Pakistan makes no gains in reducing pneumonia, diarrhoea mortality

Islamabad

Year after year, pneumonia and diarrhoea mortality in young children continues to be disproportionally concentrated in 15 countries, which harbour 72% of the global burden of these diseases. Pakistan, alongside Nigeria and Congo, showed small or no changes in their GAPPD (Global Action Plan for Pneumonia and Diarrhoea) scores during 2015 and 2016, reveals the 2016 Pneumonia and Diarrhoea Progress Report. These three countries are consistently in the top four highest burden countries.

Titled ‘Reaching Goals Through Action and Innovation,’ the report was issued by the International Vaccine Access Center (IVAC) at the Johns Hopkins Bloomberg School of Public Health ahead of World Pneumonia Day, which takes place every year on November 12.

According to the report, 5.9 million children died in 2015 before reaching their fifth birthday. Of these 5.9 million deaths, pneumonia was responsible for 16% and diarrhoea was responsible for 9%, making these diseases two of the leading killers of children worldwide. Together, these diseases claimed the lives of nearly 1.5 million children under the age of five in a single year.

“Seventy-two per cent of the global burden of pneumonia and diarrhoea child deaths occur in just 15 countries, even though they are home to only 55% of the world’s under-5 population,” the report states. Between 2015 and 2016, the ranking of the 15 countries accounting for the greatest number of pneumonia and diarrhoea deaths remain unchanged. GAPPD scores improved for 12 countries: six countries realised an improvement of five or greater percentage points (India, Angola, Ethiopia, Indonesia, Niger, and Bangladesh), six countries had only a very modest change ranging from one to three percentage points (Nigeria, DRC, Afghanistan, Chad, Sudan, and Tanzania), three remained unchanged from 2015 (Pakistan, China, and Somalia).

Improved GAPPD scores were driven by new vaccine introductions and ongoing country rollouts. “It is increasingly evident that without significant gains in GAPPD scores in countries with large birth cohorts, such as India, Nigeria, Pakistan, and DRC, reduction in global pneumonia and diarrhoea mortality in children will not be achieved. The pace of progress must be accelerated to make a difference in reducing global totals, which will occur through both the increased use of recommended interventions and treatment innovations,” the report states.

The rate of uptake and scale-up of evidence-based interventions that protect against, prevent, and treat pneumonia and diarrhoea must improve for countries to meet the GAPPD goal of ending preventable childhood deaths due to pneumonia and diarrhoea by 2025, as well as the SDG 3 target of reducing under-5 mortality to at least as low as 25 per 1,000 live births by 2030. The report reveals that of the 15 countries profiled in this report, 7 have mortality rates over 25 per 1,000 live births due to pneumonia and diarrhoea alone. Pakistan had a pneumonia and diarrhoea mortality rate of 19 per 1,000 live births; pneumonia and diarrhoea deaths in children under 5 remained 103,444 in 2015.

Low GAPPD scores may result from factors such as no introduction of vaccines that can impact pneumonia and diarrhoea mortality, slow rollout of vaccines, slow uptake of interventions such as ORS, zinc or antibiotics, and challenges in changing health behaviours, specifically with regard to adopting protective and treatment measures. The coverage targets for interventions included in this report are: 90% for vaccinations; 90% for pneumonia and diarrhoea treatments; and 50% for exclusive breastfeeding.

Integrated and mutually beneficial interventions that begin at birth can protect from, prevent, and treat pneumonia and diarrhoea. These include clean air and water, vaccines, adequate nutrition and supplements, and exclusive breastfeeding in the first six months of life. It is critical to promote a set of health practices-no one intervention is enough-to prevent pneumonia and diarrhoea, especially for children without reliable access to health care and treatment. Treatments that are vital to the successful management of these childhood diseases can include appropriate use of antibiotics, oxygen, oral rehydration salts (ORS) and zinc supplements amongst others.

Vaccines have long been recognised as a cornerstone to child health and survival. There are several vaccines that are safe and effective in preventing pneumonia and diarrhoea, including pertussis, measles, Hib, pneumococcal conjugate, and rotavirus vaccines. “The target coverage rate for vaccines is 90%. In the 15 highest burden countries, vaccine coverage rates vary widely in 2015 driven by a number of factors including introduction dates, infrastructure, and political will, the report flags.

“As important as protection and prevention are for tackling pneumonia and diarrhoea mortality in children, access to appropriate treatment for children who do become sick is crucial for reducing mortality and the health, economic, and social burden of hospitalisation,” the report adds.

The top 15 countries contributing to the global burden of child pneumonia and diarrhoea deaths between 2015 and 2016 are (1) India, (2) Nigeria, (3) Pakistan, (4) DRC, (5) Angola, (6) Ethiopia, (7) Indonesia, (8) Chad, (9) Afghanistan, (10) Niger, (11) China, (12) Sudan, (13) Bangladesh, (14) Somalia, and (15) United Republic of Tanzania.