Over the course of the twentieth century, and into the twenty-first, there has been a change in the relationship between disease and death. The leading causes of death in 1900 included diseases such as cholera and tuberculosis, which were predominantly infectious diseases. Fast-forward to 2010 and chronic diseases, such as heart disease and stroke, the result of lifestyle choices rather than communicable methods, take these same spots. Medical advances such as vaccines, antibiotics, and general knowledge of hygiene have all led to a reduction in the number of deaths caused by infectious diseases. However, infectious diseases continue to pester low-income countries, and one disease in particular, pneumonia, has often been overlooked. More specifically, pneumonia’s devastating effects have given it notoriety as the leading cause of child deaths worldwide. Before analyzing pneumonia’s pathogenesis and, more importantly, methods that are used to treat and prevent it, it is important to grasp its epidemiology.

Every year, pneumonia kills almost 1.4 million children under the age of five, accounting for nearly one-fifth of child deaths. Though this disease affects children everywhere, the deaths it causes are concentrated in Sub-Saharan Africa and South Asia. And in low-income countries, almost 150 million episodes of pneumonia occur every year. Understanding these figures requires background information on the nature of pneumonia.

Pneumonia is an acute lower respiratory tract infection that specifically affects the lungs. At the end of the human respiratory tract, there exist little air sacs called alveoli where gas exchange occurs. However, when a person has pneumonia, fluid and pus fill the alveoli in one or both lungs, making breathing difficult. Bacterial pathogens generally cause pneumonia, but viruses can also be the cause of serious cases.

More importantly, these pathogens can reach a child’s lungs through different routes. Although information on childhood pneumonia’s pathogenesis is limited, it is widely accepted that pathogens are already present in a child’s nose or throat and are then inhaled into the lungs, causing infection. Pathogens can originate from blood-borne infections but can also be spread through contaminated air droplets. During birth, or shortly after, infants are at a higher risk of developing pneumonia because of contaminated substances that they may come into contact with during delivery. But the most peculiar question that arises with respect to pneumonia is: why are children so vulnerable?

A healthy child has many natural defense mechanisms that protect his or her lungs from infectious agents that can cause disease. However, children with weakened immune systems are more susceptible to those same agents. This disparity is a result of one main factor that is the underlying cause of most infectious diseases today: poverty.

Child mortality due to pneumonia is indissolubly linked to poverty. Poverty-related factors such as lack of access to safe water, poor access to health care, and inadequate sanitation all attenuate the likelihood and amplify the effects of pneumonia. Children with deficiencies such as malnourishment, particularly those who are not breastfed or do not consume enough zinc, are at a higher risk of developing pneumonia. In this context, children suffering from infectious diseases such as AIDS or measles are also more likely to develop pneumonia. Environmental factors, such as crowded living conditions or exposure to smoking, can also increase a child’s predisposition for pneumonia.  Given all these triggers, poverty’s effects on child mortality and the prevalence of pneumonia intensify yet another issue: achieving Millennium Development Goal (MDG) 4.

Millenium Development Goals, established following the Millenium Summit in 2000, are eight international development goals that UN member states plan to reach by 2015. Of the eight, one of them, number four, specifically aims to reduce by two thirds, between 1990 and 2005, the under-five mortality rate. In addition it looks to decrease, by one-third, deaths due to acute respiratory infection between 2000 and 2010. The 2013 Progress Chart indicates that Sub-Saharan Africa, one of the two regions with the highest concentration of pneumonia-related deaths, still has a high mortality rate amongst under-five-year olds. But a more worrisome fact that the chart reveals is that the progress being made by Sub-Saharan Africa, in addition to South Asia and Oceania is insufficient to reach the target if prevailing trends persist. It remains to be seen is how effective current courses of dealing with pneumonia are.

Because pneumonia can arise from a variety of bacteria, and climactic and cultural conditions in different parts of the world can also affect the etiology of the disease, each region needs a tailored action plan to deal with pneumonia. Some practices that are specific to each region include diagnostic techniques optimized to identify the region’s strain of pneumonia-causing pathogens and regularly monitoring clinical efficacy of pneumonia to revise national treatment policies. However, there are a few qualities regarding pneumonia and its consequences that are quintessential across all affected regions. Most of them concern ascertaining the signs of the disease (cough and difficult breathing are amongst the most common symptoms), the presence of trained personnel and provisional health facilities (though the number vary from region to region), and treatment through antibiotics.

In the end, there are two important axioms to keep in mind in order to end pneumonia’s reign of terror. The first is that preventing pneumonia, as with any other disease, is even more important than treating in. Preventive measures should include adequate nutrition, which addresses malnourishment, exclusive breastfeeding, which helps infants acquire passive immunity until they can develop their own active immunity, and most importantly, immunization. This final measure does two things: it helps prevent children from developing infections that directly cause pneumonia, such as various strains of influenza, and it can prevent infections that can lead to pneumonia as a complication, such as measles.

The second point to keep in mind is that efforts to deal with pneumonia and its costs are only as effective as the political, economic, and social will of the government and society in which they are implemented. It is difficult to conceive of any set of measures aimed at treating or preventing pneumonia, or any disease for that matter, which will be effective if the presiding government shows no motivation to apply them.