fighting pneumonia: issues and challenges
TRANSCRIPT
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