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Pneumonia, the biggest killer of children

2020-11-20T23:51:55.854Z


It causes more deaths of children under five in the world each year than any other disease: more than 800,000. In most cases they could have been avoided, since it is easy to detect, preventable and curable. But something is wrong


Every 39 seconds a child under the age of five dies from pneumonia.

They are more than 2,200 a day, 800,000 in a year, which makes it the deadliest disease for children.

It is despite the fact that it is preventable with a vaccine and treatable in most cases.

For this reason, it is exceptional for a young child to die from this ailment in a prosperous country, with a robust healthcare system and the ability to access medications and oxygen therapies.

But if not, the story may be very different.

It is usually a bacterium, some type of pneumococcus, but it can also be a virus, such as influenza, or a fungus.

When any of these pathogens take over the upper respiratory tract, it causes an infection.

They do not usually go from there, but in some people they continue their advance until they colonize the lungs.

Their arrival in the alveoli - tiny air-filled sacs in which the exchange of oxygen and carbon dioxide between the lung and the blood takes place - triggers an immune reaction.

The leukocytes come to fight the intruder and, when there are many, they form what we know as pus.

“A gaseous environment is then filled with liquid”, explains Quique Bassat, a researcher at ICREA at the Barcelona Institute for Global Health (ISGlobal), a center promoted by the “la Caixa” Foundation.

That is pneumonia.

What happens when there is pus and fluid in the lung?

That it cannot perform its function of carrying oxygen into the blood and getting rid of carbon dioxide.

“You breathe worse;

it is like pulling a fish out of under water: it drowns.

But the other way around ”, describes the expert.

When the infection only affects one area, pneumonia is not fatal;

but if it spreads to both lungs, respiratory failure will be severe, other organs of the body will be affected by the lack of their fuel to function (oxygen) and can cause death.

In 2020, all these concepts have become popular because SARS-CoV-2, which causes covid-19, is in fact a virus that in the most severe cases causes pneumonia.

And it is so deadly that since the pandemic was declared in March 2020, it has killed more than 1.3 million people.

The hope to halt its deadly advance is that an effective vaccine is approved and mass-supplied.

In the meantime, it has proven vital to have sufficient health facilities - diagnostic tests, human resources, respirators, intensive care beds - so that as many patients as possible recover.

Another revelation that covid-19 has uncovered is that "viruses do not understand borders".

The proclamation has been repeated in recent months to alert the population of the need to follow the recommendations to protect themselves against this disease anywhere on the planet and regardless of the wealth of countries or people.

A disease that discriminates

The data show that childhood pneumonia does distinguish between borders and socioeconomic status, as it kills the most vulnerable in the poorest countries.

84% of the children who died from it are concentrated in 30 countries in sub-Saharan Africa and Asia.

Here, children are 60 times more likely to be affected and die than those who reside in high-income nations.

Nigeria is the one that registers the most deaths, with 162,000 in 2018, according to the latest data from Unicef.

They are followed by India (127,000), Pakistan (58,000), the Democratic Republic of the Congo (40,000) and Ethiopia (32,000).

Luc, 19 months old, suffers from severe pneumonia.

He fell ill five days before his mother took him to the hospital in the Democratic Republic of Congo (DRC).

His breathing was very fast (55 breaths per minute) and his saturation was 86% when it should be between 92% and 94%.

Doctors give him oxygen, give him a blood transfusion and antibiotic treatment.

(Jonathan Hyams / Save the Children)

A child at the Bhalswa landfill in New Delhi.

In India, air and water pollution damage the lungs of the very young, increasing the risk of respiratory diseases.

With 127,000 deaths in 2018, it is the second country, after Nigeria, with the most childhood deaths from pneumonia.

(Sanchit Khanna / Hindustan Times via Getty)

Other pollution that damages the respiratory systems of poor adults and children occurs in the home.

In the world, 4 billion people lack access to "clean, efficient, convenient, safe, reliable and affordable" energy, according to the World Bank.

In the picture, an Indian woman cooks bread in the wood and charcoal oven at home.

