Implementing measures to improve nutrition, indoor air pollution, immunization coverage and the
management of pneumonia cases could be cost-effective and significantly reduce child mortality from
pneumonia, according to a study led by the Johns Hopkins Bloomberg School of Public Health.
Researchers found that these strategies combined could reduce total child mortality by 17
percent and pneumonia deaths by more than 90 percent.
Pneumonia is a leading cause of death of infants in many developing countries, resulting in 2.2
million deaths each year. The study is published in the June 2009 issue of the Bulletin of the World
The study, conducted by Johns Hopkins in collaboration with the WHO and other schools of
public health, assessed economic aspects of existing child interventions and identified the most
efficient pneumonia control strategies. Programs to promote better community-based treatment of
pneumonia, promotion of exclusive breastfeeding, zinc supplementation and vaccination for Hib and S.
pneumoniae were found to be the most cost-effective interventions. The burning of solid fuels like
wood, for cooking and heating, was found to contribute at least 20 percent to the burden of childhood
"The interventions we examined already exist but are not fully implemented in the developing
world. In addition, implementation of these interventions do not require a great deal of new
infrastructure to carry out," said Louis Niessen, lead author of the study and associate professor in
the Bloomberg School's Department of International Health. "Fully funding and implementing these
interventions could bring us a big step closer towards reaching the U.N. Millennium Development
Majid Ezzati, co-investigator of the study and associate professor at the Harvard School of
Public Health, said that the next step is "to assess how donors and countries currently deliver these
interventions and want to progress in the coming years."
The study was written by Niessen, Anne ten Hove, Henk Hilderink, Martin Weber, Kim
Mulholland and Ezzati. The research was supported by grants from the Netherlands Environmental
Assessment Agency, the WHO and the United Nations Children's Fund.