World Pneumonia Day: Bangladesh Perspective

Pulse oximeter and oxygen facilities must be available at an upazila level to ensure treatment of pneumonia or coronavirus patients. The patients must be treated in time. If all this can be ensured, then it will be possible to lower the number of pneumonia-related infant deaths.

These observations were made by speakers on Tuesday evening at a roundtable on ‘World Pneumonia Day: Bangladesh Context,’ organised by Save the Children, UNICEF and Prothom Alo. Physicians and representatives of partner development agencies participated in the discussion.

Professor. Dr. Mohammod Shahidullah, Chairman, Department of Neonatology, BSMMU, Chairman National Advisory Committee for COVID-19

Dr. MdShamsul Haque, Line Director MNCAH, DGHS

Alyssa Om’Iniabohs, Global Project Lead, Pneumonia Centenary Commitment, Save the Children

Anne Detjen, Child and Community Health Unit, Health Section, UNICEF Global office.

Dr. Shams El Arifeen, Senior Director, icddr,b

Risal Bandana, Deputy Country Director, Save the Children in Bangladesh.

Maya Vandenent, Chief of Health, Unicef Bangladesh.

Dr. SalimSadruddin, Director Child Health, for the USAID global project, Momentum Country and Global Leadership (MCGL), Save the Children.

Opening presentation: Abdul Quayum, Associate Editor, Prothom Alo

Moderator: Firoz Choudhury, Assistant Editor, Prothom Alo

Abdul Quayum: Pneumonia is an acute respiratory infection. Children's death from pneumonia is high in some South Asian countries and developing countries, including Bangladesh. In the Sustainable Development Goals (SDG), we have proclaimed that we will reduce such deaths of children. In today's virtual roundtable, we will discuss the management and control of this deadly disease. Children and the elderly are a high-risk group. Low immunity and other associated diseases are among the risk factors for childhood pneumonia.

Pneumonia is one of the significant causes of child deaths. However, Bangladesh has made pneumonia vaccines available. If we can reach every child and also develop awareness, then we can achieve success in reducing child death from pneumonia. Bangladesh has achieved commendable achievement in EPI, and this is appreciated globally. So if we can put more effort here, then we can achieve remarkable progress in protecting children from pneumonia.

Winter is approaching. Coughs, cold and fever are very common during the season change. These are primary symptoms of pneumonia. We also need to be more careful about the nutrition and healthcare of children so that they do not catch a cold easily. If we can ensure vaccination, then we will be able to control the overall situation.

Save the Children and Unicef in Bangladesh have been working relentlessly for immunization and child survival. They have contributed to including this vaccine in the EPI programme. Today they are with us in organising the discussion of World Pneumonia Day. This roundtable discussion will facilitate awareness and also remind mass people about their responsibility for taking care of children. Pneumonia control in the context of COVID is more critical since together they can create a disaster. Prof. Shahidullah, a child specialist and also the chairman of the COVID-19 technical advisory committee is with us. We also have Dr Arifeen and other learned discussants from home and abroad. I wish today's discussion will be most effective and will strengthen the country's efforts to bring down the death rate of pneumonia.

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Professor Dr Mohammod Shahidullah, Chairman, Department of Neonatology, Bangabandhu Sheikh Mujib Medical University and Chairman, National Technical Advisory Committee for COVID-19: Pneumonia is an infection of the lungs. Sometimes it becomes very serious. It is a disease of all ages-- elderly, children even newborns. Each year many people, including children, die from pneumonia. In 2018, about 12,000 children died from pneumonia. But even then it is not in focus. Now we are facing the crisis of the COVID-19 pandemic. COVID can affect any age, including children and cause pneumonia. November 12 is the World Pneumonia Day. This year it is the tenth World Pneumonia Day. In the context of COVID-19, this year World Pneumonia Day is significant.

