A working group of the Adult and Child scientific section
Overall Goal
To establish a child pneumonia hub within the Union that has an overall theme of capacity building and two sub-themes of advocacy and implementation research.
Background
Each year pneumonia kills more children less than five years of age than any other infectious disease (1). The most recent data estimate that 800,000 children died from pneumonia in 2017 (2). The vast majority of these deaths, at least 80%, occurred in low-income and middle-income countries (LMICs) and were concentrated within the sub-Saharan African and South Asian regions (2). Although notable progress has been made over the past two decades in reducing overall child mortality, reductions in child pneumonia mortality have lagged (1). Despite the substantial disease burden and relatively slow progress in reducing global child mortality from pneumonia, policy makers, program managers, implementation partners, healthcare providers, and researchers have low awareness of child pneumonia and the challenges in reducing the disease burden. Accelerating improvements in health outcomes for children with pneumonia will require a well-coordinated, multi-disciplinary effort.
For the last two years, the world’s attention has focused on the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral pandemic, further reducing the already limited visibility and prioritization of child pneumonia (3). Nevertheless, the pandemic presents key, time-sensitive opportunities to improve child pneumonia outcomes in LMICs. The importance of oxygen as a mainstay of treatment for severe COVID-19, the disease caused by SARS-CoV-2, has exposed well-known respiratory care weaknesses in LMIC pulse oximeter access and oxygen supply to a more general audience for the first time (4). Prior to the COVID-19 pandemic, oxygen ecosystem weaknesses mainly affected children with pneumonia (5, 6). This broader awareness and investment in LMIC oxygen ecosystems may be a positive pandemic legacy; however, history shows that without strong advocacy few of these resources will be reallocated in a way that reaches children.
The Union’s expertise and longstanding activism for tuberculosis and other respiratory health issues pertinent to LMICs uniquely positions the organization to fill this time-sensitive, critical child pneumonia advocacy gap. To date, the Union has yet to incorporate child pneumonia as an area of focus despite the clear need and the organization’s expertise and platform. Both the importance of pneumonia issues to children across LMICs and the potential for the Union to serve as a multi-disciplinary child pneumonia hub for donors, policy makers, program managers, implementation partners, healthcare providers, and researchers form the basis of this working group proposal.
Capacity building: child pneumonia advocacy
Rationale: The COVID-19 pandemic has resulted in unprecedented focus and mobilization of resources to strengthen previously neglected respiratory health systems in LMICs including oxygen ecosystems, emergency and critical care, and infection prevention efforts such as vaccination. Given that severe COVID-19 has to date primarily impacted adults, these resources have unfortunately had little or no impact on the care of infants and children with pneumonia and other respiratory illnesses, despite these conditions being the leading infectious cause of death for children globally.
Aim: Establish a child pneumonia advocacy hub focused on ensuring that existing COVID-19 initiatives like expanded access to pulse oximeters, increased availability of oxygen delivery systems, and efforts to strengthen emergency and critical care services also benefit infants and children with pneumonia and other respiratory illnesses in LMICs.
Partners: The working group would seek to target members and non-members to be partners in this advocacy effort. Working group members would include child health advocates, policy makers, health care planners, implementers, researchers, paediatric health care providers, and community members from high-burden countries. Potential key partners include the World Health Organization (WHO) and the Every Breath Counts Coalition.
Capacity building: child pneumonia implementation research in LMICs
Rationale: Although pneumonia is the leading infectious cause of death among children under five years of age globally, and nearly all paediatric deaths attributed to pneumonia occur in LMICs, there is a paucity of funding to support child pneumonia research in LMICs and to support the development of local scientific capacity for child pneumonia research.
Aim: Establish child pneumonia implementation research hub focused on supporting the development of local scientific capacity for conducting child pneumonia implementation research in LMICs.
Partners: The working group would seek to engage partners like WHO, Every Breath Counts Coalition, The Bill and Melinda Gates Foundation, and others, to support the development of this effort.
References
1. Liu L, Oza S, Hogan D, Chu Y, Perin J, Zhu J, et al. Global, regional, and national causes of under-5 mortality in 2000-15: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet 2016;388:3027-35.
2. Global Burden of Disease. Quantifying risks and interventions that have affected the burden of lower respiratory infections among children younger than 5 years: an analysis for the Global Burden of Disease Study 2017. Lancet Infect Dis 2020;20:60-79.
3. Ahmed S, Mvalo T, Akech S, Agweyu A, Baker K, Bar-Zeev N, et al. Protecting children in low-income and middle-income countries from COVID-19. BMJ Glob Health 2020;5:e002844.
4. Navuluri N, Srour ML, Kussin PS, Murdoch DM, MacIntyre NR, Que LG, et al. Oxygen delivery systems for adults in Sub-Saharan Africa: A scoping review. J Glob Health 2021;11:04018.
5. Graham HR, Bakare AA, Gray A, Ayede AI, Qazi S, McPake B, et al. Adoption of paediatric and neonatal pulse oximetry by 12 hospitals in Nigeria: a mixed-methods realist evaluation. BMJ Glob Health 2018;3:e000812.
6. McCollum ED, Bjornstad E, Preidis GA, Hosseinipour MC, Lufesi N. Multicenter study of hypoxemia prevalence and quality of oxygen treatment for hospitalized Malawian children. Trans R Soc Trop Med Hyg 2013;107:285-92.