Childhood pneumonia
Journalist-to-Journalist Lung Health ProgrammeBerlin, Germany
November 12, 2010
Penny EnarsonThe Union, Paris France
WHAT IS PNEUMONIA?
ARI Clinical Syndromes
ARI in ChildrenIs any infection ofacute onset, affecting the:• ear• nose• throat• larynx• trachea• bronchi• bronchioles• lungs
It ranges from the
• common cold
• ear infection
• sore throat
• bronchitis
• bronchiolitis
• pneumonia
Categories of pneumoniaPneumonia:
– very sever– severe – non-severe
• The lungs are made up of
small sacs called alveoli,
which fill with air when a
healthy person breathes.
When an individual has
pneumonia, the alveoli are
filled with pus and fluid, which
makes breathing painful and
limits oxygen intake.
WHO DOES PNEUMONIA AFFECT?
UNDER-FIVE CLINIC AT DISTRICT HOSPITAL
Pneumonia is the single biggest killer of children <5 years in the developing world
ARI Burden on Health Services
• 5-8 episodes per child year in urban areas• 3-5 in rural areas• Overall ARI incidence same for low-income
and industrialized countries• ARI is very often the most common
- acute illness amongst children- reason for visit to a health worker- reason for admission to hospital
WHERE?
Disease profiles
Neonatal
AIDS
MalariaMalaria +
AIDS
Diarrhea +
pneumonia
Child Mortality: Geographic Distribution
Major Causes of Child Death (2005)
EIP/WHO
All other (19.2%)
HIV/AIDS (3.6%)
Pertussis (2.9%)
Tetanus (1.8%)
Malaria (10.7%)
Measles (5.4%)
Diarrhoeal diseases (15.2%)
Pneumonia (19.1%)
Perinatal (23.1%) Majority from pneumonia
Total deaths: 10.8 million
Malnutrition is estimated to contribute to around 50% of all childhood deaths.
for 60% of all
diseases account
child deaths
These seven
communicable
Pneumonia:The forgotten killer of children New York: UNICEF/WHO 2006.
Pneumonia:The forgotten killer of children New York: UNICEF/WHO 2006.
Incidence of Pneumonia
• Pneumonia is more frequent & severe in children in low-income countries than in children in industrialized countries
• Mortality rate for pneumonia is 10 to 50
times higher than in developed countries
WHY?
It’s not just the disease.
The incidence and mortality due to pneumonia must be understood in the broader context of the child’s environment and the care he or she receives.
Those that are most disadvantaged are at highest risk of exposure to these risks and at highest risk of death.
Significant Risk Factors Pneumonia in Children
• Lack of immunization• Poor nutrition• Environmental pollution• Poor case management/prophylaxis• Social/behavioural issues• Poverty• Malaria• HIV/AIDS
Proximate Determinants Feeding and nutrition Hygiene and indoor air pollution Other preventive activities Care during illness
Underlying Determinants Financial barriers Health care provision Maternal education Water, sanitation, and the home
environment Other underlying determinants
Socio-economic Socio-economic differencesdifferences
For each of theseFor each of thesedeterminants:determinants:The poor areThe poor are
disadvantageddisadvantaged
Source: Wagstaff, Bryce, Bustreo, Claeson. Child health: reaching the poor. AJPH
Child Survival: Determinants
Is the MDG 4 for child survival achievable globally?
The limiting factors/obstacles in reducing
child mortality by two-thirds by 2015?
– Scaling up health delivery
– Lack of funds
Child Survival:The ObstaclesImplementation Challenges
Health Systems Constraints Community Constraints
Underfunded
Over-crowded
Poverty
The reality of HIV/AIDs
Byass P, Ghebreyesus TA. Making the world’s children count Lancet 2005; 365 1114
Monthly health expenditure per capita, deaths at age under 5 years per 1000 livebirths,6 and “preventable” component of under-5 mortality*
*Deaths from pneumonia, diarrhoea, malaria, and measles.Six WHO regions: AFR=sub-Saharan Africa, SEAR=southeast Asia, EMR=eastern Mediterranean, WPR=western Pacific, EUR=Europe, AMR=Americas.
Estimated proportion of children < 5 years who received survival prevention interventions in 42 countries accounting for 90% of under-5 deaths, 2003
Bryce J, et.al. Reducing child mortality: can public health deliver? Lancet 2003; 362: 159–64
Percent of per capita GNP needed to buy primary series of Hib vaccine
0.060.5
2.3
6
0
1
2
3
4
5
6
7
USA South Africa Egypt Niger
Per
cen
t o
f P
er c
apit
a G
NP
The cost of scaling-up interventions
• US$5·1 billion in new resources is needed
annually to save 6 million child lives in the
42 countries responsible for 90% of child
deaths in 2000.
