Pneumonia and diarrhoea are two leading causes of death in children under the age of five worldwide. And earlier this month, marking World Pneumonia Day, the Pneumonia & Diarrhea Progress Report was released by the International Vaccine Access Center (IVAC) at the Johns Hopkins Bloomberg School of Public Health.

The report is significant not only because it presents alarming statistics of the 15 highest burden countries, but also since it calls for urgent, accelerated, and coordinated efforts from stakeholders across countries for an integrated approach to combat child deaths on these counts.

It is important to collect reliable data, regularly, through collective measures, since it helps identify problems and keep a close eye on monitoring progress. And more importantly, it helps ensure that efforts are targeted, especially at children and regions that need it the most.

The World Health Organization (WHO) estimates over 50 million cases of pneumonia in children under age 5, including 20 million cases that require hospitalisation. Most of the morbidity and mortality worldwide due to pneumonia occurs in low- and middle-income countries (LMICs).

The 15 countries highlighted in this year’s report are struggling to inch towards their Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) targets. Immunisation coverage for five key childhood vaccines scored the highest and saw the most consistent performance for the majority of countries, while treatment indicators were the lowest performing measures. In comparing performance on pneumonia and diarrhoea indicators, the median GAPPD pneumonia score was over 20 points greater than the median GAPPD score for diarrhoea, at 59 per cent and 36 per cent, respectively — suggesting that countries are doing better in providing pneumonia prevention and treatment than in the case of diarrhoeal disease.

Across India there is lower vaccine coverage among female children in rural areas and in poor urban areas. Improvements to full immunisation have not succeeded in closing the gender gap in coverage, as only 78 females were fully immunised for every 100 males.

Globally, pneumonia and diarrhoea together led to one of every four deaths that occurred in children under five in 2016.

The solution to this problem is as simple as exclusive breastfeeding for six months, hand-washing, safe drinking water, vaccines and appropriate treatments. However, the children most at risk — in poor settings or hard-to-reach communities — don’t receive these interventions. Only a third of children who fall sick with diarrhoea receive the right care, for example.

Evidence-based intervention

Also, Rotavirus, which predominates in diarrhoea, doesn’t get disinfected easily with the usual disinfectants and affects rich and poor equally — hence it is called a democratic virus. It is very important that we ensure equity in immunisation coverage which will be driven by a number of factors, including sociocultural influences like gender equality, poverty and cross-cutting factors like education. India recently sanctioned Rotaviral vaccine (which is indigenously produced) for all babies in India and Pneumococcal vaccine has been sanctioned under GAVI in four States with highest mortality from pneumonia since May 1, 2017, on pilot basis. Finally we seem to be on track to control these 18 years after the vaccination became available in the world.

We need to continue investing to identify and deliver evidence-based interventions — vaccines, treatment, and programmes to ensure that children get a good start in life.

Without that, we risk losing the gains we've made in improving the health and lives of children. These diseases must be addressed if we are to move the needle significantly in achieving the MDG4 as well as successful implementation of the “Every Woman Every Child” movement towards the goals of the UN Global Strategy for Women’s and Children’s Health, and “A Promise Renewed” commitment to child survival.

The writer is Chairman and Neonatologist, Cloudnine Group of Hospitals. He is also the National coordinator, Accreditation Committee, National Neonatology Forum. Views are personal

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