Management of pneumonia in India and Indonesia

Although the death rates from neonatal tetanus have been lowered and the death rates from childhood diarrhoea are becoming lower in India and Indonesia, death rates from pneumonia have not yet begun to fall. Pneumonia has become the greatest killer of children and the most important cause of preventable death. The reason for this relative rise in significance may lie in the failure to realize that the majority of the most acute cases of respiratory illness are not viral but rather bacterial infections which rapidly respond to appropriate antibiotic therapy. This paper reviews recent research on the aetiology of pneumonia; it examines age distribution and regional variation in morbidity and mortality; and it concludes by suggesting appropriate pneumonia treatment and case management guidelines. The essential priority is to make procaine penicillin available to children presenting with cough and a respiratory rate over 50 breaths per minute. This alone would substantially reduce the number of child deaths in India and Indonesia.