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Health

Pneumonia
The most dangerous killer

Ershad Kamol

Professor M Abid Hossain Mollah

Pneumonia has become the number one cause of under-five deaths contributing to 19 percent of such deaths all over the world. According to several studies, an estimated three million children under 5 years of age die annually due to pneumonia, despite a remarkable progress in under-five child survival strategy particularly immunisation and oral saline over the last three decades. In fact, pneumonia alone kills more children than combined deaths due to AIDS, malaria tuberculosis and measles. In Bangladesh, an estimated 80,000 children die annually from pneumonia only. According to pediatricians and health scientists, pneumonia attributes 47 percent of total under five illnesses in the country.

Streptococcus pneumoniae and Haemophilus Influenza type b (Hib) are the two major bacteria causing pneumonia in developing countries including Bangladesh. A few other virus and bacteria are also responsible for pneumonia. Pneumonia occurs when germs enter the lungs and cause inflammation there. Children who find difficulties to fight these germs are more vulnerable to acquire pneumonia.

Child specialist Professor M Abid Hossain Mollah elaborates that symptoms of the disease include fever, cough, and difficulty in breathing. "According to WHO and UNICEF guideline if the child is affected by cough and breathing problems" says Prof. Mollah, "parents must look out for two particular signs: “whether the baby is breathing faster than the normal rate and if there is indrawing of the lower part of the chest”. If they find such symptoms the baby must be immediately taken to a doctor or health worker for proper diagnosis and appropriate treatment", he adds.

"Antibiotics can cure pneumonia; however, the treatment failure rate is very high because of growing resistance of the germs against the antibiotics. Many children with pneumonia die because of late arrival to the hospital or to a physician, Professor Mollah continues, "Lack of awareness of the parents about the disease is a great problem in many countries like Bangladesh. Most pneumonia cases can be treated at home with oral antibiotics. But children with severe pneumonia should be hospitalised for further evaluation, treatment with injectable antibiotics and other supportive measures particularly oxygen inhalation."

According to Professor Mollah, parents often take the pneumonia-afflicted child at the last stage to the hospitals where the doctors have little to do to save the child. "Many a times, at the beginning of illness, parents collect medicine from the nearby medicine stores without any prescription of the registered doctor. This indiscriminate use of antibiotics can make the germs resistant to the commonly used effective antibiotics. And this is one of the important cause of treatment failure for pneumonia cases." says Professor Mollah.

"Malnutrition is another major cause that makes children more vulnerable to pneumonia. Moreover, treatment failure rate and mortality is again very high among the malnourished children".

He emphasised the need for popularising breastfeeding further among mothers from all walks of life. The children who are not breastfed are four times more susceptible to infection than the breastfed children, he pointed out and added that breastfeeding could be one of the best means to prevent child mortality even pneumonia.

"If the child gets exclusive breastfeeding up to the age of six months and appropriate complementary foods afterwards along with breastfeeding up to the age of 2 years, he or she is almost safe from pneumonia and as well as other infections", continues Professor Mollah, "There are some other risk factors such as indoor air pollution and inappropriate immunisation that accelerate the risk of pneumonia."

The government is already aware of the problem and has taken measures to reduce the deaths from pneumonia. In January 2009, the government initiated a pilot project on immunisation against Haemophilus Influenza type b and has just been introduced in Khulna division. “The vaccine is being incorporated in the National EPI programme and is now expanding gradually all over the country which will definitely reduce the rate of pneumonia from Haemophilus Influenza type b. But, pneumonia caused by another major germ Streptococcus pneumoniae will remain a threat, since such immunisation is not available in Bangladesh. The western countries have made such immunisation; however, it is not very effective in our country as the germ serotypes are different from those in western countries.

Therefore, it is our hope and aspiration that the government will extend it's collaboration with the International agencies to make effective immunisation against Streptococcus pneumoniae of Bangladeshi children.” says Professor Mollah.

It is obvious that a combined effort by pediatricians, parents and policymakers to combat this killer disease that kills so many children under five years old, is of utmost importance.