Thorax 68:1052-1056 doi:10.1136/thoraxjnl-2013-204247
  • Review

Pneumonia in low and middle income countries: progress and challenges

Open Access
  1. S B Gordon5
  1. 1Department of Paediatrics and Child Health, Red Cross War Memorial Childrens Hospital, University of Cape Town, Cape Town, South Africa
  2. 2National Institute for Communicable Diseases, Division of National Health Laboratory Service, Johannesburg, South Africa
  3. 3Medical Research Council: Respiratory and Meningeal Pathogens Research Unit & Department of Science/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
  4. 4Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
  5. 5Liverpool School of Tropical Medicine, Liverpool, UK
  1. Correspondence to Professor Heather J Zar, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, 5th Floor, ICH Building, Cape Town 7700, South Africa; heather.zar{at}
  • Received 26 July 2013
  • Accepted 29 July 2013
  • Published Online First 16 August 2013


Pneumonia remains the leading cause of childhood mortality and the most common reason for adult hospitalisation in low and middle income countries, despite advances in preventative and management strategies. In the last decade, pneumonia mortality in children has fallen to approximately 1.3 million cases in 2011, with most deaths occurring in low income countries. Important recent advances include more widespread implementation of protein-polysaccharide conjugate vaccines against Haemophilus influenzae type B and Streptococcus pneumoniae, implementation of case-management algorithms and better prevention and treatment of HIV. Determining the aetiology of pneumonia is challenging in the absence of reliable diagnostic tests. High uptake of new bacterial conjugate vaccines may impact on pneumonia burden, aetiology and empiric therapy but implementation in immunisation programmes in many low and middle income countries remains an obstacle. Widespread implementation of currently effective preventative and management strategies for pneumonia remains challenging in many low and middle income countries.

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