Reaching the most vulnerable

To reduce child and adult pneumonia deaths, countries will need to tackle the risk factors and improve the coverage of high-impact interventions – especially pneumonia-fighting vaccines and treatments like oxygen – among the most vulnerable populations. 

The Risk Factors

Many pneumonia deaths are attributed to environmental (e.g., air pollution, hand washing and extreme temperatures) and behavioural (e.g., child wasting, smoking and low birth weight) risks as defined by the Global Burden of Disease.  The risk factors for pneumonia death vary by age and by gender.

It starts from birth…

Three-quarters of child pneumonia deaths occur in the first year of life, with almost a fifth in the first week after birth.

Although there has been significant progress in reducing risk-related child pneumonia deaths in most countries, large populations of children remain exposed to wasting, air pollution, no access to hand washing and other risks, and subsequently die from pneumonia.

The most urgent priority in pneumonia risk reduction is to further reduce child wasting.

Child Wasting

Child wasting

Wasting is the leading risk factor for child pneumonia deaths, contributing to more than half of the deaths in 2019.

  • More than 70 per cent of the estimated 47 million wasted children live in high-burden pneumonia countries. India alone is home to 20 million wasted children.
  • In 14 Sub-Saharan African countries more than 60 per cent of child pneumonia deaths are attributable to wasting.

Wasting-related child pneumonia deaths are concentrated among children aged one month to one year. Evidence suggests wasting often begins much earlier in the womb and that children who are born with low birth weight are more likely to become wasted.

A child is wasted when they have extremely low weight-for-height. Wasting often indicates recent and severe weight loss, although it can also persist for a long time. It usually occurs when a child has not had food of adequate quality and quantity and/or they have had frequent or prolonged illnesses.

Wasting is a much greater risk factor for child pneumonia death than stunting and being underweight.

Read more – here

Air Pollution

Air Pollution

Almost a third of all pneumonia deaths were attributable to polluted air – killing around 749,200 in 2019. Household air pollution contributed to 423,000 of these deaths while outdoor air pollution contributed to 326,000.

Children are more susceptible to household air pollution in homes that regularly use polluting fuels and technologies for cooking, heating and lighting. While outdoor air pollution, especially from pollutants emitted by industries and car exhaust smoke, disproportionately affects older adults.

Ninety per cent of air pollution-related deaths are concentrated in 40 low- and middle-income countries. In many African countries, air pollution contributes to more than 50 per cent of all pneumonia deaths. And while pneumonia deaths from household air pollution are declining in Africa, they are tragically increasing due to outdoor air pollution. This is also the case for Asia.

Read more – here

Hand Washing

Hand washing

Low or no access to hand washing is key to preventing the spread of pneumonia. Of all WASH interventions, hand washing has the greatest potential to reduce the risk of death from pneumonia for children and adults.

Studies have shown that improved hand washing with soap reduces pneumonia risk. Evidence suggests that washing hands with soap after defecation and before eating can cut the respiratory infection rate by up to 25 per cent. Investing in this simple intervention for the most vulnerable children has the potential to make a big impact.

Yet, in low-income countries one in four health care facilities has no water and one out of six has no hygiene service, meaning they lack hand hygiene facilities at points of care, as well as soap and water at toilets. – placing patients at great risk. Further, in 2017, 40 per cent of the world’s population lacked hand washing facilities with soap and water at home.

Read more about the risk factors in the Missing Piece Report.

Pneumonia-fighting vaccines

Beyond risk reduction strategies, there are very effective tools to prevent pneumonia. Chief among them are the “pneumonia-fighting” vaccines. These include the pneumococcal conjugate vaccine (PCV) and the haemophilus influenzae type B vaccine (Hib), which target the leading bacterial causes of childhood pneumonia, as well as vaccines against diphtheria, tetanus and pertussis (DTP), measles (MCV) and COVID-19 vaccines.

The expansion of this “basket” of pneumonia- fighting vaccines has contributed to a 57 per cent decline in childhood pneumonia deaths since 2000, from an estimated 1.6 million to 672,000.

But despite recent progress, there are still massive gaps in the coverage of pneumonia-fighting vaccines – particularly PCV:

  • More than one out of every two children under five globally is not fully protected with the PCV. That is 353 million children.
  • More than half of child pneumonia deaths are in countries with low pneumonia vaccine coverage – most notably, Nigeria and India.
  • 52 countries do not offer the PCV, including countries with the heaviest burdens of child pneumonia deaths – China, Somalia, Chad, Guinea, Egypt and South Sudan.

The cost of low coverage of the pneumonia-fighting vaccines is starkly measured in lives lost to pneumonia.

The wide adoption of the PCV – and other vaccines that prevent pneumonia – is especially important in Africa where careseeking rates for children with pneumonia symptoms are low (46 per cent).

Studies also show that widespread use of the PCV could reduce antimicrobial resistance by lowering the number of days children with pneumonia receive antibiotics each year by half.

In an era where respiratory pandemics are increasingly likely, pneumonia-fighting vaccines have become even more critical.

Read more – here

Pneumonia Fighting Vaccines