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Childhood Pneumonia and Diarrhoea 4
Ending of preventable deaths from pneumonia and diarrhoea:
an achievable goal
Mickey Chopra, Elizabeth Mason, John Borrazzo, Harry Campbell, Igor Rudan,
Li Liu, Robert E Black, Zulfiqar A Bhutta
Source: Global, regional and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2010. The Lancet, 11 May 2012.
15 countries with largest burden of pneumonia deaths
15 countries with largest burden of diarrhoea deaths
85% of global pneumonia deaths 81% of global diarrhoea deaths
13 of the 15 countries with the highest pneumonia mortality are also among the 15 countries with the
highest diarrhoea mortality. These 13 countries account for 78% of pneumonia and diarrhoea mortality.
AfghanistanAngolaBurkina FasoDemocratic Republic of the Congo EthiopiaIndiaKenyaMaliPakistanNigerNigeriaSudan-precession
Uganda
Countries with the largest burden of pneumonia and diarrhoea deaths
To reach this target, reducing
deaths from pneumonia and diarrhoea will be critical, especially in countries with higher under-five mortality rates.
Promise Renewed: Target <20 deaths/1000 live birthsfor under five mortality by 2035
Under-5 mortality rate (per 1000) versus percentage of under-5 deaths attributed to pneumonia and diarrhoea in 2010
Target is global average by 2025, all countries by 2035
Proposed target: < 3 deaths/1000 from pneumonia and< 1 death/1000 from diarrhoea
Aggregate reduction in cause-specific mortality across 74 Countdown countries
Increased financial
resources
New products
and technology
Integrated service delivery
A health system
approach
Four opportunities for further acceleration:
• New vaccines for preventing pneumonia and diarrhoea
– Hib, pneumococcal conjugate vaccines
– Rotavirus vaccines
• Improvements in case management
– Low osmolarity ORS
– Zinc supplementation
– Short course antibiotics for non-severe pneumonia
– Oral amoxicillin for severe pneumonia
• New evidence on other preventive modalities
– Reduction of indoor air pollution
– Hand washing
Diarrhoea
Pneumonia
New approaches reinvigorate and accelerate progress
Family Planning
Summit Born too soon
A Promise
Renewed
Country leadership & Implementation
Decade of Vaccines
Innovation Working Group
Key advocacy events and catalytic initiatives in support of
Every Woman Every Child
Commission on Live-saving Commodities
CoIA independent Expert Review Group
Action Steps: Strengthen Global and National Leadership
Foster IntersectoralCollaboration
Prioritiseinterventions
Addressing global drivers of mortality is critical
Global drivers of pneumonia and diarrhoea mortality in the years 2000 and 2010
WASH = water supply, sanitation, and hygiene
A multi-pronged approach is necessary
• Pneumonia and diarrhoea are caused by
multiple pathogens and no single intervention
will address the entirety of the problem.
• Multiple interventions of proven effectiveness
exist, which are complementary but not
implemented in a coordinated fashion.
• Establishing better coordination between
existing programmes can lead to synergies and
efficiencies that will maximize the benefits of
the individual interventions.
Strategies for preventing and treating pneumonia and diarrhoea
The Integrated Global Action Plan
for the Prevention and Control
of Pneumonia and Diarrhoea
Protect, Prevent, Treat: a useful framework for an integrated approach
Be accountable for progress
Establish an enabling environment
Understand existing investments and barriers
Understand the health system context
Understand disease epidemiology and intervention packages
Five-step process can be used to translate evidence into policy and action
Substantial reductions in deaths due to pneumonia and diarrhoea –but still cause 2 million deaths per year
Ending preventable deaths form pneumonia and diarrhoea is possible: Target: < 3/1000 deaths for pneumonia; <1/1000 for diarrhoea
Scaling up cost-effective interventions can prevent 95% diarrhoeal deaths and 65% pneumonia deaths by 2025
Five-step approach to planning and management of programmes can rapidly lead to scale-up
The cost to achieve the goal by 2025 is about $6.7 billion
Key messages