Pneumonia has become a major health risk for children in Bangladesh. Air pollution, unplanned urbanisation, malnutrition and gaps in medical care are raising the risk of the disease. The current measles outbreak has made the situation more worrying: nearly 1,200 children have died of measles in the past eight months, and doctors say many of them had pneumonia. Infections with antibiotic-resistant germs are also creating a new crisis for treatment.
According to the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), pneumonia is the leading infectious cause of death among children under five worldwide. About 700,000 children die of it every year. In Bangladesh the figure is about 26,000, meaning two to three children die of the disease every hour.
Pneumonia accounts for about 24 percent of all deaths of children under five. An estimated 700,000 children are admitted to hospital with pneumonia every year. It is against this background that World Pneumonia Day is observed today, Thursday. This year’s theme is “A new era in pneumonia control”. Government and private organisations have arranged rallies, discussions and other events to mark the day.
Doctors say pneumonia is an infection of the lungs that can be caused by bacteria, viruses or fungi. The infection inflames the air sacs of the lungs, which fill with fluid or pus. This disrupts the body’s oxygen supply and makes breathing difficult. Without timely treatment the disease can be fatal. Children under five, older people and people with long-term illnesses are most at risk.
In children, the common signs of pneumonia are fever, cough, coughing up phlegm, fast breathing, the lower chest drawing inwards, being unable to feed or eat, and unusual restlessness. Weakness, fatigue and loss of appetite may also appear. In severe cases, the oxygen level in the blood falls and the lips and fingers can turn bluish.
According to UNICEF, a child dies of pneumonia somewhere in the world every 39 seconds, and the disease accounts for about 14 percent of deaths of children under five worldwide. People aged 65 and over with chronic obstructive pulmonary disease (COPD) are 7.7 times more likely than healthy people to get pneumococcal pneumonia; for people with asthma the risk is 5.9 times. Air pollution and smoking are also considered among the main causes of pneumonia deaths in people over 50.
Large gaps in treatment
The World Health Organization (WHO) says there are major gaps in Bangladesh’s capacity to treat pneumonia despite the high risk. According to the WHO, air pollution lies behind about a third of pneumonia deaths worldwide. In Bangladesh, 95 percent of district and upazila hospitals lack adequate facilities to treat pneumonia. Only 42 percent of children under five who show signs of a lung infection are taken to a nearby health centre for treatment.
Because of these gaps, many children cannot be given proper treatment. Government hospitals are short of essential equipment, including devices to measure oxygen levels. Parents’ lack of awareness is also a barrier to treatment. For these reasons, child deaths from pneumonia are not falling as fast as expected.
Asked why child deaths from pneumonia are not falling, Dr Ahmed Ehsanur Rahman, a researcher and scientist in icddr,b’s maternal and child health division, told the daily Amar Desh that unplanned urbanisation and air pollution are making more children ill, that many children do not get treatment in time once they fall ill, and that late arrival at hospital is making cases more complicated.
He said hospitals are short of oxygen. Many children are not properly breastfed, so malnutrition is higher among them. Infections with various germs for which there is no effective vaccine are also rising. All of this makes it hard to bring down child deaths from pneumonia.
Citing research findings, he said 42 percent of children with pneumonia suffer from hypoxaemia, a shortage of oxygen in the blood, which makes oxygen therapy vital in their treatment. Every health centre therefore needs a pulse oximeter. Proper planning and vaccination must also be ensured to reduce child deaths, he said.
Antibiotic-resistant germs raise concern
Antibiotic-resistant germs have created a new concern in treating pneumonia. Cases of antibiotics losing their effect are emerging, particularly among children with measles and those in intensive care. An icddr,b study found evidence of infection with rare antibiotic-resistant species of Gram-negative bacteria and identified them as new causes of pneumonia in children.
Prof Dr Sanjoy Kumar Dey of the neonatology department at Bangladesh Medical University (BMU) told Amar Desh that many of the infections now seen in hospitals’ neonatal intensive care units (NICUs) are highly complex and dangerous. In some babies only one antibiotic still works and the rest have become ineffective, which he called a new warning sign for the health sector.
He said pneumonia can spread beyond the lungs and airways to the blood and other organs. In newborns, pneumonia is usually of two kinds: early-onset, which appears within the first three days after birth, and late-onset, which can appear after three days.
A newborn can catch pneumonia from an infection in the mother, or while being treated in hospital, or even after returning home. He therefore advised against touching newborns unnecessarily. To protect them from pneumonia, he stressed feeding newborns breast milk rather than from a bottle and making sure they get enough nutrition.
বাংলায় মূল প্রতিবেদন পড়ুন · Read the original Bengali report