Stop­ping the child killers

Financial Mirror (Cyprus) - - FRONT PAGE -

In far too many places around the world, the big­gest child killers are caused by the small­est of or­gan­isms – the viruses, bac­te­ria, and sin­gle cell par­a­sites that cause di­ar­rhea and pneu­mo­nia. Given the mon­u­men­tal ad­vances that have been made in pub­lic health – both diseases are pre­ventable and cur­able – this is in­ex­cus­able. It is im­per­a­tive that all chil­dren, es­pe­cially those most at risk, have ac­cess to life-saving health-care ser­vices.

Ac­cord­ing to UNICEF, pneu­mo­nia and di­ar­rhea kill a full one-quar­ter of the 5.9 mil­lion chil­dren un­der the age of five who die each year. And a new re­port from the In­ter­na­tional Vac­cine Ac­cess Cen­ter shows that nearly three-quar­ters of pneu­mo­nia and di­ar­rhea deaths oc­cur in just 15 coun­tries. In th­ese coun­tries and else­where, such deaths are most preva­lent within the poor­est and most marginalised com­mu­ni­ties.

While the fig­ures do re­flect progress in re­cent decades, the tragedy is that the im­prove­ment could have been much larger, had gov­ern­ments not con­sis­tently suc­cumbed to the temp­ta­tion to fo­cus on only one or two in­ter­ven­tions at a time. To end child deaths from th­ese diseases once and for all, gov­ern­ments must com­mit to scal­ing up si­mul­ta­ne­ously the full suite of in­ter­ven­tions iden­ti­fied by the World Health Or­gan­i­sa­tion and UNICEF two years ago, in their in­te­grated Global Ac­tion Plan for Pneu­mo­nia and Di­ar­rhea.

One crit­i­cal – and ex­traor­di­nar­ily cost­ef­fec­tive – in­ter­ven­tion is the pro­mo­tion of ex­clu­sive breast­feed­ing for the first six months of life, a prac­tice that helps sup­ports the de­vel­op­ment of a baby’s im­mune sys­tem. As it stands, in 12 of the 15 coun­tries suf­fer­ing the most child deaths from pneu­mo­nia and di­ar­rhea, ex­clu­sive breast­feed­ing rates fall short of the WHO’s 50% global tar­get.

Fur­ther­more, gov­ern­ments must en­sure that all chil­dren have ac­cess to life-saving vac­cines. Though a vac­cine for pneu­mo­coc­cal in­fec­tion – a lead­ing cause of pneu­mo­nia – was de­vel­oped at the turn of the cen­tury, it is not in­cluded in rou­tine im­mu­ni­sa­tion pro­grammes in five of the coun­tries where pneu­mo­nia is most per­va­sive (Chad, China, In­dia, In­done­sia, and So­ma­lia). This must change.

As for di­ar­rhea, a com­pre­hen­sive global study found that mod­er­ate to se­vere cases are caused pri­mar­ily by ro­tavirus, making that virus the lead­ing killer of in­fants and tod­dlers world­wide. But, though ro­tavirus vac­cines have been rolled out in 79 coun­tries – a sig­nif­i­cant ac­com­plish­ment – a stag­ger­ing 74% of the world’s in­fants re­main un­likely to be in­oc­u­lated this year. The vac­cine’s in­tro­duc­tion for In­dian in­fants next year will be a ma­jor mile­stone. But other Asian coun­tries, such as Bangladesh and Pak­istan, have not yet de­cided whether to do the same.

When chil­dren con­tract di­ar­rhea, they need ac­cess to the right treat­ments. Oral re­hy­dra­tion salts and zinc sup­ple­ments not only dras­ti­cally re­duce mor­tal­ity rates; they are also in­ex­pen­sive to scale up. In treat­ing pneu­mo­nia, ac­cess to an­tibi­otics is es­sen­tial.

The com­mon de­nom­i­na­tor among th­ese in­ter­ven­tions is the need for suf­fi­cient well­trained health work­ers serv­ing im­pov­er­ished com­mu­ni­ties. In­deed, health work­ers are needed to guide moth­ers as they at­tempt to breast­feed – which is not al­ways as easy as it sounds – and re­in­force the im­por­tance of the prac­tice. They are needed to de­liver vac­cines and treat­ments. And they are needed to dis­pense ad­vice to fam­i­lies on how to pro­tect their chil­dren from death by pneu­mo­nia, di­ar­rhea, and other diseases, in­clud­ing through in­for­ma­tion about when to seek care if they do.

Gov­ern­ments have a piv­otal role to play in en­sur­ing that the poor­est and most marginalised com­mu­ni­ties have ac­cess to crit­i­cal health ser­vices, by pro­vid­ing the right train­ing, tools, su­per­vi­sion, fund­ing, and lo­gis­ti­cal sup­port for health work­ers. This – to­gether with other crit­i­cal in­ter­ven­tions, such as the pro­vi­sion of clean wa­ter and ef­fec­tive san­i­ta­tion fa­cil­i­ties – will re­quire a strong and sus­tained po­lit­i­cal com­mit­ment, one that civil so­ci­ety and the me­dia, by keep­ing their gov­ern­ments ac­count­able, can help to se­cure.

There are still far too many

chil­dren around the world who do not have ac­cess to the es­sen­tial health ser­vices they need to sur­vive and thrive. Ac­cel­er­at­ing the dis­cus­sion of proven, low-cost meth­ods to pre­vent, treat, and cure pneu­mo­nia and di­ar­rhea is crit­i­cal to give all chil­dren the chance they de­serve. Where you live should not de­ter­mine whether you live.

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