A walk in a clinic in an urban slum or rural setting is invariably associated with one coming across a parent sitting with their child helping them to breathe through the mouthpiece of a nebulizer machine. Such is the presence of pneumonia cases in developing countries and resource constraint settings. Pneumonia, previously known as the ‘captain of the men of death’ for its ability to claim so many lives, is a public health menace affecting both the extremes of the age group-- children <5 years and elderly >64 years. It is an inflammatory condition of the lung affecting the alveoli and is primarily caused by virus or bacteria with cough, chest pain, fever and difficulty in breathing as primary symptoms.
Pneumonia has been associated with high mortality and morbidity across the globe. However, in recent years, the case rates have come down, owing to identification of etiological agents and availability of treatment modalities. But the illness still has a remarkable presence in the developing nations owing to the association of pneumonia with malnutrition, poverty, and inadequate access to health care--the raging issues in certain parts of the world. Dr Visham Dhiman, Child Health Consultant, National Health Mission (Haryana) told CNS that under-nutrition in infants resulting from lack of exclusive breastfeeding during the first 6 months, and lack of supplementary feeding after 6 months makes the child more vulnerable to infections. Out of a total of 5.9 million deaths across the globe, 16% have been caused by pneumonia. With 2,97,114 deaths, India tops the list of countries having the highest incidence of pneumonia in children under 5.
The irony of the situation lies in the fact that pneumonia is a completely preventable illness and still claims so many lives every year. It can be treated through appropriate use of antibiotics and can be prevented through vaccination, exclusive breast feeding for first 6 months of life, control of air pollution and ensuring education of parents about hand washing and hygiene. In a recent webinar hosted by CNS, Dr. Lois Privor-Dumm, Director (Policy, Advocacy and Communications), International Vaccine Access Center (IVAC), Johns Hopkins Bloomberg School of Public Health, mentioned that it is imperative to develop an action plan to protect, prevent and treat the illness. She also highlighted the fact that India is witnessing a phase of strong political commitment and formulating aggressive health targets. However, when questioned about the possible reasons for the slow roll out of certain vaccines and delay in introducing the PCV (Pneumococcal conjugated vaccine), she explained that the strength of the state machinery to handle and manage the vaccines, availability of trained human resource and facilities like cold storage and transportation can be the probable factors responsible for the delay.
In an interview with CNS, Dr.Byomakesh Mishra, State Child Health Consultant, Ministry of Health and Family Welfare, Assam, added that the high cost of the vaccine can be a major barrier in its procurement by the government and also suggested indigenous manufacturing of PCV to handle the cost issues. Dr Dhiman too supported this, saying that the disease severity, vaccine efficacy, poor treatment outcomes and increasing antibiotic resistance etc. are all in favour of the introduction of PCV in the interest of public health. He also added that this new addition should be backed by scientific evidence.
To cope up with the future burden of pneumonia cases, Dr Byomakesh also suggested focusing on implementing preventive strategies, such as development of simple protocol for management of cases at facility level, community management of pneumonia through front line healthcare workers. Dr Dhiman felt that involving private practitioners; ensuring availability of antibiotics; improving the coverage of immunization (especially measles/pentavalent vaccine); creating community awareness about the impact of malnutrition on pneumonia; and establishing efficient referral systems will go a long way in reducing deaths from pneumonia.
Fortunately, pneumonia is getting global attention now, as a major health problem and the launch of Integrated Global Action Plan for Pneumonia and Diarrhoea (GAPDD) by WHO and UNICEF has highlighted the burden of this illness. It is time for the government to locate the lacuna, call for action, step up and tilt the scales in a favourable direction to ensure a safe and healthy childhood free from pneumonia.
Dr Richa Sharma, Citizen News Service - CNS
December 15, 2015
