By 2035: Keep pneumonia, diarrhea from killing kids

BOSTON U. (US) — Researchers say the goal of ending all preventable child deaths from pneumonia and diarrhea by 2035 is achievable.

In a series of articles published in The Lancet, leading academics and public health professionals lay out an action plan that they say could offer “an unprecedented opportunity to eliminate preventable child deaths” caused by these two diseases.

Pneumonia and diarrhea claimed the lives of two million children worldwide in 2011.

A child waits to receive routine immunization at the Joe Haft Basic Health Centre, in Jalalabad City, Nangathar Province, Afghanistan. Researchers say nearly a third of episodes of severe diarrhea could be prevented by widespread vaccinations against rotavirus and cholera, and up to two-thirds of pneumonia deaths could be prevented by vaccines. (Credit: Gates Foundation/Flickr)


Among their findings are that vaccinations, zinc supplementation, breastfeeding promotion, and a dozen other key interventions could prevent the vast majority of deaths from pneumonia and diarrhea, at a projected cost of $6.7 billion over the next 12 years—less than a quarter of the estimated cost of the 2012 London Olympics.

The researchers say that despite the “huge global impact” of the two illnesses, they remain low on the list of worldwide priorities, such as HIV/AIDS.

“Our failure to get any traction on this issue is entirely due to political will. It’s not that we don’t know how to do it, or that we don’t have the tools,” says Christopher Gill, associate professor of international health at Boston University School of Public Health, who was lead author of one of the five Lancet articles.

“We hope that the series will be a call to action that encourages someone to take up the charge and own this, to make it a priority,” he adds.

The Lancet articles coincide with the release of the Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD), a UNICEF and World Health Organization publication which provides a guide for governments and their partners to plan integrated approaches for the prevention of pneumonia and diarrhea.

Africa and Asia

Together, diarrhea and pneumonia—regarded as relatively minor illnesses for most people in high-income countries—are the leading causes of death worldwide for children under age five. They account for about 29 percent of all childhood deaths, with the highest mortality among children under two years old.

The research consortium, led by Professor Zulfiqar Bhutta of Aga Khan University in Pakistan, determined that sub-Saharan Africa and southeast Asia experienced the highest burden of the two diseases, with nearly three quarters (74 percent) of deaths from diarrhea and pneumonia occurring in just 15 countries.

Although mortality rates from the diseases are falling in most areas, some countries are still experiencing increasing numbers of deaths each year, including Afghanistan, the Democratic Republic of Congo, Cameroon, Chad, and Mali.

While diarrhea and pneumonia have different symptoms and causes, the researchers said, several risk factors for the two diseases are the same, including under-nutrition, sub-optimal breastfeeding, and zinc deficiency—all of which could be “effectively prevented and treated as part of a coordinated program.”

The authors estimate that nearly a third of episodes of severe diarrhea could be prevented by widespread vaccinations against rotavirus and cholera, and up to two-thirds of pneumonia deaths could be prevented by vaccines.

In one paper, Gill and co-authors from the WHO, UNICEF, and the Clinton Health Access Initiative identified key barriers to intensifying efforts to reduce pneumonia and diarrhea mortality. In convening experts from seven countries, they found that most public health practitioners believed the diseases were considered low on the list of worldwide priorities—far below HIV/AIDS or malaria.

Just the way things are?

Gill says that part of the problem is a lack of advocacy around the two diseases.

“At some point, we decided that children should not be allowed to die of AIDS—we said it, and we did something about it,” Gill adds. “HIV/AIDS benefited tremendously from passionate advocacy by celebrities” and investments by donors.

But with pneumonia and diarrhea, “It feels like we’ve just sort of accepted that this is the way things are.”

Other barriers included inadequate training and support for health workers, poor national coordination, and sporadic availability of key commodities. For example, barely half of children with severe acute pneumonia receive antibiotics; only a third of children with acute diarrhea receive oral rehydration salts; and less than one percent of those with diarrhea receive zinc supplements.

The authors suggest that one reason why many of the barriers remain, despite being “solvable” problems, is that recent child-survival investments in low- and middle-income countries have favored technically sophisticated, expensive solutions targeting specific pathogens, at the expense of broader-based investments in health-care systems.

“The solutions to reducing childhood pneumonia and diarrhea deaths are well within our capacity” if they become priorities, the research team notes.

Easily preventable

Gill says the fact that just one percent of diarrhea cases globally are treated with zinc was “shockingly bad,” and that deaths caused by dehydration could be easily prevented, if the same kind of investments in prevention and treatment were made as with other diseases.

“How are we saying this problem isn’t solvable, when it is?” he says. “Look at HIV/AIDS – it’s much more expensive to manage, the drugs are incredibly complicated . . . It’s two orders of complexity up from giving kids zinc and some salt water.”

Bhutta, the lead author of the series, says the magnitude of the effort needed to eliminate preventable childhood deaths “should not be underestimated.” But he and other authors say the goal of drastically reducing mortality is achievable.

“Many of the interventions exist within present health systems, although their coverage and availability to poor and marginalized populations varies greatly,” say co-authors Harry Campbell and Igor Rudan, professors at the University of Edinburgh. “Despite persistent burden, childhood deaths from diarrhea and pneumonia are avoidable, and these interventions can save most of these avoidable deaths.”

Source: Boston University