Childhood Pneumonia- Fact Sheet

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    Globally, every 15 seconds, a child dies of pneumonia. Almost all of these deaths occur in

    countries such as ours.

    Pneumonia causes more child deaths than any other illness. The death toll due to

    childhood pneumonia is higher than the total deaths due to AIDS, malaria and measles

    combined.1

    One in five child deaths in the world due to pneumonia occur in India. It is the number one

    cause of child deaths in India.

    In India 20%, or one in five, deaths of children under the age of five years are due topneumonia.

    Pneumonia kills over 400,000 children in India each year; highest in the world.2 This is

    roughly equivalent to a school bus full of young children dying every hour.

    In India, one child younger than five years of age is affected by pneumonia every second. 3

    Early diagnosis and treatment of pneumonia is the key to survival; however mothers

    generally fail to recognize the early symptoms like cough and wheezing.

    Two out of five cases from the poorest families do not seek treatment for acute respiratory

    infection (ARI), even when children have identifiable symptoms.4,5 Families often delay

    treatment for girls more than boys in some states of India.

    Treatment with appropriate antibiotics can prevent child deaths due to pneumonia. In India,

    only 10-20% of the children affected by ARI, receive antibiotics for treatment.5

    Immediate breastfeeding within the first hour of birth and exclusive breastfeeding till the

    age of six months confers protective benefits to the infant against infections such as

    pneumonia. In India, less than 50% of children are exclusively breastfed upto six months of

    age.5

    Immunization against measles and pertussis (whooping cough) can reduce the risk of

    pneumonia. Only half the children receive measles vaccination before completion of 12months of age or the required three doses of the Diphtheria Pertussis Tetanus (DPT)

    vaccine.5

    Fact Sheet

    1 United Nations Childrens Fund (UNICEF) and World Health Organization (WHO). Pneumoniathe Forgotten Killer of

    Children. September 2006. ISBN-13:978-92-806-4048-9/ISBN-10:92-806-4048-82 Rudan I, Tomaskovic L, Boschi-Pinto C, Campbell H. Global estimate of the incidence of clinical pneumonia among children

    under five years of age. Bull World Health Organ. 2004;82:895903.3 Calculated based on data available from- Rudan I, Tomaskovic L, Boschi-Pinto C, Campbell H. Global estimate of the

    incidence of clinical pneumonia among children under five years of age. Bull World Health Organ. 2004;82:895903.4 Includes children with symptom of rapid breathing which is one of the diagnostic symptoms of pneumonia.5 International Institute for Population Sciences (IIPS) and Macro International. 2007. National Family Health Survey (NFHS-

    3), 2005-06:India:Volume I. Mumbai: IIPS.

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    The contents of this leaf are made possible by the support of the American People through the United States Agency for

    International Development (USAID). The contents of this document are the sole responsibility of Emerging Markets Group

    Ltd. and do not necessarily reflect the views of USAID or the United States Government.

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    Reshmas Survival Story:

    Not all is well

    Every second in India, a child falls sick with the

    number one killer, pneumonia. It is estimated that

    pneumonia kills one child younger than five years

    of age almost every minute, or four lakh children a

    year. This is an unacceptable fact considering that

    pneumonia can be prevented and treated simply and

    inexpensively. However, all that is known has not

    been put to action. Reshmas story describes this

    unmistakably.

    1 Reshmas story was shared by Sayan Chatterjee (MD student) and Sriram Krishnamurthy (Assistant Professor). Lady Hardinge

    Medical College and Kalawati Saran Childrens Hospital

    T

    hetimetoactisnowUSAID

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    ReshmalivesinasluminDelhiwithherparent

    sandfoursiblings.HerfamilymigratedfromA

    ssam

    fewyearsagoinsearchofabetterstandardof

    living.Reshmasfatherisadailywager,earnin

    g

    aboutRupees100perday,whenheiscontract

    ed. Hereldestbrother,whoisonly12yearsol

    d,

    worksatateashopearningRupees800perm

    onth.

