Pneumonia is an acute respiratory infection of the lungs caused by viruses, bacteria and fungi. Despite pneumonia being treatable and preventable, estimates suggest that over 2 million children die every year from pneumonia, making it the leading cause of childhood death worldwide.
On the 2nd November the World Health Organisation and the United Nations Children’s Fund launched the Global Action Plan for Prevention and Control of Pneumonia (GAPP) to raise awareness of the devastating death toll from pneumonia and call on governments, public health policy-makers, charities, non-governmental organisations and the public to work together to implement their action plan.
The GAPP aims to:
- protect children from pneumonia by providing an environment with low risk of pneumonia (strategies include increasing hand-washing or providing adequate nutrition)
- prevent pneumonia in children (with vaccinations against the microorganisms that cause it such as Streptococcus pneumonia and Haemophilus influenzae b)
- Treat children sick with pneumonia with the correct healthcare and antibiotics.
If successful their plan could save 5.3 million children from dying of pneumonia by 2015.
A new “Health in Action” article in this week’s PLoS Medicine by Enarson and colleagues describes efforts by the government in Malawi to introduce a national programme to cut childhood deaths from pneumonia. This strategy, known as standard case management (or SCM), aims to ensure that children with pneumonia in Malawi receive effective treatment, like antibiotics and oxygen therapy.
The SCM strategy for treatment of children with pneumonia in Malawi was based on a similar programme established by the International Union against Tuberculosis and Lung Disease. This was a cost-effective health intervention that has been successfully used to prevent and control tuberculosis in 190 countries. To improve the management of severe and very severe pneumonia in children admitted to district hospitals (accessible to the whole population) the Child Lung Health Programme (CLHP) for pneumonia in Malawi focused on:
- getting lasting commitment from the government to sustain the health programme
- establishing diagnosis and treatment based on the SCM
- teaching clinical staff the SCM
- safeguarding uninterrupted supplies of standardised drugs and equipment needed for pneumonia treatment
- recording and reporting clinical outcomes of pneumonia
- supervising and evaluating the programme
The CLHP in Malawi has been in place since 1999 and was funded by the Malawi government and support from the Bill and Melinda Gates foundation. The CLHP was gradually scaled-up across the entire country over the next 5 years. Between Oct 2000 and Dec 2005, the CLHP successfully trained 312 health workers (including nurses and medical assistants) in SCM and there was a consistent increase in the numbers of children receiving pneumonia treatment in district and central hospitals. Furthermore, the proportion of children dying from pneumonia dropped from 18.6% to 8.4%. The CLHP is now successfully maintained by the Malawi government after the end of external funding for the project. However, there are still ongoing challenges that need to be addressed, such as a shortage of healthcare workers and the effects of malnutrition, malaria, HIV/AIDS and anaemia on the outcome of pneumonia infection.
The reduction of child mortality by two-thirds by 2015 is a major challenge set by the United Nations Millenium Development goals and programmes, like the CLHP in Malawi to reduce deaths from pneumonia, will make a significant contribution to this goal.
Enarson, P., Gie, R., Enarson, D., & Mwansambo, C. (2009). Development and Implementation of a National Programme for the Management of Severe and Very Severe Pneumonia in Children in Malawi PLoS Medicine, 6 (11) DOI: 10.1371/journal.pmed.1000137