In order to increase the likelihood of child survival and aim to reach the child mortality Millennium Development Goal (4), international focus needs to be on reducing deaths from pneumonia and diarrhoea; the two biggest threats to children under five. Pneumonia and diarrhoea account for over two million deaths in children under five each year; hindering any hopes in reducing overall child mortality.
The international community is focused on tackling these two diseases and is showing renewed energy and focus. In April 2013, a roundtable was held in New York, bringing together key stakeholders in the fight against pneumonia and diarrhoea.
“It was inspiring to see so many committed people in the same meeting, all working to reduce the unacceptably high number of children dying every day from these diseases,” says Dr. Karin Källander who attended the roundtable on behalf of Malaria Consortium. “We are also happy to see that integration is at the centre of all discussions; aligning policies, practices and approaches to improve access to the right care for the children most in need.”
As a result of the roundtable, it was decided that more concrete strategic planning would be made around the support for integrated approaches to pneumonia and diarrhoea interventions. Already, a pneumonia and diarrhoea working group has been set up to coordinate all partner efforts; this groups is chaired by the United Nations Children’s Fund (UNICEF) and the Clinton Health Access Initiative (CHAI).
In order to advocate for the importance of continued and improved investment in pneumonia and diarrhoea, the working group has put together a Best Practice Pneumonia and Diarrhoea Demonstration Projects product which aims to highlight the importance of and fundraise for integrated services for tackling these two diseases and suggesting feasible approaches for doing so.
According to available data (MDG Health Alliance, 2013) 10 countries have the key to achieving significant impact in reducing childhood mortality and the aim is to accelerate child pneumonia and diarrhoea mortality reduction in these countries where the largest number of deaths in children under five occur. Over 60 percent of the 1.3 million lives that can be saved as a result of interventions to address pneumonia and diarrhoea come from 10 countries; of particular interest to Malaria Consortium are Nigeria and Uganda where significant investment is being made to improve child health outcomes already.
In Nigeria and Uganda pneumonia, malaria and diarrhoea cause 361,000 and 54,000 child deaths respectively, each year. In order to achieve significant reductions in child mortality and see over 600,000 deaths prevented in both countries by 2015 it is recommended that Best Practice Projects should combine:At least 80 percent coverage of measles, pentavalent and pneumococcal vaccines and long-lasting insecticide treated nets Rates of exclusive breastfeeding, hand washing with soap and access to toilets and clean water to be at least 60 percent. 80 percent coverage of rapid diagnostic tests for malaria, oral rehydration salts and zinc for diarrhoea treatment, dispersible amoxicillin tablets for pneumonia and artemisinin combination therapies for malaria treatment. At least 80 percent coverage of community management for acute malnutrition, Vitamin A and zinc supplementation
Malaria Consortium is working in both Nigeria and Uganda to support the Governments to achieve these goals through mass Long Lasting Insecticide Treated Net campaigns and support for continuous distribution at ante-natal clinics. Furthermore Malaria Consortium is seeking to achieve these goals through extensive support to Ministries of Health in implementing Integrated Community Case Management, which sees community health workers diagnosing and treating malaria, pneumonia and diarrhoea in children under five as well as referring sick newborns and severe cases to the nearest health facility. In addition, these community health workers are trained to conduct health promotion and health education activities in their villages.
In Uganda alone, there have been impressive results in the areas where Malaria Consortium has been implementing programmes over a long period of time. In mid-Western Uganda , an area with a population of just over two million, Malaria Consortium conducted baseline and endline surveys in 2009 and 2012 respectively to measure the impact of its programmes on the health of the communities with a sample size of approximately 1560 children under five. There was a remarkable and significant increase in the number of children sleeping under an insecticide treated net the night before the survey; from 13 percent at baseline to 60 percent at midterm during programme implementation. As anticipated, the proportion dropped slightly at endline due to wear and tear over the extended time period but usage remained high at 45 percent.
Treatment seeking within 24 hours of fever onset among children aged who had a fever in the two weeks preceding the survey significantly increased from 33 percent at baseline to 57 percent at endline (49 percent of these, sought treatment from a community health worker; increased from 2 percent at baseline). Impressively, the proportion of children who took medication within 24 hours of onset of illness for pneumonia increased from 10 percent at baseline to 31 percent at endline. The number of children taking ORS and zinc in 2012 also significantly increased from 2009.
“Our impressive data from mid-Western Uganda shows that integrated approaches to reducing childhood mortality are the future of disease control, “ concludes Dr. Källander. “ Malaria Consortium believes that in order to sustain achievements in child health and make significant progress in achieving the MDGs, continued investment and support need to be focused on integrated strategies that have shown impact and potential for innovation and scale up.”
Read more about Malaria Consortium’s innovative work to support the scale up of quality ICCM at www.malariaconsortium.org/inscale