Although vaccines for pneumonia are now widely available, they have not been fully implemented in African health care sector. This is the main cause of death of under-5 children who are the world’s largest sufferers of the condition. The introduction of vaccination programs may help reduce the mortality rates in African region and will improve health outcomes for children and their survivability. The article looks into the various researches that support this theory.



































Pneumonia is an acute respiratory infection that can take various forms of severity, all affecting various parts of the respiratory system. The two most common bacteria known to cause it are the Streptococcus pneumoniae and the Haemophilus influenzae type B or HiB. There is lack of research that identifies other possible viral, bacterial or fungal contributors to the condition (Pneumonia, the Forgotten Killer of Children, 2006, pp 7).

The signs and symptoms of the condition include high fever, rapid breathing, cough, fever, chills, headaches, loss of appetite and wheezing. Children can display the characteristic lower chest wall indrawing sign. These signs and symptoms are easily observable and parents and caretakers should therefore, be educated so that they can take steps earlier (Pneumonia, the Forgotten Killer of Children, 2006, pp 7).

In Africa and other developing countries, the risk of developing the condition is high as the children may not have optimum defense systems. This could be due to malnutrition or starvation, lack of breast feeding, and illnesses such as HIV. In such conditions the prognosis of the condition becomes much worse (Pneumonia, the Forgotten Killer of Children, 2006, pp 7). However, lack of proper funding and unpredictable support for African welfare programs have also contributed to the rise in various preventable illnesses, including preventable under-5 age deaths. The lack of effort has to be redirected to include a comprehensive program of health care provision, treatment, education and prevention in order to improve outcomes of the African population (Sachs, 2001, pp 521 and 522).




The Millennium Development Goals Report of 2008 showed some very dismal statistics of under-five children dying in Africa. These figures have been dropping, albeit in very slow pace, with 2006 showing death rates to be 157 per 1000 births, still the highest in the world (Millennium Development Goals Report, 2008, pp 22). Most of these deaths are still caused by some of the preventable diseases of the world, including pneumonia, diarrhea, malaria and measles. Pneumonia has become the largest killer of under-five children in Africa, with no improvement in the treatment seeking behavior among the people (Millennium Development Goals Report, 2008, pp 23).

The findings have shown that despite the intense efforts to educate the people about pneumonia, it remains still the main cause of death among children under the ages of five around the world. The caregivers are poorly knowledgeable about the signs of pneumonia, which results in late diagnosis of the condition, by the time most of the children are dead or on the verge of dying. The efforts to make antibiotics available to people in Africa have failed, and only 20 percent of the population receives any form of medication to treat pneumonia (Pneumonia, the Forgotten Killer of Children, 2006, pp 6). Of the total illnesses, the percentage occupied by pneumonia which kills children under-five years is 19 percent (Pneumonia, the Forgotten Killer of Children, 2006, pp 7). This is too high a percentage given that medical cure is available and thus it is a preventable form of illness. The number it translates to in infant deaths is as high as 3 million, making it an issue of considerable global significance (Pneumonia, the Forgotten Killer of Children, 2006, pp 7). Africa shares the highest death rates due to pneumonia with South Asia, meaning that this phenomenon is not only limited to Africa, but is a global threat (Pneumonia, the Forgotten Killer of Children, 2006, pp 7).

There is also a lack of various community based programs in areas where high prevalence is seen for under-5 mortality due to pneumonia. These two factors are related, and point out that without a good infrastructure of preventive health care as well as clinics; the figures are not likely to change (Adam et al, 2005, pp 4)

The extensive programs that have been introduced during the last decades have only led to marginal improvement in the improvements in death rates among children. For example, the study of Mozambique where Integrated Management of Childhood Illness model was applied showed a good percentage of reduction of preventable deaths in children. However, pneumonia still remained the leading cause of death among under 5 children at 21.3% (Edward et al, 2007, 814). Although the overall findings of the research were very helpful and beneficial in their outcomes, the still high percentage of children afflicted with pneumonia point towards the severity of the problem in Gaza as well as other African regions that need concentrated attention (Edward et al, 2007, 819 and 820).


A main concern recently raised by researchers is the bias that can come into analysis and demographic calculations in African countries regarding HIV prevalence in children. This is because mothers may not be able to report their own or their child status because of ill health or death due to HIV. The reason for pointing out this particular piece of information is that as in HIV, many mothers may not approach health authorities due to similar reasons, with the result that the actual figures of children who are under the ages of five may remain obscure (Gregson et al, 2009, pp 2). This is one of the many challenges that the Millennium Development Goals are facing. And these problems are not likely to go away unless proper demographic statistical methods are employed (Gregson et al, 2009, pp 2).

Other identified causes of possible inaccuracy in demographic data collection include the lack of methods that may be termed transparent or that could be repeatedly carried out with the same results, no identification of factors such as uncertainty, predictions or measurements etc. (Murray et al, 2007, pp 1040 and 1042).


