Acute Respiratory Infections

Excerpt

Acute respiratory infections (ARI), particularly lower respiratory tract infections (LRTI), are the leading cause of death among children under five years of age and are estimated to be responsible for between 1.9 million and 2.2 million childhood deaths globally. Forty-two percent of these ARI-associated deaths occur in Africa (Williams 2002). Despite its importance in regard to morbidity as well as childhood mortality, the epidemiology and pathogenesis of LRTI, particularly in Africa, remains understudied and consequently underappreciated. Although structured management programs coordinated by the World Health Organization (WHO) made some strides during the 1980s and early 1990s toward reducing childhood mortality from LRTI (Sazawal and Black 2003; WHO 1990), the HIV epidemic in many countries of Sub-Saharan Africa has reversed many of these gains (Walker, Schwartlander, and Bryce 2002). The reduction of morbidity and mortality in Sub-Saharan Africa requires a multifaceted approach that includes addressing risk factors associated with increased susceptibility to LRTI among children. These factors include lack of access to basic amenities, such as adequate housing, electricity, and running tap water. Availability of these amenities would help to reduce exposure to such risk factors as indoor smoke pollution and overcrowding in households. Reducing these risk factors may take some time, but recent advances in medical science hold promise in regard to preventing morbidity and possibly mortality from the most common perceived causes of severe LRTI—those due to bacteria, such as Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae (Cutts et al. 2005; Klugman et al. 2003; Mulholland et al. 1997). Despite these advances, the challenge remains to address the inequity in health care accessibility and affordability of new-generation vaccines that have been found to be effective in preventing disease caused by these bacteria in developed and developing countries. Furthermore, a priority for most countries in Sub-Saharan Africa in dealing with the reversal of gains that occurred during the late 1980s and early 1990s is to work to prevent the transmission of HIV to children through effective HIV mother-to-child transmission prevention programs.