Pneumonia is the most common cause of death in young children beyond the immediate neonatal period, accounting for over 800 000 deaths in children under 5 annually. Pneumonia is also the third leading cause of sepsis in this age group.
The introduction of vaccines for Haemophilus influenza type B and Streptococcus pneumoniae has contributed to a decline in pneumonia-related mortality over the past 2 decades. The World Health Organization’s (WHO) Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) aims to further reduce deaths from pneumonia to less than 3 children per 1000 live births by 2025. Among 30 high pneumonia-burden countries according to the GAPPD, Bangladesh is 1 of only 3 countries on track to achieve the GAPPD 2025 milestones. However, pneumonia still accounts for 12% of all deaths in children under 5 in Bangladesh, and the country needs to continue to achieve an 8% average annual rate of reduction in pneumonia-related deaths to meet the GAPPD target [4].
A major obstacle to further reducing childhood pneumonia-associated mortality in Bangladesh and elsewhere is the lack of data regarding its infectious causes; this knowledge gap is due to the lack of accurate diagnostic tests and is amplified by variability in the microbial etiologies of pneumonia across populations. This variation is indicated by findings from the Pneumonia Etiology Research for Child Health (PERCH) study, a large multicountry case-control study performed in 7 countries between 2011 and 2014, which evaluated viral and bacterial causes in young children hospitalized for pneumonia. The study found that blood cultures were positive in only 56 (3%) of 1749 cases, and that S pneumoniae was the most common pathogen isolated (33.9% of 56) [5]. However, among the 211 children with pneumonia and a blood culture enrolled in the Dhaka site of the PERCH study, only 2 had a positive blood culture and both were positive for Enterobacteriaceae. This variation across populations and geographic locations underscores the need to expand laboratory diagnostic and surveillance activities. This is especially true in South Asia, where the aggregate levels of antibiotic resistance are very high and have increased rapidly.
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