Reinforce smoke-free laws to reduce pneumonia deaths in children
W o r l d Pneumonia D a y - 2 November 2009
Pneumonia kills more children than any other disease. Every 15 seconds it claims another child. Two million (twenty lakhs) children (less than 5 years) die of pneumonia every year. This is when diagnosis and treatment of pneumonia is widely available and affordable, says experts on the first-ever WorldPneumonia Day on 2nd of November 2009.
Pneumonia is a form of acute respiratory infection that affects the lungs. The lungs are made up of small sacs called alveoli, which fill with air when a healthy person breathes. When an individual has pneumonia, the alveoli are filled with pus and fluid, which makes breathing painful and limits oxygen intake.
"Pneumonia can be caused by viruses, bacteria, fungi or chemicals. Pneumonia can be prevented by immunization, adequate nutrition and by addressing environmental factors such as enforcing smoke-free laws and patient-safety practices. Pneumonia can be treated with antibiotics, but according to the WHO, less than 20% of children with pneumonia receive the antibiotics they need" says Prof Kant. "Recently Ventilator Associated Pneumonia (VAP), Pneumonia in immuno-compromised states like diabetes mellitus and AIDS, has caused resurgence of this serious problem" adds Prof Kant. "This can occur at any age and is irrespective of gender. Nosocomial infections (hospital born) are most of the times resistant to antibiotics and have a high mortality. The infections in early stage in such situations might respond to recent, much broad-spectrum and expensive antibiotics but late Pneumonia are commonly resistant and have high mortality. Use of infected endo-tracheal tubes, oxygen masks and anaesthesia gas tubes can also be responsible for such grave situations. Here only patient safety practices can save patients" cautions Prof Kant, who is the former Chief Medical Superintendent of Gandhi Memorial & Associated Hospitals, CSMMU.
"VAP has become important because of use of ventilator in serious patients of trauma, burn, neuro-surgical problems and surgery for instance" says Prof Rama Kant.
According to the World Health Organization (WHO), Pneumonia is the single largest cause of death in children worldwide. "Every year, it kills an estimated 1.8 million children under the age of five years, accounting for 20% of all deaths of children under five years old worldwide. There are some 155 million cases of childhood pneumonia every year in the world. Pneumonia affects children and families everywhere, but is most prevalent in South Asia and sub-Saharan Africa. It can be prevented with simple interventions, and treated with low-cost, low-tech medication and care" says WHO site.
Pneumonia can be spread in a number of ways. The viruses and bacteria that are commonly found in a child's nose or throat, can infect the lungs if they are inhaled. They may also spread via air-borne droplets from a cough or sneeze. In addition, pneumonia may spread through blood, especially during and shortly after birth. More research needs to be done on the different pathogens causing pneumonia and the ways they are transmitted, as this has critical importance for treatment and prevention.
The symptoms of viral and bacterial pneumonia are similar. However, the symptoms of viral pneumonia may be more numerous than the symptoms of bacterial pneumonia.
When pneumonia becomes severe, children may experience lower chest wall indrawing, where their chests move in or retract during inhalation (in a healthy person, the chest expands during inhalation). Infants may be unable to feed or drink and may also experience unconsciousness, hypothermia and convulsions.
While most healthy children can fight the infection with their natural defences, children whose immune systems are compromised are at higher risk of developing pneumonia. A child's immune system may be weakened by malnutrition or undernourishment, especially in infants who are not exclusively breastfed.
Pre-existing illnesses, such as symptomatic HIV infections and measles, also increase a child's risk of contracting pneumonia.
The following environmental factors also increase a child's susceptibility to pneumonia:
* indoor air pollution caused by cooking and heating with biomass fuels (such as wood or dung)
* living in crowded homes
* parental smoking.
"In India, on 2nd October 2008, the smoke-free laws were implemented country-wide, in line with the Cigarette and Other Tobacco Products Act (2003) and also the global tobacco treaty (Famework Convention on Tobacco Control - FCTC) which India has ratified in 2005. The implementation of smoke-free laws has been far from ideal - and this needs to be implemented strictly - not only to harness tobacco control outcomes but also broader public health, environmental and social justice outcomes this law aims to deliver" says WHO's Director-General's Awardee on tobacco control for the year 2005 Professor (Dr) Rama Kant. Parental smoking is one of the key factors to increase child's susceptibility to pneumonia, says Professor (Dr) Rama Kant.
Pneumonia can be treated with antibiotics. These are usually prescribed at a health centre or hospital, but the vast majority of cases of childhood pneumonia can be administered effectively within the home. Hospitalization is recommended in infants aged two months and younger, and also in very severe cases.
Preventing pneumonia in children is an essential component of a strategy to reduce child mortality. Immunization against Hib, pneumococcus, measles and whooping cough (pertussis) is the most effective way to prevent pneumonia.
Adequate nutrition is key to improving children's natural defences, starting with exclusive breastfeeding for the first six months of life. This is also effective in preventing pneumonia and reducing the length of the illness.
Addressing environmental factors such as indoor air pollution (by providing affordable clean indoor stoves, for example) and encouraging good hygiene in crowded homes also reduces the number of children who fall ill with pneumonia.
In children infected with HIV, the antibiotic cotrimoxazole is given daily to decrease the risk of contracting pneumonia.
A very effective and important preventive method for pneumonia and other conditions too is proper hand washing, informs Prof Kant.
Bobby Ramakant, CNS
(The author is a World Health Organization (WHO) Director-General's WNTD Awardee 2008 and writes extensively on health and development. He is a Fellow of CitizenNews Service (CNS) Writers' Bureau. Website: www.citizen-news.org, email: [email protected])
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