Portable X-ray machines can help with early pneumonia diagnosis so treatment can be started promptly. — Filepic
It was recently announced that pneumonia was the leading cause of death in Malaysia in 2023, with more than 18,000 deaths recorded.
The situation is not too dissimilar globally – according to the Forum of International Respiratory Societies (FIRS), pneumonia claimed the lives of 2.2 million people in 2021, including 502,000 children aged less than five years and 152,000 newborn babies.
In fact, the World Health Organization estimates that pneumonia accounts for approximately 15% of all deaths in children under five years old.
What is it?
Pneumonia is inflammation of the lungs that is usually due to infection caused by bacteria, virus or fungi.
Severity ranges from mild to fatal, with risk factors such as extremes of age (the elderly, those below the age of five), pre-existing diseases (e.g. chronic obstructive pulmonary disease, kidney failure, heart failure and diabetes) and limited access to healthcare increasing its severity.
Symptoms can manifest in a variety of ways: respiratory symptoms such as coughing, phlegm production and difficulty breathing, and non-specific ones such as fever, body ache, fatigue, appetite loss and even confusion.
Treatment is via antimicrobials, although more severe cases may require additional supportive measures such as the use of a ventilator and dialysis in acute kidney injury.
Long term impact
In severe cases, pneumonia can lead to complications such as sepsis, acute respiratory distress syndrome (ARDS) and lung abscesses.
Even after recovery, patients may experience long-term respiratory symptoms or reduced quality of life, further exacerbating public health challenges.
Pneumonia imposes substantial economic burdens on individuals, families and healthcare systems, encompassing both direct and indirect costs.
Direct costs would include medical expenses (from hospitalisations and medication) as well as stress on the healthcare infrastructure.
We only have to think to a few years back when our healthcare system was under pressure from the Covid-19 epidemic, leading to a lack of hospital beds and even basic equipment such as oxygen supply.
Indirect costs are harder to measure – loss of productivity due to absences from work or school result in lost wages for individuals and economic losses for employers.
Caregivers, often family members, also face disruptions to their daily lives.
For children, those who suffer severe pneumonia may experience stunted growth or developmental delays, affecting their future earning potential and overall economic productivity.
According to Save the Children organisation, pneumonia kills two children every minute around the world. — 123rf.com
Preventative steps
There are currently vaccines against a number of respiratory pathogens – Influenza virus (not to be confused with the common cold); SARS-CoV-2 (the virus that causes Covid-19); respiratory syncytial virus (a cause of pneumonia in children and the elderly); and Streptococcus pneumoniae, which is one of the most important bacteria causing pneumonia across all age groups.
Addressing environmental and lifestyle factors is crucial – these include reducing air pollution, promoting exclusive breastfeeding in infants to boost immunity and ensuring adequate nutrition to prevent malnutrition-related vulnerability (it is worth noting that approximately 20% of children under five years old in Malaysia are affected by stunting due to malnutrition).
Strengthening health systems
Improving access to diagnostic technologies, such as portable X-rays and rapid point-of-care tests, can facilitate early and accurate diagnosis, which in turn will ensure that patients receive the right antibiotics and/or antivirals.
This is also related to improving access to healthcare professionals, particularly in the community.
It is worth noting that the risk of increasing anti-vaccination sentiment is high.
Constantly repeating and sharing non-evidence based statements will continue to create confusion and embolden proponents of fake news who do not have to fear reprisal for propagating information that can lead to patient deaths.
With the above in mind, the government should proactively run campaigns promoting vaccination that not only highlights its benefits, but addresses the concerns or fears of the public.
Combining pneumonia prevention and treatment with broader child health initiatives, such as immunisation drives and nutrition programmes, can amplify impact.
The government should also provide free vaccinations for those at high risk in order to further reduce the burden on both the individual and on public health.
Lung Health Initiative
Given the preventable and treatable nature of pneumonia, targeted strategies can significantly reduce its burden.
These measures include prevention, early detection and effective treatment, alongside addressing social determinants of health.
For World Pneumonia Day on November 12, FIRS led the call on governments and stakeholders to:
> Ensure equitable and sustained access to vaccines against the commonest pathogens;
> Strengthen health systems to deliver interventions which reduce pneumonia deaths, including correct use of antibiotics;
> Strengthen national and international commitment to support interventions against the leading risk factors for pneumonia;
> Improve support for research into cost-effective interventions to prevent and treat pneumonia in poorer settings.
Our Health Ministry recently launched the Lung Health Initiative, a strategic roadmap looking at policy proposals that can be implemented over the next five years in an attempt to improve outcomes from respiratory diseases such as pneumonia.
The roadmap covers health promotion and prevention (including quit smoking initiatives), lung health screening (using spirometry and chest X-rays), improving access to diagnostics and therapeutics as well as developing infrastructure for care and rehabilitation.
As with all roadmaps, the key is proper and consistent implementation by all stakeholders involved.
By generating more awareness and efforts to reduce its prevalence, it is hoped that we will see a reduction in the number of fatal pneumonia cases.
Dr Helmy Haja Mydin is a consultant respiratory physician and Social & Economic Research Initiative senior policy advisor. For further information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
