Breaking Down Child Mortality (Pneumonia)

Improving Global Access to Vaccines

Nyla Pirani
9 min readFeb 22, 2021

Think back to your childhood. Running around the playground until sunset. Sledding down the snowy park hills (Canadian winters weren’t all bad, I promise).

When I think about my childhood, the only thing I truly remember is happiness, and in my opinion, every child deserves to have that memory. But sadly, that isn’t reality.

1 in 27 children die before the age of 5. Read that again. That’s insane. I think about how happy my childhood was, but 1 in 27 children under 5 won’t even get to experience a childhood.

I couldn’t wrap my head around this. I couldn’t accept the status quo. So I started going deeper into the problem.

A Holistic View on Child Mortality

The first thing I looked for was the main causes of child mortality.

According to World Health Organization (WHO), the leading causes of death in children under 5 are preterm birth complications (birth asphyxia/trauma), pneumonia, congenital anomalies, diarrhea and malaria.

All of these can be prevented or treated with the use of vaccines, antibiotics, nutritious food, clean water and adequate health care.

WHO says that half of all under-five deaths in 2019 occurred in just five countries: Nigeria, India, Pakistan, the Democratic Republic of the Congo and Ethiopia. Nigeria and India alone account for almost a third of all deaths.

These are some of the poorest countries in the world, which mean they don’t have access to vaccines, antibiotics, nutritious food, clean water and adequate health care making these preventable diseases almost impossible to prevent.

As a result, millions of children are dying. I wanted to dive deeper into this and figure out how I can stop it.

What disease has the largest impact?

To be able to break down a disease or problem, having a very specific target is important. I took the leading causes of death stated by WHO (preterm birth complications (birth asphyxia/trauma), pneumonia, congenital anomalies, diarrhea and malaria.) and chose specific problems.

The three diseases I looked at were birth asphyxia, pneumonia (both of which were directly stated by WHO) and malnutrition.

The reason I chose malnutrition is that it leads to increased frequencies and durations of diarrheal illnesses. A study showed that there is a 37% increase in frequency and a 73% increase in duration accounting for a doubling of the diarrhea burden (days of diarrhea) in malnourished children. It’s also the underlying contributing factor, making children more vulnerable to severe diseases.

Birth Asphyxia

Birth asphyxia happens when a baby’s brain and other organs do not get enough oxygen and nutrients before, during, or right after birth. This can happen without anyone knowing.

WHO estimates that 4 million neonatal deaths occur yearly due to birth asphyxia, representing 38% of deaths of children under 5 years of age.

This is a HUGE chunk of the problem.

A study done showed that in Sub-Saharan Africa, South Asia, and Southeast Asia, more than 70% of all births in the lowest two wealth quintiles occurred at home which heavily increases the percentage of birth asphyxia deaths.

The core problem: a lack of good health care.

Three main buckets go into the lack of health care problem:

  • Lack of knowledge
  • Lack of medical practitioners
  • Lack of resources

By tackling those 3 things we can significantly decrease the percentage of birth asphyxia.

Unfortunately, that’s a lot easier said than done. There are also a lot of cultural barriers to this problem.

In the same study, “not necessary” was given as a reason by 68% of women whose births were unattended and by 66% of women whose births were attended.

There are clearly a lot of barriers and layers to this huge problem. If you want to learn more here are some resources to get you started:


Pneumonia is a form of an acute respiratory infection that affects your lungs. Our lungs are made up of small sacs which are called alveoli. These will fill up with air when we’re healthy. What pneumonia does is fill the alveoli with pus and fluid which will limit the amount of oxygen you have in your lungs and make breathing incredibly painful.

Pneumonia killed 808,694 children under the age of 5 in 2017, accounting for 15% of all deaths of children under five years old.

Another HUGE problem. This is the problem I will be focusing on breaking down later in the article but here’s some quick information:

There are two solutions to this problem. The first one is preventative. This means improving access to vaccines. The second one is reactive. This means getting people access to antibiotics when they do get sick.

More on how we can tackle this problem soon.


Malnutrition is essentially when you don’t get enough nutrients. It’s one of the largest causes of death in developing countries.

This accounts for around 45% of deaths among children under five. All because they don’t have access to a basic human right: food.

About 40% of people in Nigeria live under the poverty line. This means that families will make approximately $352 a year and are forced to live for under a dollar a day.

In Nigeria, you can get a meal from a street vendor or a local restaurant for $3–$5. The average household size in Nigeria is 5 people.

That alone doesn’t add up, not to mention any other daily living expenses people have.

They can’t even afford one full meal for an entire family in just one day, let alone health care.

A huge cause of malnutrition is open defecation. Open defecation contributes to diarrhea, cholera and to the spread of intestinal parasites, which causes people to be malnourished.

