Indian Academy of Pediatrics

HEALTH

India’s under-five death toll is higher than the deaths in Nigeria, Congo and Pakistan put together -‘Child Mortality Estimates Report 2012’ 

 

by Prashant Kapadia

Indian Academy of Pediatrics (IAP) is a body of 20,300 member 

Pediatricians from all regions of India. IAP is engaged in advocating, strategizing and training for measures to reduce childhood mortality and morbidity because of various childhood illnesses, amongst which Diarrhea and Pneumonia are the leading causes.

To express its role and responsibility toward the health of the children of India, and to participate in Global efforts to increase awareness about Pneumonia prevention, protection and treatment, IAP is organizing a Pneumonia Congress, with the objective of revisiting the current scenario of pneumonia deaths in the country, looking at strategies for reduction of pneumonia deaths in the community and enlisting IAP’s role in catalysing these strategies.

The congress will be attended by Pediatricians from all over the country and the science will be delivered by speakers of National and International repute as well as highly placed representatives from NRHM of the Ministry of health, and Unicef, India.

50% of worlds pneumonia deaths occur in India. 3,70,000 Indian children die due to the disease annually and 60,00,000 children are affected by it every year. It is probably the next big challenge for the country after Polio. Unfortunately, India does not have robust epidemiological data of its own about causes of Pneumonia in children in India.

Global Action Plan for the Prevention and Control of Pneumonia (GAPP), issued by WHO and UNICEF last year said that two-thirds of child pneumonia deaths globally could be prevented if children had access to seven simple interventions: prevention measures – including the use of measles, pertussis, pneumococcal and Hib vaccines, protection measures including rates of exclusive breastfeeding in the first six months of life, and treatment, namely the rates of children with suspected pneumonia being taken to a health facility and of children with pneumonia receiving treatment with antibiotics. A Pneumonia progress report, 2011, released by the International Access Vaccine Centre (IVAC) and John Hopkins Bloomberg School of Public Health in India, mentioned that, while 69% of children suspected to have pneumonia were taken to a health facility, only 13% were administered antibiotics. In vitrio resistance to co-trimoxzole is high. Case-finding and community-based management have low coverage in India due to policy and programmatic barriers. There is a significant gap in the utilization of existing services, provider practices as well as family practices in seeking care.

According to the ‘Child Mortality Estimates Report 2012’, India’s under-five death toll is higher than the deaths in Nigeria, Congo and Pakistan put together. India may miss meeting MDG4. Scaling up breastfeeding, vaccinations, and case management, as outlined in the WHO/UNICEF Global Action Plan for Prevention and Control of Pneumonia (GAPP), could save 1.2 million post-neonatal pneumonia deaths worldwide by 2015. The cost to execute that plan on a global scale is estimated at US$39 billion, US$7 billion for India. Treating pneumonia in South Asia and sub-Saharan Africa – which account for 85% of deaths – would cost around US$ 200 million.

The price includes the antibiotics themselves, as well as the cost of training health workers, which strengthens the health systems as a whole. The WHO has identified the inclusion of Pneumococcal Conjugate Vaccine (PCV) in the national immunization programs as a priority in countries where the mortality rate of children under five 5 years is more than 50 per 1,000 live births, or where more than 50,000 children die annually.  India is an ideal candidate for the inclusion of PCV in the national immunization program.

However, an effective disease surveillance system and more studies on the efficacy of newer vaccines are required before promoting PCV for universal immunization. It is estimated that as many as 3-4 million child deaths could be prevented by accelerating pneumococcal vaccines in all developing countries over the next decade. India records the highest number of child pneumonia deaths globally, but is among the only four of the 15 countries with the highest child pneumonia death toll that is yet to introduce the newest generation of pneumococcal vaccines.

IAP is a large professional body with a reputation for rationality, good academics, a real concern for the health of children, and a readiness for partnership with various agencies engaged in childcare. IAP maybe the most suitable catalyst to speed up the interventions for pneumonia prevention and treatment, so that India may progress toward achievement of MDG4 by 2015.

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