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Lancet pneumonia study offers new hope for reducing No. 1 cause of child death

WESTPORT, Conn. (November 11, 2011) Children treated at home for severe pneumonia by Pakistan's "Lady Health Workers" were more likely to recover than children referred to health facilities, Save the Children found in a USAID-funded, WHO-coordinated study published in The Lancet medical journal today.

The results come the day before World Pneumonia Day, which aims to focus the world's attention on the leading cause of child death. Roughly 1.4 million children under age 5 die annually from the disease99 percent of them in the developing world.

"Pneumonia is highly treatable with inexpensive antibiotics, yet it remains the world's number-one killer of children," said Carolyn Miles, President & CEO of Save the Children. "Today's results point to an extremely promising and practical way to reduce child deaths from severe pneumonia in the hardest hit communities. Training and supporting more frontline health workers is at the heart of the solution."

The Lancet study addresses a significant barrier to effective treatment for millions of poor families around the world the difficulty in accessing quality health services. In poor and isolated communities where pneumonia takes its biggest toll, major challenges include distance to a health facility, lack of transportation and costs.

Amidst a global health workforce crisis, Pakistan is one of a growing number of low-income countries to deploy community health workers to improve child and maternal health. In Pakistan, Lady Health Workers receive several months training, ongoing supervision and basic supplies and attend to about 150-200 families at home monthly.

Previous studies have shown that community health workers can successfully treat children with non-severe pneumonia at home and substantially reduce mortality rates. However, current World Health Organization (WHO) guidelines do not allow for in-home treatment when pneumonia is defined as severe (when a child's chest draws in instead of expanding during inhalation). Instead, community health workers are to administer the first dose of antibiotic and then refer a child to a facility.

Around the world, many families never make it to a health facility. Until today's publication, no rigorous randomized study had shown whether community health workers could safely and effectively treat cases of severe pneumonia at home.

"Our study aimed to show that children can recover just as well from severe pneumonia when treated at home as when referred to a health facility. In fact, we found that frontline health workers treating children at home can be even more effective," said the study's principal investigator, Dr. Salim Sadruddin of Save the Children.

Dr. Elizabeth Mason, Director of WHO's Department of Maternal, Newborn, Child and Adolescent Health, said: "The results of the Pakistan trial are very promising, and we will be looking closely at future studies. If we see similar results in other places, we can update the global guidance to make treatment much more accessible for families, help governments make the most of limited resources, and save more children's lives."

The study followed 3,211 children with severe pneumonia in the Haripur district of Pakistan. The control group was given an initial dose of oral antibiotic and referred to a health facility. Some families did not make the trip, while others failed to receive proper treatment even after they did. The experimental group of children was treated in the community with oral antibiotics for five days by Lady Health Workers who had received additional training.

Treatment failures occurred 50 percent less often in the experimental group. After five days, 18 percent of children referred to a facility were still ill, compared to 9 percent of those treated by Lady Health Workers.

The U.S. Agency for International Development (USAID) funded the new Lancet study.

USAID Administrator Raj Shah said: "This study adds to the evidence base that frontline health workers can safely and effectively manage illness and prevent child deaths, especially in communities where doctors and health facilities are out of reach for poor families."

He added: "USAID supports an integrated prevention and treatment approach to prevent death and severe illness in children. Vaccines along with frontline health workers are sustainable, cost-effective strategies to strengthening health systems where children are most in need."


Contact: Tanya Weinberg
Save the Children

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