Pneumonia

Word spreads throughout the slums of Kibera outside of Nairobi, Kenya – a new vaccine is available to help fight pneumonia. Immunizations of the new vaccine, supported by GAVI, began in January 2011. Kenya is the first African country to introduce this updated pneumonia vaccine in the public sector. Advanced Market Commitments for Vaccines is an innovative new approach to vaccine distribution that is working to accelerate the development of vaccines that meet developing country needs. (Kibera, Kenya, 2011)

While global child deaths have declined from an estimated 12.6 million to 6.6 million over the last two decades, pneumonia has remained a leading worldwide cause of death among children under age 5.

Current challenges in pneumonia research

  • Despite available interventions, pneumonia claimed the lives of an estimated 1.3 million children in 2011 and was responsible for an estimated 18 percent of child deaths worldwide—nearly all of them in developing countries, particularly in Sub-Saharan Africa and South Asia.
  • Childhood deaths from pneumonia are preventable using vaccines, diagnostic tools, and treatments, but issues of availability, access, and cost remain obstacles in the developing world. Nearly half of early childhood deaths from pneumonia are estimated to result from lack of, or delay in, appropriate diagnosis and treatment.

Why are diagnostics and prognostic essential in pneumonia control strategies?

While vaccines have substantially reduced childhood pneumonia, they cannot prevent all cases and incidence of this disease remains high. Therefore improved access to diagnosis and treatment is particularly critical in countries where the introduction of vaccines is lagging. This includes interventions at multiple points in the continuum of care ranging from increasing availability of appropriate prognostic devices, improving care-seeking practices to guiding informal care providers in appropriate disease management.

New diagnostic and prognostic tools are being considered to improve on the current use of presumptive treatment for management of respiratory illness. Key aims will be to improve: a) treatment and case management and b) early identification of potential severe illness or drug failure to facilitate timely hospital referral. Tools being considered include pulse oximetry to measure O2 saturation, chest auscultation to determine lung status, respiratory rate devices, and other clinical indicators such as age, malnutrition, and HIV status.

The proposed DxMc modelling project will aim to identify diagnostic and prognostic strategies that optimize health impact and cost-effectiveness.

Project Methodology

The exercise is primarily focusing on the analysis of existing febrile and respiratory illness models developed by Boston Consulting Group, the Bill and Melinda Gates Foundation and Imperial College London. It is integratrating elements from all models and augmenting them with new methods and data.

Key Research Questions

The primary research question aims to address ""What is the public health impact and cost effectiveness of prognostic and diagnostic tools for case management of respiratory illness in children under 5?"

Other secondary questions include:

  • What is the health impact/cost-effectiveness of the introduction of new diagnostic and prognostic strategies (as compared with IMCI)?
  • Where and when in the health system is a diagnostic or prognostic most useful?
  • Does order or combination of diagnostic/prognostic tools and indicators used impact on outcomes?

Useful Resources

 

Key people: 
Miss Jessica Floyd
Lindsey Wu
Prof Azra Ghani
Dr Christine Rousseau
Dr Deborah Burgess
Dr David Mukanga