KARACHI, Nov 15: The president of the Pakistan Chest Society, Sindh chapter, has said that primary healthcare units in the province did not have capability to diagnose and treat paediatric pneumonia cases.

Talking to Dawn after a workshop held in connection with the 2nd World Pneumonia Day at the Ojha Institute of Chest Disease on Monday, the president, Dr Amanullah Ansari, said that there was a dire need to equip primary healthcare centres in rural areas both in terms of diagnostic tools and personnel for children up to age of five, besides additional efforts were needed for a strong linkage between the people and the primary healthcare system.

Mr Ansari said that one-third of all children reporting to the primary care units suffered from respiratory diseases, but it was a matter of concern that the health units did have a diagnosis system based on symptoms, nor any intervention model for the management of children with signs of pneumonia.

A large proportion of child deaths or complications could be prevented through early, appropriate and low-cost treatment of sick children in homes, he said, adding that his association would soon be launching standardised guidelines in collaboration with competent authorities to handle respiratory diseases in children.

He further said that the chest society was also planning to develop a model for healthcare workers’ training to manage and treat acute respiratory infections with a protocol developed in the country in the indigenous context.

“The ideal thing would be that our children could be vaccinated against pneumonia in their infancy on the doorstep,” he said and expressed the hope that the government of Pakistan under its expanded programme on immunisation with the support of the Gavi Alliance would ensure, as announced earlier, the administration of pneumococcal vaccines to all Pakistani children aged up to five years right from January 2011.

It is said that pneumonia is a seasonal calamity taking lives of 52,000 to 60,000 Pakistani children every year.

Worldwide, there are 156 million cases of pneumonia each year, of which 7-13 per cent are severe and life threatening, contributing to nearly 19 per cent of all deaths in children below the age of five years, according to estimates.

The workshop in question was organised mainly for medical practitioners and graduates to commemorate the World Pneumonia Day, which falls on November 12.

Speaking at the workshop, Dr Iftikhar Ahmad, director of the Ojha Institute of Chest Diseases, Dow University of Health Science, said that pneumonia was a very fatal disease, particularly in children.

He said that mortality rate in the cases of pneumonia worldwide was around two million below the age of five years.

He said that the mortality rate could be minimised to half by taking proper preventive measures, which cost one dollar per patient.

He said that every year more than a half million adult patients, mainly the elderly, admitted to hospitals because of pneumonia and almost half of them died.

Senior chest specialist at the DHUS institute Dr Faizullah Shafqat said that pneumococcal disease was the term used to describe a range of illnesses like pneumonia, septicaemia (blood poisoning) and meningitis (inflammation around brain), when these were caused by the streptococcus pneumonia bug (bacterium).

“The bugs that cause pneomococcal disease are spread by coughing, sneezing or close contact between people. These bugs get into the nose and throat where they may stay without doing any harm, but sometimes they can invade the lungs or bloodstream causing pneumonia and septicaemia or they can reach the brain and cause meningitis,” the doctor said.

Dr Faisal F. Zuberi of the DHUS said that were at least five types of pneumonia — community acquired pneumonia (CAP), hospital acquired, ventilator associated, healthcare associated and pneumonia in an immunocompromised HIV associated and non-HIV associated.

He discussed in details the CAP and said that the social circumstances and the family support should be kept in mind when deciding whether to refer to hospital or manage such patients in community.

He said that incorrect diagnosis or complicating conditions, unexpected pathogen or pathogens not covered by antibiotic choice, antibiotic infection or causing allergic reaction, impaired local or systemic defences and local or distant complications of CAP were reasons for failure to improve the therapy as expected.

Dr Ali Bin Sarwar Zuberi of the Aga Khan University said CAP was a common and potentially serious infection.

It was responsible for a considerably high mortality despite effective antimicrobial therapy, he said and added that there was a need to have multi-centre studies instead of a single intuition’s research and studies.

Replying to a question from the attendees, he said that therapeutic guidelines for empiric treatment of CAP relied on studies from the western world, but there was also a need to modify the local treatment guidelines for CAP in the local perspectives and studies.

Dr Mushtaq Memon, general secretary of the Pakistan Chest Society Sindh, also spoke.



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