Managing an outbreak

Chest infections can occur at any time if the year but they are more common during the cold months. Even in hot climates, such as the Sahara desert and the Sahel region of Africa, temperatures can drop very low at night. MSF teams have found high rates of bronchopneumonia among nomad children in countries such as Mauritania and Mali. Because chest infections can be fatal to a child so quickly it is essentially that antibiotic treatment should be given early. This may be difficult in isolated rural situations, where people may be several days' walk from the nearest dispensary or hospital. The solution found by MSF teams is to train community health workers to diagnose and treat chest infections. These health workers may have only minimal medical skills and knowledge and they are not able to use a stethoscope. They are taught to diagnose bronchopneumonia by the signs of fever, cough, and rapid breathing. If the child is breathing at a rate of 40 or more breaths per minute, this is probably pneumonia and the child should be started on an antibiotic. If, in addition, there is chest indrawing, which means that with each inspiration the skin above or below the rib cage is drawn in, this is a sign of severe pneumonia. In this case the child must be started on the antibiotics and sent on to the nearest dispensary or hospital.