Gender, income, geography bias remain in health delivery

THE PNEUMONIA AND DIARRHOEA PROGRESS REPORT 2018, SAID 70% OF THE GLOBAL DEATHS CONTINUE TO OCCUR IN 15 COUNTRIES, INCLUDING INDIA

More children in India are getting immunised against vaccine-preventable illnesses than ever before, but progress remains mixed and a lot more needs to be done to prevent illnesses among poor and marginalised children in both urban and rural areas, according to a new report.

The Pneumonia and Diarrhoea Progress Report 2018, which tracks efforts to being down deaths from the two preventable diseases that killed 1.36 million under-5 children – one in four under-5 child deaths globally – said 70% of the global deaths continue to occur in 15 countries, including India.

With 26 million births every year, it was not surprising that India had the most pneumonia and diarrhoea deaths with 260,990 children dying in 2016, followed by Nigeria and Pakistan. What was worrying was that India tied with Pakistan for the seventh place among 15 countries in the Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) score, which ranked countries on delivering key life-saving interventions such as breastfeeding, vaccination, access to care, use of antibiotics, ORS, and zinc supplementation. Tanzania followed by Bangladesh topped the ranking.

Despite India showing improvement in child health, indicated by falling under-5 mortality rate (U5-MR), from 43 in 2015 to 39 per 1,000 births in 2016, a deeper dive into data reveals that access to vaccination and interventions varies substantially by geography, gender, mother’s education and income. The gender gap in routine immunisation coverage remains across India, which is reflected in the U5-MR data. Despite an impressive 9% annual drop in under-5 deaths, U5-MR is 37 for boys and 41 for girls, which indicates more girls continue to die of preventable causes before their fifth birthday. Even in low-income areas and urban slums in Delhi, 78 girls were fully immunised for every 100 boys.

India’s scores for exclusive breastfeeding declined, as did coverage of oral rehydration solution used to treat diarrhoeal disease, which is given only to barely 20% sick children, found the report. Along with promoting breastfeeding, increasing Haemophilus influenzae type b (Hib) vaccination, scaling up the rotavirus vaccine that was first introduced in mid-2016 against diarrhoea, and expanding the pneumococcal conjugate vaccine (PCV) beyond six states can lead to further fall in child deaths. The report recommends the use of high-quality data to ensure children are not missed and the country meets the UN’S Sustainable Development Goal target of reducing U5-MR to less than 25 per 1,000 live births by 2030.

Recognising that vaccines are the most effective way to stop preventable deaths from infections and disease, India expanded its vaccine arsenal under universal immunisation programme and vaccinated at least 106.144 lakh children under Intensified Mission Indradhanush in 2017-18.

Apart from the seven vaccines that gave the programme its name -- tuberculosis, poliomyelitis, hepatitis B, diphtheria, pertussis, tetanus and measles – new vaccines against measles rubella, rotavirus, Hib, PCV and polio have been added, along with Japanese Encephalitis vaccine for children under 15 in 112 endemic districts.

The target is to reach the unvaccinated and partially vaccinated to reach at least 90% children by December 2018.

The benefits of vaccination go beyond the immunised child. Vaccinating a critical mass of people in a community creates a “herd immunity” that protects even those who haven’t been vaccinated. In cases where a vaccine offers partial protection, such as flu vaccines, people who have been vaccinated have milder symptoms, lower chances of hospitalisation and complications, less use of potent antibiotics and anti-virals, and lower risk of death.

Apart from the direct savings on cost of treatment, the indirect gains include staying healthy, not missing school, increased productivity, better educational attainment and improved job potential, all of which lead to an improved quality of life.