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Pneumonia: Perception Problem

10/23/2009

Dr. Orin Levine on one of the greatest threats to children

Photo courtesy of Save the Children

A doctor examines a chest x-ray of a child with severe pneumonia at the Oscar Danilo Rosales Hospital in León, Nicaragua. A special emergency room has been created in this hospital for children with pneumonia and other respiratory infections. ©Brent Stirton/Getty Photos.

Ask anyone which disease kills more children than any other, and odds are you'll hear malaria or HIV/AIDS. Fewer than 5 percent of Americans will give you the correct answer: pneumonia.

America's perceptions are more closely aligned with spending priorities than on-the-ground realities. Pneumonia kills 2 million children under five every year, more than HIV/AIDS and malaria combined, yet it receives only 1/50th of their combined R&D funding. How is it possible that such a large cause of childhood mortality persists despite affordable, effective interventions? The answer has a little to do with science and everything to do with perception.

The Science

• Pneumonia is a widespread and common childhood illness. In children under five, there are more than 158 million cases of and 2 million deaths from pneumonia every year.
• Complex etiology: Pneumonia, a severe form of acute lower respiratory infection, can be caused by many different pathogens. However, the two leading causes of pneumonia death in children - Streptococcus pneumoniae and Haemophilus influenzae type b - are both vaccine-preventable.
• Diagnosis is hindered by limited access to x-rays and laboratory tests in many parts of the world. Yet simple techniques, such as listening for a cough and counting a child's breaths per minute, have proven to be effective diagnostic tools.

A Perception Problem

• Unlike HIV and malaria, pneumonia has yet to inspire substantial donor support or grassroots activism.
• One possible explanation for this neglect is pneumonia's familiar yet unthreatening image in the developed world.
• In the many parts of the developing world, childhood fevers are presumed to be malarial, resulting in the inappropriate treatment of pneumonia cases. Only 1 in 5 health-care workers knows the danger signs of pneumonia, and less than 20 percent of children with pneumonia receive antibiotics, the recommended treatment for this infection.

The Solution

• Providing data to policy makers to demonstrate pneumonia's impact. Global disease burden data was recently published in the Lancet, and a new interactive cost-effectiveness model is currently available on the PneumoADIP Web site.
• Implementing proven interventions
(1) Protection of children is enhanced by exclusive breastfeeding
(2) Prevention is critical, and vaccines are now available to combat this disease
(3) Treatment at a local level is effective and inexpensive when health-care workers are trained to identify and appropriately treat pneumonia

These three steps: protection, prevention and treatment, comprise an integrated control strategy recently endorsed by the WHO, UNICEF and leading academic researchers. Yet the impact of these interventions will undoubtedly depend on the strength of health systems, parental awareness, and the capacity of health-care workers. Ultimately, success in controlling pneumonia will require a balance between disease-specific initiatives and broader child health programs.

Global Coalition Against Pneumonia, a group of health leaders from developed and developing countries, has now banded together to promote pneumonia control. On Nov. 2, 2009, the Coalition will kick off the first-ever World Pneumonia Day. With supporters from India to the United States to Kenya, this day intends to address pneumonia's perception problem and, in doing so, change its reality.