Pneumonia — no child should die from a disease we can prevent

Every 39 seconds a child dies from pneumonia.1 By the time you finish reading this post at least five children will have died from it. For a disease we know how to treat and prevent, this should never be the case. 

Pneumonia is the leading cause of child mortality

5.4 million children under five years old died in 2017. Pneumonia was the cause of death of one-in-seven of them.2 As the visualization shows, pneumonia is the leading cause of child mortality globally and has been the leading cause for the past three decades.

Today more than 2000 children will die from pneumonia

809,000 children under five years old died from pneumonia in 2017. This means, on average, the disease claimed more than 2,200 children every day.3

As the map shows, children are most likely to die from pneumonia across Sub-Saharan Africa and South Asia. Just 5 countries — India, Nigeria, Pakistan, the Democratic Republic of Congo, and Ethiopia – accounted for more than half of all deaths from childhood pneumonia in 2017.

In a 2018 comment in the journal Lancet, Kevin Watkins and Devi Sridhar called pneumonia “the ultimate disease of poverty”.4 There is a strong correlation between a country’s income and child mortality from pneumonia. Pneumonia is not a disease that transmits easily across borders; it is generally restricted to local communities and can be controlled when basic health measures are available. The disease is therefore most common in places where healthcare infrastructure is lacking and people are least able to afford treatment.5

We’ve made enormous progress against pneumonia, but many more lives could be saved

In the visualization here we see global deaths from pneumonia by age group. The number of children dying from pneumonia has decreased substantially over the past three decades. In 1990, more than two million children died from pneumonia each year; by 2017 this number had fallen by almost two-thirds.

As well as increased availability of interventions and treatments such as pneumococcal vaccines and antibiotics, improvements in the major risk factors such as childhood wasting, high air pollution, and poor sanitation have all contributed to this decline. By continuing to reduce child exposure to these risk factors we can continue to reduce child mortality from pneumonia. We explore the role of these risk factors in more detail here.

Apart from limiting risk factors, one of the best ways to prevent pneumonia is to vaccinate children against the pathogens that cause it – and we have very effective vaccines available. PCV and Hib vaccines protect children from pneumonia caused by pneumococcus and H. influenzae. Researchers have estimated that, combined, these vaccines saved the lives of 1.4 million children between the years of 2000 and 2015.6

But still too few children are vaccinated, which means we are missing out on the much greater impacts vaccines could have. Cynthia Chen et al. (2019) suggest that if almost every child would be immunised with pneumococcal vaccine, we could save the lives of close to 400,000 children annually.7 We discuss the potential of pneumococcal vaccines in more detail here

In addition to vaccination, promoting breastfeeding of newborns is also an essential preventative measure. Research by Laura Lamberti et al. (2013) suggests mortality from pneumonia in lower-income countries among children who are not breastfed in the first 5 months of their lives is 15 times greater than those who exclusively received their mother’s milk.8

And when prevention is not sufficient, we need to provide more access to available treatments. Better access to healthcare facilities, antibiotics, and oxygen therapy can all contribute to saving more lives.

In 1902 William Osler, one of the founders of Johns Hopkins Hospital and a pioneer medical teacher, referred to pneumonia as “Captain of the Men of Death”. In the early 20th century there were few treatments for pneumonia available; in the 1940s medical textbooks would still recommend bloodletting as one of them.9 Today we know the causes of the disease, what risk factors make children more likely to get the disease and we have multiple ways we can prevent and treat it. Many of the interventions we have today not only protect children from pneumonia but also help to limit diseases such as diarrhea, meningitis, tuberculosis, and others.

Pneumonia today is no longer a Captain — we know how to steer the course of the disease. But with all the tools we have at our disposal, there is still much work left to be done to save the 800,000 children lost each year due to this preventable disease.