(Lys Arango / Action Against Hunger)

Malnutrition encourages pneumonia.

The lack of clean water and adequate sanitation, too.

In 2019, 2 billion people were living without one and 4.2 billion without the other.

Almost 300,000 children under the age of five die each year from diarrheal processes.

In the image, a woman of the Borana ethnic group collects water to take home, in Somalia (Lys Arango / Action Against Hunger)

The pneumococcal vaccine was introduced in 2019 in 149 countries, but the global coverage of the three doses is still very low: 48%.

In the image, a nurse vaccinates a six-month-old baby in León, Nicaragua, where it has been used since December 2010 with the help of the Global Alliance for Vaccines (GAVI).

(Brent Stirton / Save the Children for Getty)

In young children, the symptoms of life-threatening illnesses like malaria, septicemia, and pneumonia are very similar.

To confirm the latter, an x-ray is necessary.

In it, the air is black and the liquid, white.

But in rural areas they do not have the means to carry them out.

In the image, a girl in a Doctors Without Borders hospital in Port-au-Prince (Haiti).

(Spencer Platt / Getty)

In children with weak immune systems, the pathogens that cause pneumonia find their way into the lungs where they cause damage that, without proper medical attention, is fatal.

Globally, 32% of children with symptoms do not reach a health center, even less in poor countries.

In the image, a doctor cares for a girl in India.

(Jonas Gratzer / LightRocket via Getty)

The first requirement for strong defenses is adequate nutrition in the first 1,000 days of life.

Exclusive breastfeeding in the first six months is the best way to avoid malnutrition and strengthen the immune system.

In the picture, Zoungrana Rabiatou, 24 years old and mother of 2 children, breastfeeding the child, at Saint Camille Hospital, in Ouagadougou, Burkina Faso.

(Frank Dejongh / Unicef)

A global positive fact is that infant mortality has been reduced by half since 1990 on the planet.

However, still more than five million children under the age of five die each year from preventable causes.

Pneumonia is responsible for just over 16%.

Before the coronavirus, it was already the leading cause of death in childhood, above diarrhea, malaria or HIV.

In 2018, 802,000 children were killed, of which 153,000 (19%) perished in their first month of life, according to Unicef.

Deaths are 54% less than in 2000, but this rate of progress is very slow compared to the decline in deaths from diarrhea (64%) and malaria (68%).

Progress in the battle against childhood pneumonia is also insufficient to achieve the UN Sustainable Development Goal 3.2, which reads as follows: “By 2030, end the preventable deaths of newborns and children under five years of age , ensuring that all countries try to reduce neonatal mortality to at least 12 per 1,000 live births, and the mortality of children under five years of age to at least 25 per 1,000 live births ”.

At the current rate, 53 countries will not succeed, denounces the latest report by UNICEF, Save the Children and Every Breath Counts.

Gail Rodgers

of the Bill and Melinda Gates Foundation

In Nigeria they are well aware of the frustration of their children dying from this disease for which there are effective vaccines and treatment when it is pneumococcal in origin.

This is how Dr. Nma Noble feels when he speaks, frustrated: "Very bad."

Last October alone, 248 children under the age of five were admitted for respiratory infections in the two hospitals run by Doctors Without Borders in northwestern Nigeria, in the state of Zamfara.

The cases that come to them are serious, confirms the doctor, who works in the center that the NGO has in Shinkafi.

"In primary care, antibiotic treatment is practically non-existent," he explains.

Hafsat Rufai is breathing heavily, choking.

This 10-month-old baby tries to survive pneumonia at Hasiya Bayero Pediatric Hospital in Kano State, also in northwestern Nigeria.

“We've been here for five or six days, we brought her in as soon as she got worse,” explains her mother, Hauwa Rufai, over the phone and in Hausa, one of the native languages.

The 20-year-old responds worriedly.

He is afraid of losing her.

She is the only daughter that she has with her husband Rufai Mati, a driver of

keke napep

, the motorcycle

cars

that are used to transport people.

"In our community we had been informed that there was a vaccine, but we did not get it," laments Rufai.

