When thirteen-year-old Niruta BK of Chhatiwon, Makwanpur, caught pneumonia last year, her parents rushed her to Bharatpur Hospital. The doctors at the hospital referred her to Patan Hospital in Lalitpur after her condition aggravated.

She was admitted to the intensive care unit in Patan Hospital. For two weeks, Niruta had to be kept on full ventilator support, which cost the family Rs 225,000.
"I spent around Rs500,000 for my daughter’s treatment," Niruta’s father Khadga Bahadur told the Post. "The cost was beyond my capacity, but I managed to save my daughter."
Pneumonia, an infection of lungs caused by various types of bacteria, viruses and fungi, is the number one killer of children under five in Nepal. It kills more children annually than malaria, tuberculosis and HIV combined.

Out of total under-five mortality rate, 15 percent die of pneumonia, according to the World Health Organization.

However, data of the Health Management Information System under the Department of Health Services shows about 30 percent of children under five died of pneumonia in Nepal.
Like Niruta, thousands of people throughout the country get infected every year from pneumonia, and an average cost of families for a case of hospitalisation was Rs 13,250, nearly half the average Nepali household's monthly expenses, a preliminary report of a study carried out by Pneumo Nepal, shows.

The study, which is being carried out at Patan Hospital, Kanti Children's Hospital, Mission Hospital in Palpa, Bheri Hospital in Nepalgunj and BP Koirala Institute of Health Sciences, shows that the unexpected costs frequently push families into poverty.

"Two out of five of the poorest household's experiences catastrophic expenses as a direct result of child's pneumonia hospitalisation," the report stated.
The study, which was supported by the Global Alliance for Vaccines and Immunization, aimed to evaluate the health and economic impact of pneumococcal conjugate vaccine after its nationwide introduction in 2015, will be completed in 2020.

"Our study shows significant reductions in the number of children who were immunised with vaccines," Dr Srijana Shrestha, who is also involved in the study, told the Post. "We can prevent pneumonia infection and possibly catastrophic consequences in the aftermath of infection by complete immunisation and the use of proper antibiotics after infection."
According to Shrestha, pneumonia caused by bacteria is deadlier than that one caused by viruses, and children under-five and people above 65 years of age are highly vulnerable to the disease.

Though the government has included pneumonia vaccine on the regular immunisation list to prevent under-five mortality rates, it has not brought any programme to avoid pneumonia-related deaths among adults.

"We have been working to increase the immunisation rate and have launched several other programmes to prevent pneumonia infection," Dr Jhalak Sharma, chief of the immunisation section at the Family Welfare Division, told the Post.

Apart from the pneumococcal vaccine, the government provides measles and rubella vaccines, Haemophilus influenza type B vaccine and diphtheria and pertussis vaccines to save children from possible pneumonia infection.

Just as the study shows poor people are highly vulnerable to the financial risk posed by pneumonia.

Niruta's father Khadga Bahadur, who works as a labourer to run his family, said he was forced to sell his cattle and take loans to save his daughter.
"It will take several years for me to pay back the loan," said Khadga Bahadur. "I may have to sell whatever property I have."