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In Bangladesh, about 4.25 lakh people have been affected by COVID-19, and approximately 3 lakh 40 thousand of them have recovered. About 1.44 percent of them have died, only 0.48% is under the age of 10 years. An analysis of data by Professor Sayeeda Anwar of Dhaka Medical College Hospital of 1,488 admitted children shows that among them 1,008 were COVID positive, and 39 children died.

It is observed that COVID 19 infection and death rate is much lower among children, but it leaves a long-term effect on the children. That's why it is vital to take measures to protect children from infection. Schools are closed which is an excellent decision to protect children from COVID infection, but it is also essential to care about the mental health of children while the children are staying inside the house for a long time. Parents have to give quality time to them, engage them in a creative activity such as drawing, puzzles, music, etc. otherwise they might have deterioration of mental health.

Another crucial factor is malnutrition. The risk of complication and death from COVID infection among children with malnutrition is also high. Children who are suffering from malnutrition are at more risk if they are infected. A study from John Hopkin's University among 118 low and middle-income countries shows that there is a disruption of essential health care services which may result in the death of 12 lakh under-five children.

Another study by WHO, UNICEF, and Sabin vaccine institutes have shown that about eight crore children under one year of age in 68 countries may be at risk of infection by vaccine-preventable diseases due to the disruption of immunization services. Bangladesh is also included among the countries. Especially during the month from April to June, there was a marked disruption of essential services including EPI in Bangladesh. However, we have been able to come back to the track in the subsequent month of July to October. It is good news that we have been able to mitigate our service disruption for EPI and back on track again. Our Antenatal Care, Delivery care and Post-Natal care is also good now. But we need to be careful that it continues with good coverage.

Dr Salim Sadruddin, Director Child Health, The USAID global project, Momentum Country and Global Leadership (MCGL), Save the Children: The focus of my talk is the availability of quality diagnosis and treatment of pneumonia at facility and community levels. As per WHO/UNICEF Global Action Plan for Pneumonia and Diarrhea, one of the key strategies for pneumonia control is case management at all levels. The current global and Bangladesh data show that less than 50% of the children with pneumonia seek care from appropriate health providers. Bangladesh can save thousands of lives of under-five children if we can increase care-seeking and proper treatment with antibiotics to 90% by 2030. Besides increasing demand for services, this would require ensuring the availability of providers who could diagnose and treat Pneumonia as per IMCI and iCCM guidelines.

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WHO develops treatment guidelines through a rigorous process based on evidence, and the countries adapt the guidelines. The updated WHO guidelines for pneumonia case management were released in 2014. This was a significant change as pneumonia diagnosis and treatment at the outpatient level was expanded to include previously classified severe pneumonia, which was to be treated at referral facilities as per previous guidelines, and amoxicillin was recommended as a first-line drug for the treatment of pneumonia.

Where are we now, globally, and in Bangladesh? 2018 WHO global survey on SRMNCAH policy showed that only 45% of countries had revised their pneumonia policy to conform to the WHO guidelines. This is just adoption at the national level, forget implementation at the facility level. The story is similar for Bangladesh, which revised its guidelines in 2019, five years after the WHO launch. However, the children are not getting the benefit of this intervention as implementation is limited. Imagine how many thousands of children could have benefited from the revised treatment guidelines.

But the problem doesn't end with the delay in updating the guidelines and training of health providers in IMCI. There is an issue of quality of case management by the health providers. If the trained health provider doesn't have the means to correctly diagnose and treat, i.e. having an ARI timer to count breaths and treat with amoxicillin, or doesn't follow the guidelines due to any reason, the child may not benefit from the treatment and inappropriate treatment may give rise to antibiotic resistance. Finally, it is a common observation that there is a lack of ownership of IMCI at the district level. We have to rectify this situation.

What are the key actions? 1. Empower district management with appropriate budgeting for IMCI training, essential supplies, and medicines, supervision, and monitoring. 2. Build district management capacity to prioritize effectively, plan, implement, and monitor services.

