ABIDJAN: A mother from a working-class district of Abidjan watches fearfully while the physiotherapist presses down on the thorax and abdomen of her crying, struggling baby to help him breathe.

Under the health worker's expert hands, the infant gradually expels the secretions clogging up his lungs through his nose and mouth. His mother looks astonished and the therapist keeps working until her child's airways are completely clear.

Respiratory physiotherapy is critically needed in Ivory Coast where pneumonia is second only to malaria as a killer of babies and toddlers.

The charity Agis (Association Graine d'Ivoire et Sante), founded in 2010 by Aboubakar Sylla, a physiotherapist himself, trains volunteer staff in the massage techniques to serve the poorer neighbourhoods of the commercial capital and towns in the interior of the west African country.

Their work is linked in with medical consultations and "schools for mothers", where women are taught how to help keep their little ones safe from infection and to treat them if they fall sick.

- Affects children under five -

The World Health Organisation reports that respiratory infections in 2015 claimed the lives of more than 900,000 children under the age of five around the globe.

In Ivory Coast, such infections are estimated to have killed more than 11,000 youngsters in 2012, according to the latest available count.

The Annual Report on the Health Situation (RASS) for 2014 and 2015 meanwhile showed that the number of acute respiratory infections rose to more than 202 cases per 1,000 children in 2015 from 165 per 1,000 in 2014.

Respiratory infections are "the second cause of hospitalisation in paediatric services. After malaria, it's the second cause of mortality" among Ivorian children under five, says Max Valere Itchi, a doctor at CHU of Cocody, one of the main hospitals in Abidjan.

In the countryside the death toll has worsened due to a lack of funds and equipment. Children are usually taken to hospital only when their case is very serious and more difficult to cure, doctors say.

"This is particularly regrettable since many cases could have been avoided with a little prevention," says Sylla, taking part in his Agis association's campaign in the poor Koumassi district of Abidjan.

- Don't sweep with baby on back -

In the courtyard of the city's general hospital, several dozen mothers show up early one morning to wait under tents put up to provide shelter from the rain Some are carrying their babies on their backs.

Esthetician Monique Zabia has brought two children with her.

"Every day they have colds and they have runny noses," says Zabia, who is discovering the methods of the physiotherapists for the first time.

"She has a cold all the time and she coughs in spite medication," says another mother, Linda Akele, who brought her three-year-old daughter "to experiment" with the massage techniques.

Three days later, a similar scene takes place in Attecoube, another low-income neighbourhood in Abidjan, where health staff give advice to women as well as treatments to the kids.

Young mother Saly listened attentively to a volunteer nurse while her 14-month-old baby sat calmly at her feet.

"Don't carry the child on your back to sweep the house or to light the fire. Otherwise the dust and the smoke are still going to give him colds," the nurse patiently tells the women.

Sylla, who deploys one or more practising doctors to take part in each Agis operation, explains that the volunteers "also teach the women how to give the massages themselves."

He stresses however that physiotherapy is not the primary treatment.

"People need to see their doctor. Medication is the primary means of treatment. Physiotherapy is complementary to that. Studies have shown that when physiotherapy is added to treatment with drugs, it speeds up recovery and brings respiratory comfort to the child," he says.

The charity's head is keen to see a full-fledged government policy to help the children in distress. "There is not enough money devoted to the battle against pneumonia."

His Agis association is entirely dependent on volunteer medical staff, whose numbers vary according to the workload and location. The charity is funded by private donations and patrons such as a company which may step forward to finance operations in a specific district.