UNICEF/WHO: New plan to address pneumonia and diarrhoea could save 2 million children a year


UNICEF/WHO: New plan to address pneumonia and diarrhoea could save 2 million children a year

Global News 00:27

GENEVA/ WASHINGTON/ HONG KONG, 12 April 2013 – A new Global Action Plan launched today by UNICEF and the World Health Organization (WHO) has the potential to save up to 2 million children every year from deaths caused by pneumonia and diarrhoea, some of the leading killers of children under five globally.

Community Health Volunteer Mariam Diarra times eight-month-old Gimbala Keita’s breathing, using a WHO/UNICEF timer, during an outreach visit in Kabe Village in the western Kayes Region. The baby has pneumonia. Ms. Diarra has been trained to count a child’s breaths to gauge respiratory distress and identify pneumonia. If detected early enough, the illness can be treated with antibiotics and recovery may be swift. Otherwise, the child will be referred to the nearest health facility. Community health volunteers provide basic health services and monthly outreach, helping to manage early childhood diseases in their communities. UNICEF supports community-led initiatives to raise awareness about essential family practices, which include exclusive breastfeeding for babies during the first six months of life, fully vaccinating children under age one, sleeping under insecticide-treated mosquito nets, and washing hands with soap. Each volunteer visits about 35 households (or 250 inhabitants) every month. Ms. Diarra is the eldest of three wives who, all together, have 14 children. [#2 IN SEQUENCE OF THREE] In May 2010 in Mali, the country remains one of the poorest in the world, with more than 47 per cent of the population living on less than US $1.00 a day. Many people lack access to basic health care and safe water, and more than half are without adequate sanitation. Maternal and child health indicators are also among the world’s worst: Eight women die from pregnancy-related causes each day, and nearly 20 per cent of children die before reaching their fifth birthday. Pneumonia, diarrhoea, malaria and neonatal conditions are the primary causes of under-five deaths. Additionally, more than one-third of child deaths are directly related to under-nutrition, and about 38 per cent of Malian children are stunted. Wide economic, gender, geographic and other disparities also persist. Working with the Government and other partners, UNICEF supports health, nutrition, water and sanitation and hygiene (WASH), education and protection interventions, especially in rural areas and among vulnerable populations. A health worker prepares a pentavalent vaccine at a health centre in the community of Corosal in Cobán Municipality, in Alta Verapaz Department. The pentavalent vaccine protects against five common diseases: diphtheria, tetanus, pertussis (whooping cough), hepatitis B and Haemophilus influenza type b (also called Hib, a cause of pneumonia and meningitis). The centre, which is open once a month, serves a population of 1,000, and is run by the Ministry of Health with support from UNICEF. Volunteer health workers provide routine health care and immunizations for pregnant women and children under 5 in five surrounding communities. [#2 IN SEQUENCE OF THREE] In November 2012 in Guatemala, the Government and other partners are continuing to assure sustained routine immunization of children – now reaching 92 per cent of all infants – against a range of vaccine-preventable diseases. The country’s last endemic case of measles was in 1997. In the entire Americas Region (covering North, Central and South America), the last endemic measles case was in 2002 and the last endemic case of rubella was in 2009 – part of global efforts to eradicate these diseases. Worldwide, measles remains a leading cause of death among young children: In 2010, an estimated 139,300 people – mainly children under the age of 5 – died from the disease. Nevertheless, these deaths decreased by 71 per cent from 2001 to 2011, thanks in part to the Measles & Rubella Initiative, a global partnership led by the American Red Cross, the United Nations Foundation, the United States Centers for Disease Control and Prevention (CDC), WHO and UNICEF. In Guatemala, despite this success, significant other challenges for children remain, much of it related to poverty levels that affect more than half of all children and adolescents. Poverty also contributes to chronic malnutrition affecting half of all under-5 children (with higher rates among indigenous populations); an average national education level of under six years of primary school (under three years for the rural poor); and high, though decreasing, rates of violence. Guatemala is also one of the world’s most vulnerable countries to climate change, suffering a major climate-related emergency every year since 2008. On the positive side, birth registration is improving, with more than 95 per cent of newborns now being registered. UNICEF is working with the Government and other partners to sustain achievements in health, address the high levels of malnutrition, strengthen responses to crimes against children and increase protection services for children throughout public services.

The Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea calls for closer integration of efforts to prevent and treat these two diseases and sets ambitious targets to reduce mortality rates and raise levels of children’s access to life-saving interventions.

