Protecting our children from a silent killer
Less newsworthy than Zika, pneumonia is SA’s fourth-biggest cause of fatalities. explains how many of these deaths can be prevented
PNEUMONIA, a common respiratory illness, continues to be the single largest infectious killer of children under the age of five worldwide. More than 2 500 young children lose their lives every day to this disease.
Although it is a common disease, its significance is not always recognised and it is not considered as newsworthy as perhaps Zika or Ebola, both of which cause fewer deaths globally each year than pneumonia does daily.
What is more disconcerting is that most of the 900 000 annual deaths due to pneumonia in children under five are completely preventable. However, most of these deaths occur in developing countries where resources are limited and socioeconomic risk factors are prominent.
Pneumonia is also the top cause of hospitalisation in young children and therefore contributes significantly to healthcare costs.
Yesterday, November 12, was World Pneumonia Day. This event aims to raise awareness about the devastating effect of pneumonia and the strategies that individuals, healthcare providers, policymakers and donors can use to fight this disease. The theme for this year is “Keep the promise, stop pneumonia now”, which refers to the promise that the global community made to ensure maternal and child health and wellbeing.
In South Africa, despite better access to healthcare and vaccines, pneumonia still ranked fourth overall in the leading causes of death in 2014. Pneumonia made up one in 20 of all natural deaths in adults and one in 10 deaths in children under five in 2014.
In South Africa, more than seven million adults and children are living with HIV, and they are five to 10 times more likely to contract severe bacterial pneumonia than HIV-negative individuals.
Even though the incidence of bacterial pneumonia has declined in HIV-infected individuals since the introduction of more potent antiretroviral treatment in recent years, HIV-positive individuals still remain at higher risk of hospitalisation for pneumonia.
HIV-positive individuals are also more likely to experience recurrent pneumonia and are at increased risk of death compared with HIVnegative individuals. The cost of treating HIV-infected children with pneumonia is generally higher than treating HIV-negative children.
There are a number of strategies that can be used to protect children from developing pneumonia. To help build the child’s immune system, exclusive breast-feeding during the first six months of life should be promoted.
This is not always possible in situations where mothers need to return to work early, but workplaces can be transformed into breast-feeding-friendly places.
Next, access to adequate nutrition, clean water, sanitation and reduction of indoor air pollution (for example, cigarette smoking, cooking or heating with wood or coal) all play a role. However, these are challenging interventions and may be especially difficult in poor communities.
In South Africa, prevention and treatment of HIV is key. Vaccines, such as the pneumococcal conjugate vaccine and Haemophilus influenzae type b vaccine, which act against the most important bacterial causes of pneumonia in children, are freely available in the public health system, yet thousands of children are not fully vaccinated in South Africa and remain at risk of severe disease.
Vaccinating women during pregnancy against diseases such as flu may also potentially protect young babies against the influenza virus and other superimposed bacterial infections.
If children do contract pneumonia, it is vital that it is recognised early and they receive appropriate oxygen therapy and antibiotics, if indicated, as soon as possible. Antibiotics should always be used responsibly.
There is also a need for investment in innovations in laboratory testing, diagnosis and treatment of pneumonia. There is no test that will identify the cause of pneumonia in every case, but new laboratory tests are able to identify multiple pathogens at one time.
New technologies in development include timers to count a patient’s respiratory rate, portable devices to measure oxygen concentrations in the blood, oxygen therapy, and child-friendly antibiotics.
New technologies are being developed to reduce household air pollution and increase access to breast milk.
The National Institute for Communicable Diseases in Johannesburg conducts pneumonia surveillance in a number of hospitals in South Africa. This surveillance programme monitors disease trends for the most important causes of pneumonia, detects outbreaks and identifies risk factors for pneumonia and related deaths.
Despite all the successes that have been achieved, it is imperative that the fight continues to prevent the continuing needless deaths due to pneumonia. All children, regardless of where they are born, should have access to the strategies that will protect, prevent and treat pneumonia.
Dr Von Mollendorf is a medical epidemiologist at the National Institute for Communicable Diseases
Pneumonia made up one in 20 of all natural deaths in adults in SA and one in 10 in children under five Thousands of children are not fully vaccinated in South Africa and are at risk of severe disease