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Killing pneumonia, the forgotten pandemic

© UNICEF/2011/Kiron
Rahul Debnath with his mother, Shibli Rani. He is now healthy after a severe bout of pneumonia.

By Vanessa Curney

Sunamganj and Dhaka, 10 November 2011: Globally, but especially in South Asia and Sub-Saharan Africa, pneumonia is the leading killer of children under the age of five - more than AIDS, measles and malaria combined. Fifteen countries account for three quarters of childhood pneumonia cases worldwide, of which Bangladesh is one with the northern districts of the country especially vulnerable.

Having said that, Dr. Abdul Hakim from the Jagannathpur upazila health complex says that: “I have been here (at this hospital) for the last 20 years and I’m seeing a decrease in pneumonia cases, with more patients getting treatment at their local health centre and their place of residence. Community care management is increasing and officers are being better taught.”

The reason, he says, is that his hospital has been working together with the Maternal, Neonatal and Child Survival (MNCS) project for a number of years. Jagannathpur is one of those northern areas particularly susceptible to pneumonia (three quarters of the land is submerged under water for six months of the year), and the district, Sunamganj, has been identified by UNICEF as one of the six lowest performing in Bangladesh. It is a designated pilot ‘convergence’ zone – the bringing together of services from within and across sectors to provide a more coordinated and dynamic response to meeting the Millennium Development Goals (in the case of pneumonia, MDG 4 – reducing child mortality), and to addressing the economic and social needs of the most vulnerable peoples of Bangladesh in general.

MNCS was developed as a model by UNICEF and it stretches across different services: from treating pneumonia, to breastfeeding, preventing drowning, providing immunisations, promoting maternal nutrition and essential newborn care, amongst others. It’s a joint venture between UNICEF and its various partners - in the case of this Jagannathpur health centre, implemented through NGOs Concern and VARD (Voluntary Association for Rural Development). The goal of MNCS is ‘to improve the health and survival of women and children, especially the extreme poor and marginalised, by contributing to the reduction of maternal and under-five children mortality in the project area.’

Delivering services
Generally, the hospital delivers the services whilst MNCS, through NGOs, keeps people informed about what sort of treatment they can get and how they can get it. Communication for Development specialists have a particular role to play in this. The MNCS committees also keep themselves updated on cases and can work together with the hospitals and health centres to reach actual and prospective patients and their families.

ey to this joint way of working are the volunteers, the MNCS health promoters, who not only impart their health knowledge to the local community through giving ‘courses’ in villages - teaching about handwashing or the signs of pneumonia through flashcards - but are also trained to weigh new babies, to read their temperatures and to recognise the warning signs for some illnesses. All promoters are volunteers and are women aged between 18 and 40; one is assigned to every 200-250 households.

Whatever happens in the future, Dr Hakim is confident that the knowledge instilled into and from these health promoters will remain. Whilst personal treatment is critical to the recovery of every pneumonia patient, personnel does remain a big problem. It’s difficult to find suitable local staff to train, and when they are found, hard to retain. In addition, Dr Hakim would like to see stronger service provision at the local level. “My hope for this hospital is that it may be better specialised, better equipped with better trained personnel to treat pneumonia patients” he says as he shows us round the baby care ward. “Then parents won’t need to go to the tertiary which is further away.” He recognises that parents often have to make choices about their children’s health when money and work are in extremely short supply.

Warning signs
In spite of its fatality, very few parents know the warning signs for pneumonia, and can dismiss symptoms as innocuous with sometimes devastating results.
A case in point is little Rahul Debnath.

Rahul is an only child who lives with his parents, carpenter and deliverer Shudhangshu Debnath, and his mother Shibli Rani. Their home is Bhabanipur village, Jagannathpur upazila in the district of Sunamganj.

Rahul was born in March this year. Whilst visiting the family, Shipa Rani Chanda, a 20 year old MNCS health promoter, noticed that Rahul was more restless than usual. He was also refusing breast milk and indrawing deeply through the chest. She recognised the pneumonia signs and urgently encouraged his father to take his son to Jagannathpur upazila health complex.

Shudhangshu met with a doctor and was given treatment for his son, but his condition actually deteriorated when they returned home. Only entreaties from concerned neighbours as well as interventions from Shipa and her mentor, Community Health Facilitator, Rita Rani Badya, convinced Shudhangshu to make a second visit to the hospital.

There after two days, Rahul had still made little progress, so doctors referred them up to the tertiary level Osmani Medical College Hospital at Sylhet. However Shudhangshu instead returned home with a very sick little baby. Again, interventions from Shipa, Rita and the MNCS committee members persuaded the father to admit his son to the recommended hospital, where Rahul was finally, and successfully, treated for pneumonia over six days. In Rahul’s case, disaster had been averted.

© UNICEF/2011/Kiron
Two and a half year old Muslima Begum and her mother, Rina Begum, in a UNICEF-supported baby ward at Jagannuthpur hospital. Muslima is a pneumonia patient who has had a cough and fever for ten days.

*What is pneumonia?
Pneumonia is a severe form of acute lower respiratory infection that specifically affects the lungs.

Most acute respiratory infections (ARIs) result in mild illnesses such as the common cold. But in vulnerable children, infections that begin with mild symptoms can lead to pneumonia – especially when combined with diseases such as diarrhoea or malaria. During or shortly after birth, babies are at higher risk of developing pneumonia especially during the neonatal period.

Children aged two months to five years with severe pneumonia should be referred to the nearest health facility immediately. Those diagnosed with pneumonia may be treated at home with a full course of effective antibiotics. Infants less than two months old with signs of pneumonia should be referred promptly to the nearest health facility because they are at high risk of suffering severe illness or death.

Some common symptoms in children and infants include:

  • rapid or difficulty breathing;
  • coughing;
  • chest indrawing;
  • chills;
  • fever;
  • headaches;
  • loss of appetite;
  • wheezing;
  • convulsions;
  • unconsciousness;
  • hypothermia;
  • lethargy;
  • feeding problems.

Reducing and preventing pneumonia in Bangladesh
Immunisation: In 2009, Bangladesh, with support from UNICEF, WHO, GAVI Alliance and other partners introduced a new vaccine to prevent severe forms of child pneumonia and meningitis. The Hib Pentavalent vaccine (or 5 in 1 vaccine as it is also known) also guards against diphtheria, tetanus, pertussis, and hepatitis B.

This means that children will only need one injection at three different times during their first year of life – at 6, 10 and 14 weeks. Coverage in Bangladesh currently stands at 90%.

*Pneumonia, the Forgotten Killer of Children (UNICEF/WHO, 2006)

Immunization status in Sunamganj district and Jagannathpur Upazila:

In Sunamganj District:
Target in 2010= 74090
Penta 1 coverage=74059
Penta 2 coverage=72885
Penta 3 coverage=71416

Target in 2011= 75054
Penta 1 coverage by October=60913
Penta 2 coverage by October =60051
Penta 3 coverage by October =59484

In Jagannathpur Upazila:
Target in 2010= 7941
Penta 1 coverage=7549
Penta 2 coverage=7375
Penta 3 coverage=6961

Target in 2011= 8018
Penta 1 coverage by October=6109
Penta 2 coverage by October =6110
Penta 3 coverage by October =6098

Source: Civil Surgeon Office, Sunamganj



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