Reducing childhood mortality from acute respiratory infections in Malawi

Beatriz Larrú MD, MSc, PhD Laboratorio de Imunobiología Molecular Servicio de Inmunología Hospital General Universitario Gregorio Marañón Doctor Esquerdo 46 28007, Madrid, Spain; and Liverpool School of Tropical Medicine, UK. Email: [email protected] Every year more than 10 million children die worldwide before reaching their fifth birthday. Acute respiratory infections (ARIs) are behind one in five childhood deaths in lowto middle-income countries, and 90% of these deaths are due to pneumonia.1 More than 60% of childhood mortality in developing countries could be prevented with effective interventions, like those included in the strategy developed by the World Health Organization (WHO) known as Integrated Management of Childhood Illness (IMCI), which contains both preventive and curative elements in family, community, and health facility settings.2 WHO has also produced guidelines for the management of common illness wjem resources are limited.3 Some of these recommendations have already been reviewed and scientific evidence is behind them. However, many of the strategies adopted by WHO to reduce childhood mortality need further review. The highest rates of child mortality worldwide are reported from sub-Saharan Africa, where around 180 deaths per 1000 live births still occur in some countries.4 Most of these deaths are due to only five diseases: ARI, diarrhoea, measles, malaria, or malnutrition or a combination of these.2 Malawi shares many of the health constraint of sub-Saharan Africa. The country has reported annual prevalence rates of childhood fever, diarrhoea, and pneumonia of 44%, 22%, and 45%, respectively; and mortality rates due to malaria, diarrhoea, or pneumonia represent 14%, 18%, and 23%, respectively, of the total mortality rate among children less than 5 years of age in the country. ARI severely affects morbidity among Malawian children and it is the second leading cause for children attending health facilities.5 Nevertheless, numerous reports about childhood infections have been published in Malawi during the last 25 years, so a better understanding of childhood ARI can be achieved there, and consequently it is an appropriate country in which to review WHO recommendations. Objective The main purpose of this article about ARI in Malawian children is to look at the evidence behind the WHO Guidelines in this particular setting. The review focuses on pneumonia, due to its high contribution to childhood mortality. More detailed analysis has been done on the management or diagnosis of pneumonia in children. In areas where resources are limited and other infections like HIV or tuberculosis have a high prevalence, knowing whether a child has pneumonia or not, and which is the most effective treatment, are the main two questions that every health professional needs to answer.