Slow progress in efforts to prevent child deaths from pneumonia, diarrhea: Report

In 2016, pneumonia and diarrhea were responsible for one of every four deaths in children under five years of age.

Figures released by UNICEF earlier this month show that progress against these illnesses has been stubbornly slow, despite these deaths being largely preventable with strategic investments in interventions such as vaccines, antibiotics, oxygen, breastfeeding and hand washing.

Released today, the 2017 Pneumonia and Diarrhea Progress Report: Driving Progress through Equitable Investment and Action sheds some light on the factors slowing progress against the world's two biggest killers of young children.

The Progress Report is issued by the International Vaccine Access Center at Johns Hopkins Bloomberg School of Public Health and provides an update on efforts to prevent and treat pneumonia and diarrhea in the most heavily burdened countries.

This scorecard, released annually to mark World Pneumonia Day in November, finds countries are making progress in increasing coverage of vaccines and breastfeeding goals, but treatment targets seem still far out of reach for most.

Efforts to work and invest more strategically in all three areas - immunization, nutrition, and treatment - are critical to meaningfully reducing the nearly 1.5 million childhood deaths that still occur each year as a result of pneumonia and diarrhea.

"The good news is that when we invest in child health, we save lives," says Kate O'Brien, MD, MPH, a professor in the Bloomberg School's Department of International Health and IVAC's executive director.

"Sadly, there are significant gaps in reaching global targets to make sure that medicines, food, and care get to that last child, living in the inner city or on a small rural farm. The success of investments in these countries demonstrates the potential to vastly improve equity, prioritizing the most vulnerable and catalyzing action to close those gaps."

In the report, IVAC identifies the 15 countries with the greatest number of deaths from pneumonia and diarrhea among children under 5 years of age. IVAC then uses a scoring method based on the integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhea (GAPPD) developed by the World Health Organization and UNICEF.

A country's "GAPPD score" measures the use of interventions that protect against, prevent and treat pneumonia and diarrhea. The higher the score, the more interventions are being used.

These interventions include vaccination; exclusive breastfeeding; access to care; and use of antibiotics, oral rehydration solution and zinc to treat the illnesses. These measures are known to prevent childhood deaths due to pneumonia and diarrhea and could help achieve the United Nations' Sustainable Development Goal target of reducing under-5 mortality to at least 25 per 1,000 live births by 2030.

Key report findings include:

GAPPD scores in 2017 varied widely from a low of 19 percent (Somalia) to a high of 69 percent (Tanzania), with all 15 focus countries falling below the 86 percent target for the overall GAPPD score. In 2016, the scores varied from 20 percent (Somalia) to 74 percent (Tanzania), virtually unchanged compared to this year's scores.

Rotavirus vaccine coverage: Sudan and Tanzania achieved or exceeded the 90 percent target for rotavirus vaccine coverage. Ten of 15 countries failed to meet a threshold of 45 percent for this vaccine which prevents a substantial portion of diarrhea deaths and hospitalizations. This includes nine countries (Afghanistan, Chad, China, DRC, Ethiopia, Nigeria, Pakistan, and Somalia) who had not yet introduced the vaccine and India, who began a phased introduction in 2016.

Antibiotic treatment (suspected pneumonia): In the 11 of 15 countries with available data, antibiotic treatment ranged from 7 percent (Ethiopia) to 59 percent (Sudan). Two countries met or exceeded 45 percent of children with suspected pneumonia treated (Afghanistan and Sudan); nine countries did not, and data was not available for four countries. All countries were low-performing on this indicator (covering less than 70 percent children with suspected pneumonia).

ORS treatment (diarrhea): In the 14 of 15 countries with available data, ORS treatment ranged from 20 percent (Chad and Sudan) to 77 percent (Bangladesh). Four countries met or exceeded 45 percent of children with diarrhea receiving ORS (Afghanistan, Bangladesh, Somalia, and Tanzania); 10 did not, and no data was available for China. All countries, except Bangladesh, were low-performing on this indicator (covering less than 70 percent children with diarrhea).

Breastfeeding: There is strong evidence demonstrating that about half of all diarrhea episodes and about one-third of respiratory infections could be averted by breastfeeding. The GAPPD target for exclusive breastfeeding within the first six months of a child's life is 50 percent coverage. Based on 2015 data, the report finds five countries met or exceeded the target (Bangladesh, Ethiopia, India, Sudan, and Tanzania). Nine of the 15 countries did not meet the target; of these, five countries met a threshold of 25 percent, half the target (Afghanistan, China, DRC, Indonesia, and Pakistan) and three did not (Chad, Niger, and Nigeria).

The report also captures the economic cost of the illnesses and sheds light on the complex relationship between childhood illnesses and poverty. Children in low-resource settings are at higher risk for illness; at the same time, pneumonia and diarrhea can contribute to the cycle of poverty.

Costs of illness can include: lost wages for families caring for sick children; the cost of healthcare, a large portion of which is often paid by families; and the long-term consequences of illnesses on children, including lost schooling and the longer-term effects of repeated or severe illness.

"While the price paid in lives remains staggering," explains O'Brien, "we are also beginning to understand the full economic cost of childhood illnesses. These costs push many families into poverty every year and underscore the need for significant and renewed efforts to fight pneumonia and diarrhea. Smart investments in child health allow countries and communities to reap an array of benefits, including reducing the likelihood of subsequent infections, reducing transmission of disease to others in the community, promoting greater educational attainment, and breaking the vicious cycle of poverty."