Early care-seeking for children with ARI symptoms from a health care provider is known to reduce mortality, yet population-based survey data indicate that there has been slow progress in care-seeking behaviour for children with ARI. In recent years, for example, seeking care for children with ARI symptoms from a healthcare provider has stagnated in Western and Central Africa as well as in Eastern and Southern Africa.
Pneumonia is an acute respiratory infection of the lungs. Globally, less than two-thirds 62 per cent of children with symptoms of acute respiratory infection ARI are taken to a health care provider.
Although it cannot be assumed that all children with symptoms have bacterial ARI and should receive antibiotics, the data indicate a big gap in the likelihood of treatment between the rich and the poor.
Furthermore, in sub-Saharan Africa, where most pneumonia deaths occur, less than 50 per cent of children with ARI symptoms are taken for care, with the lowest proportions in rural areas.
In areas where health personnel have become overstretched, key commodities such as oxygen treatment have become short in supply, or where care-seeking behaviours have been reduced due to transmission mitigation efforts e.
Saving children from ARI requires urgent action and recognizing danger signs — including fast and difficult breathing and a cough — is the first step. The treatment for most types of serious ARI is often antibiotics, which typically cost less than 50 cents for a full treatment.
However, not all children with ARI symptoms should receive antibiotics. Moreover, not all children classified as such have true ARI. Liu, Li , et al. Campbell, H. Acute respiratory infection ARI : This includes any infection of the upper or lower respiratory system, as defined by the International Classification of Diseases.
Acute lower respiratory infections ALRI affect the airways below the epiglottis and include severe infections, such as pneumonia. For instance, a 5 month old child who takes 50 breaths per minute would be breathing too fast, and could have pneumonia.
The treatment for pneumonia depends on the type of pneumonia. In developing countries, a large number of pneumonia cases is caused by bacteria and can be treated with low cost antibiotics.
Yet only one third of children with pneumonia receive the antibiotics they need because they lack access to quality health care. Other causes of pneumonia are viruses or mycobacteria e. Tuberculosis in particular often remains un-diagnosed. Children with severe pneumonia often require oxygen because the inflammation of their lungs prevents enough oxygen from entering the bloodstream.
However, in many countries without strong health systems oxygen is only available at higher level health facilities and hospitals. Pneumonia can be prevented in the first place by increasing protective measures, such as adequate nutrition, and by reducing risk factors like air pollution which makes the lungs more vulnerable to infection and using good hygiene practices. Studies have shown that improved handwashing with soap reduces the risk of pneumonia by up to 50 per cent by lowering exposure to bacteria.
Pneumonia caused by bacteria is easily preventable with vaccines. However, in , 71 million children did not receive the recommended three doses of the primary vaccine to prevent pneumonia PCV. A new vaccine for one of the main viral causes of pneumonia is under development.
The countries with the largest number of child pneumonia deaths are concentrated in sub-Saharan Africa and Asia, including Democratic Republic of Congo, Ethiopia, India, Nigeria and Pakistan. Together, these five countries account for more than half of all deaths due to pneumonia among children under five.
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Deogaonkar M. Socio-economic inequality and its effect on healthcare delivery in India: Inequality and healthcare. Electronic J Sociol. Duke T, Mgone CS. Measles: not just another viral exanthema. Shann F. Etiology of severe pneumonia in children in developing countries. Pediatr Infect Dis J. Bacterial isolates from blood and lung aspirate cultures in Gambian children with lobar pneumonia. When we understand what risks can lead to pneumonia, we can find ways to reduce them.
Furthermore, because a number of risks factors for pneumonia overlap with risk factors for other diseases, especially diarrheal diseases , interventions that target pneumonia have the additional benefit of helping to limit other diseases and saving more lives. There are several versions of pneumococcal conjugate vaccine PCV , which target different serotypes of S.
The PCV vaccine is given to children younger than 24 months. According to a study by Cheryl Cohen et al. It has been estimated that if PCV13 coverage in low income countries would reach the coverage of the DTP3 vaccine , then PCV13 could prevent , child deaths and Another vaccine widely used to protect children against both pneumonia is the Hib vaccine.
In there were around 0. According to Laura Lamberti et al. There has been a significant progress in reducing air pollution levels in recent decades, particularly of indoor air pollution. Death rates from indoor air pollution fell as a result of improved access to cleaner fuels for heating and cooking. And, whilst progress has been made against indoor air pollution, high levels of outdoor pollution remain a problem across many countries.
Reducing air pollution levels would have many other benefits: it would not only reduce the number of cases of pneumonia but also limit the incidence of asthma in children for example. A child with a suspected case of pneumonia — with symptoms of difficulty in breathing and coughing — should be taken to a healthcare provider so that the correct and immediate treatment can be provided. Delay in seeking treatment can increase the chances of a child dying.
Globally, less than two-thirds of children with symptoms of pneumonia were taken to a healthcare provider in As the map shows, the share of children with symptoms of pneumonia that are take to a health provider is still low in many countries. Given that most cases of pneumonia are of bacterial origin, antibiotics are the general course of treatment. Due to the lack of resources, in places where pneumonia cases are most common, a quick diagnosis for the cause of disease is not always possible.
Given the potential high risk of death from untreated pneumonia, the World Health Organisation WHO recommends antibiotic treatment depending on the disease symptoms and its severity before the cause of disease is known.
Amoxicillin, ampicillin and gentamicin are the most commonly used antibiotics to treat pneumonia. During pneumonia, alveoli in the lungs get filled with pus and fluid, which prevents oxygen from being transferred to the blood. Consequently, a condition known as hypoxaemia — a lack of oxygen — can develop. When a child with pneumonia develops hypoxaemia the risk of dying increases five-fold. However, the need for a specialist equipment to diagnose and treat hypoxaemia still poses a substantial barrier in low-resource settings.
There are a number of ways we could reduce the number of children dying from pneumonia, including eliminating the major risk factors such as undernutrition and air pollution , and providing better access to treatment.
But we have another highly effective intervention: a vaccine against the major pathogen responsible for pneumonia in children. Here we look at their effectiveness and how we can maximise the number of children they save. Since the World Health Organisation WHO started recommending including pneumococcal vaccines in national immunisation programmes for children in , there has been a progressive increase in the number of countries using the vaccine.
But the coverage of pneumococcal vaccines is still low in many countries. This means that 55 million children who could be protected by the vaccine are still not vaccinated against it — an appallingly high number for a vaccine that not only protects from pneumonia, the leading cause of childhood death, but also a range of other diseases as discussed below. Streptococcus pneumonia , often simply referred to as pneumococcus, is a bacterium that is often found in the upper respiratory tract of healthy people.
Generally, the bacterium is harmless or causes milder illnesses such as bronchitis, sinusitis, and ear infections. Pneumococcal vaccines are effective against these milder illnesses as well, but importantly also protects from what is called pneumococcal invasive disease PID.
PID occurs when the pneumococcus moves from colonizing the upper respiratory tract to colonizing sites that are normally sterile, such as blood, cerebrospinal fluid or pleural cavity fluid-filled space surrounding the lungs.
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