Doctors have given him hope.

The girl is reacting well to antibiotic treatment.

But this luck is not what the majority of children under five years of age have in their country.

Some caregivers cannot stay until the sick person recovers because they must return to work in the fields and take care of the family.

Others don't understand the procedure and refuse to admit their children, says Noble.

Many do not even go to hospitals because in poor rural communities, most cannot afford the cost of transportation.

And NGOs do what they can to cover that service.

"Here, MSF helps them, but in other areas they do not have that support," laments the specialist.

Adeleke Olorunnimbe Mamora

, Minister of State for Health of Nigeria

In Nigeria, if you are under the age of five and contract pneumonia, you may be signing a certain death warrant.

The Government is aware of the problem and in the first Global Forum on Childhood Pneumonia, held in January in Barcelona, ​​organized by ISGlobal, the Gates Foundation, Unicef ​​and Save the Children, among other entities, the Executive of the most populous country in Africa ( 208 million inhabitants), presented its national strategic plan for this fight.

One of its objectives is to reduce mortality to 26,000 children per year, a quarter of the current 100,000.

“We should be able to reduce deaths and establish a routine immunization, there is a cheaper vaccine that we want to incorporate.

We are looking for international alliances, and the involvement of the authorities at all levels ”, says Adeleke Olorunnimbe Mamora, Minister of State for Health of Nigeria.

The reason why so many children suffer from respiratory infections is, according to Noble, clear: the health indicators are not good and the immunization coverage is very low.

The data gives him reason.

Just 57% of Nigerian children were immunized with all three doses of pneumococcal conjugate vaccine (PCV) in 2019, according to the World Health Organization (WHO);

a low percentage, but 20 points above the 36% of 2015. In addition, three out of four with symptoms of pneumonia do not have access to medical treatment, warns UNICEF.

Globally, 32% of children with symptoms do not go to a health center for examination, and this proportion increases in poor and low-income countries.

As for the pneumococcal vaccine, it had been introduced in 149 countries by the end of 2019, but the global coverage of the three doses in which it is presented is still very low.

The WHO estimated it at 48%, and millions more are now at risk of missing this and other essential vaccines while the covid-19 pandemic has interrupted campaigns, the UN warns.

For the bacterium

haemophilus influenzae type b (Hib)

, which can also cause pneumonia in children, the three-dose vaccine has been given to 72% of the population, although with great disparities between regions.

While Southeast Asia - Bangladesh, India, Thailand and Nepal, among others - there is a coverage of 89%, in the Western Pacific - which includes China, Japan and Australia - it is only 24%.

Nigeria, the worst affected country: where 18 children die of pneumonia every hour

With 19% of child lives lost to this preventable and curable disease, the Government and international initiatives seek to reduce the figure with a new plan.

The pandemic is a brake, but also a spur.

“To implement our national plan we need resources.

Not only financial, but also technical support ”, Mamora confesses.

They need international help, he details, because the country faces security problems in the north.

, which causes the population to move and hinder their health care.

“We also have infrastructure challenges.

Because you need water supplies.

And clean air ”, he concludes.

But precisely in the chapter of international attention, there is a big problem: pneumonia is a neglected disease.

It receives far less development aid funds than malaria and HIV-AIDS.

Of the 105,700 million dollars (about 90,000 million euros) allocated to these three ailments, 76% was dedicated to fighting HIV-AIDS, 18% to malaria and only 6% to pneumonia, according to UNICEF. Save the Children and Every Breath Counts.

However, between 2000 and 2015, aid against this ailment increased seven times, from 140 million dollars (118 million euros) to 980 (830 euros).

Since then, just when the United Nations pledged to minimize infant mortality from preventable causes, the contribution to combat the most destructive of them has fallen by 30% to 670 million dollars (566 million euros).

According to the cited study, 95% of this amount was used in the acquisition of vaccines (the PCV) and the remaining 34.2 million dollars (28.9 million euros) in research and development (more than half) and community disease management programs, diagnostic and treatment-based interventions.

