The problem in Africa

For many decades pneumonia has ranked second only to malaria as a cause of admission to adult medical wards across Africa (Harries et al., 1990; Williams et al., 1986). However, in the last 25 years the pattern of hospital admissions has changed, reflecting the dominance of HIV-related problems. The two commonest reasons for admission among HIV-infected adults are tuberculosis and pneumonia (Grant et al., 1998), so pneumonia continues to present a considerable burden to hospital services across the continent.

Pneumonia affects economically productive people. Although its incidence is higher among those with chronic underlying diseases, the typical patient in Africa is a healthy individual with a short history of illness. Although mortality is higher in the elderly, the majority of pneumonia-related deaths in hospital occur among young adults, less than 40 years old. Furthermore, among survivors, 60 per cent of pneumonia patients have not recovered sufficiently to return to work 3 weeks after their admission (Scott et al., 2000).

Pneumonia is usually straightforward to diagnose and treat. The challenges in management are identifying the severely ill patient, predicting the aetiology of disease, dealing with resistance among respiratory pathogens and anticipating complications.