Lois King, MPH & BSc

PhD Candidate at the University of Edinburgh and Global Health Consultant

Seven Things You Didn't Know About Pneumonia

November 12, 2019

The World Health Organization defines pneumonia as an acute respiratory infection, in which the lungs become inflamed, filling up with mucus and fluid, rather than air. This can lead to a cough, difficulty breathing and a fever. This year for the 10th anniversary of World Pneumonia Day, we are putting a spotlight on this debilitating disease and addressing some myths about pneumonia. How is it contracted? Does gender discrimination play a role in treatment and diagnosis? Is there a cure? Here are seven things you didn’t know about pneumonia.

1. Biggest killer of children globally
Severe pneumonia can lead to death in vulnerable groups and, as such, it is the single biggest infectious cause of death in children under 5 around the world; more child deaths are attributed to pneumonia than malaria and diarrhoea combined. This means that pneumonia accounts for 16% of child deaths.  Despite the burden this disease carries, it is consistently underfunded compared to other infectious diseases and is considered by some experts as neglected in the global health community.

2. “Gender discrimination in healthcare costs lives”
Even among children, the disease affects males and females differently due to gender bias. Globally, while boys are physiologically more susceptible to contracting pneumonia as a result of lower oestrogen levels, girls in India are 43% more likely to die from it due to traditional care-seeking behaviour practiced in South Asia.

3. Anyone can be a victim
Pneumonia does not only affect children and can be contracted at any stage of life, particularly in those who are immuno-compromised. British songwriter George Michael and boxing champion Muhammad Ali have both been hospitalised due to pneumonia (the former in 2011 and the latter in 2014), whilst former United States President Ronald Reagan died of pneumonia, following a battle with Alzheimer’s disease.

4. Location matters
A staggering 99% of pneumonia cases are found in low-and middle-income countries. Furthermore in 2015, only 5 countries contributed to more than 54% of all global pneumonia cases: India, Nigeria, Indonesia, Pakistan, and China; 32% of the global burden is from India alone.

5. Air pollution is a significant risk factor
An editorial published by the Lancet found both indoor and outdoor (ambient) air pollution contributed to over half a million pneumonia-related deaths in children under 5 in the year 2016 alone. The dangers of air pollution are exacerbated by overcrowding and environmental issues.

6. There is no single cause
The condition can be caused by over 30 different microbes, which are all various types of bacteria, viruses and fungi. However, the most common bacteria that causes the infection is known as Streptococcus pneumoniae.

7. Minimising risk of illness
The good news is that pneumonia can be prevented through immunisation and prophylaxis. The Pneumococcal Conjugate Vaccine can prevent most bacteria-causing pneumonia such as S. pneumoniae. However, 170 million children under the age of 2 remain unvaccinated, largely due to high healthcare costs and poor access to care. Moreover, breastfeeding of children up to the age of 2 can greatly reduce the risk of contracting and therefore dying of pneumonia. Other measures include provision of antibiotics, simple hygienic practices such as handwashing with soap and adequate nutrition. 
So what can be done to change the narrative? Since pneumonia is predominantly a disease of poverty, targeted interventions are complex in such populations and require a sector-wide approach within resilient health systems to address the wider determinants of health such as malnutrition, out-of-pocket payments for healthcare and care-seeking behaviour. Ensuring the global health community mobilise efforts, political will and resources towards reducing pneumonia-related morbidity and mortality is paramount in reducing its global burden. By raising the issue higher on the political agenda and advocating for universal health coverage, those most at risk will be better able to access the care and treatment they need at an affordable price.
Echols, R., Tillotson, G., Song, J. and Tosiello, R. (2008). Clinical Trial Design for Mild‐to‐Moderate Community‐Acquired Pneumonia—An Industry Perspective. Clinical Infectious Diseases, 47(S3), pp.S166-S175. https://doi.org/10.1086/591399
Watkins, K., Wright, S., Le Nestour, A., Mathieson, K., Alfaiate, J., Leigh, C., Fiala, O., Curran, H., Szabo, S., Elliott, H., Sale, J., Brace-John, T., Ul Haq, Z. and Ahmar, S. (2017). Fighting for breath: a call to action on childhood pneumonia. Available at: https://www.savethechildren.org.uk/content/dam/global/reports/health-and-nutrition/fighting-for-breath-low-res.pdf [Accessed 6 Nov 2019].
World Health Organization (u.d.). Air pollution. Available at: https://www.who.int/airpollution/en/ [Accessed 9 Nov 2019].


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