A new study has found that the highest number of deaths caused by pneumonia – a preventable infectious disease most likely to affect children below five years of age – are recorded in India.

The report, titled “Fighting for Breath”, by non-profit Save the Children said that in 2015, 1,78,717 children below the age of five died in India because of pneumonia – this means that every hour, 20 children died of the disease in the country that year.

The study also highlighted the poor primary healthcare services in the country, which limits access to treatment for pneumonia.

Although incomes in India are almost double those in Bangladesh, the report said India has a higher death rate for child pneumonia. Seven children for every 1,000 live births recorded in India die of pneumonia even though antibiotics to treat the disease cost as less as Rs 26, it added.

Doctors said improving nutrition can lower the chances of children developing pneumonia and dying of it. Between April 2015 and March 2016, about 38% of Indian children were found to be stunted (too short for their age) as a result of under-nutrition. “Poverty and malnutrition can make pneumonia worse,” said Dr Jacob Puliyel, a pediatrician from Delhi.

In South Asian countries, including India, the report found that “girls with severe pneumonia cases are far less likely to receive care in the region, and they are more likely to die as a result.”