Tag Archives: childhood mortality

Scale up diarrhoea prevention to save lives

A widespread scale up of existing low-cost and effective tools to prevent and treat diarrhoea could substantially reduce diarrhoeal deaths and could be a major step towards achieving the Millenium Development Goal 4 of reducing child mortality by 2015, according to research published in PLoS Medicine.

Depressingly, in this modern era, diarrhoea—three or more loose bowel movements a day—is still a common cause of death in developing countries and is the 2nd biggest killer of young children (under 5 years) worldwide. Poor hygiene, inadequate sanitation and lack of clean, safe drinking water all contribute to the spread of the harmful viruses, bacteria and parasites that cause diarrhoea. Now, Fischer Walker and colleagues use their Lives Saved Tool (LiST) to estimate the potential lives saved after implementing two different scale-up scenarios for key diarrhoeal prevention (breastfeeding, vitamin A supplements, basic water, sanitation, hygiene, and rotavirus vaccination) and treatment (oral rehydration salts, zinc supplementation, and antibiotics for dysentery) intervention strategies in 68 countries with high childhood mortality.

The researchers put forward two scenarios for the priority countries, which included Bangladesh, China and Haiti, for a 5-year period (between 2010 and 2015)—the “ambitious” (which assumed feasible improvement in all interventions) and the “universal” (which assumed near 100% coverage for all interventions). By 2015, diarrhoeal deaths could be reduced by 78% and 92% in the ambitious and universal scenarios, respectively. With the universal scenario, nearly 5 million deaths could be averted at an additional costs of US$0.80 per capita using some of the key diarrhoea prevention and treatment interventions (such as rotavirus vaccination and oral rehydration salts) and $3.24 per capita when all sanitation and water interventions (such as handwashing, improved sanitation and access to safe, clean water) implemented.

Fischer Walker and co-workers argue that “real progress” could be made in the treatment and management of diarrhoeal diseases if intervention strategies are made an international priority and the global health community works together to eliminate this harmful disease. Furthermore, the research acts as a pertinent reminder that we already have the technologies and interventions needed to prevent and reduce the devastating effects of diarrhoea, we just need to use them in the right scenario.

ResearchBlogging.orgWalker, C., Friberg, I., Binkin, N., Young, M., Walker, N., Fontaine, O., Weissman, E., Gupta, A., & Black, R. (2011). Scaling Up Diarrhea Prevention and Treatment Interventions: A Lives Saved Tool Analysis PLoS Medicine, 8 (3) DOI: 10.1371/journal.pmed.1000428


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Pneumonia is world’s biggest childhood killer

Pneumonia is an acute respiratory infection of the lungs caused by viruses, bacteria and fungi. Despite pneumonia being treatable and preventable, estimates suggest that over 2 million children die every year from pneumonia, making it the leading cause of childhood death worldwide.

On the 2nd November the World Health Organisation and the United Nations Children’s Fund launched the Global Action Plan for Prevention and Control of Pneumonia (GAPP) to raise awareness of the devastating death toll from pneumonia and call on governments, public health policy-makers, charities, non-governmental organisations and the public to work together to implement their action plan.

The GAPP aims to:

  • protect children from pneumonia by providing an environment with low risk of pneumonia (strategies include increasing hand-washing or providing adequate nutrition)
  • prevent pneumonia in children (with vaccinations against the microorganisms that cause it such as Streptococcus pneumonia and Haemophilus influenzae b)
  • Treat children sick with pneumonia with the correct healthcare and antibiotics.

If successful their plan could save 5.3 million children from dying of pneumonia by 2015.

A new “Health in Action” article in this week’s PLoS Medicine by Enarson and colleagues describes efforts by the government in Malawi to introduce a national programme to cut childhood deaths from pneumonia. This strategy, known as standard case management (or SCM), aims to ensure that children with pneumonia in Malawi receive effective treatment, like antibiotics and oxygen therapy.

