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It is not that hard to prevent children from dying of pneumonia
Antara/RahmadWorld Pneumonia Day on Nov
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Antara/Rahmad
World Pneumonia Day on Nov. 12 was commemorated for a reason. Pneumonia is the world’s biggest infectious killer for children under 5 years old, and the second killer in Indonesia (after deaths due to preterm birth).
According to research by Save the Children United Kingdom, titled "Fighting for breath: A call to action on childhood pneumonia", two children per minute die from pneumonia globally. The most recent report, "Fighting for Breath Call to Action: End childhood pneumonia deaths" published on Nov. 8, mentioned that Indonesia ranked as the country with the sixth-highest pneumonia burden, with a mortality rate among under 5-year-olds of four per 1,000 live births caused by pneumonia in 2018. In the era of health science and technology progress, why is the number of child deaths because of pneumonia still high?
Pneumonia is a form of acute lower respiratory tract infection that occurs when viruses, bacteria or other microorganisms cause inflammation of the lungs. The symptoms in children are coughs, fever, fast breathing and contraction of the lower chest wall. Children are more vulnerable to pneumonia due to their immature immune system and small airways.
Preventing and protecting children from getting pneumonia is not hard. To prevent pneumonia, we need to increase vaccination coverage, reduce air pollution, improve access to safe water, sanitation and hygiene. To protect children from pneumonia, we need to ensure adequate nutrition and improve breastfeeding practices. When the child is already sick, they can recover with the right treatment.
The above report identifies some reasons why childhood pneumonia persists.
First, low coverage of the pneumococcal conjugate vaccine (PCV). In the three countries with the highest number of pneumonia deaths, Nigeria, India and Pakistan, PCV coverage is only 57 percent, 6 percent and 79 percent respectively.
Second, air pollution. Household air pollution from cooking and heating contributes to 62 percent of air pollution-related child pneumonia deaths, while the rest, 38 percent, is from outdoor pollution.
Third, a lack of good water, sanitation and hygiene (WASH) practices. In the least developed countries, nearly three-quarters of the population in 2017 lacked handwashing facilities with soap and water, and two-thirds lacked basic sanitation services at home.
Fourth, malnutrition. Last year 49 million children suffered from wasting and 149 million from stunting. Less than half of infants in low-income countries, and only one third in lower-middle-income countries, are exclusively breastfed for the first six months of life.
Fifth, a lack of care-seeking practices. Globally, only 68 percent of children with suspected pneumonia are taken to a health facility and in most high-burden pneumonia countries, for example in Somalia and Benin, the number is even lower, only 46 percent.
Save the Children Indonesia with the School of Nursing at Padjajaran University (Unpad) in Bandung, West Java, published a “Situation Analysis Report on Childhood Pneumonia: the National Regulations and Implementation Programs in Bandung and Sumba Barat Districts [regencies] of Indonesia” in 2018. East Nusa Tenggara province where Sumba Barat is situated had the nation’s highest prevalence of pneumonia (38.5 percent) and West Java which hosts Bandung regency had the same level of pneumonia prevalence as the national average of 18.5 percent.
During the World Pneumonia Day 2019 celebration in Bandung, Widyawati from West Java’s health office said pneumonia had affected 4.62 percent of children under 5 years old and there were 28 reported child deaths due to pneumonia this year, an increase from 18 child deaths last year in the province. The report highlights some challenges of ending childhood pneumonia in the Indonesian context.
Among the family respondents, among families with high risk of exposing children to pneumonia, 40 percent of the children had not received six-month exclusive breastfeeding. Most families were unaware of pneumonia symptoms and causes. In 91 percent of families surveyed, at least one member was a smoker — and most of them smoked inside the house.
Moreover, many of the health workers in Bandung and Sumba Barat cannot differentiate pneumonia from upper acute respiratory infections. In Bandung regency, a few hours from the nation’s capital, many volunteers who manage the community’s integrated health services post (Posyandu) do not know what pneumonia is. Fortunately, this is not the case in the more remote Sumba Barat because Save the Children has provided “integrated management of childhood illness” training to health volunteers in 34 villages. Our report shows it is essential to train community members, health volunteers and health workers to enable them to recognize, prevent and treat pneumonia in children.
In Indonesia, our STOP Pneumonia campaign in Sumba Barat and Bandung uses the social and behavior change communication approach, which involves raising awareness in 2019; targeting group mobilization in 2020; and engaging child campaigners in 2021. To raise awareness of the target groups, we produce information and educational materials, place advertisements in online and offline public spaces and hold events such as seminars, panel discussions and parents’ classes.
What is unique about this pneumonia awareness campaign is the engagement of fathers.
Save the Children believes that equal sharing of child rearing can improve the health of mothers and children, in addition to the health of the fathers themselves. Especially in the case of pneumonia, quick diagnosis and treatment can be a matter of life and death. At the village level, fathers’ classes and door-to-door interviews with potential “father champions” have been implemented. There will be more creative ways to engage fathers and other target groups.
Our program on childhood pneumonia focuses on prevention. Campaign activities are linked with advocacy works with the government. The target at the national level is enactment and implementation of the pneumonia national action plan.
At the local level, advocacy aims for the allocation of local government budgets and of the village funds for addressing childhood pneumonia. With such parallel campaigns and advocacy, we hope to see significant social and behavioral change that will prevent childhood pneumonia.
