Above, Story Central Photo by Guilhem Alandry, Save the Children: Shipra with her son, Nirob who is 5 months and 20 days in Bosikali Village, Badalpur union, Ajmiriganj upazila, Habiganj Division, Bangladesh. Nirob has continuous sicknesses including pneumonia and he is malnourished.
A COMMENT FROM THE COORDINATOR
As we head into the last month of 2018, we encourage you to take a moment to reflect on the tremendous efforts and accomplishments by members of our pneumonia community. We have had many victories over the last calendar year – many detailed in our monthly newsletters and on our webpage (pneumoniainnovations.org). Despite reaching new benchmarks in our ongoing fight against pneumonia, we must continue to put our best foot forward to drive down deaths from child pneumonia to zero. Charge ahead towards the new year by reading a new blog post by Save the Children’s Evangelyn Nkwopara and be sure to check out the important research findings featured in our Articles & News section. Finally, before 2018 comes to a close, we encourage you to apply for the WHO Africa Innovation Challenge and submit an abstract for the Influenza Vaccines for the World (IVW) 2019 Conference. Thank you all for a monumental year, and may 2019 be our hardest-hitting year yet in the fight against pneumonia.
- The WHO Africa Innovation Challenge will prioritize innovative and scalable healthcare solutions for selection in Product Innovation, Service Innovation, and Social Innovation categories. It will provide continued support to healthcare innovators through a digital platform. Application deadline: Monday 10 December 2018 at midnight (GMT+1). Want to apply? Click here.
DEEP BREATHS: BLOGS FROM PIN MEMBERS
Fighting childhood pneumonia in Africa: Are antibiotics necessary for treatment of non-severe fast breathing child pneumonia?
by Evangelyn Nkwopara, Senior Research Manager and Clinical Trials Specialist at Save the Children US
It is 7:30AM in a small district hospital in Lilongwe, Malawi, and the pediatric triage unit is packed full of anxious parents seeking care for their sick infants or children. Here a dedicated team of research nurses and clinicians, part of the Innovative Treatments in Pneumonia (ITIP) project, work their way through the crowd looking for possible signs of pneumonia in hopes of catching the illness at its earliest stages in order to answer critical questions about this disease. No infectious disease kills more children under the age of five than pneumonia, and the symptoms tend to mimic other childhood illnesses making pneumonia hard to detect and treat. Amoxicillin is recommended as an effective first-line treatment, and in resource-limited settings such as Malawi, the World Health Organization’s (WHO) Integrated Management of Childhood Illness (IMCI) guidelines are used to diagnose pneumonia by identifying fast breathing and/or chest indrawing in a child with cough or difficulty breathing. However, the WHO IMCI guidelines for pneumonia have low specificity, particularly in regards to fast breathing pneumonia, leading to possible misclassification and ultimately, inappropriate treatment. There are a number of conditions, as well as factors, other than pneumonia that may cause fast breathing in a child. Which fast breathing cases are true pneumonia? Are antibiotics necessary for treatment of fast breathing?
In Lilongwe, Malawi, Save the Children Federation, in collaboration with partners at the University of North Carolina Project, Lilongwe Medical Relief Fund Trust, University of Malawi College of Medicine, and the University of Washington, have been investigating these questions along with others in hopes of determining the best treatment options for childhood pneumonia. The primary goals of the ITIP project are to provide evidence assessing 1) whether treatment with amoxicillin dispersible tablets is necessary for fast breathing childhood pneumonia, and 2) the optimal duration of treatment with amoxicillin dispersible tablets for chest indrawing childhood pneumonia in a malaria-endemic setting in Africa. Collecting African-specific data may contribute to updates to the current IMCI guidelines that are informed by the local context. Comprised of two clinical trials and one prospective observational study, the ITIP project began in 2016 enrolling children two to 59 months of age with community-acquired pneumonia at Bwaila District and Kamuzu Central Hospitals in Lilongwe, Malawi.
