Has malaria been given more attention than pneumonia in the fight against child mortality? If so, why?
These are the two key questions that led an evidence-based discussion this week in Kampala, Uganda at the event ‘ROLL BACK MALARIA: ROLL BACK PNEUMONIA TOO’. The event was co-hosted by Malaria Consortium and the Bill & Melinda Gates Foundation Pneumonia Team, as part of their visit in the region to observe first-hand the country’s efforts in combating childhood pneumonia and other infections.
The debate took place at the Infectious Diseases Institute with participants from the Ministry of Health, UNICEF, Makerere University and the NGO and media sector and was moderated by Andy Hastings, Program Officer from the Global Health Strategy department at the Bill & Melinda Gates Foundation and chaired by Dr. Karin Källander, regional coordinator for the Malaria Consortium inSCALE programme in Uganda and Mozambique.
On their arrival, participants were given small remote voting devices and asked to pretend to be health advisors to international donors – and ‘decide’ if funds for malaria, pneumonia and diarrhoea should be equally distributed among the three, or if malaria or pneumonia should get the biggest share, because of their burden in terms of lives and cost of treatment.
The participants then heard from the advocates for the issue – both from Makerere University College of Health Sciences - who were invited to present their cases.
Dr. Eric Wobudeya set the stage by arguing passionately for the need to ‘roll back pneumonia now’ in order to achieve the Millennium Development Goal of reducing child mortality by two thirds by 2015.
“While malaria deaths decreased by 1.1 million during the last decade, pneumonia deaths remained at two million a year,” said Dr Wobudeya. “It’s a forgotten emergency.” To treat a child for pneumonia, up to 80 percent more resources are needed compared to malaria, he explained, but the funds – and the international attention - are simply not there. “We need a strong campaign and to re-focus our efforts.” The role of vaccines, he added, could not be stressed enough: “For pneumonia, this is the way to go – you put the money where you have the effect, and vaccines are the most effective health intervention in the history of humanity.”
Dr. Pauline Byakika then presented her case, starting with the slogan: “If you roll back malaria, you roll back pneumonia too”.
Controlling malaria means controlling correlated infections by bacteria, she said. “We have research showing that among children with pneumonia, 93 percent are also infected with malaria.” Malaria prevention and control may provide a compound benefit greater than just the reduction of malaria cases alone, she argued. Because of the costs involved, the strain of the health system, and the working days or school days lost, ultimately “controlling malaria, not only one, but even six Millennium Development Goals could be achieved”.
Dr. Mbonye from the Ministry of Health stressed the importance of giving equal attention to all and not just one of childhood diseases, as the country is now making significant progress thanks to the ICCM strategy. ICCM stands for Integrated Community Case Management and involves training of community health workers (CHWs) to assess, diagnose and treat the three major killers in children, namely diarrhoea, pneumonia and malaria. In Uganda, the CHWs within the Village Health Teams are committed volunteers, providing health care and free drugs in their own neighbourhood.
Dr. Mbonye observed: “I agree that pneumonia has been neglected, but the integration of treatment for childhood illnesses – available at community level - is key to our success. We need to talk more about pneumonia, but we need to talk more about childhood diseases in general.” His view was backed up by the final vote of the audience, with even more people supporting the idea of equal distribution of funds for malaria, pneumonia and diarrhea.
“We visited two Village Health Teams in Masaka District, and they were treating children right in their homes,” commented Saul Morris, Senior Program Officer at the Gates Foundation. “This is a very important step forward in the health system. A lot of thought has gone into designing this programme. It’s effective, it’s comprehensive, it really goes down to where the issues are. We look forward to the scale up of this programme, and also to the day when Uganda will have the pneumococco vaccine. The vaccine is an incredibly important intervention that can enormously reduce pneumonia cases, as already has been seen in Rwanda.”
Dr. Källander said after the debate: “In our projects, we want to address the constraints that currently limit community based care of childhood diseases. We recognise the positive role of the Village Health Teams in managing pneumonia cases, and we support them with new tools and the right supervision to keep them motivated. At Malaria Consortium, we know that it can be more cost-effective in addressing pneumonia, diarrhoea and malaria together”.
The inSCALE project - implemented by Malaria Consortium and funded by the Bill & Melinda Gates Foundation - and aims to make the most of Malaria Consortium’s experience in ICCM, identifying and testing new practical solutions to improve motivation and performance of Community Health Workers, such as the use of mobile phones for data collection and supervision.
It is estimated that 60 percent of the annual 10 million deaths in children under five could be prevented by the use of existing drugs and interventions, and that more than half of this reduction is made possible by community-based interventions such as ICCM. The Government of Uganda decided to adopt this strategy in 2010 and Malaria Consortium currently runs two ICCM projects in the country. As part of the advocacy component of the inSCALE project, Malaria Consortium recently took part in the joint meeting of the UK's All-Party Parliamentary Groups on Malaria and Neglected Tropical Diseases, HIV/AIDS and Tuberculosis in London, presenting the challenges faced by Village Health Teams in Uganda.
The key objective of the inSCALE project is to demonstrate that ICCM programmes – with the right support and innovations - can be scaled up rapidly, increasing health care coverage where it is most needed: at village level, where infections such as malaria and pneumonia can kill children within 24 hours of symptom onset.