“Too often, strategies to tackle pneumonia and diarrhoea run in parallel,” says Dr Elizabeth Mason, Director of Maternal, Newborn, Child and Adolescent Health at WHO. “But as countries like Bangladesh, Cambodia, Ethiopia, Malawi, Pakistan and Tanzania are already showing, it makes good health sense and good economic sense to integrate those strategies more closely.”

Many factors contribute to these two conditions, so no single intervention can effectively prevent, treat or control either pneumonia or diarrhoea. However, as richer countries have demonstrated, a number of elements are key to reducing infections and deaths from both diseases. For example, good nutrition and a clean environment help protect children from both pneumonia and diarrhoea. New vaccines are being introduced to protect children from these diseases. Good access to health services and the right medicines can ensure they get the treatment they need. But many existing efforts to address pneumonia and diarrhoea in low- and middle-income countries have yet to capitalise on these common elements. On 13 October, in the village of Manzoorabad in Jamshoro District in Sindh Province, a glass of unclean water sits on the edge of the ‘charpoy’ where Mohammed Ali, 2, lies. When he was admitted to the UNICEF-supported nutrition stabilization centre in Jamshoro City two months ago for severe malnutrition – a consequence of tuberculosis and pneumonia – doctors did not think he would survive. The centre was created following the 2010 flooding in the district, which is still recovering. By 15 October 2011 in Pakistan, over 5.4 million people – including more than 2 million children – had been affected by monsoon rains and flooding. Over 1.52 million houses were damaged or destroyed, and millions of acres of land were affected. In Sindh Province alone, more than 2.5 million people were in need of safe drinking water and sanitation facilities, food and medical care, and an estimated 1.1 million people required emergency shelter. The crisis comes one year after the country’s 2010 monsoon-related flooding disaster, which covered one fifth of the country in water. As of 26 October, in response to the latest crisis, UNICEF and its partners are administering essential newborn, child and maternal health services; supporting outpatient therapeutic feeding programmes and supplementary feeding programmes for malnourished children as well as for pregnant and lactating women; providing safe drinking water, sanitation facilities and hygiene kits; and supporting temporary learning centres. UNICEF funding needs for the next six months are US$50.3 million – part of the joint United Nations Rapid Response Plan. But, despite a recent increase in donations, 70.9 per cent remains unfunded.

“This is a question of equity. Poor children in low-income countries are most at risk of death from pneumonia or diarrhoea but much less likely to get the interventions they need,” said Dr Mickey Chopra, global head of UNICEF’s health programmes.

“We know what to do. If, in the 75 countries with the highest death rates, we apply to the entire population the same coverage of essential interventions enjoyed by the richest 20 per cent of households, we can prevent the deaths of 2 million children even as soon as 2015, the deadline for the Millennium Development Goals,” Dr Chopra added.

A packet of oral rehydration salts (ORS), to treat dehydration caused by diarrhoea, is displayed at UNICEF's central supply warehouse in Copenhagen, the capital. The packet bears the UNICEF logo. The salts are a component of an emergency health kit. Designed to meet the initial primary health care needs of a displaced population without medical facilities, the kit contains basic drugs, medical supplies and equipment for 10,000 persons for 3 months, as well as basic sterilization equipment. The Copenhagen warehouse stocks components for 40 different kinds of kits, which are often used in emergencies. In 2005 in Denmark, UNICEF Supply Division Headquarters in Copenhagen, the capital, is the centre of UNICEF's global supply operations on behalf of children and families. Supply Division carries out the procurement, shipment and distribution of supplies for UNICEF-supported programmes, including bulk purchases, storage of standard kits and preparation of supplies and equipment for direct distribution to health centres, schools or other institutions in recipient countries. It also assists Governments and other United Nations agencies and development partners in procuring quality supplies. UNICEF Supply Division is also the largest purchaser of vaccines in the world. The Copenhagen warehouse is complemented by two strategic hubs (in Dubai and Panama), which together hold enough emergency supplies to meet the needs of 320,000 people for three weeks. The Division procured over US $1.1 billion in supplies in 2005 in response to an unprecedented number of natural disasters, food crises, conflicts and other humanitarian emergencies. The Copenhagen facility is also used by the Office of the United Nations High Commissioner for Refugees (UNHCR), the International Federation of the Red Cross and Red Crescent Societies (IFRC) and other organizations to stockpile emergency items. The new WHO/UNICEF Action Plan sets clear goals for the world to achieve by 2025: a 75 per cent reduction in incidence of severe pneumonia and diarrhoea from 2010 levels among children under five, and the virtual elimination of deaths from both diseases in the same age-group. It also aims for a 40 per cent reduction in the global number of children under five who are stunted.

