Fact Sheet

 Globally, every 15 seconds, a child dies of pneumonia. Almost all of these deaths occur in
countries such as ours.

 Pneumonia causes more child deaths than any other illness. The death toll due to
childhood pneumonia is higher than the total deaths due to AIDS, malaria and measles
combined.1

 One in five child deaths in the world due to pneumonia occur in India. It is the number one
cause of child deaths in India.

 In India 20%, or one in five, deaths of children under the age of five years are due to
pneumonia.

 Pneumonia kills over 400,000 children in India each year; highest in the world.2 This is
roughly equivalent to a school bus full of young children dying every hour.

 In India, one child younger than five years of age is affected by pneumonia every second.3

 Early diagnosis and treatment of pneumonia is the key to survival; however mothers

Pneumonia is preventable and treatable

generally fail to recognize the early symptoms like cough and wheezing.

 Two out of five cases from the poorest families do not seek treatment for acute respiratory
infection (ARI), even when children have identifiable symptoms.4,5 Families often delay
treatment for girls more than boys in some states of India.

 Treatment with appropriate antibiotics can prevent child deaths due to pneumonia. In India,
only 10-20% of the children affected by ARI, receive antibiotics for treatment.5

 Immediate breastfeeding within the first hour of birth and exclusive breastfeeding till the
age of six months confers protective benefits to the infant against infections such as
pneumonia. In India, less than 50% of children are exclusively breastfed upto six months of
age.5

 Immunization against measles and pertussis (whooping cough) can reduce the risk of
pneumonia. Only half the children receive measles vaccination before completion of 12
months of age or the required three doses of the Diphtheria Pertussis Tetanus (DPT)
vaccine.5

1
United Nations Children’s Fund (UNICEF) and World Health Organization (WHO). Pneumonia—the Forgotten Killer of
Children. September 2006. ISBN-13:978-92-806-4048-9/ISBN-10:92-806-4048-8
2
Rudan I, Tomaskovic L, Boschi-Pinto C, Campbell H. Global estimate of the incidence of clinical pneumonia among children
under five years of age. Bull World Health Organ. 2004;82:895–903.
3
Calculated based on data available from- Rudan I, Tomaskovic L, Boschi-Pinto C, Campbell H. Global estimate of the
incidence of clinical pneumonia among children under five years of age. Bull World Health Organ. 2004;82:895–903.
4
Includes children with symptom of rapid breathing which is one of the diagnostic symptoms of pneumonia.
5
International Institute for Population Sciences (IIPS) and Macro International. 2007. National Family Health Survey (NFHS-
3), 2005-06:India:Volume I. Mumbai: IIPS.

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The contents of this leaf are made possible by the support of the American People through the United States Agency for
International Development (USAID). The contents of this document are the sole responsibility of Emerging Markets Group
Ltd. and do not necessarily reflect the views of USAID or the United States Government.
Reshma’s Survival Story:
Not all is well

Every second in India, a child falls sick with the

number one killer, pneumonia. It is estimated that
pneumonia kills one child younger than five years
of age almost every minute, or four lakh children a
year. This is an unacceptable fact considering that
pneumonia can be prevented and treated simply and
inexpensively. However, all that is known has not
been put to action. Reshma’s story describes this
unmistakably.

