RECOGNIZING AND DIAGNOSING PNEUMONIA IN DEVELOPING-COUNTRIES

Worldwide, acute lower respiratory infections cause about 3.8 million deaths in children under the age of 5 years, and is the single most important cause of mortality in this age group. Vaccines against the majority of pathogens causing acute lower respiratory tract infections are not readily available in developing regions, therefore, recognition and management of pneumonia using antibiotics is the method currently used to prevent this immense mortality. Simple clinical signs such as tachypnea (a respiratory rate greater than or equal to 50 per min in infants < 12 months of age and greater than or equal to 40 per min in children 12-59 months of age), and lower chest wall indrawing have been used to reliably detect pneumonia in children with cough and breathing difficulty, or both. The sensitivity and specificity of these two signs are around 80% in detecting clinical and radiological pneumonia. These two simple signs, along with the clinical recognition of a sick child, can be easily taught to medically untrained community health workers in developing countries. The World Health Organization has used such a case management strategy in its program for the control of acute respiratory infections. Studies have demonstrated that this strategy can lead to a 25% reduction in mortality of children less than 5 years old.