Childhood pneumonia: India’s silent epidemic
With the Covid-19 pandemic raging on for two years, the world has recognised the challenges around inequitable access to resilient health systems, especially access to oxygen. This remains a prime barrier in other major respiratory illness which plague India — especially India’s young. Childhood pneumonia, which causes the death of a child every 39 seconds in the country, was the cause for nearly 127,000 deaths in 2018 (UNICEF).
The National Family Health Survey (NFHS) 2019-21, reveals that the number of parents seeking medical care for childhood pneumonia dropped marginally from 73% to 69%. This, even as the cases among Indian households stood at 2.8%.
While the pandemic played a part in this disregard of the killer disease, it also points to lack of awareness about the disease. A better understanding and prioritisation of childhood pneumonia in the community are required. As with Covid-19, it is important to watch out for distinguishing symptoms of pneumonia — to differentiate it from a simple nose block or breathing problems due to upper chest congestion.
Pneumonia can be caused by bacteria, viruses or fungi, and causes acute respiratory infection. The lungs are made up of small sacs called alveoli, which fill with air when a healthy person breathes. When someone has pneumonia, the alveoli fill up with pus and fluid, limiting oxygen intake. Incorrect or delay in treatment can cause respiratory failure.
Children who live in overcrowded conditions and are exposed to environmental contaminants such as indoor and outdoor air pollution are at an elevated risk of contracting pneumonia.
As we are seeing with the Covid-19 pandemic, any change in the course a widespread disease takes can only be done if everyone, including the public, acts in unison. We need a campaign that resonates across the length and breadth of the country — something similar to the “Do Boond Zindagi Ki” campaign for polio eradication. The government’s recently launched SAANS (Social Awareness and Action Plan to Neutralise Pneumonia Successfully) campaign is expected to bring a positive change in the way the country perceives childhood pneumonia. Besides, the inclusion of the Pneumococcal Conjugate Vaccine (PCV) in the universal immunisation programme will go a long way in disease prevention.
But several challenges remain, mainly because identification of pneumonia symptoms requires a high level of diagnostic skills. It is unfair to expect such skills among the frontline health workers such as Accredited Social Health Activists (ASHAS) who are not well equipped, but are still given the responsibility of identifying signs of pneumonia in the early stages. In rural areas, a majority of the care-seeking happens through informal private providers without a formal medical background, and hence they lack the skills to make an informed diagnosis.
Diagnosing pneumonia by getting X-rays and blood samples takes time and is available at health care facilities that are not always accessible. The lack of availability of rapid testing kits that can quickly diagnose pneumonia is another challenge.
The need of the moment is an extensive network of health care providers who are equipped to traverse every nook and corner of the country, diagnosing, treating, and referring patients to the nearest health care facility. The cadre of community health workers, present in every village of India, is equipped and authorised to do so. This is the time to strengthen their capacities to improve their performance.
Private providers should also be roped in to reach the remotest corners of the country. This has to be supported by an intelligent digital backbone that studies the incidence of cases, monitors spikes, and triggers concerted action. Efforts are also needed to shift the organisational culture of accountability to ensure quality.
While we, as a country, suffered terribly from the pandemic, the hard-earned learnings can be used to manage other critical health emergencies, such as pneumonia, as well. Let’s breathe life back into our struggling children.
Rajiv Tandon is director – Health, and Lopamudra Ray Saraswati is manager – Health, Research Triangle Institute International, India The views expressed are personal