Pneumonia

Pneumonia is an acute infection of the lung tissue, most often caused by bacteria or viruses. It is one of the leading causes of illness and death in young children in Tanzania and can also affect adults, particularly those who are elderly, malnourished, or immunocompromised.

• Fast or difficult breathing
• Cough
• Fever
• Chest pain
• In young children: chest indrawing, grunting, nasal flaring, or inability to feed
• In severe cases: cyanosis (bluish lips), lethargy, or convulsions

• Streptococcus pneumoniae and Haemophilus influenzae type b are the most common bacterial causes.
• Respiratory viruses such as influenza and respiratory syncytial virus are common causes, especially in children.
• Risk is increased by malnutrition, indoor air pollution, incomplete immunisation, HIV infection, and overcrowding.

• In children, severity is assessed using the fast-breathing/chest-indrawing/danger-sign classification recommended by IMCI.
• Chest examination may reveal crackles or reduced air entry.
• Chest X-ray and pulse oximetry, where available, help assess severity.
• Sputum or blood investigations may be used in hospitalised patients when indicated.

Non-severe pneumonia at dispensary or health centre level is treated with oral amoxicillin, the first-line antibiotic for children, usually for a 5-day course.

Severe pneumonia (danger signs or hypoxia) is managed at hospital level with injectable benzylpenicillin or ampicillin plus gentamicin, or ceftriaxone in referral settings, together with oxygen therapy for hypoxia.

Adults with community-acquired pneumonia are treated with oral amoxicillin for milder disease, or a combination of a beta-lactam and a macrolide for more severe presentations requiring hospital care.

• Complete routine childhood immunisation, including pneumococcal conjugate vaccine, Hib-containing pentavalent vaccine, and measles vaccine.
• Exclusive breastfeeding for the first six months of life.
• Reduce indoor smoke exposure from cooking fires.
• Ensure adequate nutrition.
• Seek prompt care for any child with cough or difficulty breathing.