Intervention Decreases Childhood Pneumonia Mortality

Child mortality from pneumonia can be decreased by more than one-third when community-based interventions to identify and treat the disease are used, according to researchers from the Johns Hopkins Bloomberg School of Public Health. In addition, for the first time, a meta-analysis of nine studies completed in seven countries found a substantial reduction in neonatal total and pneumonia mortality as a result of community-based case management. The study, “Effect of pneumonia case management on mortality in neonates, infants and preschool children: a meta-analysis of community-based trials,” appears in the September 2003 issue of The Lancet Infectious Diseases.

The co-author of the study, Robert E. Black, MD, professor and chair of the Department of International Health at the School, explained that pneumonia is the leading cause of death in young children in developing countries and that antibiotic treatment is needed to prevent complications and death.

“The studies summarized in this analysis demonstrate that health workers are capable of managing pneumonia in the community and that such management results in a 24 percent reduction in total child (0-4 years) mortality and a 36 percent decrease in pneumonia mortality. Since the utilization of health facilities is low in many developing countries, this means that appropriate management of pneumonia can be brought to the community level and save as many as 2 million children from dying each year,” he said.

The researchers completed a meta-analysis of nine community-based studies that assessed the effects of pneumonia case-management intervention on mortality. The subjects of each study were categorized into one of three age groups: neonatal (less than one month old); infant (less than one year old) and child (0-4 years old). The case-management approach, which was proposed by the World Health Organization, is based on the assumption that a high proportion of fatal pneumonia has a bacterial origin; timely antibiotic therapy can reduce fatality; a simple algorithm is sensitive and specific enough to identify children with pneumonia that require therapy and health workers can use the algorithm and administer antibiotics to those children.

The authors of the nine studies formed the Pneumonia Case Management Trials Group. They met as a team to review the data collected from each individual study and to complete an analysis. They learned that under-nutrition was prevalent in all of the settings in which the studies were conducted. In addition, health service availability, other than that of the community workers, was variable, but low in many settings. The researchers also found that the pneumonia mortality rate was reduced by 42 percent in the neonates, 36 percent in infants and 36 percent in the child grouping.

Dr. Black said, “The diversity of pneumonia interventions and the developing countries in which these trials took place, along with the consistency of the results, lends credibility to the robustness of the findings and their application to many developing countries. Interventions of this design may have advantages in populations where recognition of illness in neonates and preschool children and the ability or willingness to seek care for respiratory illness may be limited.”

The researchers state in their report, “Interventions to improve child survival in developing countries should be built around management of pneumonia and other life-threatening diseases, as well as immunizations and other effective preventive approaches.”

Sunil Sazawal, associate research professor in the Department of International Health, co-authored the study.

Research was supported by grants from the World Health Organization, Johns Hopkins family health and child survival cooperative agreement and United States Agency for International Development.