Pneumonia remains leading cause of child mortality worldwide

ATLANTA — Closing gaps in access to health care is key to curtailing pneumonia rates throughout the world, according to a speaker here at the 2010 International Conference on Emerging Infectious Diseases.

Some estimates indicate that about 1.7 million children die from pneumonia each year, but the scope of these estimates is limited, said Edward (Kim) Mulholland, MD, of the London School of Hygiene and Tropical Medicine and the Menzies School of Health Research in Darwin, Australia.

“Pneumonia-related death is a function of nontreatment,” Mulholland said. “Deaths occur outside the vision of health services, mainly in the home, with the majority occurring in the poorest households in the poorest communities.”

Mulholland, therefore, questioned whether these estimates should be applied on a national level.

“Emphasis on national data disguises inequity,” he said. “There is gross and poorly appreciated inequity in access to health services, as well as in quality of health services, geography, economic poverty, ethnicity, language and gender preference in certain societies.”

The challenge of pneumococcal disease

Vaccines have typically been seen as pro-equity because a child at the highest risk for dying from a disease benefits most, even if only from herd immunity, Mulholland said. Pneumococcal vaccines are different from other vaccines, however, because the vaccine is only available in the private sector and in the public sector with limited coverage. Therefore, children at a higher risk for disease are excluded.

Before the introduction of vaccines, and even before the widespread use of antibiotics, pneumonia-associated mortality rates in children aged younger than 5 years began to decrease in the United States, according to Mulholland. He said better infant nutrition and reduced artificial feeding, as well as a shift away from the use of coal and wood to gas and electricity for heating, are theories about what caused initial reductions in pneumonia rates.

These changes and interventions could easily be implemented in poor communities throughout developing countries, Mulholland said, noting that the Global Action Plan for the Prevention and Control of Pneumonia, or GAPP, is actually calling for a balanced approach that seeks to use these strategies, such as improving nutrition, in addition to enhancing access to effective treatment and new vaccines.

Monitoring trends in mortality at the national level and monitoring pneumonia-related deaths within in a country is more useful than estimates derived from models, he said.

“Sharing information, appropriate research, examining data at the country level and proper coordination will be valuable to addressing the problem of child mortality due to pneumonia,” Mulholland said. – by Melissa Foster

For more information:

Mulholland E. A2. Presented at: 2010 International Conference on Emerging Infectious Diseases; July 11-14, 2010; Atlanta.