The SCM strategy for treatment of children with pneumonia in Malawi was based on a similar programme established by the International Union against Tuberculosis and Lung Disease. This was a cost-effective health intervention that has been successfully used to prevent and control tuberculosis in 190 countries. To improve the management of severe and very severe pneumonia in children admitted to district hospitals (accessible to the whole population) the Child Lung Health Programme (CLHP) for pneumonia in Malawi focused on:

  • getting lasting commitment from the government to sustain the health programme
  • establishing diagnosis and treatment based on the SCM
  • teaching clinical staff the SCM
  • safeguarding uninterrupted supplies of standardised drugs and equipment needed for pneumonia treatment
  • recording and reporting clinical outcomes of pneumonia
  • supervising and evaluating the programme

The CLHP in Malawi has been in place since 1999 and was funded by the Malawi government and support from the Bill and Melinda Gates foundation. The CLHP was gradually scaled-up across the entire country over the next 5 years. Between Oct 2000 and Dec 2005, the CLHP successfully trained 312 health workers (including nurses and medical assistants) in SCM and there was a consistent increase in the numbers of children receiving pneumonia treatment in district and central hospitals. Furthermore, the proportion of children dying from pneumonia dropped from 18.6% to 8.4%. The CLHP is now successfully maintained by the Malawi government after the end of external funding for the project. However, there are still ongoing challenges that need to be addressed, such as a shortage of healthcare workers and the effects of malnutrition, malaria, HIV/AIDS and anaemia on the outcome of pneumonia infection.

The reduction of child mortality by two-thirds by 2015 is a major challenge set by the United Nations Millenium Development goals and programmes, like the CLHP in Malawi to reduce deaths from pneumonia, will make a significant contribution to this goal.

Enarson, P., Gie, R., Enarson, D., & Mwansambo, C. (2009). Development and Implementation of a National Programme for the Management of Severe and Very Severe Pneumonia in Children in Malawi PLoS Medicine, 6 (11) DOI: 10.1371/journal.pmed.1000137


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Diarrhoea is the 2nd biggest childhood killer worldwide

Diarrhoeal disease is a significant global health problem. Every year there are ~4 billion cases, and 2.5 million deaths, from diarrhoea. Most of these cases are in developing countries, and the sad fact is each year 1.5 million children under five die from diarrhoea (that’s more than the childhood deaths caused by AIDS, malaria and measles combined). This makes diarrhoea the 2nd biggest killer of under fives globally. That’s 1.5 million under fives dying from a disease that can be easily, and cheaply treated, and in developed countries it is thought of as nothing more than the squits.

On 14th October, UNICEF and WHO published a new report “Diarrhoea: why children are still dying and what can be done” as part of a strategy to try and boost global efforts to fight childhood diarrhoea. Bacteria (such as Shigella and Vibrio cholerae), parasites (such as Crpytosporidium) and viruses (such as Rotavirus) all cause diarrhoeal disease. They are often spread in contaminated, dirty water via a faecal-oral route of transmission (that’s pathogens in faeces from one person transferred, via contaminated water or food, to the mouth). Also, limited access to medical care and malnutrition can make the burden of the disease worse. So, they’ve come up with a 7-point plan to treat and prevent childhood diarrhoea.

This plan is to:

  1. replace lost fluids to prevent dehydration (using the new improved low-osmolarity oral rehydration solution)
  2. include zinc treatment for diarrhoea (it reduces the severity and duration of diarrhoea, as well as reducing the likelihood of getting it again)
  3. rotavirus and measles vaccination
  4. promote exclusive breastfeeding (breastmilk is nutritious and provides crucial antibodies for infants to survive and develop) and vitamin A supplementation (it reduces childhood mortality and reduces the severity, duration and complications associated with childhood diarrhoea)
  5. promote handwashing with soap (this helps break the faecal-oral transmission route and reduces the incidence of diarrhoea by over 40%)
  6. improve access to clean water; improving the supply and quality as well as promoting safe household water treatment (including chlorination, filtration and solar disinfection) and storage
  7. promote sanitation in communities; especially approaches to change people’s attitudes to reduce open defecation (1.2 billion people practice open defecation worldwide)

This 7-point plan needs to be put in place in areas where it is needed the most; 80% of deaths from childhood diarrhoea occur in Africa and South Asia, with almost three quarters of these deaths in only 15 countries (the top four with the highest deaths from childhood diarrhoea are India, Nigeria, Democratic Republic of Congo and Afghanistan). Hopefully this 7-point plan will inspire governments, charities and non-governmental organisations to reduce childhood deaths from diarrhoea and help meet the Millennium Developmental Goals 4 (to reduce childhood mortality by two-thirds by 2015) and 7 (halve the number of people without access to safe drinking water and sanitation).

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