Dr. David Marsh Talks About Pneumonia, the #1 Killer of Children Under 5

David Marsh, MD, is a pediatrician, epidemiologist and researcher specializing in improving health care in the developing world. As Save the Children's senior child survival advisor he focuses on sustainable, community-based health care solutions.

Dr. Marsh answers questions about pneumonia, the number one child killer.

1.  What is pneumonia?

Pneumonia is an infection of the lung. It is usually caused by viruses or bacteria — sometimes by fungi or parasites.

2.  What do the symptoms of pneumonia look like?

Patients with pneumonia usually have a fever and a cough — neither are symptoms only of pneumonia, however.

Lots of conditions can cause fevers (other infections, for example). And lots of conditions can cause a cough, including a common cold or asthma.

More specific signs of pneumonia are fast breathing and when a child's lower rib-cage draws in deeply during breathing.

3.  Are there different kinds of pneumonia?

Yes, there are three kinds: 

• Simple pneumonia is the most common type and accounts for about 85 percent of cases. It is characterized by fast breathing.
• Severe pneumonia, which accounts for about 10-12 percent of cases, typically involves rib-cage in-drawing. The lungs are congested and stiff and don't expand properly, so when the child tries to breathe in the chest wall caves in instead of expanding. 
• Very severe pneumonia (fortunately uncommon) has all of the above characteristics, plus a lack of oxygen, resulting in blue lips or other danger signs.

4.  How serious is pneumonia?

Pneumonia is the leading killer of children in the world, claiming more than 2 million lives every year. The chance of death increases with the severity of the disease.

5.  How can we control pneumonia?

We know how to control it. We actually can prevent it by immunization, proper nutrition (especially exclusive breastfeeding), reducing HIV/AIDS,  and reducing exposure to indoor smoke.

Immunizations, or vaccines, are the most important prevention tool, especially against the most common bacteria that cause pneumonia. Two key vaccines are the "Hib" vaccine against Hemophilus influenzae, type b; and the PCV or pneumococcal vaccine against Streptococcus pneumoniae.

We can also treat pneumonia with low-cost antibiotics — effective even when provided at the community level where access to health facilities is difficult.

6. Is it important or necessary to treat pneumonia — why not just prevent it using vaccines?

Vaccines are great, but some children will still die because not all germs are covered by existing vaccines; or not all strains of a particular bacterium or virus can be included in the vaccine; new ones may develop.

Another reason we need to treat pneumonia is that children may miss receiving a vaccine because they are too young, and therefore can get sick even before they were scheduled for the shot. Some children also may miss receiving the vaccine because the family situation is too unstable or disorganized.

Finally, it is important to note that not every dose of a vaccine is 100 percent effective — some will not have been handled perfectly in each step from the factory to the patient; and some children suffer from weak immune systems so vaccination may be insufficient protection. 

Additional Resources

More information on pneumonia treatments

Find out more about World Pneumonia Day and how you can help

Watch video of a community health worker treating a child with deadly pneumonia

Last Updated October 2009