A new approach to pediatric pneumonia – Butterfly iQ used to train mid-level providers in point of care ultrasound in rural Uganda

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Above, photo provided by Bridge to Health. 

Michelle helping our local Ugandan coordinator, Nangoli Andrew, to scan

 

In the winter of 2014, Bridge to Health, working with our Ugandan partners, realized the power of portable ultrasound. We discovered its broad practicality for rural and remote settings, as well as its unique ability to incentivize patients to engage in the healthcare system who might otherwise seek traditional healers. Starting with antenatal care, we demonstrated a six-fold increase in uptake of services when ultrasound was advertised versus when it was not. From there, we empowered our community partners in Uganda with devices, and asked our colleagues who were Ugandan mid-level health care providers, what they would most like to use ultrasound for if given the opportunity. Initially, they described obstetric ultrasound and their desire to learn that technique. We wondered though, “do they know the full extent for how ultrasound can be used?” So, we changed the survey, this time we gave a menu of options and asked that they select their top choices. Now, topics like breast masses and pediatric pneumonia rose to the top. With that in mind, our team began to put together a group of world-leading experts to design curriculum, engage local partners and find the devices necessary for the program.

 

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Big Opportunities & High Stakes for Immunization

June PIN

Above, photo by Nina Raingold Save the Children, UK Creative Team. 

Pneumococcal vaccine before it is administered at Lodwar County Hospital, Turkana region, Kenya. Babies are routinely offered the pneumococcal vaccine at age 6 weeks to prevent them from contracting pneumonia. However, many families don't have the means to travel to hospital to obtain the vaccine.

 

By: Kirsten Mathieson, Save the Children UK

The coming year will be critical to getting it right for the nearly 20 million children still missing out on immunization. Governments and national and global immunization partners must step up to the plate so that all children have access to this and other vital health services.

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The Children’s Oxygen Administration Strategies Trial (COAST)

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Above, photo by Jonathan Hyams, Save the Children, Bangladesh, July 2018: Laila,* holds an oxygen mask to the face of her son Sohai,* two, at Save the Children’s primary healthcare centre (PHCC) in Cox’s Bazar, Bangladesh. Sohai* was admitted to the inpatient ward at the PHCC, suffering from acute pneumonia.

 

by Kathryn Maitland, Professor of Tropical Paediatric Infectious Diseases at Imperial College, London and KEMRI-Wellcome Trust

 

Although oxygen is a basic element of hospital care, strongly recommended as a life-saving therapy for children with severe pneumonia and specifically for children with hypoxaemia (oxygen saturations, SpO2 less than 90%), the evidence underpinning these recommendations is weak. Yet, many African hospitals lack the facility to measure oxygen saturations (using pulse oximetry) and thus, therapeutic oxygen is often poorly targeted. Furthermore, despite a high demand, there is often very limited resources of oxygen therapy which is both costly (if using bottled oxygen) and erratic (if using oxygen concentrators) as electricity is unreliable. Although oxygen has been used in supportive treatment for a large part of the last century, the recognition of oxygen toxicity as a problem has been relatively recent. Toxicity is related to the concentration of oxygen and length of exposure. Worldwide, there is an increasing recognition of the harms of oxygen therapy. The evolving literature on its harms has resulted in oxygen no longer being recommended for a number of indications. Thus, there is a justifiable scientific question about whether oxygen can be safely and effectively administered, and results in better outcomes in children with severe pneumonia.

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Timing is everything! Preventing more pneumonia with an innovative vaccine schedule

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Above: Photo by Charlie Forgham-Bailey, Save the Children. Democratic Republic of Congo (DRC). Vaccinations are given at various points during the child's development, and helps prevent numerous ailments, including pneumonia.

 

 

by Cynthia Whitney, IHRC, Inc. and Emory Global Health Institute

 

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Roald Dahl’s Heartbreaking Letter to Anti-Vaxxers

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Photo by PA/ Getty Images

By Kashmira Gander, published on 30 January 2019. Featured in Newsweek, 01 March 2019.

 

 

A 1986 essay written by the late Charlie and the Chocolate Factory author Roald Dahl about his daughter dying of measles has been shared widely online, as new outbreaks of the dangerous disease have given it fresh relevance. The U.S. is once again witnessing outbreaks of measles, with 2018 seeing the second-highest number of cases since the disease was eliminated from the country in 2000. The false belief that measles is relatively harmless while the MMR vaccine is dangerous is partly to blame. Neither claim is backed by scientific evidence. 

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What do the people we are designing for have to say?

