Dr. Shyam P Lohani

Every year 12 November is celebrated as a World Pneumonia Day with the aims to raise awareness about the illness and to advocate for global action for protection. Pneumonia is the single largest infectious cause of death in children and most prevalent in South Asia and sub-Saharan Africa. It, however, affects children throughout the world.
Despite major advances in our understanding of the burden and epidemiology of childhood acute respiratory infections, pneumonia killed 808,694 children under the age of five in 2017, accounting for 15 per cent of all deaths of children under five years old (WHO, 2019). Pneumonia causes infection in one or both lungs. Infection can be bacterial, viral, and fungal in origin.

Symptoms & risk factors
Pneumonia is preventable. It can be prevented with simple interventions and treated with low-cost medication and appropriate care. Pneumonia can range from mild to severe that may end in hospital admission. The causes of childhood pneumonia may vary with the age. Respiratory viruses such as Streptococcus pneumoniae, and Haemophilus influenza commonly cause pneumonia in children under five. Pneumonia caused by Mycoplasma pneumoniae is frequently observed in children between the ages of five and 13. Mycoplasma pneumoniae is one of the causes of walking pneumonia. However, it is a milder form.
Pneumonia is contagious and can spread from person to person. Airborne droplets through sneeze or cough are the main source of transmission of both viral and bacterial pneumonia. These types of pneumonia are also contracted by coming into contact with surfaces or objects that are contaminated with pneumonia-causing bacteria or viruses. Fungal pneumonia is mainly contracted from the environment. But it doesn’t spread from person to person.
Pneumonia symptoms can be mild to life-threatening. Symptoms ranges from coughing that may produce phlegm (mucus), fever, sweating or chills, shortness of breath to chest pain that becomes worse when breathing or coughing, feelings of tiredness or fatigue, loss of appetite, nausea or vomiting, and to headaches. Other symptoms can vary according to the age and general health in which children less than 5 years old may have fast breathing or wheezing. Infants sometimes do not show symptoms but may vomit, lack energy, or have trouble drinking or eating. Older people may have milder symptoms. Symptoms may include confusion or a lower than normal body temperature (hypothermia).
Pneumonia can be classified based on where or how it was acquired. Hospital-acquired pneumonia (HAP) is a type of bacterial pneumonia acquired during a hospital stay. It can be more serious than other types as the bacteria involved are more resistant to common antibiotics. Community-acquired pneumonia (CAP) refers to pneumonia which is acquired outside of a medical or health care setting. Ventilator-associated pneumonia (VAP) occurs when people who are using on a ventilator. Aspiration pneumonia occurs by inhaling bacteria into the lungs from food, drink, or saliva. This type is more likely to occur in people who have a swallowing problem or when a person is too sedate from the use of medications, alcohol, or other drugs.
Although anyone can catch pneumonia, certain groups of people have a higher risk. People at higher risks include infants from birth to two years old, people ages 65 years and older, those with weakened immune systems due to disease or use of medications, such as steroids or certain cancer drugs that interfere with the body’s immune system.
People with certain chronic medical conditions such as asthma, cystic fibrosis, diabetes, or heart failure, people with a recent respiratory infection like a cold or flu, people who have been recently or are currently hospitalised and treated on a ventilator, people who have had a stroke, or have problems with swallowing. People who smoke, or drink excessive amounts of alcohol, and those who have been exposed to lung irritants, such as pollution, fumes, and certain chemicals are also at a higher risk.

Prevention
Besides vaccination, there are other things that can help avoid pneumonia. Smoking makes people more susceptible to respiratory infections, especially pneumonia; therefore quitting it should be encouraged. Regularly washing hands with soap and water, covering coughs and sneezes, promptly disposing used tissues, and maintaining a healthy lifestyle to strengthen the immune system with enough rest, a healthy diet, and regular exercise are key preventive strategies. A provision to prevent pneumonia in children is an essential component of a comprehensive strategy to reduce child mortality. The most effective way to prevent pneumonia is immunisation against Hib, pneumococcus, measles, and whooping cough (pertussis).
Adequate nutrition plays a key role to improving children's natural defenses which include exclusive breastfeeding for the first 6 months of life. It not only prevents children from pneumonia but also helps reduce the length of the illness. Indoor air pollution should be addressed by providing affordable clean indoor stoves and encouraging good hygiene in crowded homes. The antibiotic cotrimoxazole should be given daily to decrease the risk of contracting pneumonia in children with HIV.
Integrated global action plan of WHO and UNICEF call upon accelerating pneumonia control with a combination of interventions to protect, prevent, and treat pneumonia in children. The action plan urges countries to protect children from pneumonia including promoting exclusive breastfeeding and adequate complementary feeding. Vaccinations and hand washing with soap are also important in preventing pneumonia. It also urges for reducing household air pollution with environment-friendly stoves, HIV prevention and cotrimoxazole prophylaxis for HIV-infected and exposed children and treating pneumonia focusing on making sure that every infected child has access to the appropriate care either from a community health worker or in a health facility and can get the antibiotics and oxygen when needed.

(A Professor, Lohani is the founder and academic director at Nobel College. lohanis@gmail.com)