18 Nov Improving Diagnosis and Treatment of Childhood Pneumonia and Hypoxemia
In a rural town in the Amhara region of Ethiopia, Wondu has again been admitted to Woreta Health Center. Wondu has been in and out of the center more than a dozen times already and he isn’t even two. His parents thought he was just a child that got sick easily, but when they noticed he was struggling to breathe, they knew it was something more serious. When they brought him in, he was quickly diagnosed with severe pneumonia and hypoxemia – a condition where he wasn’t getting enough oxygen into his body. Luckily, the health centre, which is near Wondu’s home, was well-equipped to treat him as the Clinton Health Access Initiative (CHAI) is piloting pulse oximeters and oxygen concentrators at the facility. Wondu received antibiotics and oxygen therapy and recovered. Prior to the pilot, Wondu and other patients needed to travel more than 70 kilometres to the nearest hospital with such equipment.
Pneumonia is the leading cause of death for children. More than 800,000 children under five die from pneumonia each year. In other words, a child dies nearly every minute from pneumonia. CHAI’s work across five countries – Ethiopia, India, Kenya, Nigeria and Uganda – to address this challenge has revealed several critical issues:
(1) Low rates of respiratory rate counting to screen for pneumonia. Based on several studies, the World Health Organization recommends counting breaths to screen sick children for pneumonia. Children who breathe faster are more likely to have pneumonia because it blocks the passage of oxygen between the lungs and blood. To compensate, the child will breathe faster. However, CHAI’s research has found that healthcare workers rarely count a child’s breath. For example, in India, Nigeria and Uganda, less than 37% of children with clinically diagnosed pneumonia had their respiratory rate counted.
(2) Most healthcare facilities in low- and middle-income countries do not have pulse oximeters to diagnose hypoxemia. Hypoxemia is frequently seen in children with pneumonia. It can easily be diagnosed with a pulse oximeter: a non-invasive medical device that simply clips onto a child’s finger or foot and measures the concentration of oxygen in the blood under the skin. Pulse oximeters can be found in nearly every clinic in high-income countries like the United States as they are invaluable for clinical decision-making. In Ethiopia, India, Kenya, Nigeria and Uganda, less than 11% of children with pneumonia are screened with pulse oximetry.
(3) Children are not receiving optimal treatments. Antibiotics and oxygen therapy are used to treat pneumonia and hypoxemia, respectively, but many children receive inaccurate diagnoses and are not treated. Oxygen equipment in health care facilities are also not functioning due to several factors – such as poor maintenance of existing equipment leading to frequent breakdowns and poor, inefficient coordination to purchase devices and accessories that are compatible with one another.
While complex, these issues can be solved. CHAI aims to introduce new medical devices that can assist in accurate respiratory rate measurement and hypoxemia screening; improve availability and use of correct antibiotics; scale-up access to oxygen to treat hypoxemia; and strengthen monitoring systems to ensure accountability.
We have already taken the first steps. We are working with governments in each of these countries to both launch national pneumonia and oxygen strategies that set a vision for how to address these issues, and to coordinate efforts among partners and stakeholders to make a difference on the ground where children are being treated. This is especially important at the primary care level in places like Ethiopia, where referral to hospitals can be difficult. By ensuring healthcare providers are equipped with the right screening tools and treatments, they will be able to accurately diagnose and treat pneumonia and hypoxemia and save children’s lives. Just like they did with Wondu.
By Felix Lam, Alebel Yaregal Desale, Audrey Battu, Habtamu Seyoum, Clinton Health Access Initiative