To control pneumonia and diarrhoea, which claim a large number of child victims every year, the state must strengthen existing child health strategies
Pneumonia is responsible for 13 per cent of deaths among children under the age of five in South East Asia. It is also one of the biggest infectious killers. Many of these deaths can be prevented through well-known interventions and treatment. The sixth global pneumonia day, celebrated on 12 November, underscores that deaths from pneumonia are unacceptable. We need to review the causes and move forward to end these preventable child deaths.
Some countries in the South East Asia have reduced child mortality, however, these gains are not enough to achieve the Millennium Development Goals by the end of 2015. One of the reason is that big countries like India, Indonesia, Bangladesh and Myanmar have not been able to achieve high-level coverage. For example, in India, while 69 per cent of children with symptoms of pneumonia were taken to health care providers, only 13 per cent were treated with antibiotics. In Bangladesh only 35 per cent and in Indonesia only 51 per cent of children, sought treatment from healthcare workers. Unfortunately, children who are left out are the ones who are the most vulnerable like the poor, and those living in rural areas, urban slums or the ones who live in ‘hard to reach areas’ and whose need for such life-saving interventions are the greatest.
Another major cause for childhood death is diarrhoea which is responsible for almost 10 per cent of child mortality in the region. Several preventive strategies and interventions for diarrhoea are similar to the ones for pneumonia and could be delivered by the same set of health services.
The Integrated Global Action Plan for Pneumonia and Diarrhoea, proposed by the World Health Organisation and United Nations Children Fund, is a timely integrated approach to rapidly reduce childhood mortality caused by pneumonia and diarrhoea. It has been designed to accelerate progress towards achieving the Millennium Development Goal and the successful implementation of the Every Woman Every Child movement under the United Nations global strategy for women's and children's health. GAPPD provides the road map for reducing mortality from pneumonia in children under five to fewer than three per 1,000 live births, and from diarrhoea to less than one per 1,000 by 2025.
Prevention and control of pneumonia and diarrhoea should be addressed through integrated programmes. National Governments must rapidly expand the coverage of well-known life-saving interventions such as exclusive breast-feeding, good nutrition for children, hand washing, safe drinking water, improved cooking stoves to prevent exposure of children to indoor air pollution, zinc and oral re-hydration solution for management of diarrhoea, amoxicillin for treatment of pneumonia, vitamin A and vaccination.
This requires close collaboration among different schemes within the Ministry of Health and Family Welfare and also with relevant programmes managed by other Ministries. Coordination among all stakeholders like the Government, development partners, donors, civil society, families and communities is required. With accelerated and coordinated implementation, the gains are likely to be significant in terms of efficient and effective use of scarce resources.
The Swachch Bharat Abhiyan is a timely effort to improve public health. WHO, along with its partners, looks forward to work with member states to develop locally applicable national strategies for prevention and control of pneumonia and diarrhoea. The Union 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 existing child health strategies like the Integrated Management of Newborn and Childhood Illness at all levels of health care — from home and community to first level and referral level hospitals. Innovative approaches must be deployed for increasing public awareness and reaching out to vulnerable children.
Availability of newer vaccines, like Haemophilus influenzae and Pneumococcus for prevention of pneumonia and rotavirus vaccine for prevention of serious diarrhea, brings new opportunities to strengthen national efforts to reduce childhood deaths.
(The writer is Regional Director for the World Health Organisation's South East Asia programme)