3. Develop a feasible national and sub-national operational plan to build the capacity of all providers at Upazila Health Complex, Maternal, and Child Welfare Centers, Union Health & Family Welfare Centers, and Community Clinics on new pneumonia case management guidelines. This plan should have a robust post-training quality assurance plan and supply chain management plan to ensure the availability of diagnostics and medicines, and 4. Develop a similar strategy for private sector providers who are the primary source of care for under-five children in Bangladesh.

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Dr Md Shamsul Haque, Line Director, MNCAH, Directorate General of Health Services, Ministry of Health and Family Welfare, Bangladesh: In Bangladesh, we have a strong infrastructure of public sector health care delivery system consisting of preventive and curative services through which we provide health care services at the district, Upazila, union and community level. In this service delivery system, more severe sick children are hospitalized at the inpatient department while essential services such as IMCI, outreach vaccination services and malnutrition are delivered through outpatient services. IMCI program is incorporated in the child survival program of Bangladesh since the '90s, and through this program, childhood pneumonia management services are available all over the country. PCV vaccination is also ongoing throughout the country.

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In Bangladesh, lockdown due to COVID-19 was imposed from March 2020, which resulted in a marked disruption of child care services. April and May were the worst hit months when about 9% of fixed vaccination site and 38% of outreach vaccination centre did not hold. About 1 lakh 80 thousand children were missed at least one dose of vaccination due to this effect. EPI coverage of 22 districts falls below 50%. MR campaign was also temporarily postponed. During this period, approximately 68 percent of children did not come to the get services from IMCI corner and about 37 percent from community clinics. The main reason was lockdown and people were scared of COVID-19 infection. Many parents did not come out of home even though the child was sick. In such a condition, we instantly developed the COVID 19 address plan with particular focus on EPI. We also produced a guideline for COVID adaptation in IMCI service delivery.

We analysed DHIS-2 data to identify vulnerable areas. Directives were given to community-level workers to prepare a list of drop-out and left-out children and ensure their vaccination. One of our strong network to reach eligible children for vaccination is through the mobile phone. Through this network, Health Assistants keep on trying to bring the children to the outreach vaccination centre and over the time the number was gradually increasing. This has also resulted in improved patient flow to the hospitals and other health centres. A monitoring system was strengthened from the national level to all level with a particular focus on the areas where there are more drop out and left out children.

All these started giving us results and it was observed from June 2020 that EPI coverage has increased considerably and reached about 100 percent of the target. IMCI services have also improved. Although we are passing through a very challenging time, yet we have been able to improve child care services under the leadership, guidance and wisdom of our honourable Prime Minister. We have been able to enhance child-health care management services promptly. We hope that the children who were drop out or left out of the immunisation programme due to COVID pandemic, we will be able to bring them back under the immunization coverage by the end of the year.

Maya Vandenent, Chief of Health, UNICEF Bangladesh: We all are crossing a huge global crisis in this Covid pandemic. At the same time, we may value this and take this as an opportunity to strengthen our oxygen system. As per the latest DHS data, 18% of under-five child death is due to pneumonia and about one to one and a half child of every hundred will develop severe pneumonia. It is crucial that we have oxygen availability for the treatment of pneumonia, and we can take this crisis as an opportunity to fix our system. Churchill said, never let a crisis go to waste, and this is another opportunity we can take to strengthen the system.

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Some other colleagues already have talked about the need for preventive, promotive and curative care. So I'll just focus on the need of oxygen. And that is of course required besides qualified health workers and medicine for the cure of pneumonia. It is important to monitor the oxygen level, and pulse oximeter does that. I think many people have heard this in this Covid crisis. It is a very simple tool that can be used by lower-level skilled staff and it is recommended that even at the community level, for example, the community health workers like Health Assistant or Family Welfare Assistant or CHCPs can monitor the oxygen level in the child or adult to know if there is a danger there. And if there is a danger there then can refer to primary or secondary level. This is not yet in place in Bangladesh. We still have work to do to improve the availability of pulse oximeters at least in the facilities and also at community level.

