While there has been significant progress made in the struggle to protect children from dying of pneumonia, some basic interventions can go a long way to combat this dominant cause of child mortality. The household environment is a critical determinant of a child’s risk of early death. Crowding and indoor air pollution greatly add to the threat.
The festive season brings with it smoke from crackers; coupled with the regular vehicular traffic, cigarette smoking, cooking on open hearths, and burning garbage - air pollution in and around the household deeply affects vulnerable infants. In fact half a million children under five die each year from pneumonia caused by exposure to household air pollution.
Malnutrition too is a significant contributor to childhood pneumonia. This is of particular importance at a time when many countries have worked to reduce child mortality rates, yet continue to suffer with high rates of malnutrition. With the widespread availability of antibiotics, childhood pneumonia is a largely treatable condition, and the high pneumonia mortality burden is a poor reflection of our health system. We know that most of the one million children around the world who die every year from pneumonia are essentially dying due to lack of the most basic medical care.
Guidance for the provision of the most basic curative care have been devised by WHO and UNICEF and promoted as part of the Integrated Management of Childhood Illness approach.
Vaccines against measles and pertussis have done much to prevent pneumonia caused by certain agents over the past 30 years, and it is critical that we continue to ensure that all of our children receive the full course of these two vaccines. Now we have potent vaccines against the two major bacterial causes of pneumonia, Streptococcus pneumoniae (pneumococcus) and Haemophilus influenza type b (Hib). With support from Gavi, The Vaccine Alliance, these vaccines are now becoming increasingly available even in the poorest countries.
Pneumococcal conjugate vaccine (PCV) is a critical tool in a comprehensive pneumonia prevention strategy and has been proven to be safe, effective, and cost-effective. More than 130 countries have introduced PCV in their national immunisation programs, including India’s neighbours Pakistan, Nepal and Bangladesh. The Government of India recently joined more than 190 countries in complete national rollout of Hib vaccine, which can protect against one bacterial cause of pneumonia; PCV, however, is not yet part of India’s Universal Immunization Programme.
The wide range of factors contributing to pneumonia has resulted in a fragmented response. People working in nutrition may not be aware of available vaccines, and those working on clinical case management may not be knowledgeable about social determinants of pneumonia. A solid understanding of the factors influencing pneumonia mortality and morbidity will help health workers choose interventions wisely and advocate for pneumonia control to reduce the unnecessary loss of lives.
It is also vital that, while we work to prevent pneumonia among our children by reducing air pollution and malnutrition and ensuring access to life-saving vaccines, we also improve our diagnosis and treatment standards. Correct diagnosis of pneumonia and timely treatment or referral to hospitals can mean the difference between life and death. Making sure that we use antibiotics appropriately—using the correct antibiotics for the correct amount of time, and only when they’re truly needed—will help us prevent antibiotic-resistant pneumonia and ensure that we are able to adequately treat ill children.
Health is one of the priorities in UN’s Sustainable Development Goals (SDGs), and child health is a key component. As we approach World Pneumonia Day, held each year on November 12, we have the opportunity to uphold the promise of the SDGs and improve the health of our children. Too many precious lives are at stake to ignore this child killer called pneumonia.
Dr. Pramod Jog currently serves as President of the Indian Academy of Pediatrics (IAP), standing committee member of International Pediatric Association (IPA), and a member of the GAVI CSO Standing Committee. He is a paediatrician and neonatologist with over 30 years of experience in these fields. Dr. Jog is Professor of Paediatrics at D.Y. Patil Medical College, Pune, and practices at Jog Children’s Clinic in Aundh, Pune. He has an MD in Paediatrics from the B.J. Medical College, Pune.