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1-So as most of you know, we published in @NEJM this week. This was so important for us for many reasons but fist a recap/summary of the paper. https://www.nejm.org/doi/full/10.1056/NEJMoa1911998
2/In low resource settings, WHO recommends standard of care for management of common illnesses in non-school going children. These illnesses include diarrhoea, pneumonia, malnutrition ; among others.
3/ Pneumonia is commonly called ARI ( acute respiratory illness) and classified into no, mild or severe pneumonia. For our study we decided to study mild pneumonia.
4/ The diagnosis of pneumonia is made clinically, though counting respiratory rate or looking for chest indrawing or other signs of systemic infection in a child with cough or difficul breathing
5/The respiratory rate is counted via a timer and cut points are used to define pneumonia. A rate of 50 per min or more for infant and 40 per min or more for child is considered pneumonia. If it occurs in absence of indrawing or dangerous signs of infection, itâs non-severe/mild
6/ For mild fast breathing pneumonia, a simple 3 day course of antibiotic is prescribed.
7/ This is in conflict with recommendations of @IDSA and @PIDSociety where withholding is recommended for young children with mild pneumonia
8/Not give antibiotic for pneumonia? 
Does it even make sense? Seems like it may. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30721-4/fulltext
Does it even make sense? Seems like it may. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30721-4/fulltext
9/ The biggest study looking at causes of pneumonia in South Asia and Africa identified viruses as the major cause of pneumonia in young children. This was conducted in hospitalised children.
10/ But wait. There are bacteria 
too. This bug called Streptococcus Pneumonia causes the highest deaths from pneumonia in children. Is counting respiratory rate enough?
too. This bug called Streptococcus Pneumonia causes the highest deaths from pneumonia in children. Is counting respiratory rate enough?
11/ It may be, according to a review of evidence by WHO. But the strength of recommendation is moderately weak https://apps.who.int/iris/bitstream/handle/10665/137319/9789241507813_eng.pdf;jsessionid=30B3B1391CF5C39351A6B50938985E77?sequence=1
12/ This summary is getting rather long...please bear with me ...because I love you guys
13/ Even if the infection is viral, the children in these settings are malnourished, may have delay in seeking help and may be at risk of dying from bacterial pneumonia. The net thrown in to find these children has to be wide enough. Cannot let any child die from #pneumonia
