Though it’s been termed the silent killer, pneumonia’s record speaks for itself. Pneumonia—lung infection caused by bacteria or viruses—is the leading cause of death worldwide for children under five. In Peru and other developing countries, pneumonia is extremely prevalent. Between 2008-2012, 59% of Peruvians sought care for suspected pneumonia, reports the Demographic and Health Survey. Further, 17.2% of deaths among Peruvian children 1-5 years old are caused by acute lower respiratory infections (a category that contains pneumonia), while only 6% of deaths among US children 1-5 years old are caused by acute lower respiratory infections. This gap is not about medical technology—the same pneumonia treatments used in New York City are available in Ollantaytambo. Children in Peru are dying because they are at a greater risk for respiratory disease during the course of their everyday lives, and they are less likely to be treated if they do fall ill with respiratory disease.
Let’s think about a typical household in one of the altoandina communities we serve. The average home is located high in the Andes mountains. Its walls are constructed of adobe, which provides shelter from the weather, but windows are rare because hauling glass up a mountain is impractical and expensive, and open windows would expose the family to high winds and freezing temperatures. Heating and cooking requires fuel, and while firewood isn’t abundant at 12,000 feet, llama dung is readily available. The problem is that burning solid fuels (like animal dung) in an enclosed space day in and day out exposes the entire family to smoke inhalation (indoor air pollution), which leads to chronic respiratory disease—a major risk factor for pneumonia.
And what’s cooking on the biomass-burning stove? Usually corn- and potato-based meals, like broths, that lack iron and essential vitamins. Malnutrition compromises family members’ abilities to fight off disease, making them more likely to fall ill with pneumonia and subsequent complications.
Let’s venture outside the home’s four walls. Typically, the community is relatively isolated, accessed only by unreliable roads that may be washed out entirely during the rainy season. It’s difficult to reach a clinic, and sometimes indigenous poor people are treated badly by clinic staff. Although national vaccination rates in Peru are relatively high, there are significant gaps of immunization coverage in poorer, geographically isolated areas where people live far from clinics and may feel intimidated by clinic personnel . In areas where people—mostly children—are not vaccinated, infectious diseases, including pneumonia spread more easily.
UNICEF has identified key areas for pneumonia prevention: clean heating and cooking practices, nutrition, and immunizations. All of these are included in our 2015 promotora training curriculum. We intend to facilitate access to cleaner energy resources, like chimneys and gas stoves, by seeking partnerships with organizations that provide these. Through the promotoras, we can use education to foster behavior change. Promotoras that live and work in the communities they serve are ideally positioned to persuade their neighbors of the risks associated with indoor air pollution, malnutrition and under-immunization. Through community presentations and home visits, promotoras will involve fellow citizens in discussions about the importance of good ventilation and up-to-date immunizations. By sustained engagement with their neighbors, promotoras are in an excellent position to reduce pneumonia in their home communities.
We’ve honed in on one of the most critical—and preventable—health problems in our communities, one that can be effectively tackled by the promotoras. Over the next year, SVH promotoras will expose the silent killer and educate fellow community members in the health-promoting behaviors that combat it.
—Written by Courtney Weintraub