1.

Background & introduction

Childhood pneumonia continues to be the topmost infectious killer among under-
five children, contributing to 141 per cent of under-five deaths in India, claiming
around 1.272 lakhs each year.
Pneumonia morbidity & mortality in India
Number of episodes of ARI/Pneumonia every year3 30 Million
Incidence rate (per child per year)4 0.22
Severe pneumonia cases out of total cases 3 Million (10%)
Mortality rate per 1000 live births5 5.1

According to SRS 2018 report, the under-5 mortality is 36 per1000 live births and the
goal of National Health Policy 2017 is to reduce U5M to 23 per 1000 live births by 2025.
In order to achieve the National Health Policy goals, the Pneumonia mortality in children
needs to reduce to less than 3 per 1000 live births. This is also in tune with the goal of
India Integrated Action Plan for Pneumonia & Diarrhoea (IAPPD) in the State like Bihar,
Madhya Pradesh, Rajasthan and Uttar Pradesh.

 Pneumonia being the number one infectious cause of death of Under-five children
in India. It demands prioritization & more investment of resources in view of the
ongoing COVID-19 pandemic.
 Early preparedness, roll out and monitoring of the SAANS 2021 campaign by
States/UTs and districts would be key to the success of control of childhood pneu-
monia
 Additional emphasis and focus for early identification and appropriate management
of childhood pneumonia cases through home visits by ASHAs and other front-line
workers during the campaign period.
 Front Line Workers will be sensitized towards COVID-19 appropriate behaviors such
as wearing masks, maintaining social distance and hand hygiene as per MoHFW
guidelines
 Learning from the second wave of COVID-19 and considering the vulnerability of
children; SAANS 2021 campaign should also focus on sstrengthening of health fa-
cilities for pediatric care.
 Ensure that all eligible children receive 3 doses of Pneumococcal Conjugate Vaccine
(two primary doses at 6 weeks and 14 weeks and a booster dose at 9 months) as per
the national immunization schedule under the universal immunization programme
(UIP).

2. SAANS initiative

Goal: To intensify action for reducing mortality due to childhood Pneumonia

in India to less than 3 per thousand live births, by 2025.

1
State of World Children, 2019
2
‘Fighting for breath call to action – end childhood pneumonia deaths’ report, 2019
3
Lancet Volume 17, November 2017
4
Pneumonia Estimates based on Census 2011, SRS 2017 and Pneumonia morbidity data from Lancet Volume 17, November 2017
5
Estimates based on Census 2011 population, SRS 2017 and Pneumonia mortality data from Lancet Volume 17, November 2017
It is expected that the SAANS (Social Awareness & Action to Neutralize Pneumonia Suc-
cessfully) campaign will ensure health system strengthening and community awareness
towards childhood pneumonia. The SAANS campaign will carry the tagline “Pneumonia
nahi, toh bachpan sahi” which clearly establishes the positive impact of a Pneumonia
Free Childhood.

Key objectives of the SAANS campaign initiative are:

 Adoption and adherence to National Childhood Pneumonia Management guidelines
2019
 Create awareness & mobilize community for Pneumonia Protection, Prevention &
Treatment
 Early identification and management of under-five children to detect suspected
pneumonia cases
 Strengthen facility-level management for cases of severe-pneumonia

For detailed technical information, please refer to the

“Childhood Pneumonia Management Guidelines” available on www.nhm.org

3. SAANS initiative preparation

Following is a suggested roadmap for implementation of SAANS campaign at the
state/UT & district level.

1. Organise 2. Prepare 3. Pediatric care 5. Use digital &

state and implementation strengthening in mass media for
4. Capacity
district plans for State / healh facilities community
building of
orientation cum District & Block including access awarness
heath staff
planning as per annual to medical generation and
meeting PIPs oxygen mobilization

6. Awareness &
8. Management
Promotion of
7. Screen under- of suspected 9. Supportive 10. Reporting
Pneumococal
five children at Pneumonia supervision and and feedback
Vaccine (PCV)
household level cases at monitoring mechanism
& its
Facilities
administration

3.1 Overall Planning:

o Orientation of state and district level officials on SAANS
o Launch on 12 November 2021 on the World Pneumonia Day
o Ensure availability of essential drugs (including Amoxicillin (tablet / syrup), In-
jection Gentamycin and Ampicillin) and equipment (including pulse oximeter, ox-
ygen concentrators / cylinders / generation plants, PPEs, hand-sanitizers) at the
facility and FLW level as appropriate
o Orientation / training of health care workers
 o Plan for display of pneumonia treatment protocols in health facilities
o Plan for community awareness generation on Pneumonia and Pneumococcal
Conjugate Vaccine (PCV)
o Plan for Supportive supervision and reporting

3.2. Launch and Implementation Mechanism:

o Launch of SAANS on 12 November 2021 on the World Pneumonia Day
o Trained ASHAs and other front-line workers will visit the homes of under-five
children for early identification of cases of childhood pneumonia cases. They will
carry Amoxicillin with them. If the child has cough, difficulty breathing, then he
/ she will be assessed. (Details of management placed at annexure 1)
o In case referral is required, then the child will be referred to a health facility that
is equipped for Pneumonia management.
o Upon arrival in the health facility, the child will be assessed again by the doctor.
Appropriate treatment, including admission, will be provided.

