New therapy for treatment of child pneumonia

The Bangladeshi inventor for scaling up the low-cost device

An alternative device for delivering oxygen therapy has recently been developed for the first time by a Bangladeshi scientist, which made a breakthrough in treatment of young children inflicted with severe pneumonia and hypoxaemia.
The invention of the low-cost device, CPAP (continuous positive airway pressure) therapy, is the outcome of a long research published in The Lancet this week.
The research, conducted by Dr Mohammod Jobayer Chisti of Centre for Nutrition and Food Security at the ICDDR,B, has shown that application of the CPAP therapy in pneumonia-inflicted children under five years of age successfully reduced deaths to only 4 per cent, compared to the World Health Organization (WHO) standard low flow oxygen therapy-related death rate of 15 per cent.
The current recommendation by the WHO for oxygen therapy of young children with severe pneumonia and hypoxaemia in resource-limited settings is low-flow oxygen therapy, as part of a standard regime of care.
While talking to the Daily Observer, Dr Chisti said,”In premature baby, lung has a tendency to collapse. What the new device does is, it prevents this collapsing action by maintaining continued sustained pressure of oxygen in the lung.”
Despite the fact that CPAP therapy has been used in middle and high-income countries for many years, its high cost has kept it out of reach for healthcare facilities in developing countries, making it virtually unknown if this type of therapy is effective for treating severe pneumonia among children in poor resource settings. Dr Chisti in his study tried to address this knowledge gap by designing a randomised trial.
During the research at the ICDDR,B hospital in Dhaka, Chisti and his team used an oxygen concentrator in most cases which produced oxygen from atmospheric air without needing to be replenished (making it low cost).
As many as 225 children under five years who presented with these symptoms were brought under the research at the hospital during a period between August 2011 and July 2013. They came under three study groups – a Bubble-CPAP oxygen therapy group, a standard low-flow oxygen therapy group and a high-flow oxygen therapy group.
Children who received bubble-CPAP oxygen therapy had a significantly lower risk of treatment failure and death than children who received standard low-flow oxygen therapy.
“If the death rate for severe pneumonia exceeds 10 per cent in our hospital and many others, we need to keep researching better alternatives of treatment,” Dr Chisti said, adding that this intervention with Bubble CPAP therapy could be part of that solution.
Dr Chisti also said, “We are hopeful to have bubble CPAP on the WHO recommended treatments for under-five severe pneumonia and hypoxemia in near future.”
Pneumonia still remains as the leading cause of under-five childhood deaths globally, including a substantial number in Bangladesh. Death from pneumonia is largely caused by hypoxemia (lack of oxygen in blood). In case of hypoxemia in a child with pneumonia, the patient wants to take oxygen from the normal atmosphere which is not very adequate (only 20 per cent oxygen). A child with pneumonia having hypoxemia initially needs 100 per cent oxygen to fulfill the demand.
Professor Lutful Kabir, Head of Paediatrics at Dhaka Mitford Hospital, sharing his views on the development of the device, said, “The Bubble CPAP device developed here is very promising as it is easy to use and much cheaper.”
He also said, “If this device can be made available to most hospitals (referring to poor countries), I think we could avoid a significant number of deaths of children every year.”