Pneumonia deaths haunt S-E Asia

Diarrhoea, which is responsible for almost 10 per cent of child mortality in the region, is another major cause.

A shocking 1.7 million under-five children died in a year in 2013 in eleven countries of WHO’s South-East Asia Region. This amounts to 27 per cent of global deaths among under-five children. India alone contributes over 1.34 million such deaths which are over three quarters of the regional deaths.

Pneumonia in children is responsible for 13 per cent of under-five deaths in the region and is the number one infectious killer of children. Most of these deaths can be prevented through well-known interventions for prevention and treatment to the children. Countries of region have made progress in reducing child mortality. However, these gains are not sufficient for us to achieve the target of Millennium Development Goal – MDG 4 – by the end of 2015. One of the reasons is that some of the bigger 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 per cent children with symptoms of pneumonia were taken to healthcare providers, only 13 per cent were treated with antibiotics recommended by the national guidelines. Exclusive breastfeeding for the first 6 months of life can prevent childhood pneumonia. However, it is practiced for 46 per cent of children according to the National Family Health Survey-3, 2007.

The other major cause of childhood deaths 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 in children and could be delivered by the same set of health services. The story of prevention and management of childhood diarrhoea is similar to that of childhood pneumonia.

The Integrated Global Action Plan for Pneumonia and Diarrhoea (GAPPD) proposed by the WHO and United Nations Children Fund is a timely initiative to promote an integrated approach to rapidly reduce childhood mortality caused by pneumonia and diarrhoea. 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, 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 the Promise Renewed commitment to child survival to which the countries in the region have committed.

National governments must rapidly expand the coverage of well-known evidence based life-saving interventions such as exclusive breastfeeding, good nutrition for children, hand washing, safe drinking water, improved cooking stoves to prevent exposure of children to indoor air pollution, zinc and oral rehydration solution for management of diarrhoea, amoxicillin for treatment of pneumonia, vitamin A and vaccination. The unreached children who are most vulnerable must be reached with all these interventions for the desired impact.

This would need a 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.

Cleanliness campaign
With accelerated and coordinated implementation the gains are likely to be significant in terms of efficient and effective use of scarce resources. Government of India’s recent ‘Swachh Bharat Abhiyan’ including an emphasis on hand washing, is very timely in supporting national public health efforts including fight against these two scourges among young children in the country.

The WHO, along with partners, looks forward to work with our Member States to develop locally applicable national strategies and national and sub-national work plans for prevention and control of pneumonia and diarrhoea, within their national health plans, with identified budget and responsibilities clearly assigned. The national government, while taking the leadership role, should engage critical partners in the overall work plan for coordinated and accelerated implementation.

The 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 newer vaccines like Haemophillus influenzae and Pneumococcus for prevention of pneumonia and Rotavirus vaccine for prevention of serious diarrhoea 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 4,00,000 vulnerable children will continue to die from pneumonia and diarrhoea each year in the South-East Asia Region.

(The write is WHO Regional Director for South-East Asia)