The under-five child mortality rate is 31 per 1000,according to the BDHS report of 2022.The survey also shows thattwo major causes of child mortality ispneumonia and prematurity & low birth weight (LBW).World Pneumonia Daywas observedthroughout the world on 12th November, with the theme for 2003 being "Every Breath Counts: Stop Pneumonia in Its Track."Besides, World Prematurity Day was observed on 17th November and the theme for the year 2023 is- “Small Actions, Big Impact: Immediate Skin-to-Skin Care for Every Baby, Everywhere.” 

On 22nd November 2023, a seminarwas conducted atDr. MR Khan Shishu Hospital & Institute of Child Health (ICH) to observe World Pneumonia Day 2023 and World Prematurity Day 2023. The programwas supported by National Newborn Health Program & Integrated Management of Childhood Illness (IMCI) and theSaving Women and Premature Babies (SWAP) project of Save The Children. Guests from Directorate General of Health Services (DGHS), Obstetrical and Gynecological Society of Bangladesh (OGSB), Bangladesh Perinatal Association (BPA), Bangladesh Neonatal Forum (BNF), Bangladesh Perinatal Society (BPS), Bangladesh Pediatric Pulmonology Forum (BPPF), Ophthalmological Society of Bangladesh (OSB),ICDDR,B,WHO, UNICEF, Projahnmo Research Foundation, Noora Health, and other organizations took part in this program. The event was chaired by Prof. Dr. Mohammod Shahidullah, President-BCPS & Chairperson-National Technical Working Committee for Newborn Health (NTWC-NBH).Prof. Dr. Nobo Krishna Ghosh, Director (Academic), Dr. MR Khan Shishu Hospital & ICH inaugurated the program with a welcome speech. He said, “We are observing World Pneumonia Day along with World Prematurity Day for increasing the awareness to reduce the rate of child death. In our country the cause of most of the newborn death is prematurity and low birth weight. The death under five children is caused mostly by pneumonia.”  

Dr. Md Shakibur Rahman, Assistant Professor of Pediatric Pulmonology, shared a presentation on World Pneumonia Dayand Dr. Sharmin Afroze, Assistant Professor of Neonatology, shared a presentation on World Prematurity Daywith the participants.  

Yearly, 26,766 children under-five die due to pneumonia in Bangladesh. BDHS 2022 report reveals the causes of under-five deaths where 24% death is caused by pneumonia and World Health Organization is ambitious to achieve the goal-zero preventable death caused by pneumonia by 2025 following the strategy-Protect, Treat, and Prevent. Bangladesh has adopted the strategies and determined to reach the target. Integrated Management of Childhood Illness (IMCI) service at the facilities is adapted as a strategy. 

32% newborn death is caused by prematurity and LBW and the mortality rate is 20/1000 live birth according to the BDHS 2022 report. In Bangladesh, the premature babies are treated in SCANU and NICU and provided Kangaroo Mother Care (KMC).The Government of Bangladesh has stablished 59 SCANU till 2021. In total, 408 facilities are initiated with KMC service till 2023. According to the recommendation of WHO, Bangladesh Government has also included the infants less than 2.5 kilogram under KMC support.However, there remains challenges at SCANU and KMC. High caseload, shortage of skilled human resources, maintenance of SCANU equipment and nosocomial infection are the major challenges to treat newborns at SCANU. On the other hand, low utilization of KMC services in comparison to the number of babies born less than 2000 gm, short duration of KMC stay, inadequate skin-to-skin contact are addressed as challenges for KMC service. Low post-discharge follow up is the common challenge both for SCANU and KMC. 

The guests, health care providers and the students took part in the question answer through an open discussion session. Then the guests from government bodies, non-government sectors and development partners shared theirthoughts through short speech.  

