Neonatal and Pediatric Medicine
Open Access

Abstract

Pneumonia in children is an important cause of under 5 yr mortality accounting 12.9 percent of postnatal deaths and 3 percent of Neonatal deaths globally (Lancet Vol 7 June 2019). Infant Mortality rate is 27 in Haryana state as compared to national (India) where it is 32. To reduce the infant mortality rate and under 5 mortality rate National health mission has initiated a program called SAANS i.e. Social Awareness and Action to Neutralize pneumonia Successfully, in Hindi language it means BREATH. Childhood pneumonia is a lung infection caused by bacterial, viral or fungal infection. In pneumonia the air sacs (alveoli) of lungs are filled with pus and become solid and interferes with delivery of oxygen from air sacs to blood and removal of carbon dioxide from blood. Low Birth Weight, malnutrition, non-exclusive breastfeeding(during first 6 Month Of Life), indoor air pollution, lack of vaccination esp. measles, Hib, PCV and concomitant diseases like cleft palate , congenital heart diseases ,asthma are the common risk factors that contribute to pneumonia. Pneumonia deaths are common in winter seasons and common in children of low socio-economic status. Exposure to household air population almost double the risk of pneumonia and contributes to 45% of all pneumonia deaths in under five children. As per NFHS IV data, in India 65% of the children suffering from ARI use unclean fuel source. Birth defects i.e. cleft palate, congenital heart diseases are important contributors for recurrent childhood pneumonia. Pneumonia is a respiratory infection that affects the lung. Pneumococcus is the leading causative agent of pneumonia. Nearly 1 million child deaths occur worldwide from pneumonia, which otherwise is a preventable & treatable illness. Pneumonia (16%) is biggest infectious killers of children under 5yrs of age. Other major causes are Diarrhoea (9%), Malaria (5%), Meningitis (1%) and HIV/AIDS (1%). Regarding burden of Childhood pneumonia, 300 lakh episode of pneumonia occur in a year in India and 5.2 lakh in Haryana, with incidence rate of 0.22 per child per year. State wise under five deaths were estimated along with cause specific deaths using modeling for 2015. ΓΆΒ?ΒΆ Estimated total number of under five children in Haryana ΓΆΒ?Β? 2362519 ΓΆΒ?ΒΆ Estimated no of under 5 Deaths in Haryana ΓΆΒ?Β? 22645 ΓΆΒ?ΒΆ Estimated no of Pneumonia Deaths in under five children ΓΆΒ?Β? 3298 ΓΆΒ?ΒΆ In Neonatal period ΓΆΒ?Β? 731 ΓΆΒ?ΒΆ In Post neonatal Period ΓΆΒ?Β? 2567 So to reduce the number of deaths in children, goals were set for SAANS initiative to reduce the mortality due to childhood pneumonia to less than 3 per thousand live birth by 2025, which is 5.7 per thousand live birth at present. For this some objective has beendefined which are:- ΓΆΒ?ΒΆ To create awareness in community on interventions for protection and prevention of childhood pneumonia ΓΆΒ?ΒΆ To increase care-givers awareness to enable them to identify pneumonia early ΓΆΒ?ΒΆ Dispel myths and notions and trigger behavior change to take pneumonia seriously and seek care. To achieve Goals for SAANS a PPT i.e, Protect, Prevent and Treat Strategy has been adopted. Pediatric Nursing from LUMS (Lahore University of Management Sciences). PROTECT:- ΓΆΒ?ΒΆ Children by establishing good health practices from birth ΓΆΒ?ΒΆ Exclusive breastfeeding for 6 months ΓΆΒ?ΒΆ Adequate complimentary feeding ΓΆΒ?ΒΆ Vit A supplementation ΓΆΒ?ΒΆ Vaccines - Pertusis , measles , Hib , PCV and rotavirus. ΓΆΒ?ΒΆ Hand washing with soaps ΓΆΒ?ΒΆ Safe drinking water and sanitation ΓΆΒ?ΒΆ Reduce household air pollution ΓΆΒ?ΒΆ Improved care seeking and referral PREVENT:- ΓΆΒ?ΒΆ Children becoming ill from pneumonia and diarrhea TREAT:- ΓΆΒ?ΒΆ Children who are ill from pneumonia with appropriate treatment Three Pronged Interventions for SAANS in Haryana has been established like Demand side Interventions ΓΆΒ?Β? SAANS Campaign, Supply Side Interventions - Strengthen Community and Facility based management of Childhood Pneumonia by Capacity building, ensuring supplies of equipment and medicines at all levels, and Innovations like Pneumococcal vaccine introduced by Haryana in 2018 and use of multimodal pulse oximeter for pneumonia detection. The 'Social Awareness and Action to Neutralize Pneumonia Successfully' (SAANS) campaign has been launched with Comprehensive Communication plan, like Building an enabling environment for reducing Pneumonia morbidity and mortality, Advocacy with key stakeholders ΓΆΒ?