A Call for Strong Pharmaceutical Systems to Prevent Pneumonia Deaths in Children

By Jane Briggs, Senior Principal Technical Advisor and MNCH Lead, MTaPS

Pneumonia is the leading cause of death in children under age five worldwide, according to WHO. The disease claimed the lives of more than 800,000 children under the age of five last year—one child every 39 seconds (UNICEF).

November 12 is World Pneumonia Day—an event that began in 2009 to raise awareness about pneumonia and to advocate for action to prevent and treat this deadly disease. This year is different as the global COVID-19 pandemic is dramatically increasing pneumonia deaths. Further, disruptions in essential health services globally are estimated to cause up to an additional 805,000 child deaths from pneumonia and newborn sepsis over a 12-month period.

The management of childhood pneumonia should be straightforward: diagnose correctly; administer a course of an appropriate, quality antibiotic; and administer medical oxygen if the child is hypoxemic. But in many low- and middle-income countries, the appropriate antibiotic (oral amoxicillin according to WHO treatment guidelines) may be unavailable or used incorrectly. Further, substandard medicines circulate in markets and access to medical oxygen is poor.

The USAID MTaPS program aims to strengthen pharmaceutical systems to ensure access to and appropriate use of safe, effective, and quality medicines and technologies. In an ongoing MTaPS study in project countries, we found that one of nine countries surveyed had no registered products for amoxicillin 125 mg dispersible tablets (DT) or 250 mg DT, and only two countries had registered products for one presentation of amoxicillin DT. Additionally, only two of the nine countries had regulatory frameworks in place and were registering medical devices and medical gases to ensure their safety and quality. MTaPS is working in four countries –   Bangladesh, Mozambique, Nepal and Rwanda – to help strengthen their regulatory systems, including streamlining medicine registration processes and setting up legal frameworks and procedures to register medical devices and gases.

Appropriate use of antibiotics for pneumonia includes both appropriate prescribing and adherence to the full treatment. Barriers to adherence to amoxicillin treatment may exist if caregivers do not administer the amoxicillin appropriately, which can lead to poor health outcomes for children with pneumonia and to increased antimicrobial resistance.

MTaPS has recently updated a package of job aids and dispensing envelopes for use in countries to bolster adherence to treatment with amoxicillin DT by caregivers of sick children and adherence of health care providers to treatment protocols. These tools, originally developed in 2015 by a group of organizations led by PATH and commissioned by UNICEF under the UN Commission on Life-Saving Commodities for Women and Children, were validated in several countries. MTaPS updated the tools based on the recommendations from those country studies.

The Toolkit for Administration of Amoxicillin for Childhood Pneumonia consists of:

• Dispensing envelopes to visually orient caregivers and health care workers in administration of the tablets
• Leaflets for use with amoxicillin suspension in contexts where that is used instead of amoxicillin DT
• Job aids for community health workers and health workers in primary health care settings that explain proper treatment administration and adherence to amoxicillin

While this toolkit alone cannot address all the diverse barriers to adherence, it can serve as a useful adjunct to other interventions targeting improved use of and adherence to antibiotics for childhood pneumonia.

Children do not need to die from pneumonia if a country’s pharmaceutical system can ensure that children have access to safe, effective, quality medicines and technologies that are used appropriately.