    Attheageofthree,Reshmaweighsonly9kgs,

    muchbelowthenormalweightforherage.Sh

    ehas

    notreceivedalltherecommendedvaccinat

    ions. Shehashadtwoepisodesofpneumonia

    inthelast

    sixmonths.Herfamilyconsultedanearbyprivatepractitionerfortreatmentduringthefi

    rstepisode.

    Herconditionimprovedandsymptomsofcoug

    h,feverandfastbreathinggraduallydisappeare

    dwith

    theuseoforalantibiotic. Thefamilydidnothav

    eenoughfinancestoconsultaprivatepractition

    er

    duringthesecondepisode.Theypostponedsee

    kingmedicaladviceandtreatmenttillReshmas

    conditionbecamevisiblylifethreatening.Shew

    asfinallytakentoagovernmenthospitalwhere

    shereceivedpromptmedicalattention.Reshm

    arecoveredafter14daysofhospitalization.Th

    ough

    thefamilydidnotincuranydirectmedicalexpe

    nses,Reshmasfatherlosthisdailywagesfor

    the

    durationofherhospitalstay. Therewereothe

    rexpensespertainingtotransportationandRes

    hmas

    medicalandnutritionalneedsafterhospitaldis

    charge.Herfamilywasforcedtoborrowmoney

    from

    alocalmoneylenderatanexorbitantinterestra

    tetosustaineventhefamilysbasicneeds

    1.

    IfReshmasfamilyhadactedquicklyandtakenhertothegovernmenthealthfac

    ilitywhen

    thesymptomsofcoughinganddifficultbreathin

    gfirststarted,Reshmamaynothaverequired

    hospitalizationandthefamilywouldnothaveh

    adtospendsomuchonhertreatment.

    Coughanddifficultbreathinginachildme

    anspneumonia,seektreatment

    immediately.

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    The

    now

    timeto

    actis

    Preventing childhood pneumonia requires a multi-faceted approach. Children who are not

    fully immunized and get preventable childhood diseases such as measles and/or whooping

    cough are at risk of pneumonia. Factors in the home that put children at risk of pneumonia

    include overcrowded living, tobacco smoke and smoke from open chullahs(cooking fires).

    Weak children are at greater risk of acquiring pneumonia. These include, children whoare undernourished, are born weighing less than 2500 grams, and are sick with measles,

    whooping cough or infected by HIV. Families can prevent pneumonia by:

    ensuring their newborns and infants are fully immunized,

    initiating breastfeeding within an hour of birth, practicing exclusive breastfeeding for the first

    six months and providing sufficient healthy complementary foods once children reach six

    months, and

    eliminating indoor smoke by using smokeless chullahsand prohibiting smoking in the home.

    Early recognition of symptoms and prompt treatment seeking by caregivers can preventdeterioration of the illness and can save poor families from a financial catastrophe. Rural

    children, children of non/less educated mothers and those coming from poor families are less

    likely to seek treatment. Paradoxically, these children are at greatest risk of acquiring and

    dying of pneumonia.

    Preventive measures like practicing exclusive breastfeeding for the first six months, providing

    appropriate nutrition to children based on daily requirements for essential nutrients, growth

    monitoring and vaccination amongst others will go a long way in reducing the incidence of

    pneumonia.

    However, once the child is affected, the key to survival is timely recognition and prompttreatment. Pneumonia begins as something less severe and if detected on time can be

    managed effectively with inexpensive antibiotics.

    Pneumonia kills more children than any other disease. This silent killer claims more

    children every year in India than the total casualties of tsunami in 2004 across 11

    countries.

    The contents of this leaf are made possible by the support of the American People through the United States Agency for

    International Development (USAID). The contents of this document are the sole responsibility of Emerging Markets Group

    Ltd. and do not necessarily reflect the views of USAID or the United States Government.

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    Frequently Asked Questions

    on Childhood Pneumonia

    What is pneumonia?

    Pneumonia is a severe acute lower respiratory infection that specifically affects the lungs. Pusand fluid fill the alveoli, the smallest air spaces in the lungs, and make it difficult to absorboxygen.1,2

    How do I identify pneumonia? What are the commonsymptoms?

    Rapid breathing is the most sensitive sign of pneumonia. There are different cut-offs forbreathing rate (that is, number of breaths per minute) depending on the age of the child. 3

    Other symptoms include cough, fever, chills, loss of appetite and wheezing.