migrated from Assam

wit h her par ent s and four siblings. Her family
in Delhi ning
Reshma lives in a slum father is a daily wager, ear
sea rch of a bet ter sta ndard of living. Reshma’s 12 yea rs old,
few years ago in r, who is only
day , wh en he is con tracted. Her eldest brothe
about Rupees 100 per nth.
ning Rupees 800 per mo
works at a tea shop ear
. She has
normal weight for her age
Re shm a we igh s onl y 9 kgs, much below the oni a in the last
At the age of thr ee, episodes of pne um
rec om me nde d vac cin ations. She has had two epi sode.
not received all the during the first
a nea rby priv ate practitioner for treatment
six months. Her family con
sul ted dually disappeared with
pto ms of cou gh, fev er and fast breathing gra
and sym ioner
Her condition improved to consult a private practit
ibio tic. Th e fam ily did not have enough finances Re shm a’s
the use of oral ant and treatment till
sod e. Th ey pos tpo ned seeking medical advice ere
during the second epi ment hospita l wh
s finally taken to a govern
diti on bec am e vis ibly life threatening. She wa s of hospitalization. Though
con a rec overed after 14 day
dical atte ntio n. Re shm for the
she received prompt me father lost his daily wages
not inc ur any dire ct me dical expenses, Reshma’s n and Re shma’s
the family did to transportatio
l sta y. Th ere we re oth er expenses pertaining ney from
duration of her hospita to borrow mo
ds afte r hos pita l dis cha rge. Her family was forced
medical and nutritional nee ic needs .
1
tain even the family’s bas
ney len der at an exo rbitant interest rate to sus
The time to act is now
a local mo
nt health facility when
ed qui ckl y and taken her to the governme
If Reshma’s family had act may not have required
ng and diffi cul t bre ath ing first started, Reshma
the symptoms of coughi nd so much on her treatm
ent.
tion and the fam ily wo uld not have had to spe
hospitaliza
ek treatment
athing in a child means pneumonia, se
“Cough and difficult bre
immediately.”

1
Reshma’s story was shared by Sayan Chatterjee (MD student) and Sriram Krishnamurthy (Assistant Professor). Lady Hardinge
Medical College and Kalawati Saran Children’s Hospital

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Preventing childhood pneumonia requires a multi-faceted approach. Children who are not
fully immunized and get preventable childhood diseases such as measles and/or whooping
cough are at risk of pneumonia. Factors in the home that put children at risk of pneumonia
include overcrowded living, tobacco smoke and smoke from open chullahs (cooking fires).
Weak children are at greater risk of acquiring pneumonia. These include, children who
are undernourished, are born weighing less than 2500 grams, and are sick with measles,
whooping cough or infected by HIV. Families can prevent pneumonia by:

 ensuring their newborns and infants are fully immunized,

 initiating breastfeeding within an hour of birth, practicing exclusive breastfeeding for the first
six months and providing sufficient healthy complementary foods once children reach six
months, and

 eliminating indoor smoke by using smokeless chullahs and prohibiting smoking in the home.

Early recognition of symptoms and prompt treatment seeking by caregivers can prevent
deterioration of the illness and can save poor families from a financial catastrophe. Rural
children, children of non/less educated mothers and those coming from poor families are less
likely to seek treatment. Paradoxically, these children are at greatest risk of acquiring and
dying of pneumonia.

Preventive measures like practicing exclusive breastfeeding for the first six months, providing
appropriate nutrition to children based on daily requirements for essential nutrients, growth
monitoring and vaccination amongst others will go a long way in reducing the incidence of
pneumonia.

However, once the child is affected, the key to survival is timely recognition and prompt
treatment. Pneumonia begins as something less severe and if detected on time can be
managed effectively with inexpensive antibiotics.

Pneumonia kills more children than any other disease. This silent killer claims more
children every year in India than the total casualties of tsunami in 2004 across 11
countries.

The time to
act
now
is

The contents of this leaf are made possible by the support of the American People through the United States Agency for
International Development (USAID). The contents of this document are the sole responsibility of Emerging Markets Group
Ltd. and do not necessarily reflect the views of USAID or the United States Government.
Frequently Asked Questions
on Childhood Pneumonia

What is pneumonia?
Pneumonia is a severe acute lower respiratory infection that specifically affects the lungs. Pus
and fluid fill the alveoli, the smallest air spaces in the lungs, and make it difficult to absorb
oxygen.1,2

How do I identify pneumonia? What are the common

symptoms?
Rapid breathing is the most sensitive sign of pneumonia. There are different cut-offs for
breathing rate (that is, number of breaths per minute) depending on the age of the child.3

Other symptoms include cough, fever, chills, loss of appetite and wheezing.

In severe pneumonia, children may experience lower chest wall indrawing, where their chests
move in during inhalation (in a healthy person, the chest expands during inhalation).