"All children deserve access to immunization, but the sick also need to be diagnosed and treated to save their lives," they point out.

Michel Hamala Sidibé

, Minister of Health and Social Affairs of Mali

For Margaret Agama-Anyetei, Head of Health, Nutrition and Population of the African Union, not only donors should prioritize this disease in their investments, but also the countries themselves.

In his opinion, other diseases (such as Ebola), political instability, economic crises and conflicts on the African continent reduce the focus on pneumonia.

And they have an impact on health systems, already under-endowed to meet basic health challenges.

Dr. Noble knows well what Agama-Anyetei is talking about.

In the state of Zamfara, in northwestern Nigeria, Boko Haram terrorism has not only displaced thousands of families, but has also caused doctors and health workers, targeted by the violent, to flee from rural areas to cities in looking for security.

Thus, primary care in remote villages is precarious.

This conflict situation prevents vaccination campaigns from proceeding normally, so the coverage rate is very low in the region, less than 50%.

And covid-19 is a juxtaposed crisis that has worsened what was already wrong.

“Here, community health workers went door to door to detect illnesses;

but we had to suspend it because we did not have the means to protect them and we had to focus on the hospitals, "says Noble by phone.

"And the mobile vaccination units stopped."

The victim of this disruption is one of Noble's pneumonia patients at Shinkafi General Hospital: Six-month-old Farida Rilwanu.

Her parents, a farmer couple, brought her downtown from their village, Kayaye, on November 16 because she had had a fever and gastroenteritis for days and the acetaminophen was not helping.

In addition, although the mother was breastfeeding, the disease left her too weak to suck, so she was being fed cereal porridge.

The little girl had not been vaccinated with PCV, despite the fact that the Nigerian vaccination schedule establishes the three doses at six, 10 and 14 weeks, something that the family knows because Farida's three older brothers were immunized.

Seth Berkley

, Executive Director of the Vaccine Alliance (Gavi)

Optimistic, Noble tries to see the bright side of the pandemic in raising awareness of the need for respirators in hospitals.

All those that are used now to care for those affected by the coronavirus will serve for children who arrive with the usual pneumonia, he points out.

"It represents a great opportunity in terms of oxygen," says Unicef ​​expert Anne Detjen along the same lines.

This organization has provided 15,000 oxygen concentrators to more than 90 countries and supports the repair and construction of production plants in some, in addition to training biomedical engineers and local health personnel.

"Beyond supporting the response against covid-19, these investments reinforce oxygen systems that will benefit millions of newborns and sick children," he explains.

Prevention: cheaper vaccines and against more pneumococci

"Prevention is the best way to deal with infectious diseases, as the COVID-19 pandemic is highlighting," says Dr. Gail Rodgers, an expert in the Pneumonia Program at the Bill & Melinda Gates Foundation.

His team is supporting the development of more effective, affordable vaccines against more variants of pneumococcus, the leading bacterial cause of pneumonia in children.

Researchers are working on versions against 30 varieties, up from 10 or 13 now being fought on routine shows.

Another milestone is reducing the number of doses from three to two, which Rodgers says would significantly lower the cost of the campaigns and lighten the vaccination schedule.

"We have shown that two doses administered properly continue to build immunity, and in 2021 we will have the results of ongoing studies in Asia and Africa," he says.

Innovations to protect the lives of young children from pneumonia

Simple, reliable and affordable new vaccines and tests are at the center of global research efforts against childhood pneumonia, which causes more than 2,000 deaths a day.

Low-income countries can access the pneumococcal conjugate vaccine (PCV) at two dollars (1.70 euros) per dose as a result of the agreement that Gavi (the Global Alliance for Vaccination), Unicef ​​and the Serum Institute of India closed this June .

This represents a reduction of 43% compared to the 3.5 dollars (2.95 euros) that those available cost in 2009, at the beginning of the Gavi pilot program to accelerate its introduction in the poorest countries.

"The Serum Institute of India has succeeded in reducing the price of the dose, a great example of why continuing product research and development is so important."

Especially for countries that have an income level that is too high to receive aid, but too low to incorporate PCV into their childhood vaccination schedule.