    In severe pneumonia, children may experience lower chest wall indrawing, where their chestsmove in during inhalation (in a healthy person, the chest expands during inhalation).

    Infants (that is, children less than 12 months of age) may be unable to feed or drink and mayalso experience unconsciousness, hypothermia (body temperature lower than normal) andconvulsions.1

    What causes pneumonia?

    There is no single cause of pneumonia. It can be bacterial, viral or fungal and often starts assomething less severe.1,2

    Bacteria are more likely to result in severe pneumonia, with Streptococcus pneumoniae(pneumococcus) being the leading cause of severe pneumonia among children in thedeveloping world. Haemophilus influenzae type b (Hib) is also another common bacterialcause of pneumonia.2,4

    Some diseases, like measles and pertussis (whooping cough), can lead to pneumonia as acomplication.5

    Is my child at risk?

    Children under the age of five years are at risk. Children with low immunity are at greater risk

    for acquiring pneumonia. This means that undernourished children, low birth-weight infants(birth weight less than 2.5 kgs), infants who are not breastfed and children suffering from otherillnesses such as measles, whooping cough and infected by HIV have increased risk.

    1 WHO factsheet available from http://www.who.int/mediacentre/factsheets/fs331/en/index.html2 Pneumo ADIP fact sheet available from www.preventpneumo.org/3 For infants less than 2 months it is 60 per minute, for infant between 2 months to 12 months of age it is 50 per

    minute and 40 per minute for children older than 12 months but below 5 years of age.4 OBrien KL, Wolfoson LJ, Watt JP, Henkle E, Deloria-Knoll M, McCall N, Lee E, Mulholland K, Levine O, Cherian T,

    for the Hib and Pneumococcal Global Burden of Disease Study Team. Burden of Disease caused by StreptococcusPneumoniae in children younger than 5 years: global estimates. Lancet. 2009;374:893-902.

    5 Duke T, Mgone CS. Measles: not just another viral exanthem. Lancet 2003; 361:763-73.

    Ismychild

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    Children who lack sufficient amounts of specific micronutrients, particularly zinc, face additionalrisks of developing and dying from pneumonia.

    Environmental risk factors such as: 1) overcrowding in homes; 2) exposure to tobacco smokemainly through parental smoking; and 3) indoor air pollution2 can also increase the risk of

    acquiring pneumonia.

    Can pneumonia be prevented? How do I protect my childfrom pneumonia?

    Pneumonia is preventable. Prevention of pneumonia requires reducing exposure to biologicaland environmental risk factors associated with development of the condition.6

    Measles and DPT vaccination reduces the risk of pneumonia.

    Exclusive breastfeeding from birth to six months of age7 and adequate complementary feeding8is protective against pneumonia.

    It is essential to reduce indoor air pollution by using smokeless cooking stoves and prohibitingsmoking in home.

    What is the treatment for pneumonia?

    Pneumonia can be treated by inexpensive oral antibiotics, if diagnosed early. Severepneumonia cases may require hospitalization, intravenous antibiotics and oxygen treatment.

    How do I care for my child at home if she/he haspneumonia?

    Seek medical care when early signs like cough or wheezing are seen in the child.

    Follow the instructions for the prescribed antibiotic the amount and timing to be given perday and complete the entire course of medicine, even if symptoms improve.

    Continue feeding as usual.

    Provide the child plenty of fluids.

    Rush the child to the hospital if condition worsens (difficult breathing/rise in bodytemperature/inability to feed or drink).

    What are the governments initiatives to control pneumonia

    in India?Acute Respiratory Infection (ARI), (which includes pneumonia) control is a priority for theGovernment of India and a part of the Reproductive and Child Health Programme (RCH) underthe National Rural Health Mission (NRHM).

    The Hib vaccine which protects against one of the common pneumonia causing bacteria, isbeing included in the Government of Indias routine immunization program in 10 states.

    2 Ibid (refer footnote 2)6 Niessen L et al. Comparative impact assessment of child pneumonia interventions. Bull World Health Organ.