Infants (that is, children less than 12 months of age) may be unable to feed or drink and may
also experience unconsciousness, hypothermia (body temperature lower than normal) and
convulsions.1

What causes pneumonia?

There is no single cause of pneumonia. It can be bacterial, viral or fungal and often starts as
something less severe.1,2

Bacteria are more likely to result in severe pneumonia, with Streptococcus pneumoniae
(pneumococcus) being the leading cause of severe pneumonia among children in the
developing world. Haemophilus influenzae type b (Hib) is also another common bacterial
cause of pneumonia.2,4
Some diseases, like measles and pertussis (whooping cough), can lead to pneumonia as a
complication.5

Is my child at risk?
Children under the age of five years are at risk. Children with low immunity are at greater risk
for acquiring pneumonia. This means that undernourished children, low birth-weight infants
(birth weight less than 2.5 kgs), infants who are not breastfed and children suffering from other
Is my child at risk?

illnesses such as measles, whooping cough and infected by HIV have increased risk.

1
WHO factsheet available from http://www.who.int/mediacentre/factsheets/fs331/en/index.html
2
Pneumo ADIP fact sheet available from www.preventpneumo.org/
3
For infants less than 2 months it is ≥60 per minute, for infant between 2 months to 12 months of age it is ≥50 per
minute and ≥40 per minute for children older than 12 months but below 5 years of age.
4
O’Brien KL, Wolfoson LJ, Watt JP, Henkle E, Deloria-Knoll M, McCall N, Lee E, Mulholland K, Levine O, Cherian T,
for the Hib and Pneumococcal Global Burden of Disease Study Team. Burden of Disease caused by Streptococcus
Pneumoniae in children younger than 5 years: global estimates. Lancet. 2009;374:893-902.
5
Duke T, Mgone CS. Measles: not just another viral exanthem. Lancet 2003; 361:763-73.

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Children who lack sufficient amounts of specific micronutrients, particularly zinc, face additional
risks of developing and dying from pneumonia.

Environmental risk factors such as: 1) overcrowding in homes; 2) exposure to tobacco smoke
mainly through parental smoking; and 3) indoor air pollution2 can also increase the risk of
acquiring pneumonia.

Can pneumonia be prevented? How do I protect my child

from pneumonia?
Pneumonia is preventable. Prevention of pneumonia requires reducing exposure to biological
and environmental risk factors associated with development of the condition.6

Measles and DPT vaccination reduces the risk of pneumonia.

Exclusive breastfeeding from birth to six months of age7 and adequate complementary feeding8
is protective against pneumonia.

It is essential to reduce indoor air pollution by using smokeless cooking stoves and prohibiting
smoking in home.

What is the treatment for pneumonia?

Pneumonia can be treated by inexpensive oral antibiotics, if diagnosed early. Severe
pneumonia cases may require hospitalization, intravenous antibiotics and oxygen treatment.

How do I care for my child at home if she/he has

pneumonia?
 Seek medical care when early signs like cough or wheezing are seen in the child.
 Follow the instructions for the prescribed antibiotic – the amount and timing to be given per
day and complete the entire course of medicine, even if symptoms improve.
 Continue feeding as usual.
 Provide the child plenty of fluids.
 Rush the child to the hospital if condition worsens (difficult breathing/rise in body
temperature/inability to feed or drink).

What are the government’s initiatives to control pneumonia

in India?
Acute Respiratory Infection (ARI), (which includes pneumonia) control is a priority for the
Government of India and a part of the Reproductive and Child Health Programme (RCH) under
the National Rural Health Mission (NRHM).