• This cost represents $1·23 per head in
these countries, or an average cost per
child life saved of $887.
Jones G, et al How many deaths can we prevent this year? Lancet 2003; 362: 65-71
Coverage estimates for child survival treatment interventions forthe 42 countries with 90% of worldwide child deaths in 2000
Data source: State of the World’s Children 2003. *Where available. For interventions with no country-level coverage data a single estimate was used for all countries.
Cost of scaling-up pneumonia interventions
• More than 1 million lives could be saved if both prevention and treatment interventions for pneumonia were implemented universally.
• Around 600,000 children’s lives could be saved each year through universal treatment with antibiotics alone, costing around $600 million
Bryce, J., et al., ‘Can the World Afford to Save the Lives of 6 Million Children Each Year?’, The Lancet, vol. 365, 2005, pp. 2193-2200; Jones, G., et al., ‘How Many Child Deaths Can We Prevent This Year?’, The Lancet, vol. 362, 2003, pp. 65-71.
Cost of scaling-up pneumonia interventions
This investment is not only critical for expandingtreatment coverage with antibiotics but is alsonecessary for strengthening the broader Health system. The cost includes • The purchase price of antibiotics, • Scaling up treatment coverage to universal
levels:– training – supervising staff– funding hospital stays for children with severe
pneumonia
Reaching MDG 4
Child Survival: The Opportunities
• Taking Known Interventions to Scale
–Preventive interventions
–Care of the sick child
• Pneumonia Standard Case
Management – a proven intervention
Child survival interventions with sufficient or limited evidence of effect on reducing mortality from the major causes of under-5 deaths
Jones G, et. al. How many child deaths can we prevent this year? Lancet 2003; 362: 65–71
Community-based implementation of standard case management
of pneumoniaSazawal S, Black RE. Lancet Infect Dis 2003
Reduced pneumonia-specific mortality
–35-40% reduction
• Reduced all cause under 5 mortality
–20-25% reduction
Child Lung Health Programme (CLHP) MALAWI
Making a Difference in Child Survival
The Union’s Health Service Delivery Model for Lung Health Goal:
• To promote better lung health in children through the development of a cost-effective, sustainable project for the surveillance, diagnosis, and management of severe respiratory disease in children
• The building of sustainable management and technical capacity for these activities in the target country, and
• The ultimate establishment of national self-sufficiency for this model of health services delivery for severe childhood respiratory disease.
Basis of case management strategy
• Value of simple clinical signs– Ability of health workers to utilize the
signs• Most pneumonia deaths in high burden
countries due to bacteria– Effective antibiotics will reduce CFR
• Avoids unnecessary use of antibiotics– Minimize development of MDR
pathogens• Rational use of oxygen
Achievements of the CLHP Malawi
• Total number of children admitted between
October 2000-December 2005 48 285
• Baseline pneumonia CFR 18.6%
• Pneumonia CFR December 2005 8.4%
• Reduction over the baseline 54.8%
• There was a significant statistical intervention
effect OR .79 p> 0.037 95% Conf
Interval .63 to.99
• Total number lives saved 2000-2005 4357
Lack of funding
20 diseases graded by disability-adjusted life-years (DALYs)
*Countries classified by the World Health Organization as having very high or high child and adult mortality. Data from WorldHealth Report 2001 (WHO 2001).
Shiffman J. Donor funding priorities for communicable diseases. The Author 2006.
Disease burden in the developing world versus share of donor funding, direct grants only*
*Donor funding is considered for the years 1996–2003 in deflated dollars, with 2002 as the base year. Burdens are measured in DALYs for theyear 2000 for developing countries. Percentages are of the total for the
20 diseases considered, not of all developing world diseases.
Shiffman J. Donor funding priorities for communicable diseases. The Author 2006.
Percentage of developing world burden and percentage of donor funding for selected diseases For the period 1996-2003
Shiffman J. Donor funding priorities for communicable diseases. The Author 2006.
Conclusion• Pneumonia remains the major cause of mortality
in children• Standard case management has been shown to
be effective in reducing mortality rates but is expensive in relation to other interventions
• If MGD 4 is to be achieved there is an urgent need for a major increase in funding for universal coverage of SCM for pneumonia in the developing world
• There needs to be a more balanced allocation of the resources already being provided
What You Can Do As Journalists
• Generate a new “buzz” about pneumonia and its role in child survival
• Track and report on progress of MDG 4
• Become a champion yourself
THANK YOU
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