3.2.1 Paediatric care strengthening in health facilities

o Map facilities that provide comprehensive Pneumonia care & share list with FLWs
for further dissemination
o Establish Triage Areas for triaging, management and referral (including COVID-19
management)
o Modify patient record keeping template – include ‘close proximity’ individual details
for contact-tracing if the child is diagnosed with COVID-19
o Display of pneumonia treatment protocols in health facilities
o Oxygen Therapy:
 Ensure medical Oxygen supply to health facilities that treat Pneumonia cases
 Give oxygen to all children with oxygen saturation < 90% (< 94% if they also
have other emergency signs like shock etc).
 Use nasal prongs as the preferred method of oxygen delivery to young infants;
if not available, a nasal or nasopharyngeal catheter may be used.
 Use a pulse oximeter to guide oxygen therapy (keep oxygen saturation >
90%). If a pulse oximeter is not available, continue oxygen until the clinical
signs of hypoxia (such as inability to breastfeed or breathing rate > 70/min)
are no longer present.

3.2.2. Setting-up Skill Station:

o A Skill Station is to be established in each district integrated with the mini/com-
prehensive skill lab at DHH level.
o The Skill Station is to be utilized during District Level ToTs and training.
o Following of the items to be made available at skill stations (as per SAANS guide-
lines, Approved in 6.1.1.2.b as per State Proposal):
 Paediatric Mannequins: 04
 Nebulizers: 04
 Salbutamol MDI inhalers with spacer: 04
 Pulse Oximeters: 04
 Oxygen Cylinder: 02
  Oxygen Concentrator: 02
 Oxygen hood: 04
 Nasal Prongs: 04
 Suction Catheters: 04

3.2.3. Capacity Building: Skill based training of health care providers

o One of the key interventions to address high childhood Pneumonia mortality is
early case identification and its appropriate management at all levels.
o The trained health workers can easily identify, classify and manage cases of Pneu-
monia, using standard algorithms. It is desirable that all the medical officers/
CHOs / SNs/ ANMs / ASHAs are provided skill-based training on Pneumonia
control and management for 1-2 days.
o Regular refresher sessions should be held during routine monthly meetings for
Mid-Level Healthcare Providers, ANMs/MPW-F, MPW-M & ASHAs by the PHC
medical officers.

Trainings need to be conducted keeping in mind the context of ongoing

COVID-19 pandemic.

3.2.4: Promotion of Pneumococcal Conjugate Vaccine (PCV) & its administra-

tion
o Pneumococcal Conjugate Vaccine (PCV) is one of the most cost-effective tools to
prevent pneumonia and other pneumococcal diseases. Pneumococcus is the most
common cause of severe pneumonia in children.
o Under the Universal Immunization Programme of Government of India, PCV is
now available free of cost to all eligible children across the country.
o Under UIP, 3 doses of PCV to be given at 6 weeks and 14 weeks and a booster
dose at 9 months. High coverage of PCV to be ensured to achieve significant re-
duction in pneumonia caused by pneumococcus.
o PCV coverage to be monitored and discussed in the appropriate forums such as
District and State level task force meeting for corrective actions.
o Plan for PCV supportive supervision should be there along with other RI vaccines.

3.2.5 Communication strategy & plan

Key Objectives

 Promote awareness amongst caregivers to accept & adopt protection & preven-
tion interventions for their children (including vaccination of infants with PCV)
& associating air pollution with Pneumonia
 Enable caregivers to identify & recognize the early signs & symptoms and seek
care immediately for on-time referral & treatment of Pneumonia
 Dispel myths & notions and trigger behaviour change to take Pneumonia seri-
ously and seek care early
Strategy for communication to caregivers
1. Ensure sufficient budget for mass media (TV, Radio) under SAANS for generating
awareness about early identification of Pneumonia (shift budget from physical out-
reach program).
2. Use of digital platforms / mobile platforms to help disseminate Pneumonia mes-
sages. Help promote messaging through local WhatsApp groups or other social
media platforms like facebook, twitter etc
3. Orientation sessions to be conducted at the PRI level to sensitise the community.
Other associations like youth community, CBOs, SHGs & teacher orientations us-
ing virtual mediums can be involved
4. Sensitise field staff, deployed by partner organisations, working across other pro-
grams etc.

Digital & IEC material resources are annexed

Mobile / Digital Content IEC Material

All Digital Content, Mass media content & IEC materials can be downloaded from
https://nhm.gov.in/index1.php?lang=1&level=4&sublinkid=1336&lid=716

3.2.6 Monitoring & Evaluation

Tracking progress on efforts to control Childhood Pneumonia needs dedicated attention.
Monitoring & supportive supervision involves:
o Data monitoring through routine Health Management Information Systems
(HMIS)
o Analysis of under-five morbidity and mortality due to pneumonia
o Supportive supervision in the field
(Reporting format is annexed)
Annexure 1: DURING HOME VISIT

ASSESSMENT AND CLASSIFICATION OF A SICK CHILD (AGE 2 MONTHS UP TO 5

YEARS) WITH COUGH &/OR DIFFICULT BREATHING BY ASHA DURING HOME
VISIT

 Follow COVID-19 appropriate behaviour

 Greet the mother.
 ASK the mother if the child has cough & / or difficult breathing
o If the mother says that the child has cough & / or difficult breathing, then
proceed as under:

 ASK: For how long?

o A child who has had cough for more than 14 days needs to be referred to
hospital for further assessment.

