Tackling Pneumonia Globally: World Pneumonia Day on 12 November – a Reflection

November 12, 2011
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Watch Message from Sir Fazle Hasan Abed, BRAC Founder & Chairperson on World Pneumonia Day 2011Globally, in every 20 second a child dies from pneumonia. This loss of life is even more tragic because nearly all of these deaths are preventable, and more than 98% of childhood pneumonia deaths occur in developing countries. Safe and effective vaccines, inexpensive treatments and preventive measures exist that can save lives.

Watch Message from Sir Fazle Hasan Abed, BRAC Founder & Chairperson on World Pneumonia Day 2011Globally, in every 20 second a child dies from pneumonia. This loss of life is even more tragic because nearly all of these deaths are preventable, and more than 98% of childhood pneumonia deaths occur in developing countries. Safe and effective vaccines, inexpensive treatments and preventive measures exist that can save lives. If developing countries had these vaccines and medicines, the lives of almost 1 million children under age 5 could be saved every year. Pneumococcal vaccines to prevent pneumonia are desperately needed in developing countries to save the children dying from pneumonia.

Saving children’s life by tackling pneumonia—Bangladesh perspectives
Recently, Bangladesh has made enormous progress with reducing child mortality rate. Along with few other countries, Bangladesh is in track to reaching towards MDG 4 of reducing two thirds of fewer than five child mortality rate by 2015. The current under five child mortality rate is 54 deaths per 1,000 live births, and the immunization rate is 82%. Pneumonia kills almost one fourth of Bangladeshi children who die under the age of five.

Pneumococcus (Streptococcus pneumonae) and Hib (Haemophilus influenza) are two known causes of life-threatening pneumonia and it was found that most strains (72%) of pneumococcus are resistant to coomonly used antibiotic called co-trimoxazole. As a prevention effort, pneumococcal conjugate vaccine would be expected to meaningfully improve child survival in Bangladesh. Since 2009, with the help of Global Alliance for Vaccines and Immunization (GAVI), children of Bangladesh are getting Hib Vaccine as a routine immunization. Yet, pneumococcal vaccine is not in the national EPI schedule so far.

Good news is that, currently GAVI is considering a conditional approval for pneumococcal vaccines as a routine in Bangladesh (Ref: personal contact, Dr. Bari, Deputy Program Manager, EPI, Dhaka; October 2011). Therefore, country readiness including ensuring cold chain facilities at all points of immunization across the country is important for the effective management of new vaccine. The existing vaccine infrastructure, human resources and transport capacities are equally important. Still, this pneumococcal vaccine rolls out needs strong political commitment and guidance from the government through EPI and a mutual collaboration of public and private sector.

Bangladesh could successfully reduce child mortality from pneumococcal infection by introducing affordable pneumococcal conjugate vaccine in the EPI schedule once get required support from GAVI. We wish entire nations commitment for an ambition to make our children free from deadly pneumonia.

Community-based Pneumonia Interventions — Example from BRAC, Bangladesh
Acute Respiratory Infection (ARI) or mostly known as ‘Pneumonia’ is one of the main public health problem in Bangladesh. Both the government of Bangladesh and non-government organizations (NGO) have been working together to reduce the prevalence of ARI among under-five children. Since its inception in 1972, BRAC now emerged as the largest NGO in the world. BRAC’s approach to health is built on a partnership with the people, particularly to the poor. Based on sound epidemiology to determine the most important problems for children, BRAC Health Program (BHP) started the community-based ARI control programme in 2007. Initially, from eight districts (8) in two northern divisions of Bangladesh, currently BHP is implementing the ARI control programme in forty (40) districts across the country.

In ARI programme, BRAC Community Health Volunteer or Shasthya Shebika (SS) receives an extensive 3 days training from para-professionals experienced in managing and treating ARI. This basic training follows a monthly refresher training every month to reinforce their knowledge of ARI/pneumonia. The SS regularly visit households in the catchment areas to screen out the under-five children with ARI symptoms. After detection of the disease, the SSs either treat the children with advice and medicine or refer them to hospital if required. They also educate mothers about recognizing the signs and symptoms of ARI including pneumonia and how and where to get the treatment. The community awareness, case identification and management of ARI by Shebikas(SS) are closely monitored by the Shasthya Kormis (SK, the paid health cadre of BRAC). The Program Organizer (PO) and Upazila (sub-district) Managers also monitor the overall activities of SS and document the disease outcomes. Currently, the number of SS in BRAC Health Programme Bangladesh is more than eighty thousand (80,000) who are supervised by more than seven thousand (7,000) SKs.

Recently, the BRAC Research and Evaluation Division (RED) conducted a research titled “Revisiting the ARI Programme of BRAC: How Well are We Doing?”— in collaboration with BRAC’s Maternal, Neonatal and Child Health (MNCH) program. This study revealed some realities on the ground and learning points for future like mother and SS’s knowledge about pneumonia, care-seeking behavior of mother, barriers of implementing ARI programme etc. The study clearly showed, despite BRAC has taken the noble initiative to prevent and treat pneumonia in the children below five year old, however, the knowledge of BRAC SS and the mothers was not enough to deal with ARI management. Thus it is difficult to expect quick management to save a huge number of children in the community. Many mothers still sought treatment from unqualified providers. May be this is the time to find out innovative ways to save the one quarter children who die from pneumonia every year in Bangladesh before reaching their fifth birthday.

On this 12 November 2011, World pneumonia day is been observed for the third time around the world. GAVI and BRAC are arranging field visits in different locations of Bangladesh to observe activities related to pneumonia awareness.

References:

  • Arifeen et al (2009). Invasive Pneumococcal Disease among Children in Rural Bangladesh.
  • Results from a Population-based Surveillance. Clinical Infectious Disease , S103-S113.
  • Expanded Programme on Immunization (EPI). (2010). Bangladesh EPI Coverage Evaluation
  • Survey. Dhaka: EPI, Directorate General of Health Services.
  • Alamgir, N. I., Naheed, A., & Luby, S. P. (2010). Coping strategies for financial burdens in families with childhood pneumonia in Bangladesh. BMC Public Health.
  • ICDDR,B. (2008, March). Invasive pneumococcal disease burden and implications for vaccine policy in urban Bangladesh. Health and Science Bulletin , 6 (1).
  • GAVI Alliance
  • World Health Organisation (WHO)
  • BRAC Health Programme, Bangladesh
  • Rohde JE. Learning to reach health for all: thirty years of instructive experience at BRAC. Dhaka,The University Press Limited, 2005
  • Islam QS, Ahmed SM and Khan MAU. Revisiting the ARI programme of BRAC: how well are we doing? Dhaka: BRAC, 2011 (RED Working Paper No. 23)

By Dr. Sharmin Zahan, M.B.B.S, M.P.H. (Special Advisor to Mr Faruque Ahmed, GAVI CSO Board Member, 2009-2011) Senior Monitoring and Evaluation Specialist BRAC Health Programme

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