Dr. Amy Ginsburg, an infectious diseases physician and epidemiologist, develops and leads PATH’s portfolio of innovations addressing childhood pneumonia. In recognition of World Pneumonia Day, she spoke with PATH editor Jolayne Houtz on promising new ways to diagnose and treat pneumonia in children.
Jolayne: Pneumonia is the world’s top killer of young children, yet public attention and investment in fighting it don’t seem to reflect that reality. Why?
Amy: Increased attention to pneumonia would have tremendous public health payoffs. Each year, pneumonia kills an estimated 1.1 million children under the age of five. And here’s the thing: nearly all of these deaths are preventable with proper diagnosis and treatment.
There are a lot of reasons why we haven’t made more inroads with pneumonia. First, it’s just really hard to identify a kid with pneumonia. With diarrhea, malaria, and other diseases, you can either quickly identify it or run tests to confirm the diagnosis. Those tests don’t currently exist for pneumonia. Chest X-rays aren’t routinely available in low-resource settings. If you can’t adequately diagnose pneumonia, how are you going to treat it?
In addition to developing diagnostics, we need to empower community health workers to both diagnose and treat pneumonia at the community level with tools designed for their specific needs. Too often, proven tools like pulse oximeters or antibiotics are out of reach.
What diagnostic innovations is PATH working on?
Pulse oximetry is what I’m most excited about. It’s the accepted standard for detecting hypoxemia, an often-fatal complication of pneumonia. We’re currently field-testing a user-friendly application for mobile phones and tablets called mPneumonia, which uses the Integrated Management of Childhood Illness algorithms developed by UNICEF and the World Health Organization to support an integrated approach to diagnosing and treating childhood illnesses. With our partners at the University of Washington, we designed the application to incorporate a pulse oximeter and a manual respiratory rate counter to help health care providers detect and manage pneumonia.
We’re also trying to learn more about the barriers to using pulse oximetry in low-resource settings. What we’re finding is that it’s not a matter of cost. It’s the lack of policies and guidelines as well as training in its use.
How about treatment innovations?
The vast majority of pneumonia cases, even severe pneumonia, can be treated at the community level. Amoxicillin is an antibiotic that is the recommended first-line treatment. It’s cheap and effective but must be taken correctly and for the full course of treatment.
PATH is identifying new product presentations for amoxicillin dispersible tablets. These include packaging designs and user-friendly instructions to help health care providers appropriately dispense the medication and caregivers to administer it properly to their children.
What needs to happen next to move these innovations ahead?
We need to raise awareness of pneumonia and increase advocacy to drive these innovations forward. Our next steps are to evaluate existing solutions, speed up development of the most promising new innovations, and explore how to integrate them into health systems.
The good news is that many of the interventions needed to tackle pneumonia also work for diarrheal disease and malaria, both leading killers of children. We can take on these threats together with a coordinated strategy that includes prevention through immunization, appropriate case management, proper nutrition, safe water, basic sanitation, insecticide-treated bednets, and the reduction of household air pollution, along with innovative diagnostic and treatment approaches.
We already have some of the answers in hand, with more in the pipeline. Our focus now is to mobilize resources and partners to scale up what we know works and quicken the pace of development for new tools to protect children.