Q: Do we really know the burden of disease of pneumonia among children in Pakistan and in other developing countries? A: In most developing countries there are gaps in knowledge of the disease burden. There is documentation of pneumonia cases in data from DHS [Demographic and Health Surveys] and MICS [Multiple Indicator Cluster Surveys of the United Nations Children's Fund (UNICEF)], but the way we classify and identify pneumonia cases is not very specific. The numbers that we have are not 100% accurate but they are the best possible estimates. The estimates from Pakistan tell us that the [annual] incidence of ARI [acute respiratory infection] in children aged less than five years is 1-4% in the community--a group constituting roughly 22% of the country's population of 160 million. Taking this 1-4% figure, we can calculate that there are 15 million episodes of ARI every year among under-fives. There are slight differences in data sources, such as DHS and those collected by UNICEF, but irrespective of the differences the disease burden is huge. Q: Why are so many children still dying of a disease for which there are vaccines and effective treatment? What is Pakistan's government doing to tackle the problem? A: Vaccines against Hib [Haemophilus influenzae type b] and pneumococcal infections, the two leading causes of childhood pneumonia, are very expensive. P, eight now the Expanded Pakistan vaccinates children against six diseases, but doesn't include these two because of financial constraints. The brighter side is that the GAVI Alliance is giving financial assistance to countries, like Pakistan, that cannot afford vaccinations. The GAVI Alliance has agreed to fund the Hib vaccine for all children in Pakistan and our children should start getting these vaccinations later this year. With support from the GAVI Alliance, the pneumococcal vaccine is also in the pipeline and our EPI programme is considering introducing it by 2010. Once these two vaccines are introduced, we expect a reasonable decline in the number of pneumonia cases. Q: Can you tell us about disease control initiatives that have had an impact in Pakistan? A: The polio eradication programme is a good example. Most of the districts in Pakistan are now polio flee. Since eradication efforts were stepped up just over a decade ago, we have seen a steady decline from hundreds to something like 30 cases per year. This is due to pressure from health-care professionals and donors as well as from WHO and other international organizations [for Pakistan] to do something about polio. They were able to get the political commitment at the highest level and there has been a very close coordination for monitoring and implementation. We now need the same kind of pressure and commitment to do more about pneumonia. Q: Why do so few mothers in Pakistan fail to pick up on the early signs of pneumonia and why do many mothers fail to seek help when their children show signs of respiratory disease? A: I agree with you that this has been the weakest link we have had in our national ARI and other child health-related programmes. On paper, there is much emphasis on behaviour-change communications such as counselling mothers and working in communities. In reality very little is being done to educate mothers or involve them in case management. Most pneumonia deaths take place in the under-privileged segment of society, where women are not very literate, have little formal education and are dependent on men. They have problems leaving the house unless accompanied by a relative. Then there are socioeconomic factors such as the lack of transportation and scarce finances. Even if the mother is able to recognize signs of pneumonia and is able to overcome the constraints, the lack of access to quality health services makes matters more complicated. Q: Why does pneumonia receive less media attention in your country than health problems which have a smaller disease burden? …
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Jun 20, 2012
Monazza Aslam + 1
Open Access
