‘Kids with bronchiolitis get pneumonia cure’

“I found misdiagnosis of pneumonia … I found misuse of antibiotics,” Prof M S Akbar, a lawmaker and Chairman of the Bangladesh Red Crescent Society, said at the inauguration of a workshop in Dhaka on Tuesday.

He said pneumonia was ‘over diagnosed and mixed up with the bronchiolitis’.

The comment came at a time when the government is planning to introduce pneumococcal vaccine in its routine immunisation programme to prevent pneumonia, one of the main reasons of childhood deaths in Bangladesh.

The common symptoms of pneumonia and bronchiolitis include cough, difficult breathing with muscles around the ribs sinking as child tries to breathe, and fever.

Doctors say pneumonia treatment needs antibiotics, while in bronchiolitis they do not work as it is viral infection.

Akbar suggested proper diagnosis to stop ‘inappropriate’ use of antibiotics that he said ‘can trigger resistance.’

When asked, a professor of paediatrics at the Dhaka Medical College Hospital, Abid Hossain Mollah told bdnew24.com that “he (Prof Akbar) is right, but it was needed in the context of Bangladesh”.

“There are no experts or facilities in remote areas to differentiate between pneumonia and bronchiolitis. If we try to do that, more children will die due to pneumonia,” he said explaining that because of use of antibiotics in all cases, “pneumonia is not remaining untreated which is important for us to cut childhood deaths.”

He said, “There is no big chance of drug resistance if a child takes antibiotics only for five days … that’s what a child is currently given if comes with those symptoms.”

Bronchiolitis mostly affects under-2 children, according to him, but apart from clinical analysis, some diagnostic tests like X-ray are needed to establish it.

“But we have no such facilities at remote level,” he said.

Considering the constraints, the pneumonia management guidelines had been prepared in a way that ‘a child with cough and difficult breathing does not die untreated’.

According to the Bangladesh Demographic and Health Survey, pneumonia accounts for one-fifth of the total under-5 child deaths and has the potential to frustrate Bangladesh’s efforts to achieve MDG-4 target.

The target is to bring down the mortality rate to 48 per 1,000 live births by 2015 from the current level of 53. Experts blame widespread malnutrition and poor hygiene for the lung disease.

The ICDDR,B studies to better understand the dynamics of severe malnutrition and pneumonia in cases show where hospitalisation is not possible, home-based management with antibiotics, micronutrients and proper feeding with continuous care by parents can be an alternative to hospitalisation.The two-day workshop and symposium is being organised by the ICDDR,B.

Health Minister A F M Ruhal Haque recently said steps had been taken to launch vaccine against pneumonia in the first quarter of this year.bdnews24.com

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