fighting pneumonia: issues and challenges

Defeating Pneumonia: Overcoming the Challenges

Why pneumonia ?

• one of the biggest killers diseases in the 20th century

• 2.4 million deaths annually

• Child mortality

Why Pneumonia

Enough efforts ?

WHO & UNICEF campaigns

Sub-Sahara countries and pneumonia

Causes of pneumonia

bacterial, viral and fungal

Pneumonia and ARI

Spreading infection ways

Mechanism of the disease

Symptoms

General symptoms

Decisive symptoms

Chest X-ray and blood test

Vulnerability enhancing factors

Demographics Age

Children under 5

Immune system

Breastfeeding: GAPP Target

Gender?

Source: WHO; “Pneumonia, the forgotten killer of children”

Response through GAPP

Source: WHO: “Global Action Plan for Prevention and Control of Pneumonia” 2009

Context 1

Indoor smoke pollution

50% of mortality

Cognitive impairment, COPD, lung cancer, inflammations and immune system

GAPP Target

Response through GAPP

Source: WHO: “Global Action Plan for Prevention and Control of Pneumonia” 2009

Context 2

Disasters and crises

Rise of mortality: 17 % to 30 %

Shelter

Hygiene

Overcrowding

Nutrition

Access to healthcare

Clustering

HIV/AIDS and pneumonia

Ineffective immune system

Globally90% in low income countries

Antiretroviral therapy coverage

Different strategyPneumocystis Jirovecii

Standard vaccinations ineffective

Antiretroviral Therapy Coverage Low- and middle income countries

http://gamapserver.who.int/gho/interactive_charts/hiv/art/atlas.html

Response through GAPP

Source: WHO: “Global Action Plan for Prevention and Control of Pneumonia” 2009

Progress to reduce vulnerability

Source: IVAC “Pneumonia Progress Report” 2012

Obstacles for low income countries

No/late introduction new pneumococcal conjugate vaccines in low income countries

Low required capacity for national immunization programmes

Too little breastfeeding

Time, pain, exhaustion, traditions, advice medical staff,

socio-economic status.

Access to healthcare and antibiotics

Education parents

Diagnosis and referral

“Lady Health Workers” Pakistan

PneumoniaPrevention, Treatment and

Rehabilitation

Framework of Pneumonia Control (UNICEF, 2006)

Controlling PneumoniaVaccination, which includes the use of vaccines against Streptococcus Pneumonia and Haemophilus Influenza type b.

Case management in the community, health centers and the hospitals

Exclusive breast feeding for the first six months of life

Improvement in nutrition and prevention of low birth weight

Control of indoor air pollution and promotion of a healthy environment

Prevention and management of HIV infection

Community Based Case Management of Pneumonia

Signs Classify As Treatment

Fast Breathing

Low Chest Wall Withdrawal

Stridor in Calm Child

Severe pneumonia

Refer Urgently to Hospital for Injectable Antibiotics and Oxygen if Needed

Give First Dose of Appropriate Antibiotics

Fast Breathing Non Severe pneumonia

Prescribe Appropriate Antibiotics

Advise Mother on Other Supportive Measures and When to Return on a Follow Up Visit

Non Fast Breathing Other Respiratory Disease

Advise Mother on Other Supportive Measures and When to Return on a Follow Up Visit

What is Fast Breathing

If the Child is

2 Months to 12 Months Old 50 Breathes or More Per Minute

12 Months to 5 Years Old 40 Breathes of More Per Minute

Source: WHO/UNICEF, 2006

Treatment

Prompt identification

Full course of antibiotics (bacterial): dangerous if given without proper diagnosis

Pneumonia Prevention: Challenges

Lack of resources (46% sub sahara, 39 % south asia, 36% LDCs)

Access formal medical services

Training of community level volunteers

Creating a barrier

free environment

Socioeconomic Factors: Opportunities and

LiabilitiesMexico

Kenya

Nicaragua

Mexico: Socioeconomic Liabilities (I)

Pneumonia caused by H1N1

Pandemic and Post-Pandemic Group

Socio-economic Status (SES)

Mexico: Socioeconomic Liabilities (I)

Socio-economic Status (SES)

Basic necessities, medical care, insurance

Access to information

Health Care Seeking Behaviour

Kenya: Socioeconomic Liabilities (II)

Symptoms of Pneumonia Ignored

Traditional Equipment

CCM in Nicaragua: Socioeconomic Opportunities

Community Case Management

36% Reduction in Mortality in Children 0-4

Integral part of Nicaragua’s Maternal and Child Health Strategy

Proactive and Reactive Measures

CCM in Nicaragua: Socioeconomic Opportunities

Step 1: Find Step 4: Empower

Step 2: Train Step 5: Visit

Step 3: Educate

Policy Recommendations

GAPP: Cost Implications

Pneumonia under the National Immunization Plan

National Campaign on exclusive breast feeding

Integrated Child Disease Management Plan at the National Level

Promotion of Community Case Management

Equitable distribution of resources

Mass Awareness Program

Thank You!!!!!“Pneumonia can be prevented

and cured.... We must scale-up proven solutions and ensure they reach every

child in need."

UN SG Ban Ki-moon• Lars Faber•Mohammad Moursy•Shakeb Nabi•Tim Carpenter