Childhood pneumonia, characterised by fever, chills, cough and rapid breathing, is a leading cause of deaths in children under 5 globally. In 2008, it accounted for 1·6 million deaths worldwide and in Pakistan alone, 84,210 deaths or one-fifth of the total number of deaths in children younger than 5.
Although the government has plans to introduce new vaccines to prevent pneumonia, management of cases in rural and difficult to reach populations remains a challenge. Currently, WHO recommends that children with WHO-defined severe pneumonia be given a single antibiotic dose and referred to a health facility for treatment. However, referral often poses a problem for many families who cannot afford to travel to a hospital or to pay for services once there. Almost two-thirds of all children who die of pneumonia in Pakistan, die at home because of lack of access to appropriate and timely care.
There is now hope that innovative approaches can make a difference. A new study carried out in the Matiari district of Sindh offers hope for children with severe pneumonia in poor, rural communities; they can be recognised and treated safely at home by Lady Health Workers (LHWs) using a simple oral antibiotic.
The study, published in the leading journal The Lancet today, was conducted by the Aga Khan University’s Division of Women and Child Health in collaboration with the Lady Health Workers programme of the Government of Pakistan, the Boston University’s Center for Global Health and Development, and the World Health Organization’s Department of Child and Adolescent Health.
The trial was carried out in Matiari, 250 km north of Karachi with 1,600 villages and an estimated population of 600,000, a rural district of Pakistan with high rates of this disease and limited resources. It looked at the management of severe pneumonia in children under 5 years of age at home by LHW programme versus referral to the nearest health facility - a basic health unit, a rural health centre or even a hospital.
The study found that in only 8 per cent of children treated at home did treatment fail compared to the 13 per cent referred to a health facility.
“We found that with training, public sector LHWs in Pakistan are able to satisfactorily diagnose and treat severe pneumonia at home in rural Pakistan,” says Professor Zulfiqar A. Bhutta, head of the Division of Women and Child Health at AKU and principal investigator of the study. “This strategy might effectively reach children with pneumonia in settings where referral is difficult, and it could be a key component of community detection and management strategies for childhood pneumonia in similar populations.” This study covered a representative rural population in Sindh where this disease is quite prevalent. It could also apply to Balochistan and the Punjab where high rates of pneumonia can still be found in the rural areas.
The findings also validate a parallel trial (with a similar study design), carried out in the north of Pakistan, in Haripur district by Save the Children US with the support of USAID and WHO. The results of these two recent studies have prompted the researchers to recommend a thorough review of the national LHW programme curriculum for pneumonia detection and treatment and a phased introduction of community-based management of severe pneumonia into the LHW programme in all provinces.
Rida Turabi, Senior Media Executive, Department of Public Affairs, Aga Khan University, Stadium Road, Karachi, on +92 21 3486 2931 or firstname.lastname@example.org