Treating Pneumonia Requires a Global Response

Rachael Bonawitz, MD

Boston University School of Public Health | Assistant Professor

James Wolff, MD, MPH

Boston University School of Public Health | Associate Professor
A child stands in front of a sign reading, "Pneumonia #1 is the one killer!" at the International Society of Tropical Pediatrics Congress in the Philippines. © 2008 Ferdinand G. Fuellos, Courtesy of Photoshare.

A child stands in front of a sign reading, "Pneumonia #1 is the one killer!" at the International Society of Tropical Pediatrics Congress in the Philippines. © 2008 Ferdinand G. Fuellos, Courtesy of Photoshare.

Every day, we see children in our offices with cough, fast breathing, and fever. If we take an x-ray, there may be clear signs of pneumonia. We treat that pneumonia with amoxicillin and at a follow-up visit a week later, the child will invariably be happy, smiling, and healthy. Unfortunately, across the world, 900,000 children die each year from this treatable disease, and more than half do not even seek treatment for it.

Although child mortality resulting from pneumonia has markedly decreased in the last two decades, it still accounts for 15% of all deaths in children under five and remains the largest infectious cause of death for children in this age group. With 120 million episodes occurring annually, pneumonia places a significant burden on the health system and the household.

Treating pneumonia effectively requires appropriate antibiotics, oxygen, and attention to nutritional status. In 2014, the World Health Organization (WHO) issued revised treatment guidelines emphasizing outpatient treatment with oral amoxicillin in the community. These new recommendations were based on multiple studies over more than a decade, which showed that giving amoxicillin in the community is just as effective as doing so in a facility. Many studies highlight the cost of hospital-based treatment compared to treatment in the community; in many cases, prior to the new guidelines, community health worker referrals to health facilities were often not completed by families with sick children, largely due to cost.

While proper treatment of pneumonia is very effective in reducing morbidity and mortality, preventive interventions are critical for reducing the overall incidence of pneumonia. Improving immunization rates of PCV, Hib, pertussis, and measles would significantly impact the 1.5 million children who continue to die every year from vaccine-preventable diseases (WHO estimate). In addition, handwashing, breastfeeding, improving air quality and reducing exposure to household or indoor air pollution, and PCP prophylaxis for HIV-exposed and -positive infants are all important preventive measures to reduced pneumonia incidence worldwide.

We need global action to overcome the challenges to reducing pneumonia deaths and meeting the new targets of the Sustainable Development Goals, which call for reducing the incidence of pneumonia by 75% in children less than five years of age (compared to 2010 rates) and decreased mortality to fewer than 1 per 1,000 live births. While the Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhea (GAPPD) provides an integrated framework for reducing childhood deaths from both pneumonia and diarrhea, sustained political will to decrease the number one infectious killer of children under five worldwide is critical. Although GAPPD is intended to inform country policies and practices for pneumonia protection, prevention, and treatment, its success and that of other prevention and treatment frameworks will fall short of 2030 targets for survival without sustained investment in low-cost, effective strategies such as community-delivered amoxicillin and vaccination programs.

The global community has long had the tools to protect, prevent, and treat pneumonia in children under five. Getting these tools where they are needed most, and treating children in their communities, remains an essential component going forward so that one and a half million children don’t continue to die every year from a preventable and treatable infectious disease. To read further about current practices for preventing and treating pneumonia, take the newly updated Pneumonia course on the Global Health eLearning Center!