Lung Disease and Child Mortality

Millions of people around the world struggle to breathe, and more than 10 million die each year due to lung diseases including tuberculosis, asthma, pneumonia, influenza, lung cancer and chronic obstructive pulmonary disease.

Nonetheless, lung health is less well recognized as a key health indicator as compared to blood pressure or weight. Lung diseases afflict people in every country and every socioeconomic group, but take the heaviest toll on the poor, the old, the weak and the young. There is a critical need to raise awareness of the importance of lung health and bring it to the top of the public health agenda.

Pneumonia is the single largest cause of death in children worldwide. Despite being preventable and curable, it is the world's (and India’s) leading killer of children under five, claiming one young life every 20 seconds -- 4,300 young lives lost every day, which is more than those due to AIDS, malaria and measles combined. Every year, it kills an estimated 1.6 million children under the age of five years, accounting for 18 percent of all deaths of children under five years old worldwide. India is one of the 15 countries which together account for 75 percent of child pneumonia deaths.

Yet children can be protected from pneumonia, which can be prevented with simple interventions and treated with low-cost medication and care. Tragically, only an estimated 1 out of every 5 children with pneumonia receives antibiotics.

Physicians Penny Enarson and Graham Steve of the International Union Against Tuberculosis and Lung Disease (The Union), spoke of some simple, cost-effective interventions at the community/family level to curb pneumonia and other respiratory diseases in children. They say: “Routine immunization against pertussis, diphtheria, measles, (also hib and pneumococcal vaccine where available) is the one of the most equitable interventions globally to prevent childhood diseases.”

Moreover, they write health workers can use these vaccination visits – usually four in the first year of the child’s life – to promote and educate caregivers on the merits of exclusive breast feeding for the first six months of life as it is critical in preventing pneumonia. “There is scientific evidence to support that breast milk contains antioxidants, hormones and antibodies a child needs for growth and development,” they continue. “They should also educate mothers on the dangers of exposing children to indoor air pollution from cooking and second hand tobacco smoke. Improving ventilation inside homes, not having an infant on back during cooking and not permitting smoking close by an infant will go a long way in reducing respiratory diseases in children.”

A child’s exposure to second hand tobacco smoke adversely affects lung functioning, increasing the risk of acute respiratory illnesses by 60 percent; chronic respiratory symptoms by 24 to 40 percent and asthma by 21 percent.

Enarson and Dr Steve Graham also insist upon promoting good hygiene practices and educating mothers of the importance of hand washing in preventing diarrhea and acute respiratory infections. Caregivers should be able to recognize the signs and symptoms of pneumonia and seek/access prompt appropriate care as pneumonia progresses very quickly in severity.

“Pneumonia is one of public health’s most solvable problems”, says Dr Ajay Mishra, Managing Director of the Nelson Hospital for Pediatric and Neonatal Medicine at Aliganj, Lucknow. “We have safe, effective and affordable tools to help children. Children should have access to effective and affordable treatment using antibiotics, which typically cost less than one dollar per dose.”

Gourdas Choudhuri, Vice- Chairman, Institute of Digestive and Hepato-biliary Sciences, Medanta Medicity, Gurgaon and a noted public health expert cautions that, “Lifestyle disorders play a crucial role in upping the risk to pneumonia. Obese children are also malnourished and so have a compromised immune system. So it is important to ensure that children keep an ideal body weight and use the sports field and/or do plenty of exercise to keep their lungs healthy.”

Neelam Singh, Consultant Obstetrician and Gynaecologist and Chief Functionary of Vatsalya Resource Centre on Health says: “Pneumonia is a major life threatening disease of children after diarrhea. However, the kind of awareness drive that is needed for pneumonia prevention is lacking. There is still a lot of ignorance and a special drive needs to be conducted to spread awareness. The government has made great progress in this field and treatments are available in government hospitals too. However, the pressure of large number of patients, shortage of experts, lack of infrastructure, and non-availability of medicines are some of the concerns in the public health system that need attention.”

The forthcoming 43rd Union World Conference on Lung Health to be held in Kuala Lumpur is designed to reinforce the importance of addressing the problem of childhood pneumonia and other respiratory diseases with a view to meet the Millennium Development Goal 4 of reducing child mortality by two thirds.

More than 1 million young lives could be saved annually with vaccines and antibiotics, by reducing indoor air pollution in the form of cook stove gases and tobacco smoke and through exclusive breastfeeding for the first six months of life.

(Shobha Shukla is Managing Editor of Citizen News Service (CNS). Email: shobha@citizen-news.org, website: http://www.citizen-news.org)