 First check for general danger signs:

 Not able to drink or A child with any general danger sign needs
breastfeed URGENT attention; complete the assess-
 Vomits everything ment and any pre-referral treatment imme-
 Convulsions diately so referral is not delayed (PINK
 Lethargic or uncon- BOX)
scious

 Count the breathing rate and decide if child has fast breathing
Fast breathing:
(2 months up to 12 months-50 breaths
per minute or more)
(12 months up to 5 years- 40 breaths
per minute or more)

 Look for Chest indrawing (Present / Absent)

 Check Oxygen saturation by pulse oximeter (SpO2 level), if available

 Classify & Manage the child as per classification table given below
 Signs Classify as Management by ASHAs

 General danger signs (inabil- SEVERE

ity to breastfeed or drink, PNEUMONIA  Give first dose of Oral
vomits everything, convul- OR VERY SE- Amoxicillin
sions, lethargy or uncon- VERE DIS-  Refer urgently to health
scious) EASE facility
Or
 Chest in drawing
Or
 Oxygen saturation (Sp02) is
less than 90%

 Fast breathing: PNEUMONIA  Give first dose of Oral

(2 months up to 12 months- Amoxicillin
50 breaths per minute or  Refer urgently to health
more) facility*
(12 months up to 5 years- 40
breaths per minute or more)

 No signs of Pneumonia or NO PNEUMO-  Advise home care for

Very severe disease NIA: COUGH cough & cold
OR COLD  If coughing for more
than 14 days, refer for
assessment

* Oxygen saturation (SpO2) is between 90% to less than 94% then refer to health facility for assessment and management
ASSESSMENT AND CLASSIFICATION OF A SICK CHILD (AGE 0-59) DAYS BY ASHA
DURING HOME VISIT

 Not able to feed or  POSSIBLE SERIOUS  Give first dose of oral

 Convulsions or  BACTERIAL INFEC- Amoxicillin
 Fast breathing (60 TION  Advise mother to con-
breaths per minute or tinue breast feeding
more) or  Advise mother how to
 Severe chest indrawing or keep the young infant
 Axillary temperature 37.5 warm on the way to
0C or above (or feels hot the hospital.
to touch) or  Refer urgently to hos-
 Axillary temperature less pital
than 35.5 0C (or feels
cold to touch) or
 Movement only when
stimulated or no move-
ment at all
Annexure 2: At health facility
Refer to https://nhm.gov.in/index1.php?lang=1&level=4&sub-
linkid=1336&lid=716

Annexure 3: Summary algorithm for management of childhood pneumonia

 ASHA SCREENING FORMAT
Name of ASHA: ________________________________; Mobile number: ________________; Village: _____________;
Block: _________________; District: ____________
Name of the child Mother / Father Age If age, 0-59 days, is there? (Yes / If age, 2 In case In case Whether
name No) months – 5 signs there signs MCP card
 Not able to feed or years is are symp- there are has been
there (Yes / toms and symptoms used (Yes /
 Convulsions or
No) signs, then and signs, No)
 Fast breathing (60 breaths per was Oral then
minute or more) or  Cough
or Amoxicillin name the
 Severe chest indrawing or given to place of
 Difficult
 Axillary temperature 37.5 0C the child referral
breath-
or above (or feels hot to touch)
ing
or
 Axillary temperature less than
35.5 0C (or feels cold to touch)
or
 Movement only when stimu-
lated or no movement at all
 Reporting from States / UTs to MoHFW

Name of the State / UT

Name of Nodal Officer Incharge of SAANS 2021
Whether SAANS 2021 was inaugurated at State / UT level?
Number of districts that inaugurated SAANS 2021?
Community level activities:
No. of ASHAs trained on home visits for SAANS?
No. of ANMS trained on SAANS?
No. of nurses in PHCs, CHCs, Hospitals trained on SAANS?
No. of Doctors trained on SAANS?
No. of ASHAs that did house-to-house visits of under-five-chil-
dren for SAANS
No. of under-five-children assessed by ASHAs for symptoms and
signs
No. of under-five-children having symptoms and signs of acute
respiratory illness
No. of under-five-children administered pre-referral dose of
Amoxicillin
No. of under-five-children referred to health facilities
No. of homes where counseling was done using MCP card

Health facility level activities:

No. of under-five-children treated with cough and cold in OPD
No. of under-five-children treated with Pneumonia in OPD
No. of under-five-children treated with Severe Pneumonia by ad-
mission
No. of under-five-children administered medical oxygen
No. of Skill Station functional against approval
Number of infants given PCV-1 vs number of infants given
Penta-1
Number of infants given PCV-Booster vs number of infants given
MR-1