Potential interventions for preventing pneumonia among young children in developing countries: promoting maternal education.

The views of various disciplines on the role of education in improving the health and survival of young children in developing countries are discussed, as well as the factors and processes explaining this impact of education and the influence which education could have on risk factors especially relevant to acute respiratory infections (ARI) and pneumonia. This is by reviews of the available evidence on the impact of maternal education on mortality and morbidity. Since there are hardly any data dealing with the impact of education on pneumonia mortality, we focus on post-neonatal mortality, assuming that it is a suitable proxy for pneumonia mortality. Evidence is summarized on several processes or mechanisms which could explain why there is such an impact of education on ARI mortality (and morbidity) in children below 5. An attempt is made to quantify the reduction in pneumonia mortality which has occurred during the past 10-15 years as a result of improvement in women's education. This will also give an indication of the magnitude of the potential benefits of education for health and survival in the years ahead. Throughout this report we define maternal education as the regular schooling received by women during their youth. Some may have followed additional adult education classes before they became mothers.

Potential interventions for the prevention of childhood pneumonia in developing countries: a systematic review.

This article describes the background and framework for a systematic review of potential interventions for preventing pneumonia among under-5-year-olds in developing countries. Twenty-eight intervention areas are identified in six groups -- immunization, case management/chemoprophylaxis of high-risk children, improving nutrition, reducing environmental pollution, reducing transmission of pathogens, and improving child care practices. Calculation of the potential impacts is illustrated and the expected outcomes are also described.

PIP: In March 1992, March 1993, and June 1994, an international expert advisory committee oversaw a systematic and comprehensive review of potential interventions for preventing pneumonia among children aged less than 5 living in developing countries. The World Health Organization's Programme for the Control of Acute Respiratory Infections (ARIs) and the London School of Hygiene and Tropical Medicine conducted the review. There were 28 individual intervention areas identified among six broad intervention groups. Immunization comprises one of the six broad intervention categories. Specific immunization interventions include increased coverage of measles and pertussis and new vaccines for Pneumococcus, H. influenza B, respiratory syncytial virus, and other viral vaccines. Improving nutrition interventions revolve around breast feeding, low birth weight, malnutrition, vitamin A, severe anemia, and other micronutrients (e.g., zinc). The broad intervention category of reducing environmental pollution encompasses indoor air pollution, environmental tobacco smoke, and outdoor air pollution. Severely malnourished children, high risk neonates, ARI (upper tract), helminths, and wheezing fall under the case management and chemoprophylaxis intervention category. Crowding, direct transmission, and HIV are addressed in the category of reducing transmission of pathogens. The category of improving child care practices includes care-seeking, avoiding chilling, other child care practices, maternal education, and child spacing. The specialists conducted modeling to determine the potential impact of various interventions. It showed that the potential impact of an intervention increases independently with the pre-intervention prevalence of the risk category, with the size of the associated relative risk, and with the reduction in risk-category prevalence achieved by the intervention. Modeling will be used to compare the potential impacts of ARI preventive approaches with the impact achievable with the case management strategy.