Neil Chanchlani: The silent killer

Neil ChanchlaniFor most of us, it’s textbook – chills, fever, and phlegm. We know the impending list of causes and antibiotic management regimes off by heart, but what we don’t know recognise is that it is still the number one killer of children in the world.

Pneumonia – we’ve yet to conquer the battle. It is the cause of >2 million deaths worldwide in those under five years old, killing more than AIDS, malaria, and measles combined. Last week, Dr. Richard Adegbola of the Bill & Melinda Gates Foundation spoke about childhood pneumonia deaths at University College London. He stressed the importance of taking a new approach when dealing with pneumonia in the third world. Protect, prevent, and treat was his motto – basic rules that seemed to have gotten lost in the western world, somewhere between the antibiotic cabinet and our prescription pad.

Protect at risk groups by providing a healthy environment – breastfeeding newborns, decreasing air pollution, and washing one’s hands should all be the norm.

Prevent children from becoming ill with pneumonia, namely via vaccination.

Treat children who become ill, fast and effectively. Recognising common symptoms and signs of pneumonia before complications start to occur is essential.

The biggest struggle the third world faces is immunisation uptake. Pneumococcal vaccines are an effective treatment to pneumonia. Dr. Adegbola’s research alone, shows a decrease in mortality by 16% in children treated with a pneumococcal vaccine in The Gambia – an observation that led to 7 /1000 lives being saved. However, despite significantly increasing childhood survival, people in the third world are still not receiving vaccines. Why? Lack of awareness, uncertainty, concerns about costs are only a few reasons explored, however, the most prominent reason is the fact that there is no routine administration of a Haemophilus Influenze B (Hib) vaccine.

The World Health Organization has pushed for further spending on routine immunisation programmes. Largely sponsored by the Bill and Melinda Gates Foundation, $80m (US) is to go towards direct funding to pharmaceutical vaccine research and development, and a further $50m (US) is to be spent on additional manufactures to produce the vaccine for areas that require it.

Currently, 50% of deaths in under five year olds occur in India, Nigeria, Democratic Republic of Congo, Pakistan, and China. Dr. Adegbola stated, ‘We shouldn’t be discouraged to support and help [those] countries. We can reach our Millennium Development Goal. It’s happening in certain countries now.’

The Millennium Development Goal target currently in place aims to reduce the under five mortality rate by two-thirds between 1990 – 2015. In 1990, infant mortality was at a staggering 11.9 million. And although infant mortality has decreased by 1.1 million deaths from 2008 to 2010 – there’s still a great amount we can do to stem the tide of the current 7.7 million dying.

World Pneumonia Day is on November 12th. Visit to see how you can get more involved.

Neil Chanchlani is a fourth year medical student at the University of Birmingham, and  Clegg Scholar, BMJ.