Vaccinations are now available which can help reduce the incidences of pneumococcal infections. The vaccines decrease infection rates by preventing infections from disease causing organisms such as Haemophilus influenzae type B. However, pneumonia can also be prevented from other vaccines as well, which stop disease progressions that can lead up to pneumonia, such as measles. Therefore, by increasing the overall immunity of the child, the chances of acquiring pneumonia are considerably reduced (Pneumonia, the Forgotten Killer of Children, 2006, pp 29).

The immunizations however, must be given along with certain other measures. Breast feeding, proper nutrition and inclusion of zinc and provision of prophylactic antibiotic courses are also essential to reduce chances of developing pneumonia (Pneumonia, the Forgotten Killer of Children, 2006, pp 29).

The various vaccination programs for pneumonia were overshadowed when the rates of HIV among children began to increase. Suddenly, HIV had become the new priority in Africa, making people and health care providers forget the high rates of death that are due to pneumonia. The presence of these vaccines for years has still not been able to provide access to these in poor countries, showing one of the biggest health disparities in the world (Madhi and Klugman, 2006, np). This does not mean that HIV should be completely disregarded. Rather, HIV has been a major contributor to the surge in pneumococcal infections among children, and therefore, if these children receive vaccines, the chances of developing pneumonia in these children will decrease considerably. It is of benefit as HIV affected children are more likely to develop pneumonia than non HIV affected children (Madhi and Klugman, 2006, np).

Currently, two types of vaccines are being used for preventing pneumonia. These include the HIB vaccine and the pneumococcal conjugate vaccine respectively. The former vaccine has been available for a long time now; however, it is cost prohibitive. This is the reason why it has not been completely applied in developing countries to date. This essential vaccine can reduce the rates of death by 2 to 3 million cases, making it an essential requirement in the various pneumococcal prevention programs (Pneumonia, the Forgotten Killer of Children, 2006, pp 27).

The other vaccine, the pneumococcal conjugate vaccine contains in it the seven serotypes which can lead to pneumonia. This vaccine is now being further developed to include more serotypes, but like the HIB vaccine, this vaccine is also not distributed in enough quantities to ensure immunization of children in developing countries (Pneumonia, the Forgotten Killer of Children, 2006, pp 27).

Trials have shown its efficacy of reducing pneumonia by 21 percent via radiological assessment and an over all four percent in clinical cases. Although not a very significant result that one would wish seeing the situation in Africa, it is nevertheless an important achievement in advocating the use of vaccines as a primary mode of prevention of pneumonia.

The efficacy of both the vaccines has shown more than 90 percent of results, which means that it may be a very important and cost effective method to prevent new cases of pneumonia from developing (Madhi and Klugman, 2006, np). Multiple researches carried out continue to show the efficacy of these measures not only in Africa, but in Asian and south American countries as well. The rates of invasive forms of pneumococcal diseases have also fallen significantly, and can reduce the rates of mortality (Madhi and Klugman, 2006, np).

The study by Sinha et al, (2007) has shown high rates of prevention in death rates due to pneumococcal vaccines injection. According to the report

“The cost per life saved for all countries in the analysis was International $3,200. This ranged from Int$2,200 in countries with high to very high child mortality (>100 deaths per 1,000 births) to Int$175,000 per life saved in countries with low child mortality (<25 deaths per 1,000 births). The results were most sensitive to vaccine efficacy against all-cause mortality and vaccine cost” (Sinha et al, 2008, 395 and 396).

Researches however, also show that the reduction in the number of cases may take up some time before they start showing their results. For example, trial carried out in Kenya through childhood immunization of HiB conjugate vaccine showed a reduction 0f 12% in the pneumonia disease prevalence. However, this was seen three years after the start of the program, meaning that the overall impact, although extensive, will take some time to fully display itself (Cowgill et al, 2006, pp 672, 675 and 678). Researches by Adegbola et al in 2005 carried out in Gambia on the same lines have also shown similar improvements in the number of pneumonia cases among under-5 age children. He advocates that these results are positive despite the irregularity in the supply of vaccine (Adegbola et al, 2005, pp 146, 149).


Pneumonia treatment and prevention is estimated to cost $600 million per year, which can be reduced if proper prevention strategies, education regarding pneumonia and the application of vaccines is carried out. The prevention strategies alone can reduce the death rates by one million per year (Pneumonia, the Forgotten Killer of Children, 2006, pp 28).

The option for providing pneumococcal vaccines is a very good strategy and perhaps the only one available to prevent new cases from taking place. However, the costs of the vaccines have still not reached a level where they become affordable for the patients and the African health sector. This is the single deterrent that is preventing elimination of pneumonia from Africa (Madhi and Klugman, 2006, np).

Provision of timely and enough needed vaccines for pneumonia will prevent mortality and morbidity due to this condition, which is plaguing the lives of African children.








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