Despite robust prevention and protection measures, children all over the world still contract pneumonia. Amoxicillin—the recommended first-line treatment—and oxygen therapy can help improve the outcome for these children. But sadly, not all have access to health care services and treatment. Reaching a fifth birthday is a life milestone that many children in the poorest areas of the world don’t achieve. More equitable access to diagnosis, care and appropriate treatment—within countries and around the world—are critical to reducing pneumonia mortality.
Both diagnosing pneumonia in children and determining the cause are challenging. Pneumonia is most often detected by symptoms that may include fever, cough, and fast or strained breathing. Health care providers may have trouble distinguishing between pneumonia and other illnesses. In some countries, particularly those in Africa, pneumonia is sometimes misdiagnosed as malaria because both diseases present with high fevers in young children.
Even when pneumonia is appropriately identified, it’s tricky for providers to determine between bacterial and viral causes because the clinical symptoms are often similar. Although pneumonia may be caused by bacteria, it is often not found in the blood. This can make appropriate treatment of pneumonia difficult.
Radiography and laboratory tests can be helpful in confirming pneumonia and identifying the organism causing it. However, use of chest x-ray, blood culture, and other tests is limited by cost and technical challenges in many areas of the world. Providing the medical and human resources to high-burden communities can significantly change their ability to diagnose pneumonia in time to prevent unnecessary deaths.
Access to Care and Treatment
Effective, integrated case management strategies ensure that children receive proper and timely diagnosis of and treatment for pneumonia. Improving access to services and increasing awareness and demand for care within communities is crucial to controlling the disease. Otherwise, children may never receive potentially lifesaving treatment, or it may be delayed until the disease becomes more severe. In a young child, pneumonia can progress fairly quickly. There are several reasons why children may not receive appropriate treatment:
- Parents and caregivers may not recognize disease symptoms in a child or know to take the child to a health provider, or even wait too long to do so
- Cost of treatment and distance to a health center, among other barriers, may prevent families from accessing appropriate care for a child with suspected disease
- Families may mistrust the health system, and may prefer to seek advice from other unqualified individuals
- Health care providers may misdiagnose a child with pneumonia and therefore fail to administer appropriate treatment
Pneumonia can affect the movement of oxygen from the lungs into the bloodstream. To measure the amount of oxygen in a patient’s blood, health care workers can use the pulse oximetry test. A probe can be placed against a patient’s finger, and the device uses light to measure blood oxygen levels. When a child is experiencing abnormally low oxygen levels, or hypoxemia, a health worker can provide oxygen therapy to help prevent organ failure and death. The ability to detect and treat hypoxemia in neonates and children under 5 is critical to reducing mortality rates. For children who have trouble breathing and become hypoxic, oxygen therapy provided in time can quickly improve their state.
The antibiotic amoxicillin is currently the only first-line recommended treatment for pneumonia. It can be lifesaving in cases of infections caused by bacteria and can prevent the majority of pneumonia deaths, costing only about USD $0.21-0.42 per treatment course. Dispersable tablets, in particular, are affordable and appropriate for use in young children. Yet time is of the essence. Delayed treatment may be inadequate to prevent the devastating consequences of the disease: death.
The fight against pneumonia should be considered in the context of initiatives to combat antimicrobial resistance. Administering antibiotics appropriately to treat properly diagnosed bacterial infections can help address this global problem. The fact is that more children die due to lack of access to antibiotics, than from antibiotic resistance.
While antibiotics can be inexpensive, the overall costs of treatment can lead to serious financial difficulties for families and communities, contributing to the cycle of poverty. The costs of illness include:
- Direct medical costs of illness (e.g. hospital costs, medical personnel time, diagnostics, and medications)
- Non-medical direct costs (e.g. transportation to health care facilities, food while hospitalized)
- Productivity costs (e.g. lost work time for family members who must care for ill children)