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Though the number of children who die before age 5 has declined significantly in the last two decades, the path to ending child mortality is long and hard to navigate. Nearly 7 million young children still die yearly, largely from preventable causes. What works and what doesn’t in the fight against child mortality? What will it take to go the last mile, and end preventable child deaths?  

Tackling pneumonia, a 'forgotten killer'

In July, Zambia unveiled a new vaccine campaign to protect against pneumonia, intensifying a national response to the single leading cause of death for children under 5 around the world. Still, treatment challenges persist.

LUSAKA, Zambia — Inside the pediatric ward of a hospital here, Jess Chihumba tended to her 6-month-old daughter, Holly, alternately nursing her, cuddling her, and watching over her through the crib’s iron bars.

For the last four days, Jess had remained vigilant, foraging for moments of fitful sleep in a hard plastic chair pulled up next to the crib. Handwritten on a clipboard chart hanging above Holly’s head was her diagnosis: pneumonia and dehydration.

Holly's pediatric pneumonia case is just one of the estimated 120 million that occur each year globally, concentrated largely in Southeast Asia and Africa. Pneumonia is the greatest single cause of child death, killing an estimated 1.3 million children under 5 yearly, more than HIV/AIDS, malaria, and tuberculosis combined. Pneumonia is treatable, but formidable compared with other leading causes of child death, especially for those under the age of 2. Unlike malaria, pneumonia is caused by many different pathogens, and unlike diarrhea, its presence is tricky to detect without invasive or highly advanced techniques. Pneumonia also progresses quickly and is therefore difficult to treat in a place like Zambia, where getting to a hospital – or even a nurse at a barebones health clinic — is a challenge.

So pneumonia has been a “forgotten killer” to which funding and advocacy simply has not gone. It is a disease, as UNICEF has called it, of poverty, exacerbated by poor nutrition, poor sanitation, and poor air quality.

Holly was admitted to University Teaching Hospital, Zambia’s largest hospital, on a Tuesday in mid-July. Jess, 28, knew something was wrong with her youngest daughter days earlier. Holly had a fever, along with fits of cries and coughing, so Jess had carried her by foot to the closest clinic, one hour away. There she was given an oral rehydration solution, generic Tylenol, and an injected drug that hospital nurses later believed was an antibiotic.

“We have something we can prevent.”
~Precious Mutale

But Holly’s condition only worsened. Over the next few days her fever climbed, and she started to vomit and have diarrhea. Jess carried Holly to the clinic two more times. On the third visit, Holly was so ill that she was transported to the hospital by ambulance — a relative luxury in a country where the health system is woefully under-resourced. None of Jess’s other three children had ever been so sick, and Jess feared for Holly’s life. 

Each year, thousands of children like Holly are referred by clinics around the country to University Teaching Hospital, with its labyrinth of concrete buildings and passageways. Sick children may be forced to share cribs, and one nurse may be responsible for up to 100 patients, but the care here is among the best in Zambia for those who cannot afford private hospitals.

That is, if the children can get referred here on time, which sometimes is not the case. In the nursery room next door to Holly’s, a two-month-old boy had recently passed away, just two hours after having been admitted with severe pneumonia.

This summer Zambia became the latest country to introduce a new vaccine to protect against pneumonia. Proponents believe it can prevent 500,000 children from dying and millions more from getting sick around the world each year. The vaccine launch in Zambia comes months after a United Nations Development Programme report found that at its current pace, the country will not meet the Millennium Development Goal for reducing child mortality

In a country with long distances between health care facilities, pervasive drug shortages, and just half the health care professionals needed, the vaccine will help bring down child mortality rates. It immunizes against pneumococcal disease, a bacterial infection that causes roughly one-third of all pneumonia child deaths. Called the pneumococcal conjugate vaccine — “PCV10” for short, after the 10 pneumococcal serotypes against which it protects — it immunizes against pneumococcal disease, a bacterial infection that causes roughly one-third of all pneumonia child deaths. In July, it was kicked off in the capital with great fanfare: a marching band, theatrical performances, and celebratory speeches by high-level health officials.