By Adam L. Cohen
The operator of a clean cookstove cooperative in Mulanje, Malawi. Photo by Matt Feldman / IVAC.
When I moved to South Africa a year and a half ago to work for the U.S. Centers for Disease Control and Prevention on surveillance for pneumonia and influenza, I didn’t realize how much pneumonia affects communities here. Most of the children in the hospital wards where I work are having trouble breathing, hospitalized with pneumonia. Pneumonia is the leading cause of death among children under five in South Africa and worldwide. Mothers want their children with pneumonia to get better, and public health policymakers want to do what they can to make their country as healthy as possible. But how can we help countries do this? There are multiple, proven interventions to prevent and treat pneumonia, but it can be difficult to get these interventions to the people who need them most. At the CDC, we set out to examine the opportunities presented by the delivery of preventive measures, such as childhood immunization, to explore practical approaches for integrating other interventions to treat and control pneumonia in children. Our complete findings are published in the Bulletin of the World Health Organization.
With so many existing methods of reducing the burden of childhood pneumonia, there are exciting opportunities to integrate multiple approaches to improving child health. But there are also many challenges. Most children have access to basic immunizations—could we use this to help protect the children of the world against pneumonia? Globally, many routine vaccination programs are strong, which means that huge strides could be made in pneumonia prevention and treatment by integrating interventions like pneumococcal and Hib vaccinations, zinc distribution, and caregiver education with routine immunizations.
Neither vaccination nor case management alone is enough to eliminate child pneumonia deaths, owing in part to the large number of bacteria and viruses that cause pneumonia. Other important interventions include caregiver education, referral to health care facilities during routine immunization visits, zinc supplements, HIV testing, and the promotion of health behaviors such as breastfeeding, proper nutrition, hand-washing with soap, and the reduction of indoor air pollution.
However, not all interventions are easily distributed, like cleaner burning but bulky cookstoves, and overburdening community heath workers could cause frail health systems to falter or break. There are few of us in the field of public health working to evaluate the integration of multiple interventions. Further, integration of service delivery would require coordination and cooperation across the entire range of donor organizations, NGOs, and governmental ministries.
To address these challenges, we must conduct small-scale studies that elucidate best practices and evaluate the impact of integration before scaling up to large national programs. This will help us empty the hospital wards in South Africa and worldwide.
Dr. Adam L. Cohen is the Influenza Program Director at Centers for Disease Control and Prevention in Pretoria, South Africa.