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Above, MamaOpe team in a focus group discussion with caregivers, village health team members, and opinion leaders. 

by Olivia Koburongo, inventor and co-founder of MamaOpe Medicals Limited

 

 

“You’ve got to start with the customer experience and work backwards to the technology. You can’t start with the technology and try to figure out where you’re going to sell it.”  -Steve Jobs

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Imagination is more important than knowledge

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Above, photo by Peter Casamento: FREO2 Uganda team in Mbarara. From (L) to (R) Frank Kiwanuka, Sandrah, Ivan Muhumuza, Sheillah Mutetire Bagayana and Patrick Semata. 

by Roger Rassool, physicist at the University of Melbourne and co-founder of the FREO2 Foundation

 

 

Imagination is more important than knowledge. This was confirmed for me during a meeting of individuals from very divergent backgrounds where my physicist colleagues and I were introduced to the concept of equity and global health. Our friends from the Nossal Institute for Global Health invited our team of physicists to a “No Limits” symposium where they discussed the many challenges they faced, hoping that we might have some technology solutions. This was the first time we heard about the plight of childhood pneumonia. We listened carefully as they explained the key role that oxygen could play in treatment. Oxygen to them was a medicine. We were hooked.

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If we want a more equitable world, we need to tackle Respiratory Syncytial Virus

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Above: Neha Thakur, 25, poses with her 7 month old baby, Vanita. ©Gates Archive/Mansi Midha

By Keith Klugman, Director, Pneumonia, Bill & Melinda Gates Foundation

 

Many of us who work in global health were drawn to the field by a desire to create a more equitable world. It is this desire that fuels our efforts to level the playing field for children with respiratory illness at the Bill & Melinda Gates Foundation. Diseases like pneumonia caused by the Respiratory Syncytial Virus (RSV), though unknown to many, clearly demonstrate a troubling pattern of global inequity. For infants lucky enough to be born in wealthy countries with access to quality health care, RSV often manifests as nothing more than a bad cold, with mild symptoms like fever, congestion, cough and a runny nose; if the disease becomes more severe and leads to hospitalization for pneumonia, then death is very rarely the result. But for babies born in poorer countries without access to quality health care, these symptoms can become a matter of life-or-death.

 

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Fighting childhood pneumonia in Africa: Are antibiotics necessary for treatment of non-severe fast breathing child pneumonia?

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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.

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The vaccine saving the lives of Pacific children

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World Pneumonia Day 2018 Media Round-Up

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IMAGE: PNEUMONIA IS THE LEADING CAUSE OF DEATH OF CHILDREN GLOBALLY. (UNITED NATIONS PHOTO/FLICKR.COM/CC BY-NC-ND 2.0)

 

Authored by the Every Breath Counts Coalition 

 

Is it our imagination or was it harder than ever to get the media to pay attention to pneumonia this World Pneumonia Day? Despite the best efforts of all who worked hard to get coverage, very few health journalists and mainstream media outlets wrote stories about pneumonia. Kudos to those below who managed to break through, and thanks for your efforts to push the pace of progress fighting the #1 infectious killer. 

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The vaccine saving the lives of Pacific children

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This week, we marked World Pneumonia Day. Pneumonia is the single largest infectious cause of death in children worldwide, and about one-third of all childhood deaths from pneumonia are a result of the pneumococcal bacteria. Sadly, most of the deaths as a result of pneumonia occur in poor children from low and middle-income countries.

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Towards Elimination of Pneumococcal Disease

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Towards Elimination of Pneumococcal Disease

by Mark Alderson, Director of the Pneumococcal Vaccine Project at PATH, photos by Lauren Newhouse (PATH) and Mark Alderson (PATH)

 

Pneumococcal conjugate vaccines (PCVs) have now been introduced into many countries throughout the world, including in nearly 60 Gavi supported countries where these vaccines have markedly reduced childhood pneumococcal disease (including pneumonia).  Despite this considerable success, two major challenges remain for global pneumococcal disease control—ensuring that PCVs are sustainably affordable for low- and middle-income countries (LMICs) and addressing disease caused by non-PCV serotypes.

 

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November 2018 Member Newsletter

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A COMMENT FROM THE COORDINATOR November 12, 2018 is World Pneumonia Day. 

World Pneumonia Day (WPD) is our day to raise awareness around pneumonia and the many lives pneumonia claims every year. This year, we must promote pneumonia prevention and treatment interventions, and catalyze action to fight pneumonia with greater force than ever before. Now is the time to start dialogues, generate innovative ideas, and form new collaborations within our global community. Get inspired by this month’s blog post by Dr. Mark Alderson and be sure to check out our member and partner update, “Up your impact for World Pneumonia Day 2018,” for ways in which you can be involved and make the most of your WPD. If your group or organization is hosting an event for WPD 2018, please email Mari Couasnon (This email address is being protected from spambots. You need JavaScript enabled to view it.) for a chance to share your event on the Pneumonia Innovations Network website. We hope you join us in our hard-hitting efforts for WPD 2018.

 

 

 

ANNOUNCEMENTSWorld Pneumonia Day (WPD) 2018 is just around the corner! Be sure to check out our Events section to see WPD events happening near you.The PIN is collecting statements from members on network impact. Please send Mari Couasnon (This email address is being protected from spambots. You need JavaScript enabled to view it.) your thoughts on how the PIN has served you and how you have benefitted from being a member of our global, open-access network.Send news, updates/ announcements or publications that you would like to share with the PIN to Mari Couasnon at This email address is being protected from spambots. You need JavaScript enabled to view it.  for a PIN newsletter feature.