Gail Rodgers

of the Bill and Melinda Gates Foundation

The existence and low price of vaccines is not, however, a guarantee that they will reach everyone and, especially, those who need it most.

In 2018, 53% of the world's child population (71 million children) did not receive conjugate anti-pneumococcal (PCV).

For two reasons: they live in one of the 44 countries in which this immunization has not been introduced or, if they reside in one where it is included in the calendar, they simply did not have access to this service.

In order to guarantee access to affordable prices by least developed countries, as well as their distribution, Gavi created in 2009 the Advance Market Commiment (AMC) for pneumococcal immunizations.

The first country to introduce PVC thanks to this financial mechanism was Nicaragua, in December 2010. “During the first five years of the program, there were reductions in visits to health centers due to pneumonia in immunized age groups, as well as of mortality, which would be difficult to achieve with any other public health intervention, "concluded an independent group of experts in a study published in the journal

Plos

in 2017." There was a 30% reduction in the incidence of hospitalizations of babies due to pneumonia in the period of the vaccine, compared to previous years ”, he adds.

Quique Bassat

, ICREA researcher at ISGlobal

As for viral pneumonia, the next big step thanks to research could be the first vaccine against respiratory syncytial virus.

It is a common pathogen that usually gives mild cold-like symptoms, but can pose a risk to children under two years of age, especially in the first six months of life.

The virus is already in the crosshairs of the Gates Foundation.

Diagnosis: unclear symptoms and lack of trained personnel

Diagnosing childhood pneumonia is one of the great challenges in developing countries.

The symptoms are not always clear and there is a lack of equipment and trained personnel to detect it.

And where there are doctors, they are usually overwhelmed.

“In rural settings and with few resources, the diagnosis is based on clinical evaluation.

The algorithms that guide decision-making are very practical and have saved millions of lives, but there is a tendency to overdiagnose ”, says Bassat, from ISGlobal.

And giving antibiotics when not indicated can accelerate the development of resistant bacteria and reduce the effectiveness of existing treatments.

In young children, in addition, the symptoms of deadly diseases such as malaria, septicemia and pneumonia are very similar, says Bassat.

To confirm that it is the latter, an X-ray is necessary.

In it, the air is black and the liquid, white.

Lungs that color are a bad sign.

But in rural areas they do not have the infrastructure or the equipment to perform this test.

For the expert, it is interesting to explore what other tools can be used by health workers in remote places in developing countries for diagnosis.

"Products to measure certain variables such as oxygen saturation, respiratory rate, biomarkers that can be detected in the blood, which can help determine whether the patient should be given antibiotics or not," he points out.

Quique Bassat

, ICREA researcher at ISGlobal

The researcher also sees great potential in portable ultrasound machines.

Although they are still expensive, their goal is to demonstrate that they are reliable and easy to use by health workers beyond doctors.

"You can have it on a

tablet

and they don't radiate," he defends.

For its management to spread, it takes more than funds.

The knowledge necessary for its use, however minimal, is not available to anyone either.

It is not so uncommon for so-called community health workers, trained by governments and NGOs to identify the most common ailments, to be practically illiterate.

They often use the number of breaths per minute as an indicator of illness.

“We need automated counters to help diagnose pneumonia at the community level, and we need to deploy them on a large scale,” says Kevin Baker, research specialist at the Malaria Consortium, who is studying different devices in the field and supporting governments in the design of action plans.

In the absence of such means and training, something as simple as a necklace of colored beads can be used by community agents to detect possible cases of pneumonia in babies.

Each breath is a ball, if in a minute their fingers reach the red ones, they know that they must refer the child to a sanitary facility.

Míriam Alía

, pediatric nurse and head of vaccination and epidemics at MSF Spain

Treatment, double risk

The majority of childhood pneumonia, almost nine out of ten, are caused by bacteria.

But without a confirmed diagnosis, there is a risk of treating any other disease with similar symptoms or one of viral origin with an antibiotic.

The risk is twofold: not curing and generating resistance to this drug.

