Pneumonia in U5 children

(Image Source: https://www.connecticutchildrens.org/health-library/en/parents/az-pneumonia-bacterial/)

Pneumonia is one of the leading causes of deaths in children under five years old despite being easily preventable and treatable. It is an acute inflammation of the pulmonary parenchyma caused by microbial agents and associated with exudative solidification of lung tissue.

World Health Organization (WHO) has also given more emphasis and prioritized pneumonia as one of the serious medical condition and also has launched/affiliated different projects and organizations for preventing and reducing the risk of children getting pneumonia. WHO have recommended global clinical guideline and protocol for the effective treatment and management of pneumonia in community level.

In Nepal, vaccine against pneumonia i.e. Pneumococcal Conjugate Vaccine (PCV) has also been adjusted in National Immunization Schedule and have continuously providing 3 doses vaccination to under one year children. The 1st dose at the age of 6 weeks, 2nd dose at the age of 10 weeks & 3rd dose at 9 month of age. Although vaccines and other preventable efforts are decreasing the burden of the diseases, much more work is still required. Those living in poor communities are at highest risk of pneumonia. Every child, regardless of where they are born, deserves access to lifesaving vaccines and medicines.

Globally, World Pneumonia Day (established in 2009) is marked or celebrated every year on November 12th to:

  • Raise awareness about pneumonia, the world’s leading infectious killer of children under the age of 5.
  • Promote interventions to protect against, prevent and treat pneumonia and highlight proven approaches and solutions in need of additional resources and attention.
  • Generate action, including continued donor investment, to combat pneumonia and other common, yet sometimes deadly, childhood diseases.

National & provincial facts about pneumonia and Acute Respiratory Infections (ARI):

Total ARI cases: 18,10,722
ARI incidence (new cases): 612 per 1000 <5yr children
Incidence of pneumonia: 66 per 1000 <5yr children
% of pneumonia among ARI cases: 10.47% (national)
Total deaths due to ARI at health facility: 176
Highest ARI incidence was seen at Province 7 (992/1000 U5 children) followed by Province 6 (927/1000) and least at Province 3 (439/1000 U5 children)
Province 1 and 6 had the highest percentage of pneumonia cases among ARI cases (12.15% and 12.14%) and Province 7 has the lowest (8.31%)

Source:HMIS,MD, DoHS, Annual Report 2073/74

Some of the bacteria responsible for causing pneumonia are:

-Streptococcus pneumoniae

-Haemophilus influenza

-Haemophilus pneumoniae

-Klebsiella pneumoniae

-Mycoplasma pneumoniae etc.

Clinical features (signs & symptoms):

  • Feeding problem (unable to suck breast milk)
  • Fever & productive cough
  • Dyspnoea (difficulty in breathing)
  • Lethargic or unconscious
  • Fast breathing
   Age:   Respiratory rate:
  Under 2 month  60/min or more
  2-11month  50/min or more
12-59month  40/min or more
  • Chest indrawing
  • Wheezing
  • Stridor in a calm child
  • Apnoic episodes
  • Central cyanosis may also be seen
  • Chest Xray reveals consolidation of lung tissue.

Treatment:

-Advice mother to give home care.

-increase breast feeding

-offer the child extra to drink

-avoid from cold, make baby warm

-Antibiotics:

-Cotrimoxazole/Amoxycillin/Azithromycin

-Cefixime/Cefpodoxime/Ceftriaxone/Cefuroxime

-Amoxycillin plus Clavulanic Acid etc.

-Treat for cough & wheeze (bronchomucolytic or bronchodilator).

-Nebulization if possible and necessary.

-Treat for fever (plain paracetamol paediatric syrup or ibuprofen combined syrup).

-Injection Gentamycin 3-5mg/kg/day in divided doses for severe pneumonia.

-Refer to better health facility if condition didn’t improve or if severity increases.

Complications:

  • Emphysema
  • Lung abscess
  • Persistent  pneumatocele
  • Otitis media
  • Septicaemia

By:

Mr. HEMANT SUNDAS

Health Assistant Officer

NHPC no. 7461

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