Dr. Md Jahurul Islam, PM, NNHP & IMCI said that Government launched Sheikh Russel Special Care Newborn Unit (SCANU) at the district level to reduce child mortality rate in Bangladesh where premature babies are also treated. He mentioned that prevention is better than treating pneumonia. It can be prevented by ensuring vaccination in proper time, regular handwashing, maintaining cleanliness and increasing breastfeeding. He also added that we need to ensure the treatment of the severe patient. He is hopeful about the Family Centered Care approach which is incorporated with the support of the SWAP project of Save The Children.  

Dr. Lima Rahman, Director- Health & Nutrition sector, Save The Children mentioned that as a child-based organization, Save The Children has been working for the wellbeing of the children. The Tackling Pneumonia in Bangladesh project is one of the of the initiatives, implemented in Barisal and Bhola district. She recommended Pre-referral identification and management for the pneumonia affected children in the community level and then refer to the upper-level facility to treat pneumonia which can reduce the death caused by pneumonia. Dr. Lima also mentioned about the capacity building initiatives, evidence-based practices, and the new innovative approaches of SWAP project which are being implementing in five facilities in Bangladesh. 

Dr. Laila Anjumand Banu, President of Bangladesh Perinatal Society recommended that proper ANC checkup during pregnancy can reduce preterm birth and increasing awareness is also important. She also mentioned that maternal mortality and neonatal mortality rate is decreased as the Government has taken steps as well as the development partners and other sectors have come forward.  

Dr. Sheikh Daud Adnan, Deputy Director of Hospital & Clinic mentioned that non-government organizations need to come forward with Governments to reduce the pneumonia outbreak. Because pneumonia is one of the major barriers for child health. 

Jahangir Alam, Director of Bangladesh Shishu Hospital & Institutesaid, “Though pneumonia is fully preventable disease, we could not prevent it yet. The dust and dump of our surroundings carry a lot of bacteria. This enormous number of bacteria is also a major reason behind the increasing patients affected by pneumonia.” 

Prof. Dr. Mohammad Shahidullah emphasized on the prevention of pneumonia. He recommended that we could prevent pneumonia by exclusive breastfeeding for 6 months and continued breastfeeding to two years of a child. Besides,pneumonia preventive vaccination, maintaining hygiene, avoiding overcrowd, and controlling indoor and outdoor air pollution especially caused by smoke can prevent this disease. Parents and caregivers often do not take the pneumonia affected child to the hospital in the primary stage. They only seek the treatment when the situation of the child gets worse. The Government has been making awareness about the primary symptoms of pneumonia through billboards, radio, and television.  

He also talked about the major cause of newborn death-prematurity. Prematurity is caused mostly by preterm birth. He discouraged child marriage, teenage pregnancy and encouraged 4 Antenatal Care (ANC) forthe pregnant women. He also mentioned about Antenatal Corticosteroid (ACS) dose for the pregnant mother in case of preterm birth (24-37 weeks) to prevent the prematurity complications of the child. He also mentioned that Immediate Kangaroo Mother Care,thermal care and skin to skin contact, proper monitoring at SCANU, infection prevention control initiatives must be needed to treat the premature babies.  

Dr. Mohammad Shahidullah mentioned that Bangladesh Government has initiated many programs regarding prematurity and pneumonia which are implemented by NNHP & IMCI under DGHS, development partners especially Save The Children, UNICEF and WHOhave stepped forward to join these programs with Government.He also prioritized on early initiation of CPAP as WHO recommendation and establishment of Mother SCANU along with the SCANU in the health facilities. 

Brig Gen. Dr. Abdullah Al Mamun, Director of Dr. MR Khan Shishu Hospital & ICH put his closing remarks and thanked all for their participation. 

In the seminar, speakers also prioritized on the importance of health seeking behaviorfor receiving treatment at proper timeand regular follow-up to mitigate child mortality. The seminar was remarkable as representatives from all sectors joined in the gathering and shared their valuablethoughts. The healthcare experts encouraged all to continue the programs and initiatives not only the day we observe but also every day in our practice.