    2009;87(6):472-87 Roth DE, Caulfield LE, Ezzati M, Black RE. Acute lower respiratory tract infections in childhood: opportunities for reducing

    the global burden through nutritional interventions. Bull World Health Organ 2008; 86: 356-64.8 Adequate complementary feeding means that infants/ childs daily requirement for energy and other essential nutrients

    is met through a variety of food groups.

    The contents of this leaf are made possible by the support of the American People through the United States Agency for

    International Development (USAID). The contents of this document are the sole responsibility of Emerging Markets Group

    Ltd. and do not necessarily reflect the views of USAID or the United States Government.

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    What you can do?

    What you can do as a media representative

    Media has a large circle of influence. It can change individual views and shape nationalpolicies. As a media representative, there are various pathways through which you can jointhe effort in combating childhood pneumonia in India.

    Many people are surprised to learn that pneumonia causes the maximum number ofchild deaths in India. Creating awareness about the health, social and financial burden ofchildhood pneumonia is necessary to initiate peoples and institutions thinking on the issue.

    You can influence change at individual or family level through the following ways:

    Provide people information on the grave health and socio-economic consequences of achild acquiring pneumonia.

    Also, provide them with solutions with respect to prevention and treatment of pneumonia.

    Generate awareness about vaccinations that is, the type of vaccine and age at whichthese have to be administered.

    Highlight the issue of early detection and prompt treatment for pneumonia as key to childsurvival.

    Provide information to child caregivers on how to detect early signs and when to seek

    medical advice. Publish contact details of nearest public and private health facilities by neighbourhood

    where pneumonia treatment is available.

    You can generate political will and influence institutional change through the following ways:

    Publish data and facts on the health and socio-economic burden of childhood pneumoniaat the national or regional level.

    Present the big socio-demographic and economic picture of the patterns of childhoodpneumonia; highlight who are most vulnerable and where they are.

    Publish primary health care status reports for different states to highlight strengths anddeficiencies of the health care system across regions of India.

    Share success stories on community case management as well as facility basedmanagement of severe pneumonia or complicated cases.

    Document and share human interest stories to mobilize interest, commitment and action.

    Make pneumonia an issue for editorials.

    This list can be extended further. The means of making this information available and makingchildhood pneumonia an issue of concern are best known to you.

    Collectively, we can work together to keep the issue of childhood pneumonia in the news andin peoples minds so that it no longer remains Indias number one killer among children.

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    atingchildhoo

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    What parents or family members with a young child can do

    Families can prevent pneumonia. Families should ensure that:

    Children are adequately nourished. This implies, newborns are breastfed within an hourof birth, infants are exclusively breastfed for six months and thereafter receive adequatecomplementary feed as required for their age. Infants aged 6-8 months should receive twomeals in addition to breastfeed while children aged 9-23 months should be given threemeals along with breastfeeds.

    Childrens height and weight should be monitored regularly and compared withrecommended standards to identify growth faltering as early as possible.

    Newborns and infants should receive all vaccinations as per Government of Indiasrecommended guidelines that is:

    BCG at birth

    Three doses of DPT (at 1.5, 2.5 and 3.5 months)

    OPV at birth, three doses (at 1.5, 2.5 and 3.5 months) and on every Pulse Polio Daytill the child completes five years of age

    Measles at the age of nine months.

    Reduce indoor air pollution in your house by using smokeless chullahsand prohibitingsmoking inside the house

    You should know and take action:

    If the child gets sick with signs of fever, cough and or wheezing consult a doctorwithout delay.

    Pneumonia can be treated using inexpensive antibiotics if identified early. It isessential to follow doctors advice and prescribed medication which includes thedosage, frequency and duration of administration of the medicine.

    Continue providing food and fluids. Do not restrict food or fluid intake.

    Take the child to hospital immediately if condition worsens (as in, difficult breathing/rise in body temperature/ inability to feed or drink).

    Maintain contact details of nearby clinic and hospitals so that these are easilyaccessible in case of an emergency.

    The contents of this leaf are made possible by the support of the American People through the United States Agency for

    International Development (USAID). The contents of this document are the sole responsibility of Emerging Markets Group Ltd.

    and do not necessarily reflect the views of USAID or the United States Government.