The Hib vaccine which protects against one of the common pneumonia causing bacteria, is
being included in the Government of India’s routine immunization program in 10 states.
2
Ibid (refer footnote 2)
6
Niessen L et al. Comparative impact assessment of child pneumonia interventions. Bull World Health Organ.
2009;87(6):472-8
7
Roth DE, Caulfield LE, Ezzati M, Black RE. Acute lower respiratory tract infections in childhood: opportunities for reducing
the global burden through nutritional interventions. Bull World Health Organ 2008; 86: 356-64.
8
Adequate complementary feeding means that infant’s/ child’s daily requirement for energy and other essential nutrients
is met through a variety of food groups.
The contents of this leaf are made possible by the support of the American People through the United States Agency for
International Development (USAID). The contents of this document are the sole responsibility of Emerging Markets Group
Ltd. and do not necessarily reflect the views of USAID or the United States Government.
What you can do?

What you can do as a media representative

Join the effort in combating childhood pneumonia in India

Media has a large circle of influence. It can change individual views and shape national
policies. As a media representative, there are various pathways through which you can join
the effort in combating childhood pneumonia in India.

Many people are surprised to learn that pneumonia causes the maximum number of
child deaths in India. Creating awareness about the health, social and financial burden of
childhood pneumonia is necessary to initiate people’s and institutions’ thinking on the issue.

You can influence change at individual or family level through the following ways:

 Provide people information on the grave health and socio-economic consequences of a

child acquiring pneumonia.
 Also, provide them with solutions with respect to prevention and treatment of pneumonia.
 Generate awareness about vaccinations that is, the type of vaccine and age at which
these have to be administered.
 Highlight the issue of early detection and prompt treatment for pneumonia as key to child
survival.
 Provide information to child caregivers on how to detect early signs and when to seek
medical advice.
 Publish contact details of nearest public and private health facilities by neighbourhood
where pneumonia treatment is available.

You can generate political will and influence institutional change through the following ways:

 Publish data and facts on the health and socio-economic burden of childhood pneumonia
at the national or regional level.
 Present the big socio-demographic and economic picture of the patterns of childhood
pneumonia; highlight who are most vulnerable and where they are.
 Publish primary health care status reports for different states to highlight strengths and
deficiencies of the health care system across regions of India.
 Share success stories on community case management as well as facility based
management of severe pneumonia or complicated cases.
 Document and share human interest stories to mobilize interest, commitment and action.
 Make pneumonia an issue for editorials.

This list can be extended further. The means of making this information available and making
childhood pneumonia an issue of concern are best known to you.

Collectively, we can work together to keep the issue of childhood pneumonia in the news and
in people’s minds so that it no longer remains India’s number one killer among children.

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What parents or family members with a young child can do
Families can prevent pneumonia. Families should ensure that:

 Children are adequately nourished. This implies, newborns are breastfed within an hour
of birth, infants are exclusively breastfed for six months and thereafter receive adequate
complementary feed as required for their age. Infants aged 6-8 months should receive two
meals in addition to breastfeed while children aged 9-23 months should be given three
meals along with breastfeeds.

 Children’s height and weight should be monitored regularly and compared with
recommended standards to identify growth faltering as early as possible.

 Newborns and infants should receive all vaccinations as per Government of India’s
recommended guidelines that is:

 BCG at birth

 Three doses of DPT (at 1.5, 2.5 and 3.5 months)

 OPV at birth, three doses (at 1.5, 2.5 and 3.5 months) and on every Pulse Polio Day
till the child completes five years of age
 Measles at the age of nine months.

 Reduce indoor air pollution in your house by using smokeless chullahs and prohibiting
smoking inside the house

 You should know and take action:

 If the child gets sick with signs of fever, cough and or wheezing consult a doctor
without delay.
 Pneumonia can be treated using inexpensive antibiotics if identified early. It is
essential to follow doctor’s advice and prescribed medication which includes the
dosage, frequency and duration of administration of the medicine.

 Continue providing food and fluids. Do not restrict food or fluid intake.

 Take the child to hospital immediately if condition worsens (as in, difficult breathing/
rise in body temperature/ inability to feed or drink).

 Maintain contact details of nearby clinic and hospitals so that these are easily
accessible in case of an emergency.

The contents of this leaf are made possible by the support of the American People through the United States Agency for
International Development (USAID). The contents of this document are the sole responsibility of Emerging Markets Group Ltd.
and do not necessarily reflect the views of USAID or the United States Government.