Pneumonia is one of the biggest killers of children under 5 globally, responsible for over 2 million deaths annually. It is caused by bacterial, viral and fungal infections which are often spread through airborne transmission. Those most at risk are young children and individuals with compromised immune systems. Efforts through programs like GAPP aim to increase vaccination coverage, improve access to healthcare and antibiotics, reduce indoor air pollution, and promote breastfeeding to help prevent and treat pneumonia cases. However, challenges remain in resource-limited settings where socioeconomic factors can create both liabilities and opportunities in controlling this disease.

1. Defeating Pneumonia:
Overcoming the Challenges

2. Why pneumonia ?
• one of the biggest killers diseases in the 20th
century
• 2.4 million deaths annually
• Child mortality

3. Why Pneumonia

4. Enough efforts ?
WHO & UNICEF campaigns
Sub-Sahara countries and pneumonia

5. Causes of pneumonia
bacterial, viral and fungal
Pneumonia and ARI
Spreading infection ways
Mechanism of the disease

6. Symptoms
General symptoms
Decisive symptoms
Chest X-ray and blood test

7. Vulnerability enhancing
factors

8. Demographics
Age
Children under 5
Immune system
Breastfeeding: GAPP Target
Gender?
Source: WHO; “Pneumonia, the forgotten killer of children”

9. Response through GAPP
Source: WHO: “Global Action Plan for Prevention and Control of Pneumonia” 2009

10. Context 1
Indoor smoke pollution
50% of mortality
Cognitive
impairment, COPD, lung
cancer, inflammations and
immune system
GAPP Target

11. Response through GAPP
Source: WHO: “Global Action Plan for Prevention and Control of Pneumonia” 2009

12. Context 2
Disasters and crises
Rise of mortality: 17 %
to 30 %
Shelter
Hygiene
Overcrowding
Nutrition
Access to healthcare
Clustering

13. HIV/AIDS and pneumonia
Ineffective immune
system
Globally
90% in low income
countries
Antiretroviral therapy
coverage
Different strategy
Pneumocystis Jirovecii
Standard vaccinations
ineffective

14. Antiretroviral Therapy Coverage Low-
and middle income countries
http://gamapserver.who.int/gho/interactive_charts/hi
v/art/atlas.html

15. Response through GAPP
Source: WHO: “Global Action Plan for Prevention and Control of Pneumonia” 2009

16. Progress to reduce vulnerability
Source: IVAC “Pneumonia Progress Report” 2012

17. Obstacles for low income countries
No/late introduction new pneumococcal
conjugate vaccines in low income
countries
Low required capacity for national
immunization programmes
Too little breastfeeding
Time, pain, exhaustion, traditions,
advice medical staff,
socio-economic status.
Access to healthcare and antibiotics
Education parents
Diagnosis and referral
“Lady Health Workers” Pakistan

18. Pneumonia
Prevention, Treatment and
Rehabilitation

22. Framework of Pneumonia Control
(UNICEF, 2006)

23. Controlling Pneumonia
Vaccination, which includes the use of vaccines against
Streptococcus Pneumonia and Haemophilus Influenza type b.
Case management in the community, health centers and
the hospitals
Exclusive breast feeding for the first six months of life
Improvement in nutrition and prevention of low birth
weight
Control of indoor air pollution and promotion of a
healthy environment
Prevention and management of HIV infection

24. Source: WHO/UNICEF, 2006
Community Based Case Management of Pneumonia
Signs Classify As Treatment
Fast Breathing
Refer Urgently to Hospital for Injectable
Antibiotics and Oxygen if Needed
Low Chest Wall Withdrawal Severe pneumonia
Give First Dose of Appropriate Antibiotics
Stridor in Calm Child
Prescribe Appropriate Antibiotics
Fast Breathing Non Severe pneumonia
Advise Mother on Other Supportive Measures and
When to Return on a Follow Up Visit
Non Fast Breathing Other Respiratory Disease
Advise Mother on Other Supportive Measures and
When to Return on a Follow Up Visit
What is Fast Breathing
If the Child is
2 Months to 12 Months Old 50 Breathes or More Per Minute
12 Months to 5 Years Old 40 Breathes of More Per Minute

25. Treatment
Prompt identification
Full course of antibiotics (bacterial): dangerous if given
without proper diagnosis

26. Pneumonia Prevention:
Challenges
Lack of resources (46% sub sahara, 39 % south asia, 36%
LDCs)
Access formal medical services
Training of community level volunteers
Creating a barrier
free environment

27. Socioeconomic Factors:
Opportunities and Liabilities
Mexico
Kenya
Nicaragua

28. Mexico: Socioeconomic Liabilities
(I)
Pneumonia caused by H1N1
Pandemic and Post-Pandemic Group
Socio-economic Status (SES)

29. Mexico: Socioeconomic Liabilities
(I)
Socio-economic Status (SES)
Basic necessities, medical care, insurance
Access to information
Health Care Seeking Behaviour

30. Kenya: Socioeconomic
Liabilities (II)
Symptoms of Pneumonia Ignored
Traditional Equipment

31. CCM in Nicaragua:
Socioeconomic Opportunities
Community Case Management
36% Reduction in Mortality in Children 0-4
Integral part of Nicaragua’s Maternal and Child Health
Strategy
Proactive and Reactive Measures

33. CCM in Nicaragua:
Socioeconomic Opportunities
Step 1: Find Step 4: Empower
Step 2: Train Step 5: Visit
Step 3: Educate

34. Policy Recommendations
GAPP: Cost Implications
Pneumonia under the National Immunization
Plan
National Campaign on exclusive breast feeding
Integrated Child Disease Management Plan at the
National Level
Promotion of Community Case Management
Equitable distribution of resources
Mass Awareness Program

35. Thank You!!!!!
“Pneumonia can be prevented and
cured.... We must scale-up proven
solutions and ensure they reach every
child in need."
UN SG Ban Ki-moon
•Lars Faber
•Mohammad Moursy
•Shakeb Nabi
•Tim Carpenter