Unicef has supported the government in the procurement of over 1000 pulse oximeters since March this year due to the Covid crisis and we hope this can also further strengthen the system and we are sure that many more will come. Now in terms of the medical oxygen supply, there are different ways. The health systems need to get their supply in different levels like the primary health care level that is on Upazila health complex would require a kind of smaller skill oxygen like oxygen concentrator to supplement oxygen cylinder and this can serve very well for pneumonia case management and other hypoxia management. Whereas in the district hospital and medical colleges where we have a larger need for the Oxygen we need to look into right oxygen mix, and we are thinking around central oxygen lines, liquid medical Oxygen or manifold oxygen system with oxygen cylinder behind it and also some oxygen concentrator, and of course with accessories that need to be taken care of and sterilized when required and after every single use. So oxygen supply is critical.

Partners in the context of Bangladesh preparedness response plan for Covid 19 have supported the ministry to look into what is available at the moment in the hospital and seeing that lot of oxygen cylinders are there, but the system needs to be improved. A survey was done for 120 facilities back in June-July and was found that 84% did not have any oxygen plant or liquid oxygen and 20% had an available concentrator. Since then, lots have been done. The ministry has a plan to expand the central oxygen line in most of the medical college hospitals and some of the larger district hospitals. Unicef stands by the ministry to supporting this effort to potentially be ready for the second wave of Covid but also very important in the context of the pneumonia day in terms of strengthening the health system and making sure that Oxygen is available for every patient that needed and specially in cases of severe pneumonia.

Besides that, the case management and capacity of health staff for oxygen management is very, very important. Because oxygen is life-saving but can also be toxic. So we need to make sure that the health worker has the right capacity and is supported throughout the system. And Unicef stands by to support the ministry in building capacity engaging professional bodies and we are working on introducing pediatric care standards to have the quality of care for the children in the hospitals and the outpatient department as well, and this comes in addition to all the work we do already for the newborn in the special newborn care unit and quality improvement in that context.

Unicef is very proud to support the ministry of health, and we have provided 2300 oxygen concentrators in the last few months, and we hope that this will also further strengthen the system, and we want to congratulate frontline health workers in their effort combating not only Covid but also in continuing supporting essential health care services and in the fight against pneumonia.

Bandana Risal, Deputy Country Director, Save the Children in Bangladesh: Despite the global crisis due to Covid, we cannot ignore the fact that pneumonia is the single biggest infectious killer of children under five years of age, and it has a significant impact on children's life. We need to pay attention to Pneumonia which remains a neglected disease-a forgotten killer of children.

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Statistics show that in 2018 about 12000 children died from pneumonia which is almost one child every hour. That the facts are here. Despite the fact that that lot of efforts have been taken by the government and international community primarily WHO, Unicef. I want to recognise their contribution here to the reduction of morbidity and mortality of childhood pneumonia.

There has already been a guideline for managing childhood pneumonia which is the Integrated Global Action Plan of 10plus interventions for Pneumonia and diarrhoea to end preventable child death from pneumonia and diarrhoea by 2025. So there is guidance, action plan, and Bangladesh have incorporated already known solution into the existing health system programs such as IMCI, EPI, and nutrition-related programs. So it is already there.

Nevertheless the numbers of childhood pneumonia deaths are coming down but far too slowly to achieve that what there is a commitment SDG 2030 ambition of ending preventable child deaths. We cannot ignore that fact as well.

Save the Children in Bangladesh is implementing our common approaches to deal with this disease such as Treating Children Close to Home (ICCM), Saving Newborn Lives, and Nourishing the Youngest (IYCF), all of which contribute to reducing child deaths from Pneumonia. We are also implementing maternal and newborn health interventions by providing good nutrition and feeding for children up to 2 years. We are taking the approach here to mobilise the community health worker, and with this, we are trying to support and to reduce some of the child death from pneumonia as well.

I would be glad to mention some of our relevant programmes which we have completed, such as the Breathe for Life Project, CCM, Enhanced Management of Pneumonia in Community (EMPIC), Pneumonia Centenary Commitment (PCC) and Tackling Pneumonia in Bangladesh. We had been working with the village doctor. We had been working with case management. We continue to support to strengthen government policy wherever possible, and we will utilize our global expertise experiences and lessons learned that we derive globally not only from Bangladesh but globally that we can derive here and tackling Pneumonia in Bangladesh as well.