However, where testing is inaccessible, the benefit of giving amoxicillin to children with fever and respiratory distress is most likely life-saving.

Again, the lack of availability of the drug prevents millions of babies from surviving.

In addition to antibiotics to kill bacteria that cause infection, medical oxygen could save the lives of many.

But again, poverty gets in the way.

"Severe pneumonia leaves an estimated 4.2 million children under the age of five in 124 low- and middle-income countries with critically low oxygen levels each year," say UNICEF, the Clinton Health Access Initiative (CHAI), Save the Children and the Murdoch Children's Research Institute (MCRI) in a recent analysis on this.

In many places, organizations say, oxygen to treat a child with severe pneumonia for three to four days can cost between € 33 and € 50.

An unaffordable fortune for families without resources.

The result is that they cannot afford the treatment, even if they have managed to take their little ones to health centers with the necessary tools to cure them.

For now, Dr. Noble's hopes that greater investment and awareness of the need for medical oxygen in health facilities will lead to better treatment of childhood pneumonia when the Covid-19 storm passes, are just that: hopes.

As are the claims in the same vein by Unicef ​​pulmonologist Anne Detjen.

High oxygen demand during the pandemic has triggered a rise in prices in some of the countries with the highest infant mortality rates from pneumonia such as India, Bangladesh and Nigeria.

According to WHO, the poorest countries currently have between 5% and 20% of what they need.

"Covid-19 should have served to increase the visibility of pediatric pneumonias, but the opposite has happened," laments Bassat, from ISGlobal, one of the promoters of the first international congress on this problem, held in January 2020 precisely to increase interest and arouse efforts.

Childhood pneumonia and poverty, the perfect storm

Strictly medical and health indicators are not the only factors behind the high mortality rates.

“It is a perfect storm: in developing countries there are more people living in poverty and more children with malnutrition who breathe polluted air in their homes and outside;

They also have a fragile and poor health system, where there is no vaccination service or there are not enough medicines.

The combination of all these factors means that pneumonia continues to be the biggest killer of children, ”says Stefan Peterson, Unicef ​​Deputy Director of Health.

“Pneumonia and poverty are deadly interconnected.

While infection in a healthy body does not survive, it does very well when children are malnourished.

It's one of the reasons the numbers are higher in Africa and in some of its most vulnerable communities, ”agrees Githnji Gitahi, director of the medical NGO Amref Africa.


In children with weak immune systems, the pathogens that cause this disease find a free path to the lungs.

Once there, they cause damage that, without timely medical attention, is fatal.

The first requirement for strong defenses is adequate and sufficient nutrition in the first 1,000 days of life.

In the world, 52 million children under the age of five suffer from wasting (low weight for their height), of which 17 million suffer from severe wasting, with imminent risk for their survival.

Another 155 million suffer from chronic malnutrition, known as growth retardation, as this is the main manifestation of a continued lack of essential nutrients for normal physical and cognitive development.

All of these malnourished bodies are easy targets for the bacteria, viruses, or fungi that cause pneumonia.

And also from other diseases that further weaken your immune systems.

As the first and main recommendation to combat malnutrition and strengthen the baby's defenses, exclusive breastfeeding for at least the first six months of life is also an effective measure to protect against death from pneumonia.

Stefan Peterson

, Unicef ​​Deputy Director of Health

Not only the lack of sufficient and nutritious food explain malnutrition.

Lack of clean water and adequate sanitation also count.

And still in 2019, 2 billion people lived deprived of the one and 4.2 billion (half of the human beings on the planet) of the other, according to data from the WHO and Unicef.

Drinking contaminated water, the inability to maintain minimal hygiene and not having toilets multiply the chances of getting sick.

Diarrhea is one of the most common ailments related to these deprivations and is directly related to the weakening of the immune system, malnutrition and the danger of death from any other disease such as pneumonia.

According to his calculations, 297,000 children under the age of five die each year due to diarrhea.

Other factors that explain why infant mortality from pneumonia is higher in the poorest countries is that, in them, children are more exposed to environmental pollution, both outside and inside homes.

