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Pneumonia. Pneumonia leads causes of childhood deaths Source: WHO estimates of the causes of death in children, 2000-03 Bryce, Lancet, 26 March 2005

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  • Pneumonia
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  • Pneumonia leads causes of childhood deaths Source: WHO estimates of the causes of death in children, 2000-03 Bryce, Lancet, 26 March 2005
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  • Where do 10 million children die each year? WHO estimates of the causes of death in children, Lancet, 2005
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  • Source: World Health Report, 2005
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  • Percentage of children that die from pneumonia, by country From Williams et al. Lancet Infect Dis, 2002.
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  • Age-specific incidence / mortality of pneumonia
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  • Is pneumonia a problem in emergencies? Examples of pneumonia deaths Examples of pneumonia deaths 63% among Nicaraguan refugees in 1989 63% among Nicaraguan refugees in 1989 30% of under-5 deaths in Kabul in 1993 30% of under-5 deaths in Kabul in 1993 80% when combined with malaria and diarrhea among Congolese refugees in 1999 80% when combined with malaria and diarrhea among Congolese refugees in 1999 Most data limited to mortality Most data limited to mortality Few studies of morbidity Few studies of morbidity
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  • Major Causes of Death in emergencies for
  • Case Definition Case Definition Moderate Severe Lower Respiratory Infection in children: 1) Fever + 2) Cough + 3) Rapid breathing (more than 50 breaths/minute) A child has tacypnoea if Respiratory rate >60/min in children 50/min in children 2-11 months Respiratory rate >40/min in children 12-59months
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  • WHO focuses on the reduction of mortality requiring: Early/adequate diagnosis Correct case management Hospitalize for danger signs Access to health care Trained health staff Simple treatment protocols Immunization May increase transmission risk for meningitis Control of Lower Respiratory Infections MSF book, p. 178
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  • Clinical management of a sick child with cough or difficult breathing Danger signs* YES Refer to hospital Give antibiotics NO Assess for chest indrawing YES NO Refer to hospital Give antibiotics VERY SEVERE DISEASE * Danger signs include cyanosis, convulsions, severe malnutrition, difficult to wake, not able to drink SEVERE PNEUMONIA Assess for fast breathing (RR>50/40 breaths/minute) YES NO=NO PNEUMONIA; COUGH OR COLD Give antibiotics PNEUMONIA
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  • Recommended Antibiotics for Pneumonia AntibioticDoses/dayRelative cost Cotrimoxazole2 POLowest Amoxicillin3 POHighest Procaine penicillin1 IM Middle Antibiotic dose needs to be calculated by the weight of the child
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  • Results of community case management interventions on mortality, by age Sazawal and Black. Lancet ID, 2003
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  • Potential Barriers to Effective Case Management Depends on care seeking and access recognition of illness access to care acceptability of care Depends on training and supervising health care workers Depends on availability of antibiotics
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  • Pneumonia: Prevention Avoid overcrowding Provide alternatives to open indoor fires Provide adequate shelter and blankets/heating Prevent malnutrition Encourage breastfeeding Vitamin A supplementation Vaccinate Reduce Pneumonia Reduce secondary bacterial infections
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  • Existing vaccines to prevent pneumonia Routinely used Routinely used Measles Measles Pertussis Pertussis Diphtheria Diphtheria Haemophilus influenzae type b (In some countries) Haemophilus influenzae type b (In some countries) Future Future Pneumococcal Pneumococcal RSV RSV
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  • Efficacy of Haemophilus influenzae type b (Hib) vaccine on pneumonia outcomes
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  • Tuberculosis in Emergencies Not cause of significant mortality Not cause of significant mortality Post emergency setting: affects morbidity & mortality Post emergency setting: affects morbidity & mortality Depending on the epidemiology of the disease Depending on the epidemiology of the disease Need for continuation of treatment for those patients who already are on treatment Need for continuation of treatment for those patients who already are on treatment Need for effective control program Need for effective control program
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  • Tb Control Conditions for implementing TB Program: Conditions for implementing TB Program: Basic health priorities already addressed Basic health priorities already addressed Long term commitment - 1 year from last case Long term commitment - 1 year from last case Stable population - patients complete treatment Stable population - patients complete treatment Adequate drug supply Adequate drug supply Knowledge of baseline drug resistance Knowledge of baseline drug resistance Laboratory confirmation Laboratory confirmation Appropriate treatment algorithm Appropriate treatment algorithm