Save the Children's Pneumonia Centenary Commitment (PCC) was launched in early 2017, linked to its 100th anniversary and as a key objective within its Survive Breakthrough to ensure that no child dies from preventable causes before their fifth birthday.

Over the period of time, Save the Children has fostered a greater partnership with the Ministry, UNICEF, academicians, professional organizations, researchers with the aim of building momentum of stakeholders to tackle this challenge together.

In the context of COVID-19, our fight against childhood pneumonia has been very challenging. We reiterate our centennial commitment and to work together for the survival of children from pneumonia.

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Dr Shams El Arifeen, Senior Director, Maternal and Child Health, icddr,b: Instead of talking only about child pneumonia due to Covid, we need to think about the chronic problems of child care in Bangladesh. Problems in receiving appropriate inpatient care of sick children have been an issue for a long time.

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If we see the cause of death data of DHS 2017, we can estimate that approximately 24,000 children die from pneumonia in Bangladesh, that means every 20 to 25 minutes 1 child die from pneumonia. If a child dies from pneumonia, it means that child was suffering from severe illness, and ideally, this child should be hospitalized and treated in the facility. It is observed that less than half of these children visited the hospital and died in the hospital. Others have died either at home or on the way. Why does this happen? Dr Sadruddin has mentioned that we have a problem of care-seeking; of course, there is a problem. Parents of sick children suffering from Pneumonia are not taking them to the hospital or an appropriate provider. Again why this happen? This is not a new issue, it has been in discussion for a long time and but still, the situation is not changing, although the solution is known.

One other important issue is the lack of confidence. Careseekers go to the provider or place where they have confidence. During this Covid 19 crisis, this lack of trust has become a big issue. We have observed that care-seeking of children and adults from all types of health facilities has markedly reduced. So we do not know what happened to those children at home who did not go to the hospital or appropriate provider. Possibly there had been many child pneumonia cases during the period, but we do not know what happened to them.

Specifically, about inpatient care, a child suffering from pneumonia should go to the hospital. But many of them did not visit any hospital, and again many of them who visited have died in the hospital.

According to the Bangladesh Health Facility Survey 2017 report, only 5% of health facilities in Bangladesh are ready to provide standard health care services for children. This is again, unacceptable. We all are talking about oxygen this year, and of course, this is an opportunity. Many of the problems of availability of oxygen may be resolved due to Covid. Need assessment and ensure supply of oxygen is essential. Availability of oxygen for the treatment of children with pneumonia is critical. We have observed in Bangladesh Health Facility Survey and also in the rapid assessment of the facility this year that there is a gap in the sustained supply of oxygen. We are expecting due to greater attention the problems of oxygen supply system will be resolved. But my concern will be remaining about the inpatient care.

Many a time, our perception is that a good building with the doctor, nurse, medicine, equipment and other essentials is all that required for the treatment of sick children. But the reality is different. When a sick child suffering from pneumonia visits an upazila health complex, it has been observed that much time is wasted to start treatment with antibiotics and Oxygen which is critical for saving the life of the child. This is because either we do not have an appropriate protocol or SOPs or even it exists, it is not in practice. IMCI and iCCM program need to be linked with a standard and proper inpatient care because a small percentage of children will always be referred to hospital for hospitalisation and treatment. And if the child does not get appropriate and timely treatment, then chances of survival of those children become very significantly less.

In Bangladesh, childhood pneumonia is under MNCAH of DGHS while hospitals, quality improvement are under another directorate. There is a need to develop a mechanism to strengthen coordination among the relevant directorates; otherwise, all our effort to prevent child death from Pneumonia will not be successful.

