In early November, Malaria Consortium held a highly successful symposium on access to better diagnostic tools for pneumonia. Held at the annual American Society of Tropical Medicine and Hygiene (ASTMH) meeting in New Orleans, the symposium was the first of its kind, bringing together a full room of experts to discuss developments in diagnostic tools suitable for community level use, which is a key part of the ongoing global pneumonia response.
In her presentation ‘Progress towards universal access to pneumonia treatment’ Dr Karin Källander from Malaria Consortium provided an overview of the broader environmental and structural factors that have led to an increased focus on pneumonia response.
Presenting on behalf of Dr Shamim Qazi from the World Health Organization (WHO), Dr Källander also spoke on the challenge of appropriate pneumonia case management and the impact for child health. Recent figures from WHO showed that while pneumonia is no longer the number one killer of children under five years of age, it still kills over 2,500 children every day. Effective case management of pneumonia at all levels of the health system is essential, but especially at community level. The presentation also highlighted the importance of tackling pneumonia and diarrhoea (another leading cause of child death) at the same time, as the two common childhood diseases have overlapping risk factors, as well as similar prevention and treatment interventions.
Dr Theresa Diaz on behalf of Dr Mark Young from UNICEF gave a presentation on integrated case management at the community level (iCCM) and specifically pneumonia case management. The scale of iCCM across 10 high burden pneumonia countries was discussed, highlighting the large number - now over 1.3 million - of community health workers on the ground. Findings of community health workers’ experiences using the existing timer for acute respiratory infections were outlined, as well as the work currently underway at UNICEF to procure new timers as part of the ARIDA Target Product Profile process.
Mr Kevin Baker from Malaria Consortium presented on ‘Key considerations, best practice methodologies and preliminary findings from an evaluation of accuracy and acceptability of pneumonia diagnostic tools for community health workers in low and middle income countries’. As coordinator of Malaria Consortium’s pneumonia diagnostics project, Mr Baker described how the study was looking at a range of factors including accuracy, acceptability, scalability and user friendliness of diagnostic devices that could be used by community health workers to detect signs of pneumonia in Uganda, South Sudan, Ethiopia and Cambodia. The presentation also included highlights from formative research already undertaken in all four countries, which showed that community health workers want improved tools to help them detect the signs of pneumonia in children. Findings so far have shown that the more automated, accurate and easy the timers are to use, the better the health outcomes.
Dr Debbie Burgess from the Bill & Melinda Gates Foundation then looked to the future in her presentation ‘Key considerations and implications for the future development of pneumonia diagnostic tools for community health workers in resource poor countries’. Dr Burgess talked about a range of the exciting new developments, including the work that is being done in biomarkers for ultimate use in point of care diagnostic tests for bacterial pneumonia. She explained that this was complex work, however, and we could only expect to see concrete results in the search for biomarkers in the next five years. Commitment and resources to support this work was also mentioned, with European Union- funded prize competitions and the Grand Challenges in Global Health Explorations grants identified as good opportunities for future research and developments supporting the pneumonia response.
Some of the points raised during the discussion that followed included the importance of continued feeding for the sick child (both for pneumonia and diarrhoea), the questionable evidence on the effect of zinc to prevent pneumonia, and the importance of user preference testing for new diagnostic devices.