Here are some resources to learn more about malnutrition and open defecation:

Pneumonia Breakdown

As I mentioned previously, Pneumonia accounts for 15% of all deaths of children under 5. Pneumonia killed 808,694 thousand children under the age of 5 in 2017. This number is insanely large considering this is a disease that is completely preventable and curable.

Our World in Data published this table that shows all the risk factors to developing pneumonia as a child:

Looking at this chart we can see that child wasting is the biggest risk factor, accounting for almost the equivalent of indoor air pollution, outdoor air pollution and short gestation for birth weight combined.

By reducing the likelihood of child wasting we could significantly reduce the chances of children under 5 getting pneumonia.

Understanding Child Wasting (Acute Malnutrition)

Undernutrition can appear in four broad forms: wasting, stunting, underweight, and micronutrient deficiencies. Wasting is defined as low weight-for-height.

This not only affects childrens health, making them more susceptible to disease and infection, but also impairs their mental and physical development. This means children who suffer from this are less likely to achieve their full height and cognitive potentials.

One of the biggest causes of child wasting is a lack of breastfeeding or using the wrong method when breastfeeding.

The World Health Organization recommends exclusive breastfeeding (i.e. no other fluids or solids) for six months and then continued breastfeeding combined with solid foods for 2 years.

The Third National Family Health Survey (NFHS-3) of India reported that overall 21.5% of children aged under 3 years were breastfed within 1 hour of birth, 48.3% of the children aged 0–5 months were exclusively breastfed, and 53.8% of the children aged 6–9 months received solid or semi-solid food.

So there is a huge knowledge gap here in the proper breastfeeding methods, but also the benefits of breastfeeding.

A study was done on the relationship between breastfeeding duration and malnourished conditions among children aged 0–3 in Pakistan.

This study showed that the odds of being stunted were significantly higher for children at the age of 3 who weren’t breastfed compared to children being breastfed when they’re 2.

When I was breaking down why mothers weren't breastfeeding what I found was that there is a low number of antenatal visits. Women tend to only have 1–2 visits at most, whereas WHO recommends 8 with a minimum of 4.

The reason for this is that 64% of people don’t think it is necessary. Their grandmothers, mothers, aunts, siblings etc. didn’t so why should they?

That is the question a lot of them are asking. There is an overwhelming amount of information on the internet about the benefits of antenatal visits, breastfeeding and more but the internet penetration rate in India as of 2019 was 48.48%.

Improving access to their internet sources can educate them on the benefits of these practices which can play a role in reducing the magnitude of this problem:

Learn more about global internet access:

The Root Cause

My goal at the end of the day is to understand how we can prevent pneumonia, and have a backup reactive plan in case.

The reason people are actually dying is there is a huge lack of medical centers.

In the above table, we can see that Nigeria and South Sudan had the highest death rates from pneumonia in children under 5.

In Nigeria, only 3.87% is spent on healthcare. In South Sudan, approximately 3% is spent on healthcare.

This leads to a very small amount of expensive yet low quantity healthcare facilities. We need a better way to fund these healthcare centers.


There were two things in the back of my mind that I had to address before I could confirm a lack of health care centers as the true root cause of this problem.

Cultural Barriers

After surrounding myself with people solving hard problems in developing countries, and working on that myself, I’ve realized the huge cultural barriers to implementing solutions in developing parts of the world.

But, we can clearly see here that people do understand the value of vaccines which eliminates that problem.

Vaccine Cost

The second issue I had to address was the cost of the vaccine. In the US. Vaccines cost $169, so this was a major concern.

After doing some digging I found that GAVI had approved the cost of $3.15 in developing countries which eliminates this problem as well.

Final Overview:

To recap everything from this section:

  • The largest risk factor for pneumonia is child wasting which can be prevented by proper breastfeeding practices. Women don’t have access to the internet which means they don’t understand the value of it or the proper methods. Improving internet access can address this problem.
  • The reason people are dying from this preventable disease is a lack of health care centers. There is a very small percentage of money being spent on health care, which means a lack of centers.
  • People understand the need for vaccines and a reasonable cost for the vaccine has been approved.

Next Steps:

The next steps to solving this problem are to understand what people are currently doing to tackle it (Bill + Melinda Gates Foundation, UNICEF etc), analyze their gaps and fix them.

We need to create a vaccination program in which we leverage the capital that companies like Bill and Melinda Gates Foundation and UNICEF to fund the centers and the vaccine approved by GAVI to distribute.

It sounds simple on paper but tackling these problems is no picnic. It requires a ton of money, resources and people. If you want to understand more about this problem and what I’m doing you can contact me here.

These kids are dying from completely preventable diseases and my goal is to change that.