Anne Detjen, Health Specialist, Child and Community Health Unit, Health Section, UNICEF Headquarters New York: Over 800,000 children died globally from pneumonia last year, and this is making the largest infectious cause of death among children under five and the cause we all need to address if we want to achieve the child survival goal of less than 25 death by 1000 live birth by 2030. Almost one year age an unprecedented partnership of government leaders, UN, and multilateral agencies private companies non-profit organizations and academics over 55 countries including Dr Haque from the ministry of health Bangladesh came together for the inaugural global pneumonia forum of childhood pneumonia to call for commitment accelerated action and investment to end child pneumonia.

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The participants and country delegation agreed on primary health care as a key strategy to address child survival and achieve universal health coverage. And they endorsed a declaration in committing six strategic actions to accelerate progress in reducing high pneumonia deaths. To develop an implementation strategy for pneumonia control while embedded within child health and primary health care strategies and plan to achieve universal health coverage and multi-sectoral alignment and collaboration, to prioritize vulnerable population to reduce risk factors and reach all children including those in the fragile and humanitarian setting with good quality health services. To adequately finance pneumonia control, to coordinate domestic and development funding, to accelerate breakthrough innovations and areas of cost-effective technology and system, increase efficiency to prevent the most pneumonia deaths. To track progress with transparency and see accountability and inclusiveness and to engage all relevant public-private health and non-health actors at global as well as country levels.

The Covid 19 pandemic was declared shortly after the pneumonia forum and shock the enthusiasm and energy that was created from the forum brought pneumonia in global agenda in a different way and many of the bottlenecks that we are facing while we are trying to make sure all children have access to preventive and curative health care. As Unicef, we also believe that primary health care to comprehensively address Pneumonia by strengthening all three pillars of primary health care emphasized at the Asthana primary health care conference in 2018. First-integrated preventive and curative health services; second- multisector action and third-engage and empower the community. None of these are long to get us where we need to go to end pneumonia deaths but also to address other causes of illness and death in children. We need not only access to health services close to children where they live in community and primary health care facilities, but we also need to increase focus on ensuring the quality of care to strengthen service delivery.

Bangladesh is already a front runner in the quality of care network from maternal newborn and child health and well set up to be a front runner in scaling up of recent WHO standard for improving quality of care of children and young adolescent building on the already existing mechanism at all level of care. We need alignment across multiple sectors, including nutrition, WASH, environment to address underlying risk factors for Pneumonia and other childhood illnesses. And we need to empower communities to take charge of their health and hold a system accountable for the services they need. As part of our Covid response and my colleague, Maya Vandenent chief of health Bangladesh already mentioned we realized the real opportunity to support countries in scaling up access to oxygen and hypoxemia measurement to address the anticipated Covid-19 needs. We are also contributing to strengthening the overall oxygen system to ensure a long-term impact on newborn and children.

Since May UNICEF handed over 15,000 oxygen concentrators to over 90 countries and supported the scale-up of oxygen plant and other local solution in many countries including Bangladesh. In close partnership with Save the Children we engage at the global level and with government and other partners in nine beacon countries, Bangladesh included ensuring Pneumonia as seen as a tracer for the progress we need to make to improve child survival. I commend Bangladesh for the progress made, the commitment shown in Barcelona, and again today by the government and all partners. We look at you as an example in many ways and happy to support further the efforts.

Alyssa Om'Iniabohs, Global Project Lead, PCC, Save the Children: Save the Children has a strategic focus in line of strategic the Sustainable Development Goals (SDG). That ensuring no child dies from preventable disease before the fifth birthday and knowing that pneumonia is the leading infectious killer of children, know that we can't achieve the goal without prioritizing childhood Pneumonia. And so as part of our 100th anniversary, we as an organisation launched a commitment toward tackling childhood pneumonia. And of course, we have an aim for global impact, but we have a specific focus for what we want to demonstrate the change in 9 high burden countries, including Bangladesh.

