Fasten the pace of prevention

While India has made substantial strides in reducing child mortality, tackling the menace of pneumonia still poses a challenge
India leads the global mortality rate of pneumonia deaths in children under-five years of age. In 2010, 3.96 lakh children died of pneumonia in the country. This was an increase of 6.7 per cent from International Vaccine Access Centre (IVAC) data which in 2008 had pegged it at 3.71 lakh children.
According to IVAC’s latest Pneumonia Progress Report, 2012 on 15 developing countries, which account for three-quarters of the world’s total pneumonia deaths among children, only Bangladesh and Tanzania have slipped out of the worst-performing countries list. These two countries have been replaced by Mali and aggregated Sudan and South Sudan.
Pneumonia continues to be the number one killer of children around the world —causing 18 per cent of all child mortality, an estimated 1.3 million child deaths in 2011 alone, according to UNICEF figures. Nearly all pneumonia deaths occur in developing countries.
According to the IVAC report, none of the 15 countries have reached the 90 per cent Global Action Plan for Prevention and Control of Pneumonia (GAPP) target. The GAPP target was announced by the WHO and UNICEF in 2009 for interventions in three areas: vaccination, breastfeeding and access to care and antibiotic treatment. If 90 per cent of coverage is reached, these interventions could prevent two-thirds of all childhood pneumonia deaths.
India and Nigeria, two large countries with the highest number of child deaths worldwide, remain low scorers with an average intervention coverage rate of 55 per cent and 40 per cent, respectively. Only 46 per cent of children receive exclusive breastfeeding for the first six months in India. Though 69 per cent children suspected with pneumonia are taken to an appropriate health care provider, only 13 per cent receive antibiotics.
The report says that while India has made considerable stride in introducing the Hib vaccine for pneumonia and other serious infections in a few states, it still has much to do to strengthen its comprehensive approach in fighting pneumonia infection, including introduction of a pneumococcal conjugate vaccine.
India has recognised that while it made great strides in reducing child mortality over the past 20 years, cutting the under-five mortality rate nearly in half, it must accelerate progress to meet the Millennium Development Goals of reducing under-five mortality by two-thirds between 1990 and 2015. Preventing pneumonia is essential to this goal as it is the leading cause of child mortality, responsible for nearly 400,000 child deaths in 2010.
Pneumonia also causes the great burden of morbidity in India, which results in economic and social pressures on families and the country as a whole. Therefore, prevention of pneumonia is not only about saving child lives but also preventing illness, hospitalisation and related economic costs, the report points out.
One notable area of progress is on the coverage of two vaccines that can help prevent pneumonia, the Hib vaccine and the measles vaccine. While the Hib vaccine uptake has been slow in India’s public sector, the momentum is now shifting. This has been possible following efforts by the Ministry of Health and Family Welfare, states, health experts and advocates to prioritise implementation of the National Technical Advisory Group on Immunisations’s recommendation to add Hib to the Universal Immunisation Programme (UIP). Two States, Tamil Nadu and Kerala have already introduced the Hib vaccine (in the form of pentavalent vaccine) last year, and six more States will do it shortly.
As another positive signal, India has joined other WHO member states in introducing a second dose of measles vaccines into the UIP to ensure that its children are protected from the virus, which contributes to the burden of pneumonia.
Measles was once one of the leading causes of death among children, but global measles deaths have declined dramatically because of the widespread coverage of two doses of measles vaccine. India began a phased introduction of the second dose in 2010. By the end of the first year, the second dose of measles vaccine had been added to routine immunisation in 21 states and catch-up campaigns were completed in 197 districts in 14 states, according to the report.
Add Hib to the Universal Immunisation Programme. Photo: T. Singaravelou

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