Child mortality from pneumonia can be decreased by
more than one-third when community-based interventions to
identify and treat the disease are used, according to
researchers from the Johns Hopkins
Bloomberg School of Public
Health. In addition, for the first time, a
meta-analysis of past studies completed in seven countries
found a substantial reduction in neonatal total and
pneumonia mortality as a result of community-based case
management.
The study appears in the September issue of The
Lancet Infectious Diseases.
The co-author of the study, Robert E. Black, chair of
the Department of
International Health at the school, explained that
pneumonia is the leading cause of death in young children
in developing countries and that antibiotic treatment is
needed to prevent complications and death.
"The studies summarized in this analysis demonstrate
that health workers are capable of managing pneumonia in
the community and that such management results in a 24
percent reduction in total child (0-4 years) mortality and
a 36 percent decrease in pneumonia mortality. Since the
utilization of health facilities is low in many developing
countries, this means that appropriate management of
pneumonia can be brought to the community level and save as
many as 2 million children from dying each year," he
said.
The researchers completed a meta-analysis of nine
community-based studies that assessed the effects of
pneumonia case-management intervention on mortality. The
subjects of each study were categorized into one of three
age groups: neonatal (less than one month old); infant
(less than one year old) and child (0-4 years old). The
case-management approach, which was proposed by the World
Health Organization, is based on the assumption that a high
proportion of fatal pneumonia has a bacterial origin;
timely antibiotic therapy can reduce fatality; a simple
algorithm is sensitive and specific enough to identify
children with pneumonia that require therapy; and health
workers can use the algorithm and administer antibiotics to
those children.
The authors of the nine studies formed the Pneumonia
Case Management Trials Group, meeting as a team to review
the data collected from each individual study and to
complete an analysis. They learned that undernutrition was
prevalent in all the settings in which the studies were
conducted. In addition, health service availability, other
than that of the community workers, was variable but low in
many settings. The researchers also found that the
pneumonia mortality rate was reduced by 42 percent in the
neonates, 36 percent in infants and 36 percent in the child
grouping.
Black said, "The diversity of pneumonia interventions
and the developing countries in which these trials took
place, along with the consistency of the results, lends
credibility to the robustness of the findings and their
application to many developing countries. Interventions of
this design may have advantages in populations where
recognition of illness in neonates and preschool children
and the ability or willingness to seek care for respiratory
illness may be limited."
The researchers state in their report, "Interventions
to improve child survival in developing countries should be
built around management of pneumonia and other
life-threatening diseases, as well as immunizations and
other effective preventive approaches."
Sunil Sazawal, associate research professor in the
Department of International Health, co-authored the
study.
Research was supported by grants from the World Health
Organization, Johns Hopkins family health and child
survival cooperative agreement and United States Agency for
International Development.