Acute respiratory infections in children in the developing world

The profound decline in death rates from respiratory infections in recent decades in the developed countries of the world is a complex phenomenon that probably results from a combination of socioeconomic and environmental change and modern medical care. Death rates from respiratory infections in the developing world are very variable, and there is evidence that they can decrease dramatically when effective health services are engrafted onto a social environment in which mothers are literate and trained to observe their children's health. A worldwide case management program aimed at making lifesaving antibiotics and oxygen available for treatment of children in deprived areas is currently being spearheaded by the World Health Organization and rests on simplified approaches to diagnosis that are widely disseminated to parents and primary health workers. These guidelines have been shown in field studies to contribute to changes in child mortality. The epidemiology of pneumonia in childhood seems similar worldwide. Most children suffer five to eight respiratory infections annually if they live in the cities and fewer if they live in rural areas but, in deprived circumstances, pneumonia complicates the infection much more often and the principal organisms are pneumococcus and Haemophilus influenzae. A vaccine approach to these two organisms is attractive and needs further field testing. Meanwhile, a case management approach, making antibiotics available on a rational basis worldwide, is capable of saving lives. Until mothers in the developing world have confidence in the survival of their children, they are unlikely to be attracted to control of their fertility.