Acutepneumonia remains the leading cause of death in children throughout the world,killing 1.6 million children each year, the vast majority in developingcountries. Some 20+y years ago theWorld Health Organization developed a set of guidelines for pneumoniamanagement designed for community settings in developing countries. The aim was to reduce pneumonia relateddeaths. These guidelines werelater incorporated into the WHO Integrated Management of Childhood IllnessGuidelines., designed both for primary care and hospital based case management.
Theseguidelines call for diagnosis on the basis of three signs, cough, rapidbreathing, and lower chest in drawing or retractions. Cases are then separated into not severe, severe, and verysevere, based on the degree of difficulty. Not severe cases are treated locally by the community healthworker with either amoxicillin or co-trimoxazole. Those with severe or very severe pneumonia are referred tothe nearest health facility for treatment with injectable antibiotics. This approach does not distinguishbetween viral and bacterial causes, nor does it clearly separate pneumonia fromother causes of respiratory distress, notably bronchiolitis in infants, orcroup. Concerns overdifferentiating pneumonia from reactive airway disease (asthma) have persuadedWHO to add a trial of a bronchodilator with those children with audiblewheezing to the guidelines. Widespread use of these guidelines has created a clearer plan for thecommunity health worker. A numberof extensive studies have demonstrated a 25-50% reduction in mortality in thosethird world settings that adopt the guidelines. Some studies have shown that treatment of severe pneumoniaat home with antibiotics under the guidelines is as effective as referral tothe regional center, and resolves the often difficult problems oftransportation and follow-up.
Ref: Graham,S.M. et al. Challenges toImproving Case Management of Childhood Pneumonia at health Facilities inResource Limited Settings: BullWorld Health Org 86, May 2007
Submitted by Roger Boe MD.