Β? for acceptance of Pneumonia campaign strategy and Social and Community Mobilization ΓΆΒ?Β? for uptake of Prevent, Protect and Treat interventions Children under five year of age are managed under 2 age groups ΓΆΒ?Β? 0-59 days and 60 days ΓΆΒ?Β? 5years, as clinical presentation assessment and treatment differs in 2 age groups. The Effective case management of pneumonia includes, early recognition of cases of pneumonia at community level, appropriate use of antibiotics against major cause of bacterial pneumonia, prompt referral of cases of severe pneumonia and providing pre referral treatment, providing good supportive care including appropriate and effective oxygen use in case of hypoxia, appropriate use of bronchodilators in children with wheeze at health facility and identification of conditions mimicking pneumonia for their rational therapy and recognition of cases that do not have pneumonia and do not requires antibiotics but may benefit from supportive care.For capacity building, State level Training ( TOT ) :- 4 Batches (Each Batch of 30 participants, District level Training for 2 days for MO, Staff Nurses , Nursing Faculty (One batch /Per district ), Sub-District Level Training One day for ASHA/ANM/LHVS/ CHO (One batch /Per district has been organized. Haryana has planned to make pulse oximeters available at all facilities ΓΆΒ?Β? HWCs, PHCs, CHCs, SDH and DH. 1356 pulse oximeters has been procured. Appropriate antibiotics have been included in the Essential Drug List and an uninterrupted supply of appropriate antibiotics as per level of facility has been ensured. Pneumococcal pneumonia causes 16% of all severe pneumonia episodes and 30% of pneumonia deaths in under five children. In a study, in Haryana, there were estimated 1413 deaths due to pneumococcal pneumonia in under five children in 2010. So as an innovations Haryana state introduced Pneumococcal vaccine through state funds under Atal Jeevan Rakshak Teekakaran Yojna as part of Swaran Jayanti Yojna, and till January 2021, over 21.30 lakh doses have been administered to beneficiaries. Pneumococcal Vaccine (PCV) prevents disease and deaths due to Pneumococcus pneumonia in children. Budgets has been earmarked for each subheads for all the Districts where this program has been launched in state of Haryana and results will be evaluated five years down the line to observe the fall in under five mortality and deaths due to pneumonia in children in Haryana Conclusion: So 'Social Awareness and Action to Neutralise Pneumonia Successfully' (SAANS) compaign is a novel strategy that has been adopted by state of Haryana to reduce the childhood mortality from major cause pneumonia. The programme has been designed in scientific manner with capacity building of all level health facilities and active participation of all stake holders with community participation. Three pronged strategy has been implemented like protect, prevent and treat pneumonia with major innovations like introduction of pneumococcal vaccination to all beneficiaries and provision of pulse oximeters for detection of pneumonia. Results of the program will be evaluated 5 yrs down the line to determine whether the strategy is effective in achieving its specific goal of reducing mortality due to childhood pneumonia to less than 3 per thousand live birth by 2025, from 5.7 per thousand live birth at present.

Biography

Dr Vijay Kumar Dahiya MBBS MD Pediatrics. He lives in Jagadhri Town of District Yamunanagar in Haryana (INDIA). He retired in February 2022 as District Medical Chief (civil surgeon Yamunanagar) after 29 years of service in Health Deptt Govt of Haryana. He had an inclination towards writing start from his early student days. He remained editor and chief editor of college magazine ROHMEDCOL of Medical College Rohtak. Many of his articles got published in national and international journals of repute. He had written two books and 2 brochures of information till date. His first book titled "Thalassemia and its management" has been published by Lambert Academic Publishing and it has been translated in more than 10 international languages. His second book titled "Stress during examination and ways to cope it up" has been published by spotwrite publications recently.