Two years later, the results of the fast breathing pneumonia clinical trial, ITIP1, have now been published in the November 2018 issue of the Journal of the American Medical Association, Pediatrics. Enrolled HIV-uninfected children diagnosed with fast breathing pneumonia were randomized to receive either placebo or amoxicillin dispersible tablet treatment for three days. The findings from this trial indicate that despite the low specificity of fast breathing as a sign of pneumonia, treatment with amoxicillin for children diagnosed with fast breathing might be warranted in this setting. Out of the 1126 children enrolled to the trial, 7% of children in the placebo group failed treatment by Day 4 compared to 4% among those who received amoxicillin. Of note, however, fast breathing pneumonia resolved by Day 4 in 93% of children without antibiotics. These results shed some light on how to address fast breathing childhood pneumonia in a region such as Malawi; yet, more research is needed to define and better understand which children benefit most from antibiotic treatment.
Work continues in the ITIP project with enrollment ongoing in ITIP2, the chest indrawing pneumonia trial, as well as analysis of the data from the observational study, ITIP3. It is through research such as the ITIP project that Malawi and other countries in Africa will gain critical information needed to put into place evidence-based policies and treatment guidelines that will significantly reduce the number of children whose lives are cut short by pneumonia.
Photos submitted by Evangelyn Nkwopara, Save the Children US
Evangelyn Nkwopara, MS, is a senior research manager and clinical trials specialist in the Technology Accelerator unit at Save the Children US, and is part of the protocol and study operations team for the Innovative Treatments in Pneumonia (ITIP) project in Lilongwe, Malawi.
PNEUMONIA INNOVATIONS NETWORK MEMBER AND PARTNER UPDATES
APPLY NOW to the WHO Africa Innovation Challenge
The World Health Organization (WHO) in the African Region has launched the WHO Africa Innovation Challenge. This Challenge is calling innovators, researchers and community-based initiatives including, youths and women that are working on novel solutions to improve health outcomes and apply new and fresh thinking to address unmet health needs for Africa.
This Challenge will prioritize innovative and scalable healthcare solutions for selection in the categories of Product Innovation, Service Innovation and Social Innovation and will also provide continued support to healthcare innovators through a digital platform in the longer term.
The launch of this Challenge and platform serves as a precursor to the Africa Health Forum in Cape Verde in March 2019; the premier gathering of political and business leaders in the region devoted to health. Finalists will be awarded a sponsored opportunity for their innovations to be showcased at the Africa Health Forum where they will get the opportunity to profile their solutions and meet with top political, government and business leaders in the health space.
Applications must be submitted online and will close on Monday 10 December 2018 at midnight (GMT+1).
Please click here for information on the Challenge and application submission.
WPD2018 Snapshot: AGIS Côte d'Ivoire Conference
Chaired by Professor Timité Konan A Marguerite, Honorary Professor of Pediatrics and President of the Ivorian Pediatrics Society, the conference saw the effective participation of the National Mother and The Child Health Program, representing the Ministry of Hygiene and Public Health, also the participation of the Pasteur Institute, the International Rescue Committee (IRC), the Côte d'Ivoire Red-Cross, the Concern Health Education project of Ghana, and Save The Children in Côte d’Ivoire for World Pneumonia Day 2018.
In Côte d'Ivoire, according to figures from the 2014 and 2015 Annual Health Situation Reports (AHSR), the incidence rate of Acute Respiratory Infections (ARI) is increasing with more than 202 cases per 1000 children in 2015 as compared to 165 cases out of every 1000 in 2014. ARI, including pneumonia, remain one of the major causes of children under 5 years death. Caused by viruses and bacteria, ARI impact could be reduced by acting on risk factors, particularly respiratory infections, malnutrition and air pollution which is very high in the country.
Head of AGIS, Sylla Aboubakar, congratulated conference attendees for active participation at this conference and called upon the organizations to work together to develop interventions to tackle the quiet and killer which is becoming the number one cause of under five mortality in Côte d’Ivoire.
Pneumonia Centenary Commitment Bangladesh Team hosts successful WPD2018
World Pneumonia Day (WPD) 2018 in Bangladesh saw a round table with key stakeholders, a radio show, a TV show, a national rally from a children's hospital to the parliament, a month-long social media campaign, round tables at division and district level, and engaging facilities in Sylhet region. Activities were recapped in The Daily Star article, "Pneumonia still fatal for children," here.
On the eve of WPD2018, Save the Children gathered with government & other key stakeholders in Dhaka for a round table discussion on Bangladesh’s journey so far, the challenges faced, and the necessary next steps in the shared mission for the reduction of pneumonia-related deaths in under-5s in Bangladesh.