As World Pneumonia Day is marked globally, statistics emphasise the high toll of pneumonia in Rwanda, particularly on young children.

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In 2022, acute respiratory illnesses, including pneumonia, accounted for 16.4% of healthcare consultations for children under five, according to data from Rwanda’s health sector.

Rwanda Biomedical Center (RBC) reported that the condition also represented 16% of consultations across all health centers. Furthermore, acute respiratory illnesses contributed to 4% of all deaths in Rwanda, while pneumonia constituted an additional 7% of the national mortality, highlighting an urgent need for strengthened strategies to combat respiratory diseases as climate change exacerbates air quality challenges.

Dr. Emmanuel Sibomana, the official in charge of communicable respiratory diseases, tuberculosis, and other respiratory diseases at RBC, noted that Rwanda has made remarkable progress in reducing childhood mortality from pneumonia.

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In 2000, pneumonia, malaria, and diarrheal diseases were the primary causes of death among children under five. However, under-five mortality has since seen a decline from 196 deaths per 1,000 live births in 2000 to 45 per 1,000 by 2019 to 2020, according to Rwanda’s Demographic and Health Surveys (DHS).

Similarly, infant mortality dropped from 107 to 33 per 1,000 live births, and neonatal mortality declined from 44 to 19, reflecting the country’s efforts to enhance child health.

Dr. Sibomana explained that pneumonia in young children is primarily caused by viral and bacterial infections, including respiratory syncytial virus (RSV) and influenza, along with Streptococcus pneumoniae and Haemophilus influenzae type b (Hib).

"Factors such as malnutrition, low birth weight, and indoor pollutants, including wood smoke and tobacco, increase the risk. Rwanda has prioritised measures like vaccinations, nutrition programmes, and reducing indoor air pollution to prevent these cases,” he stated.

Dr. Sibomana added that prevention has been bolstered through the Integrated Community Case Management (iCCM) programme, an initiative launched in 2004 that trains Community Health Workers (CHWs) to diagnose and treat pneumonia, malaria, and diarrhea in remote areas.

"Through iCCM, CHWs equipped with medications and illustrated instructions provide essential care in local languages, allowing families to adhere to treatment. This model enhances access to care, especially for communities with limited access to health centers,” Dr. Sibomana explained.

He stressed that another key preventive measure has been Rwanda’s expanded immunization programme. In 2009, Rwanda became the first country in sub-Saharan Africa to introduce the pneumococcal vaccine (PCV), and by 2010, had achieved a vaccination rate of 97%. The Hib and influenza vaccines have since been incorporated, further reducing pneumonia cases among children.

With monthly evaluations, CHWs continue to maintain high immunization rates across the country, contributing to a steady decline in respiratory illness rates, he added.

Dr. Sibomana said that in cases of severe pneumonia, Rwanda’s healthcare facilities offer advanced care, including oxygen therapy and CPAP machines, available at district hospitals and clinics. Antibiotics like amoxicillin are provided at the community level to quickly treat bacterial pneumonia, improving outcomes for affected children, he noted.

Alongside these efforts, partnerships across different sectors strengthened Rwanda’s approach to preventing and managing pneumonia. The Ministry of Health’s partnerships with other government agencies helped sustain vaccine programmes and integrate school-based immunization initiatives.

Dr. Sibomana added that public health campaigns led by CHWs educated communities on recognising pneumonia symptoms such as rapid breathing and chest in-drawing. Additionally, breastfeeding promotion and nutrition programmes help strengthen children’s immune systems, reducing susceptibility to pneumonia.

"Our goal is to empower families to seek early treatment, which improves survival rates and helps prevent complications,” he said, adding that Rwanda is also addressing environmental factors influencing respiratory health.

The government’s air quality initiatives include promoting public transportation, encouraging electric vehicles, and establishing non-motorised transport options like bike lanes. These measures protect children and other vulnerable groups from pollution-related respiratory diseases, including pneumonia, and reflect the country’s commitment to Sustainable Development Goals focused on health and environmental sustainability.