Pneumonia is the leading global killer of children under five, responsible for almost 1.6 million deaths per year, which is about one-fifth of all paediatric deaths around the world. Like other acute respiratory infections, pneumonia targets the world's most vulnerable children—those who are poor and mal/undernourished. The burden of pneumonia in the developing world is nearly 10 times that of developed world In low income countries, pneumonia kills 7320 out of 100,000 children below 5 years of age, as compared to just 34 in developed countries. In South Asia and Sub Saharan Africa 21% of all deaths in children are due to pneumonia. According to the Acute Respiratory Infections Atlas 2010, lack of food contributes to 44% of deaths from pneumonia in children globally.
The prevalence, of childhood pneumonia is very high in India, and claims the lives of nearly 43,000 children every year. Proper nutrition is crucial to supporting the body's natural defences, and in helping to reduce the effects of a disease once it is contracted. There is a general consensus amongst doctors that malnutrition makes children immune suppressed, thus making them an easy target for a host of diseases, including pneumonia. Although poverty does lead to under nutrition, sometimes lack of knowledge about cheap but nutritive food items also prevents parents from providing a proper diet to their child. This is particularly true of urban families where processed and fast foods are becoming an integral part of children's daily diet. It is not uncommon even for urban slum dwellers to opt for greasy, fatty foods instead of the simple and highly nutritive, dal-roti.
Professor (Dr) Gourdas Choudhuri, Professor and Head Gastroenterology Department, Sanjay Gandhi Post-Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, agrees that malnourished children are more vulnerable to pneumonia. Prof (Dr) Choudhuri is a strong advocate of healthy living in children and feels that, “Lifestyle disorders play a crucial role in management of diseases like pneumonia. Obese children are also malnourished and so have a compromised immune system. So it is important to ensure that children keep an ideal body weight and use the sports field and/or do plenty of exercise to keep their lungs healthy, in order to avoid the onset of pneumonia and other respiratory diseases.”
Dr Dinesh Chandra Pandey, a Specialist in Paediatric Medicine at Nelson Hospital of Paediatrics and Neonatal Medicine, said that till some years back pneumonia was less prevalent in affluent homes as compared to poor families. But protein-energy malnutrition, overcrowding, indoor /outdoor pollution and life style changes are taking their toll in the upper strata of society as well, where incidences of pneumonia and diarrhoea are on the rise. He lamented the popularity of fast foods which are poor in qualitative nutrition and are making children not only malnourished, but immune compromised also. So, pneumonia is no longer confined to poor households alone, though in developing countries like India, the incidence is higher in low income families.
In Dr Pandey's opinion, “Good nutrition need not be expensive. In some villages, children are more likely to have access to good nutritive diet, like fresh fish from the river, and pure cow/buffalo milk, which urban children may not be able to get that easily. Rural kids also have better and cheaper access to green vegetables and fruits. Urban families may be spending a lot on food but compromising on its nutritive aspect. I would emphasize that diet should be nutritionally balanced by way of quality and quantity and be appropriate to the child's needs. Commercially available products like fast and junk food, which are heavily advertised in print and electronic media, should be avoided. Simple homemade food is good for the children.”
Dr Ajay Misra, Managing Director of Nelson Hospital of Paediatrics and Neonatal Medicine, also stresses upon educating the public on the role played by good diet in preventing pneumonia and other diseases. He feels that, “Parents should know the caloric needs of their child and ensure a balanced diet, containing adequate amounts of protein, carbohydrate, iron, and calcium for their children. I would highly recommend fibrous foods like green vegetables, lentils, simple roti/chapatti which is relatively cheaper and very good for the health. Parents should not initiate their kids to fast foods like pizzas, burgers, pastries, and colas drinks which are very harmful and should be indulged in once in a while only. I would strongly recommend fruits and not juices, as the former have enough fibre along with minerals.”
Inadequate nutrition—in utero, during infancy, and early childhood is closely linked to lifelong immune deficiencies and acute respiratory infections like pneumonia. Inadequate maternal nutrition is also a major risk factor for later childhood pneumonia, as it is linked to low birth weight. Suboptimal breastfeeding also increases the risk of malnutrition and vitamin deficiencies in the infant.
According to Dr Amita Pandey, Associate Professor, Department of Obstetrics and Gynaecology at the Chhatrapati Shahuji Maharaj Medical University (erstwhile King George's Medical College), “Although pneumonia affects rich and poor children, studies have shown that it is more common in malnourished children. The same infection which ends in a mere Upper Respiratory Tract Infection (URTI) in a well nourished child is very likely to cause severe debilitating pneumonia in a malnourished one. I would like to add here that well fed children from well off families can also be malnourished due to a variety of reasons—they are not breast fed, they are on top feed which does not have enough proteins, or the top feed is mixed with water with the misconception of making it more digestible. As the child grows older milk is often supplemented with food items which may not be nutritive—like colas, chocolates, fries, burgers, pizzas. All this adds to malnutrition. As the baby grows older, it has to be weaned off mother's milk and given a protein rich diet, including fruits, to boost the immune system.”
Improvements in health care and nutrition are interventions that can significantly reduce the incidence of pneumonia. According to the Acute Respiratory Infections Atlas, 2010— broad and integrated commitment on the part of the international community to improving living standards worldwide is the true foundation of prevention. With a view to improving nutrition and increasing immunity against pneumonia and other diseases, the World Health Organization stresses upon exclusive breast feeding till six months; breastfeeding and complementary foods until two years of age; and thereafter an access to nutritional supplements and a healthy diet. Rising food prices over the past few years have added to the woes of malnutrition. At the time of writing this article, food inflation in India was at an all time high of 9.13%. It is imperative to have commitments from governments to combat malnutrition at the community level.
Meanwhile one must remember that expensive foods may not always be nutritive, and that overfed/obese as well as undernourished children are low on immunity and hence breeding grounds for many childhood diseases, including pneumonia. (CNS)
Shobha Shukla - CNS
(The author is the Managing Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation (NPF) USA. She has worked earlier with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. Email: [email protected], website: http://www.citizen-news.org)