Pneumonia kills 84,210 children every year in Pakistan and it is still a challenge to provide children in the rural areas of Sindh with the vaccine for this deadly disease. However, a new study has suggested that lady health workers (LHWs) can be the solution to this problem. Recently, the World Health Orgnisation (WHO) recommended that children with WHO-defined severe pneumonia should be given a single antibiotic dose and referred to a health facility for treatment. However, referral often poses a problem for many families, who cannot afford to travel to a hospital or to pay for services once there. Almost two-thirds of all children who die of pneumonia in Pakistan, die at home because of lack of access to appropriate and timely care.
Childhood pneumonia, characterised by fever, chills, cough and rapid breathing, is a leading cause of deaths in children under five globally. In 2008, it accounted for 1.6 million deaths worldwide and in Pakistan alone, 84,210 deaths or one-fifth of the total number of deaths in children younger than five. There is now hope that innovative approaches can make a difference. A study carried out in the Matiari district of Sindh offers hope for children with severe pneumonia in poor, rural communities; they can be recognised and treated safely at home by LHWs using a simple oral antibiotic.
The study, published in the leading journal The Lancet, was conducted by the Aga Khan University’s Division of Women and Child Health in collaboration with the Lady Health Workers programme of the Pakistani government, the Boston University’s Centre for Global Health and Development, and the World Health Organisation’s Department of Child and Adolescent Health.
The trial was carried out in Matiari, 250 km north of Karachi with 1,600 villages and an estimated population of 600,000, a rural district of Pakistan with high rates of this disease and limited resources. It looked at the management of severe pneumonia in children under five years of age at home by the LHW programme versus referral to the nearest health facility – a basic health unit, a rural health centre or even a hospital.
The study found that in only eight percent of children treated at home did treatment fail compared to the 13 percent referred to a health facility. “We found that with training, public sector LHWs in Pakistan are able to satisfactorily diagnose and treat severe pneumonia at home in rural Pakistan,” said Professor Zulfiqar A Bhutta, head of the Division of Women and Child Health at the Aga Khan University and principal investigator of the study. “This strategy might effectively reach children with pneumonia in settings where referral is difficult, and it could be a key component of community detection and management strategies for childhood pneumonia in similar populations.”
This study covered a representative rural population in Sindh where this disease is quite prevalent. It could also apply to Balochistan and the Punjab where high rates of pneumonia can still be found in the rural areas. The findings also validate a parallel trial (with a similar study design), carried out in the north of Pakistan, in Haripur district by the Save the Children US with the support of USAID and WHO. The results of these two recent studies have prompted the researchers to recommend a thorough review of the national LHW programme curriculum for pneumonia detection and treatment and a phased introduction of community-based management of severe pneumonia into the LHW programme in all provinces.