 

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WPD 2018: Making the most impact

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This year, we want your World Pneumonia Day to be more impactful than ever! Here are 10 things you can do to make your contribution to World Pneumonia Day 2018:  

 

Send at least one item of content about your pneumonia-related work to This email address is being protected from spambots. You need JavaScript enabled to view it. for inclusion on the official WPD website www.stoppneumonia.org. Remember this is the 10th year of World Pneumonia Day and the theme is, "10 Years of Progress and the Path Forward”. 

 

Participate in one of the WPD-related events: (1) On November 12, the University of Edinburgh will host a World Pneumonia Day Symposium, (2) On November 13, IVAC will host an event with the United Nations Foundation's Shot@life campaign in DC, and (3) on November 13, CSIS is hosting Innovations to Improve Vaccine Equity in DC.

 

Read and share the two new pneumonia-related reports that are being released: (1) "The Missing Piece: why continued neglect of pneumonia threatens the achievement of health goals” from JustActions and Development Initiatives using Global Burden of Disease 2017 data, courtesy of the Institute for Health Metrics and Evaluation (IHME), and (2) “Pneumonia and Diarrhea Progress Report” (link is to 2017 version) from IVAC using WHO/UNICEF data to measure select country progress to the GAPPD child pneumonia targets. You will be able to find both reports on the stoppneumonia.org website in early November.

 

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Countdown to World Pneumonia Day 2018

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World Pneumonia Day 2018

 

Making progress: our fight against pneumonia

We have come a long way in reducing child mortality by pneumonia. In 2006, UNICEF/WHO released their “Pneumonia, the Forgotten Killer of Children” report, revealing a death toll of 2 million children each year. Today, it is estimated that pneumonia takes the lives of 880,000 children under age 5. Despite the ground we have covered, we are far from the finish line if we intend to reach Sustainable Development Goal 3.2, ending preventable deaths of children under 5 years of age. Pneumonia deaths are preventable. Even just one child begin taken by pneumonia is still too many. 

While we continue to push forward and gain momentum for our work, this year’s World Pneumonia Day (WPD 2018) allows pneumonia community members to showcase their progress and join forces with others in the fight against pneumonia. Don’t miss this year’s WPD events and help us spread the word! Please forward this WPD email to your colleagues and networks.

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Global Strategies Chalkboard: Oxygen saturation

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by Global Strategies 

 

 

Chalkboard: Oxygen saturationKnowing it is low doesn’t tell you what it means

Imagine that a friend calls you on the phone. He just got his driver’s license today and tells you this: “I am driving and noticed a light is on that looks like a gas pump. What does it mean?”

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Encouraging research innovations that improve health

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Encouraging research innovations that improve health

By Roger I. Glass, MD, PhD; Director, Fogarty International Center and Associate Director for Global Health, National Institutes of Health

 

I find anniversaries can provide us with useful opportunities for reflection. As a diarrheal disease expert, I have recently been contemplating the impact of a research breakthrough that occurred fifty years ago—the discovery that oral rehydration therapy (ORT) could save thousands of people at risk of dying of cholera, for a treatment that cost just pennies to administer.

 

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The Every Breath Counts Coalition

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by Leith Greenslade, co-Chair of the Pneumonia Innovations Network and Founder & CEO of JustActions

 

The growth in global health financing that began in 2000 and peaked in 2013 spawned the development of several public-private partnerships that have achieved some of the strongest results in public health (IHME, 2017). It was largely through the efforts of Gavi the Vaccine Alliance, The Global Fund to Fight AIDS, TB and Malaria and their partners that child deaths from vaccine-preventable infections and malaria fell so sharply, and the rise of HIV/AIDS was halted and reversed over the period (GBD, 2016). And with many public and private sector actors now aligned to end maternal deaths, to expand access to contraception, and to end malnutrition and non-communicable diseases, we should start to see more rapid advances in maternal survival and modern contraceptive uptake, as well as declines in child malnutrition and chronic disease. All are essential to achievement of the Sustainable Development Goals (SDGs); however, one major cause of death and disability is still largely missing from the picture.

 

Pneumonia.

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‘Recurrent Fast Breathing Pneumonia’ - A clinical syndrome worth recognizing and exploring

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by Fyezah Jehan; MBBS, MSc., Assistant Professor of Paediatrics and Paediatric Infectious Disease, Aga Khan University

 

 

In a low-income neighborhood of Karachi, Pakistan, a community health worker (CHW) has just finished counting the respiratory rate of Naeema, a 6-month-old child who has come in with her second episode of fast breathing pneumonia in a year. She had received a three-day course of amoxicillin with resolution of symptoms only three months back. “Why is she having these symptoms again?” quizzes Naeema’s mother of the CHW who now appears concerned about the recurrence.

 

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