Almost half of the deaths are associated with this environmental problem, according to Unicef.

Children living in the 30 countries with the highest number of deaths are breathing air polluted with twice as many fine particles as those residing in middle-income nations and four times more than those with high income, underlines the document

The Right of Every Child to survive: an agenda to end pneumonia deaths.

That means they inhale air that is six times the WHO threshold of good quality and twice what is acceptable.

"

Often times, these are the same children who do not access essential health care services, such as vaccinations, antibiotics and oxygen therapy when needed," he adds.

One of those countries where pollution permeates and chokes the lungs of the little ones is India.

With 127,000 deaths in 2018, it is the second country, after Nigeria, with the most childhood deaths from pneumonia.

There, the young Ridhima Pandey, now 12 years old, started a battle to demand that the government guarantee children their right to breathe clean air when she was only nine.

Her activism has made her not only a national reference as a defender of the environment and against climate change, but also of the health of future generations.

Precisely because his fight has a lot to do with the fight against pneumonia, he was invited to the Global Forum held in Barcelona.

“Rich people donate food, clothes and money for the education of the poor.

But with the emissions from their big factories and their cars, they rob them of what they should have naturally: clean air and water, ”he proclaims.

The Indian girl who demanded clean air from her government

At 13, Ridhima Pandey is a benchmark in the fight against climate change in her country.

When he was nine he waged a battle for the authorities to take measures to preserve the environment.

The other pollution that damages and weakens the respiratory systems of the poorest, and especially the smallest, is that produced in the home.

4 billion people in the world still lack access to energy to cook in a "clean, efficient, convenient, safe, reliable and affordable way," according to a recent World Bank report.

Among them, 1,250 million are in transition to better kitchen services, but the rest (almost 2,800 million) still cook their food with traditional polluting fuels and technologies with serious impacts on health, especially of women and children, in addition to the negative effects about the economy, the environment and the climate.

In rural areas of developing countries, regardless of the continent, the kitchen is often a pile of stones on which firewood or charcoal is burned.

At best, it is installed outdoors, where smoke inhalation is less.

Inside the houses, usually small rooms, the cooks, women, girls and the minors in their care breathe for hours, every day, the smoke that they give off.

This contamination in the home represents a significant threat, since it contributes to 62% of deaths from childhood pneumonia related to air toxicity, calculates Unicef.

Githnji Gitahi

, Director of Amref Africa

Knowing the enemy and his allies is key to fighting him from all fronts.

Johns Hopkins University has calculated that expanding treatment and prevention services for this disease can save the lives of 3.2 million children under the age of five.

In addition, addressing the non-strictly health causes described would create a “domino effect” that would prevent 5.7 million additional deaths from other childhood diseases, according to their study.

In total, almost nine million lives in the next 10 years.

Ajay Khera

, physician and representative of the Indian Ministry of Health and Welfare

The commitment to preserve them has been sealed since 2015 in the Sustainable Development Goals.

With a decade ahead and a pandemic that has reversed some of the progress made in the fight against hunger, poverty, achieving gender equality or improving health, the UN urges to redouble efforts to get back on track of progress.

For this, the reduction of infant mortality from pneumonia is essential.

The return on investment is clear: save a child every 39 seconds.

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  • Credits

  • Coordination: Alejandra Agudo

  • Definition and format: Brenda Valverde and Guiomar del Ser

  • Art direction: Fernando Hernández

  • Design: María José Durán

  • Layout: Nelly Natalí

  • Videos and photos: Gianluca Battista

  • Infographics: Rodrigo Silva

  • Writing and editing of texts: Alejandra Agudo, Belén Hernández, Gloria Pallarés, Lola Hierro, Lola Huete Machado, Patricia Peiró

  • Future Planet Director: Lola Huete Machado

  • This Planeta Futuro / ELPAÍS special is possible thanks to alliances with the Bill and Melinda Gates Foundation and Unicef, and the support of GAVI, Save the Children, Doctors Without Borders and Action Against Hunger.

Source: elparis

All news articles on 2020-11-20

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