Pneumonia: Deadly childhood disease
Nearly 1.7 million children under the age of five yeas died last year in WHO's South-East Asia Region, with pneumonia and diarrhea being among the major killers. The Region accounts for 27% of global deaths in this age group. These statistics are alarming and unfortunate as these deaths continue to occur despite availability of well-known evidence based interventions for prevention and treatment of diseases like pneumonia. This is a warning that the Region is far from achieving the Millennium Development Goal – MDG 4 target of reducing child mortality by 2015 end.
Pneumonia in children is responsible for 13 % of under-five deaths in the Region. These deaths are unacceptable. We need to review the causes and move forward to end these preventable child deaths.
One of the reasons is that some of the big countries like India, Indonesia, Bangladesh and Myanmar have not been able to achieve high levels of coverage with life-saving interventions for childhood pneumonia and other conditions among under-five children. For example, in India, while 69% children with symptoms of pneumonia were taken to health care providers only 13% were treated with antibiotics that are recommended by the national guidelines. Exclusive breastfeeding for the first 6 months of life can prevent childhood pneumonia; however it is practiced for 46% of children according to the National Family Health Survey-3. In Bangladesh and Indonesia, 35% and 51% children with pneumonia, respectively, sought treatment from healthcare workers. Unfortunately, the children that are left out are the ones who are the most vulnerable like the poor and the ones living in rural areas, urban slums or remote areas. their needs for such life-saving interventions are essential.
The other major cause of childhood deaths is diarrhea which is responsible for almost 10% of child mortality in the Region. Several preventive strategies and interventions for diarrhea are similar to the ones for pneumonia in children and could be delivered by the same set of health services. The story of prevention and management of childhood diarrhea is similar to that of childhood pneumonia.
The Integrated Global Action Plan for Pneumonia and Diarrhea (GAPPD) proposed by the World Health Organization and United Nations Children Fund is a timely initiative to promote an integrated approach to rapidly reduce childhood mortality caused my pneumonia and diarrhea. This innovative approach has been designed to accelerate progress towards achieving the Millennium Development Goal to save the lives of children under the age of five (MDG4), as well as successful implementation of the “Every Woman Every Child” movement under the UN Global Strategy for Women's and Children's Health, and to the renewed commitment to child survival to which the countries in the region have promised. The GAPPD provides the road map for reducing mortality from pneumonia in children under five to less than 3 per 1000 live births, and from diarrhea to less than 1 per 1000 by 2025.
It is widely accepted that prevention and control of pneumonia and diarrhea need to be addressed through integrated approaches. National governments must rapidly expand the coverage of tried and tested life-saving interventions such as exclusive breastfeeding, good nutrition for children, hygienic living , safe drinking water, improved cooking stoves to prevent exposure of children to indoor air pollution, zinc and oral dehydration. Solution for managing diarrhea and amoxicillin for treatment of pneumonia, vitamin A and vaccination are important. The neglected children in remote places, who are most vulnerable must be reached with all these interventions for the desired impact. This would need close collaboration and coordination not only among different programmes within the ministry of health but also with relevant programmes managed by other ministries. Collaboration and coordination among all stakeholders like the government, development partners, donors, civil society, families and communities would be required at the same time. With accelerated and coordinated implementation the gains are likely to be significant in terms of efficient and effective use of scarce resources.
WHO, along with partners and Member States, is working on developing locally applicable national strategies and national and sub-national work plans for prevention and control of pneumonia and diarrhea. The national government, while taking the leadership role, should engage critical partners in the overall work plan for coordinated and accelerated implementation.
WHO urges countries to strengthen the existing time-tested child health strategies like Integrated Management of Newborn and Childhood Illness at all levels of health care – from home and community to first level and referral level hospitals. At the same time, innovative approaches must be deployed for increasing awareness among communities, increase the demand for services and reach out to the unreached children.
Availability of vaccines that prevent pneumonia against Haemophillus influenzae b and Pneumococcus and Rotavirus vaccine for prevention of serious diarrhoeal disease brings new opportunities to strengthen national efforts in reducing childhood deaths through coordinated approaches.
WHO will continue to support the national governments, partners and civil society to adopt these urgent accelerated and coordinated efforts without which about 400 000 vulnerable children will continue to die from pneumonia and diarrhea each year in the South-East Asia Region.
The writer is Regional Director, WHO South-East Asia Region.
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