Pneumonia is a major cause of under five child mortality. In developing countries cases of pneumonia are very much prevalent. Usually the cases are under-diagnosed and under-reported causing a serious burden in the community. In India, around 1.4 lakhs children die due to pneumonia annually.
The national goals for pneumonia to be achieved by 2025, under the integrated action plan for pneumonia and Diarrhoea (IAPPD) are–
1. Reduce mortality from pneumonia to <3 per 1000 live births.
2. Reduce the incidence of severe pneumonia by 75% as compared to 2010 levels.
Basically pneumonia is broadly classified as
1. No pneumonia/ cough or cold
2. Pneumonia
3. Severe Pneumonia or Very severe disease
No pneumonia is when there is only minor cough or cold which can be treated at home. According to WHO, Pneumonia can be suspected when there is increased respiratory rate according to age in below 5 years children. The cut-off value of respiratory rate for babies less than 2 months is 60 per minute, 2 months to 12 months is 50 per minute and 1 year to 5 years, it is 40 per minute.
What is Protect, Prevent and Treat framework??
The interventions provide key strategy for preventing pneumonia are PPT(Protect, Prevent, Treat)
Protect
Protecting children by exclusive breast feeding and appropriate complimentary feeding reduces the severity of pneumonia.
Prevent
Preventing children by universal coverage of immunisation. Use of vaccines like MMR, pneumococcal vaccine reduces the risk of pneumonia. Handwashing is a key hygienic practice decrease risk of infections. Reduction of household air pollution also reduces the incidence of pneumonia.
Treat
Treatment of pneumonia according to standard guidelines and protocol. Identification and treatment of pneumonia in the community, timely referral, strengthening the quality care system in the grass root level substantially reduces the complications and mortality in pneumonia.
The treatment guidelines are divided according to two age groups.
– Management of sick children in below 2 months.
– Managing children in pneumonia in 2 months to below 5 years age group.
The approach, classification and treatment of cases are divided into three colour codes like pink, yellow and green.
The conditions included in the pink colour indicates the severe illness. Children with severe illness should be referred to a hospital. Conditions included in yellow box should be treated with medicines at home and home care advice given to mother. The conditions included in the green box are treated with home care without use of medicines.
What is Pneumonia ??
Pneumonia is inflammation of lungs. It can be due to infection of bacteria, virus, fungus or parasites. The most common bacteria causing pneumonia are Streptococcus pneumoniae and haemophilus influenzae. The symptoms may be fever, cough, and difficulty in breathing.
Two important clinical signs for assessing pneumonia–
– Fast breathing
– Chest indrawing
Danger signs in children–
– Not able to drink or breastfeed
– Vomiting everything
– Convulsions
– Lethargic or unconscious
Severe Pneumonia or Very severe disease– Generalized danger signs as discussed above.
Management–
-Hospitalisation
-Give oxygen if SPO2<90%
-Airway management
– Use of recommended antibiotics like Ampicillin, Gentamycin, Cefalosporins like Cefotaxime, Ceftriaxone
Pneumonia–
Signs are- Chest indrawing or fast breathing according to age group as already discussed.
Management–
-Oral amoxycillin for 5 days
– Home care of cough and cold
– Follow up after 2 days
Photo credit– nhlbi.nih.org
