Pneumonia - management in the developing world

Childhood pneumonias are an important cause of morbidity and mortality and annually contribute to over 2 million deaths among children under five years of age. To combat this, a standardized case management protocol developed by the World Health Organization has been adopted by the National programs in most high burden, resource constrained settings. This can detect patients with pneumonia early on and with ease at community level and also identify those who are at risk of dying due to a severe form of the disease if not referred or appropriately treated. However, as most deaths due to pneumonia occur in health facilities, it is equally important to standardise treatment at a facility level with pulse oximetry, regular monitoring for complications and the judicious use of antibiotics. The challenge is to identify other respiratory illnesses which mimic pneumonia resulting in under treatment with bronchodilators and over usage of antibiotics. This becomes particularly important in developing countries which have the dual burden of both the infectious and non-infectious illnesses. The strategy also needs refinement for diagnosing and treating pneumonia in severely under nourished and / or HIV co-infected children who are both at higher risk of disease as well as death due to it.