India continues to have the highest burden of pneumonia and diarrhoea child deaths in the world, with 158,176 pneumonia and 102,813 diarrhea deaths in 2016, according to 'Pneumonia and Diarrhea Progress Report' by the International Vaccine Access Center (IVAC).

The report found health systems falling "woefully short" in ensuring that the most vulnerable children have access to prevention and treatment services in the 15 countries, including India, that account for 70 per cent of global pneumonia and diarrhoea deaths in children under five.

Despite significant reductions in disease in recent years because of improvements in access and use of health interventions, nearly half a million pneumonia and diarrhoea deaths still occurred in two countries — India and Nigeria, it said.

The number of deaths of children under five years due to pneumonia in 2016 was 1,58,176, while diarrhoea deaths was 1,02,813, the report said.

Released ahead of the 10th annual World Pneumonia Day on November 12, at the Johns Hopkins Bloomberg School of Public Health, describes progress in fighting these two diseases in 15 countries.

According to the report, the 15 nations in order with the highest number of pneumonia and diarrhoea child deaths are India, Nigeria, Pakistan, the Democratic Republic of Congo, Ethiopia, Chad, Angola, Somalia, Indonesia, Tanzania, China, Niger, Bangladesh, Uganda, and Cote d'Ivoire.

Elaborating about RotaC coverage, it said as of 2017, rotavirus vaccine had not been introduced in eight of the 15 focus countries — Nigeria, DRC, Chad, Somalia, Indonesia, China, Bangladesh, and Uganda.

Of the seven countries where rotavirus vaccine has been introduced, the median coverage of complete rotavirus vaccine is 58 per cent. "Among countries that had introduced the vaccine as of 2017, the lowest coverage levels were in Pakistan (12 per cent) and India (13 per cent), both of which had recently started phased national rollouts that had not yet reached all states or provinces," the report said.

Elaborating about the progress in India, home to more under-five pneumonia and diarrhoea deaths than any other country in 2016, has been "mixed", it said. Increasing coverage of Haemophilus influenzae type b (Hib) vaccines, as well as continued scale-up of rotavirus vaccines first introduced in mid-2016, led to a bump in scoring for these interventions since last year's report.

"Introduced in 2017, the pneumococcal conjugate vaccine (PCV) has been included in only six states to-date. Further scale-up of the vaccine to all states should be considered," the report, which analysed government data, said.

It also pointed out that India's scores for exclusive breast feeding declined as did coverage of ORS. "The proportion of children receiving important treatments remains dismally low, with barely 20 per cent receiving ORS for diarrhoeal disease," it said.

"Progress to stop child deaths is being hampered by persistent inequities in countries around the world," said Kate O'Brien, MD, MPH, a professor in the Bloomberg School's Department of International Health and IVAC's executive director. "Addressing these inequities will demand greater levels of funding, strong political commitment, accountability supported by better data, and a coordinated global effort that prioritizes the most vulnerable," he added.

The report found that although countries are making progress toward improved vaccine coverage, they seriously lag in efforts to treat childhood illnesses-especially among populations that are remote, impoverished, or otherwise left behind.