Times of India
12 November 2010
By Umesh Isalkar
Pune, India

Poor Healthcare Makes Children Under Five Most Susceptible
World Pneumonia Day
Pneumonia, the respiratory infection that causes an inflammation of the lungs, snuffs out more children’s lives than HIV/AIDS, measles, and malaria put together. The condition kills an estimated 1.8 million children every year, according to World Health Organisation (WHO). In India, the casualty is as high as 3 to 4 lakh children.

The condition can be treated with antibiotics, but less than 20 per cent of children with pneumonia get the drugs they need.

Malnutrition, poverty, poor access to and inadequate healthcare services are responsible for the high death rate in children due to pneumonia.

"The WHO’s findings are relevant because the inadequate bacteriological diagnosis of pneumonia hinders the appropriate use of antibiotics. Bacteriological diagnosis includes blood culture, sputum culture and fluid from lung layers," said paediatrician Sharad Agarkhedkar, president of the city chapter of Indian Medical Association (IMA).

Another reason for fewer children with pneumonia receiving antibiotics is the selection of the drug by doctors.

"Generally, doctors have their own preferences for prescribing antibiotics irrespective of the causative factors. This leads to inadequate treatment resulting in prolonged illness," said Agarkhedkar. The third reason is that the organism responsible for pneumonia is mycoplasma.

The drug that is usually prescribed is the microlide group of antibiotics like penicillin and cephalosporins. However, these commonly used antibiotics don’t work on mycoplasma, he added.

Paediatrician Sanjay Lalwani, head of the paediatrics department at Bharati Hospital, said, "The incidence of deaths due to respiratory tract infections including pneumonia has not decreased in the last decade. In India, the under five mortality is 70–72 per 1,000 live births. Of them 25 per cent are due to respiratory tract infection."

Factors like the high birthrate, babies born with low birth weight compromising immunity and undernourishment or malnutrition, poverty and overcrowding have pushed the incidence of respiratory tract infection higher in our country, he added.

"Healthcare should concentrate on schemes where healthier babies are born. We should bring down the birth rate and look after nutrition in the first five years since the incidence of pneumonia is more common below the age of five and more so below the age of two years," he added.

Paediatrician Shishir Modak, president of Indian Academy of Paediatrics (IAP), Pune branch said, "Pneumonia is a major cause of deaths in the children under five years age, yet it not given enough attention. Early diagnosis and prompt treatment can help bring down the incidence."

Parents must identify the symptoms and take the child to the doctor early. Rapid breathing more than 50 breaths per minute, difficult breathing along with fever and cough are signs of pneumonia, said Modak.

If treated in time, most deaths are preventable. Training and awareness among general practitioners can also help, he added. Vaccines can prevent pneumonia caused by bacteria like pneumococcus and HIB, but they are costly in India.

"Vaccination can reduce pneumonia deaths in India by 40 per cent. More awareness about the vaccine among the class that can afford it should be generated," Modak said.

Subsidising the vaccines and making them available to all through funding agencies will reduce pneumonia deaths, he added.

Gavi, an international agency, has offered financial support to the central government for introduction of HIB and pneumoccoal vaccines in the universal programme of immunisation.

" The government should apply for the funds. Besides, indigenous manufacturing of pneumoccoal vaccine should be encouraged. Serum Institute of Indian manufactures HIB vaccine that is half of the cost of what the multinationals charged," said Modak.