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We have heard from some of the panelists today about the key areas of action and policies that are needed around childhood pneumonia and Save the Children work to focus on driving those efforts both in Bangladesh that we heard but also globally. It includes highlighting pneumonia as a key element and tackling child survival, looking at increasing health financing and also improving pneumonia policy around pneumonia control as part of broader health system strengthening strategies. We also focus on promoting for the research, innovation and prevention treatment and diagnosis of pneumonia and as Risal highlighted for the scaling up of program our common approaches of evidence-based approaches that we have learned on child survival and pneumonia especially but most importantly we also focus on shared learning across countries.

We recognise that every country is unique and have their own experiences and challenges. We still feel we can learn a lot from each other both at regional levels and global level in tackling this disease. So we focus on fostering cross country knowledge and sharing learning. The partnership is also vital for us. At the global level, we are working in close collaboration with Unicef and also in Bangladesh as well. That partnership extends to other partners and government, of course nationally.

Many of the panelists today are some of the key partners of tackling this disease. The country-level partnership extends to nine countries as well. We also have a key partnership at the global level to drive progress. That not only include Unicef but also members of a coalition called every breath count coalition, and it's a global coalition focused on ending preventable deaths from pneumonia. One of the key action from that group earlier this year, the global forum on childhood pneumonia which Anne mentioned earlier, the key commitments that made by partners and government coming out from that meeting. So I think world pneumonia day is an opportunity for us to revisit those commitments to talk and see what progresses have been made but also look at future need and gaps that need to be addressed.

Additionally, as some of the panelists have highlighted COVID 19 has been a big shock this year but also an opportunity for us. So far, there is a lot of attention and action for Covid 19 for improving the oxygen system and to save the children this is also a priority for us. And every breath coalition we see this as an important way and equal opportunity for addressing childhood pneumonia both during the Covid but also beyond. It is really exciting to hear some of the plan and initiative and work and thinking around in Bangladesh. From the global side, we are here to support you, but we are also quite keen to learn from all of the efforts and actions and activity that will be happening over the next ten years up to 2030 and share that with other regions and countries that we are working at the global level.

Professor Dr Mohammod Shahidullah, Chairman, Department of Neonatology, Bangabandhu Sheikh Mujib Medical University and Chairman, National technical Advisory Committee for COVID-19: Today we have heard learned panelist talking on childhood pneumonia. Let me summarize the key points of the discussion. Children are very dear to us. They are the future leaders in serving the nation. If those children die from a preventable disease like pneumonia or suffer, then it is truly very unfortunate for any country.

There are two challenges in the context of COVID19 and child pneumonia. Covid 19 itself can cause pneumonia, and again due to Covid 19, there is service disruption which is limiting appropriate care availability for sick children.

Now let us think about the management. There are two aspects. One is preventive care that is no child will be infected by COVID or become sick from pneumonia. Another one is curative care which is if the child becomes sick, then the child can get appropriate care.

For preventive care, if we can continue with our good coverage of IMCI and Immunization program, then we can prevent many children from becoming sick from pneumonia. Dr Shamsul Haque has mentioned about mitigation of service disruption of EPI and IMCI. Since we have to live with COVID, for now, we need a Covid adapted IMCI & Immunisation service delivery plan.

For curative care, we have to address the gap in readiness of hospitals, ensure availability of pulse oximeter from district to Upazila to measure the saturation of oxygen and to ensure access to oxygen through cylinder, oxygen concentrator or central oxygen supply system depending upon the level and capacity of the facility to manage a case of childhood pneumonia appropriately.

The WHO Unicef childhood pneumonia management guideline is available, but it is needed to ensure its implementation at all levels. A partnership is essential in a resource-limited country like Bangladesh. Under the leadership of the government, the development partners and professional body if we can work together, then we will be able to win the fight against childhood pneumonia. Let us renew our commitment to protect our loving children getting sick from pneumonia and ensure that if they become sick, they will get appropriate treatment and not die.

Firoz Choudhury: This has been a very meaningful discussion. The experts have come up with very important recommendations and guidelines about the prevention and treatment of pneumonia. We hope this is taken into due consideration at a policy-making level. On behalf of Prothom Alo, thank you all for your participation.