Larry Elliott is right to raise the issue of the scant attention that pneumonia gets and the lack of awareness of it as a major killer of children in poor countries, and to call for more effective action to combat it (Globalisation 4.0? How about action at Davos on pneumonia?, 21 January). He has though overlooked one of the most important factors involved in preventing the deaths of under-fives from pneumonia: breastfeeding. Malnutrition and weakened immune systems from not breastfeeding causes both diarrhoea, which puts babies at higher risk of contracting pneumonia, and pneumonia itself. Babies under six months in poor countries who are not breastfed are nine times more likely to die from it; those who are six–23 months are twice as likely to die (Save the Children report: Don’t Push It – Why the Formula Industry Must Clean Up Its Act, 2018).

The accompanying photo shows a six-month-old baby being given water from a proprietary bottle – so contributing to the problem in every way. Water further weakens the baby’s immune system, while the bottle is a carrier of further infection. To lack of education for families, lack of support for women, and lack of a coordinated approach for training around this fundamental health protection system, is added marketing of unnecessary products including bottled water, often by the same company marketing the formula milk. Yet this does not warrant even a mention in the caption.

Sally Etheridge

Deputy chair, Lactation Consultants of Great Britain

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