New and noteworthy research
A selection of recent, peer-reviewed publications challenging current orthodoxy and revealing new pathways to prevent pneumonia deaths among children and adults. The insights revealed in these studies have major implications for the ways in which global, regional, national, and local political and decision-making bodies design and deliver policies and programs to prevent, diagnose, and treat pneumonia.
Are we undervaluing the role of non-vaccine interventions to reduce childhood pneumonia deaths?
A new study of the lifesaving power of vaccines (PCV and Hib), antibiotics, and medical oxygen to reduce pneumonia deaths among children in Bangladesh, Chad, and Ethiopia, reveals many more deaths could be reduced with antibiotics and access to pulse oximetry and oxygen. In Bangladesh, which already has high PCV and Hib coverage, full coverage (>90%) of pulse oximetry, oxygen, and antibiotics could reduce ~20,000 deaths, 76,000 in Chad, and 97,000 in Ethiopia by 2030; representing 45%, 58%, and 50% of child pneumonia deaths respectively.
Pfurtscheller T et al. Predicting the potential impact of scaling up four pneumonia interventions on under-five pneumonia mortality: A prospective Lives Saved Tool (LiST) analysis for Bangladesh, Chad, and Ethiopia. Journal Global Health, 2024.
Have we underestimated the risk of Klebsiella pneumoniae infection among children?
A new analysis of Child Health and Mortality Prevention Surveillance (CHAMPS) data on what causes the deaths of 2,352 children under five and stillbirths in Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa, and Bangladesh revealed that 21% tested positive for K pneumoniae. Frequency by site ranged from 6% in Bangladesh to 52% in Ethiopia. K pneumoniae causes sepsis and pneumonia and is highly resistant to the antibiotics ceftriaxone and gentamicin, according to two recent Lancet studies here and here. Time to accelerate a vaccine?
Verani JR et al. Child deaths caused by Klebsiella pneumoniae in sub-Saharan Africa and south Asia: a secondary analysis of Child Health and Mortality Prevention Surveillance (CHAMPS) data. Lancet Microbe, 2024.
Is it time to give up on the idea that cleaner cook stoves can improve child health?
Two important new papers from the Household Air Pollution Intervention Network (HAPIN) are challenging the connection between exposure to household air pollution and childhood stunting and pneumonia. They found that significant reductions in household air pollution did not have any effect on childhood stunting or pneumonia. The results imply that efforts to focus on other risk factors – poor nutrition and sanitation, poverty, coexisting illnesses, low levels of vaccination, female illiteracy and agency, etc. – should receive greater attention.
HAPIN Investigators. Liquefied Petroleum Gas or Biomass Cooking and Severe Infant Pneumonia. N Engl J Med, 2024 and Liquefied Petroleum Gas or Biomass Cooking and Severe Infant Pneumonia. New England Journal Medicine, 2024.
When will we have more effective risk assessment tools for children with pneumonia?
Risk assessment for children with pneumonia should include routine evaluation for hypoxemia (pulse oximetry), decreased conscious state (e.g. AVPU), malnutrition (severe, moderate, and stunting), and the presence of an underlying chronic condition as these are strongly and consistently associated with increased mortality. Other potentially useful risk factors include the presence of pallor or anaemia, chest in-drawing, young age (<12 months), inadequate immunization, and leukopenia.
ARI Review Group. What are the risk factors for death among children with pneumonia in low- and middle-income countries? A systematic review. Journal Global Health, 2023.
Can we move faster to make sure children in low-resource settings do not miss out on the RSV vaccine?
Respiratory syncytial (sin-SISH-uhl) virus, or RSV, was detected in almost one third of the children hospitalized with pneumonia with a median age 4.6 months compared to RSV-negative children of 10.5 months. RSV is common in children hospitalized with pneumonia and mainly affects younger children. There is an urgent need to find an effective vaccine to prevent RSV pneumonia in children worldwide, especially in low-resource settings that carry the greatest burden of disease.
Morgan N, Buys H, Muloiwa R. RSV infection in children hospitalised with severe lower respiratory tract infection in a low-middle-income setting: A cross-sectional observational study. PLoS One, 2023.
Why are so many children being sent home to die from hospitals in low-resource settings?
Among diverse sites in Africa and south Asia, almost half of mortality occurs following hospital discharge. Despite being highly predictable, these deaths are not addressed in current guidelines. A fundamental shift to a child-centred, risk-based approach to inpatient and post-discharge management is needed to further reduce childhood mortality, and clinical trials of these approaches with outcomes of mortality, readmission, and cost are warranted.
Childhood Acute Illness and Nutrition (CHAIN) Network. Childhood mortality during and after acute illness in Africa and south Asia: a prospective cohort study. Lancet Global Health, 2022.
When will every pediatric ward have a reliable source of quality medical oxygen?
Hospitals with fully functioning oxygen in their pediatric wards can reduce child pneumonia deaths by nearly a half and all-cause child deaths by a quarter. This makes oxygen one of the most lifesaving investments a hospital and government can make. Every Breath Counts calls on international donors need to heed this research and invest more in helping countries close access to oxygen gaps.
Lam F, Stegmuller A, Chou VB, Graham HR. Oxygen systems strengthening as an intervention to prevent childhood deaths due to pneumonia in low-resource settings: systematic review, meta-analysis and cost-effectiveness. BMJ Global Health, 2021.
What are the policies and/or tools that will reduce antibiotic overuse in children?
Between birth and age 5 years, children in l0w- and middle-income countries are prescribed a remarkably high number of antibiotics. A large proportion of these prescriptions appear to be unnecessary. National and local efforts to reduce unnecessary prescription of antibiotics to children would likely improve both patient wellbeing (in terms of preventing side-effects) and reduce the global threat of antimicrobial resistance.
Fink G, D’Acremont V, Leslie HH, Cohen J. Antibiotic exposure among children younger than 5 years in low-income and middle-income countries: a cross-sectional study of nationally representative facility-based and household-based surveys. Lancet Infectious Diseases, 2020.