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The ChallengeofChildhood Pneumonia

By Maggie Bucholt
Global Health

Many of the public health challenges Boston University researchers engage on a daily basis occur thousands of miles from campus. The University’s global initiative to improve health in low-income countries around the world includes projects such as an evidence-based study of childhood pneumonia that changed the World Health Organization’s guidelines for treatment. A Spanish immersion program for School of Medicine students that benefits local citizens and community health care projects in Ecuador. In Nicaragua, researchers are seeking answers to a kidney disease epidemic affecting young workers, and in Peru, a theater arts pilot program has shown promise in improving public health.

At the heart of these efforts is the Center for Global Health & Development, where numerous research projects in Africa and Asia contribute to the body of knowledge about HIV/AIDS, malaria, and infant mortality. A new focus is rapid urbanization in India and its impact on public health. To support the complex strategic and operational issues involved with international research, education, and community service, the University established the Global Programs Office and is encouraging cross-disciplinary collaborations to address major global challenges.

Each year, 1.9 million children die from pneumonia. That is the equivalent of eight 747 jets packed with children crashing every day.

Donald M. Thea, a professor of international health who conducts clinical and epidemiological research on infectious disease, is out to reform the treatment of childhood pneumonia one step at a time, and he is succeeding. Thea was the principal investigator on a U.S. Agency for International Development-funded project demonstrating that children with severe pneumonia can be treated effectively in a community-based program with oral amoxicillin rather than in hospitals with intravenous drugs. Often cost, distance, lack of transportation, and other factors prevent children from ever reaching hospitals.

The results of the study were published in The Lancet medical journal, and prompted the World Health Organization (WHO) to change its guidelines—closely watched by health ministries worldwide—to include oral antibiotics. This was a huge coup in Thea’s crusade to help reverse the tide of childhood deaths.

“It’s extremely gratifying to spend a decade addressing a public health question of great importance and providing sufficient evidence that WHO would change its public guidelines,” Thea says. “In public health, that’s a grand slam; governments around the world look to WHO for technical guidance.”

Thea conducted research in Pakistan—where there is a highly developed community health system called the Lady Health Worker Programme—with children under the age of five. The next step will be to train low-level health care workers to recognize symptoms and to instruct mothers to administer oral antibiotics and bring the children back if symptoms worsen.

Now Thea is researching the causes of childhood pneumonia. He is the principal investigator in Zambia for the Pneumonia Etiology Research for Child Health (PERCH), a seven-nation study in Asia and Africa coordinated by Johns Hopkins University and funded by the Bill & Melinda Gates Foundation. BU was selected to enroll children in Zambia, where it has 15 existing research projects. Thea has conducted studies on Zambian communities’ management of fever, malaria in pregnancy, and determinants of child sexual abuse.

Thea refers to PERCH as a “big-iron” landmark study, meaning that highly sophisticated methods and techniques are employed to ask and hopefully answer specific questions, the foremost being what exactly causes pneumonia in children in developing countries. Pneumonia can be caused by bacteria, viruses, fungi, and parasites; in the majority of childhood cases in the developing world it’s bacteria.

“In some ways, pneumonia is an orphan disease,” he says. “In comparison to HIV and malaria, more children die from pneumonia, yet the world pays less attention to it. It’s amazing the amount of money and press that malaria and HIV have received. It far outstrips the burden of those diseases compared with pneumonia.”

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