More than two million children's lives in poor countries could be saved in the next three years by focusing on pneumonia and diarrhoea, the two biggest killers of under-fives, a UN report said on Friday.
The UN Children's Fund (Unicef) report, Pneumonia and diarrhoea: tackling the deadliest diseases for the world's poorest children, said the potential for saving children's lives is huge if proven, cost-effective interventions for pneumonia and diarrhoea can be expanded to reach the most disadvantaged children.
Pneumonia and diarrhoea account for nearly one-third of the deaths among children under five globally – or more than two million lives annually. Nearly 90% of deaths from pneumonia and diarrhoea occur in sub-Saharan Africa and South Asia.
"We know what works against pneumonia and diarrhoea – the two illnesses that hit the poorest hardest," said Anthony Lake, Unicef's executive director. "Scaling up simple interventions could overcome two of the biggest obstacles to increasing child survival, help give every child a fair chance to grow and thrive."
The prevention and treatments for both diseases often overlap, and include such basic steps as: increasing vaccine coverage; encouraging breastfeeding and hand-washing with soap; expanding access to safe drinking water and sanitation; and disseminating oral rehydration salts (ORS) to children with diarrhoea and antibiotics to children with bacterial pneumonia.
The Unicef report was released before next week's global initiative on child survival in Washington. The meeting on 14-15 June is being convened by Ethiopia, India and the US, bringing together 700 leaders and global experts from government, the private sector and civil society.
One of the simplest, most effective ways to safeguard babies from disease is exclusive breastfeeding, said the report. Yet fewer than 40% of infants younger than six months of age in developing countries are exclusively breastfed, for reasons ranging from a lack of information to competing demands on a mother's time.
"Part of it is information," said Mark Young one of the report's authors, "and the mother failing to receive it from antenatal workers or after delivery. There are also competing priorities such as fetching water or firewood. We do need better policies to give the necessary support to new mothers."
Meanwhile, appropriate care for children with symptoms of pneumonia is haphazard, with less than one-third of affected children receiving antibiotics. Oral rehydration salts, a traditional, inexpensive response for children with diarrhoea, are used by only one-third of sick children in developing countries – signalling a failure to deliver a proven child survival intervention, said the report. Young said a problem has been confusion around the "messaging" about what fluids and liquids are appropriate and again a gap in knowledge in the private and public sector. But Bangladesh was cited as a country that had made strides by targeting the poorest households.
One of the first steps to increase coverage of ORS is to boost availability through manufacturing and and procurement, said Unicef, which remains one of the largest procurers of ORS, obtaining almost 600 million packets since 2000, including a new formula (low-osmolarity) since 2000. Unicef, however, said manufacturers remain slow to shift their productions to the new formula and the pace of progress needs to quickly increase.
One way of increasing uptake of ORS is to use flavoured versions. Last year, Unicef established the first long-term agreement with an African company and is working with manufacturers to increase the number of suppliers and the variety of packet sizes recommended in the essential medicines list for children.
A joint Unicef-Johns Hopkins university study last year put the cost of prevention and treatment along with water and sanitation interventions to reduce deaths from diarrhoea in 68 priority countries at $97.3bn for 2010-15.
[Impoverished girl via Sascha Burkard / Shutterstock]