The Action Plan’s targets are significantly higher than current levels. For example, it calls for 90 per cent of all children to have access to antibiotics for pneumonia and oral rehydration salts for diarrhoea, up from current levels of 31 and 35 per cent respectively. As an interim target, at least half of all children under six months should be exclusively breastfed, against 2012 levels of 39 per cent. All children should have access to improved sanitation and safe drinking water, from 63 and 89 per cent respectively; and building on the good progress already made in some countries in introducing new vaccines against pneumococcal bacteria and rotavirus, it aims for 90 per cent coverage by the target date.

The Action Plan calls on governments and other stakeholders to prioritize investment in the population groups with the poorest access to services to prevent and treat pneumonia and diarrhoea. Nearly 90 per cent of pneumonia and diarrhoea deaths in children currently occur in sub-Saharan Africa and South Asia.

The Action Plan comes at a time when the global community has strengthened its commitment towards the health MDGs, including towards reducing child mortality. These include the United Nations Secretary-General’s Every Woman Every Child initiative and within it, Committing to Child Survival: A Promise Renewed, a global movement spearheaded by UNICEF through which more than 170 countries have committed to ending all preventable child deaths by 2035.

In scaling up and refining existing efforts to protect children from diarrhoea and pneumonia and treat them appropriately when affected, improved coordination between existing programmes and a wide range of actors, including the community and the private sector, will be key. Efforts must also be sustainable over the longer term.

Women hold their babies in the village of Sarkin Yamma Soffoua, in Sarkin Yamma Commune. The village has benefited from sessions raising awareness of essential family practices, including exclusive breastfeeding, proper hand washing and the treatment of diarrhoea with oral rehydration salts. In September-October 2010 in Niger, children continue to face high rates of illness and mortality. One of the world’s poorest countries, Niger has the world’s 12th highest rate mortality rate for children under age five, and only 10 per cent of children under six months old are exclusively breastfed. In addition, an ongoing food emergency puts nearly 400,000 children at risk of severe acute malnutrition. UNICEF is responding to these conditions with a host of health programmes that extend vital healthcare services to remote areas and educate communities about life-saving practices. UNICEF supports a Ministry of Health programme that is establishing integrated health centres to reduce infant mortality, improve maternal health, and combat preventable diseases including malaria and HIV/AIDS. The centres offer prenatal and neonatal care, promote breastfeeding, and educate families on the use of mosquito nets to prevent malaria. An estimated three quarters of all children now have access to healthcare, compared to less than half of all children in 2006. UNICEF and partners are also supporting a three-year campaign to encourage exclusive breastfeeding during a child’s first six months, a practice that dramatically improves babies’ chances of survival. UNICEF and partners also support programmes in which facilitators educate community members about essential family practices, including proper hand washing and the use of mosquito nets. Three-month-old Abdoulrachid Hamissou smiles in the village of Foura Guiké, in the southern Maradi Region. Abdoulrachid has benefitted from the promotion of essential family practices in the village. Four volunteers in the community promote essential family practices that reduce child diarrhoea, prevent malaria and improve hygiene. They also promote exclusive breastfeeding and growth monitoring for children, practices that help prevent malnutrition. In October 2009 in Niger, rates of malnutrition are escalating due to irregular rains and faltering crop yields. The country already has high chronic malnutrition rates, with half of children experiencing stunted growth, and one of the highest child mortality rates in the world, with 17 per cent of children dying before the age of five. Late and erratic rains led to failed harvests in the southern regions, where farmers and pastoralists were already contending with reduced pasture lands and high food prices. Meanwhile, heavy rains caused the worst flooding in decades in the northern Agadez Region, destroying farms and wiping out crops. The flood damage in Agadez leaves little food or employment for southern migrants who travel north to work the fields each year. According to the Government, over 100 agricultural zones, and nearly two million people, are food insecure, numbers that may rise. In response, UNICEF, the World Food Programme (WFP), Médecins sans frontières (MSF) and other partners are providing health care and nutritional support throughout the country. Food distributions have also been launched in the southern regions to limit rising malnutrition rates.