Pragmatic integrated steps will go a long way in bringing down the mortality rate, suggests Dr Naveen Thacker
A recent report by the International Vaccine Access Center revealed that India, the country with the greatest number of child deaths from pneumonia and diarrhoea, continues to struggle with improving rates of basic childhood immunisations. The study added that in 2014, additional States introduced the pentavalent vaccine, but the rollout is not expected to be completed by the end of this year — four years after the first State introduction.
The pentavalent provides protection to a child from five life-threatening diseases — Diphtheria, Pertussis, Tetanus, Hepatitis B and Hib. DPT (Diptheria, Pertussis, Tetanus) and Hep B are already part of routine immunisation in India.
The series of steps taken by the Government of India under Mission Indradhanush are pragmatic as there is a focus to bring down India’s high infant mortality rates by addressing vaccine-preventable diseases. Many people may wonder about the communication blitz around Mission Indradhanush and it is important to emphasise here that parents and communities need to be constantly reminded about their child’s immunisation schedule.
Even though India’s Universal Immunisation Programme (UIP) is the largest in the world, in terms of the number of beneficiaries as well as the quantity of vaccines used, there is still a huge unreached population of 72 lakh out of the total 2.7 crore children born annually. The most difficult task is reaching out to remote and far-flung areas of the country where many basic services have yet to reach. The challenges here are tougher: lack of awareness and insufficient information as well as misperception about vaccination among some parents that contribute to the lukewarm response to routine immunisation efforts initiated by the Government so far.
Approximately 18.3 lakh children in India die before their fifth birthday each year. It is the low-income families that lose the most children to disease. India records five lakh child deaths annually due to vaccine-preventable diseases. One out of every three children in India does not receive all vaccines that are available under UIP. Five per cent of children in urban areas and eight per cent in rural areas are unimmunised.
India’s high under-five mortality rate can be greatly reduced by immunisation, which can save many lives from diseases such as diarrhoea and pneumonia because vaccines are already available, though at a very high cost.
India unfortunately figures at the top of the list of 10 nations that have the highest disease burden for preventable diseases such as diarrhoea and pneumonia. India still reports 206,000 deaths due to diarrhoea and 388,000 from pneumonia. Many of the existing prevention and treatment measures can help control both these diseases.
As the Government of India works tirelessly to fight these silent killers, it is important to underscore the options that the Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) outlined in 2013. GAPPD detailed the crucial elements needed to address diarrhoea and pneumonia — nutrition; vaccines; access to safe water, sanitation, and better household air quality; and effective treatment with integrated case management that includes oral rehydration and zinc for diarrhoea and amoxicillin and oxygen for pneumonia.
GAPPD is, thus, a coordinated, multi-level approach to addressing the two leading causes of under-five mortality pneumonia and diarrhoea, focusing on prevention, protection, and treatment. It emphasises supporting activities to improve and accelerate the implementation of the existing interventions of proven benefit.
last year, India’s Ministry of Health and Family Welfare, along with representatives from pneumonia and diarrhoea high-burden States
and districts, the World Health Organization, UNICEF, and other stakeholders came together to propose and develop the Integrated Action Plan for Pneumonia and Diarrhoea (IAPPD).
The plan is presently being targeted in four States — Uttar Pradesh, Bihar, Rajasthan and Madhya Pradesh — which account for more than half of India’s under-five deaths. India has already begun to prioritise the fight against pneumonia and diarrhoea through integrated policies and increased resource mobilisation in these States, with district-specific plans and clear roles and responsibilities for investments and partners.
On August 27-28, India hosted the Call to Action Summit 2015 to accelerate the efforts towards realising the vision of ending preventable child and maternal deaths. It is important to understand the ground that India has covered. The country’s contribution to the global burden is decreasing — under-five deaths reduced from 24 to 22 per cent (2011 versus 2012) and there was 21 per cent decline in early neonatal mortality between 2007 and 2012. India has also reduced under-five mortality rates at a faster pace than globally, bringing it down to 59 per cent between 1990 and 2012. This said, it is still a challenging situation that the country faces.
The progress of the IAPPD States and the ground commitment following the Call to Action Summit need to be highlighted to further accelerate improvement. There is a huge task ahead for civil society, which can significantly contribute to saving children’s lives by creating awareness, allaying unfounded fears, and advocating to ensure that no child’s life is endangered.
The writer is a child specialist of Gandhidham, and President Elect of the Asia Pacific Pediatric Association