One is too manyEnding Child Deaths from Pneumonia and Diarrhoea

Key Findings2016

© UNICEF/UNI193975/MACKENZIE

ENDING PNEUMONIA AND DIARRHOEA DEATHS IS WITHIN OUR GRASP

Pneumonia and diarrhoea are responsible for the unnecessary loss of 1.4 million young lives each year and are a threat to sustainable development for the world’s poorest nations.

But we have the knowledge and the tools to do better. Child deaths due to diarrhoea and pneumonia are largely preventable – even one death is too many.

The fact that children continue to die from these diseases is a reflection of deep inequalities. UNICEF’s global report, One is too many: Ending Child Deaths from Pneumonia and Diarrhoea, makes the case for renewed efforts to tackle an age-old problem.

The report provides an overview of the coverage of high impact protective, preventive and treatment interventions, illustrating the startling

divide between those being reached and those children being left behind. The report also looks forward to project the potential lives saved by scaling up effective interventions in the context of the 2030 development agenda, and provides recommendations to guide policy action at the national level.

Read the full report at: uni.cf/oneistoomany

Low and lower-middle income countries are home to 62 percent of the world’s under-5 population, but account for more than 90 percent of global pneumonia and diarrhoea deaths.

High-income

Upper-middle-income

Lower-middle-income

Low-income

10%

28%

47%

15%

<1%

9%

60%

32%

<1%

10%

59%

31%

Percentage of children under 5 represented in each income group

Percentage ofdiarrhoea deaths

Percentage ofpneumonia deaths

Pneumonia and diarrhoea deaths disproportionately concentrated among the poor

Percentage distribution of population of children under age 5 and distribution of deaths attributed to diarrhoea and pneumonia by income levelsSource: Population of children under age five : United Nations Population Division WPP 2015 Rev.; Cause of death: WHO and Maternal and Child Epidemiology Estimation Group (MCEE) estimates 2015; Income levels: World Bank Income classification 2016

1 out of 6 childhood deaths were due to pneumonia in 2015

920,000 childhood deaths per year

2500childhood deaths perday

100 childhood deaths per hour

1 childhood death per 35 seconds

This translates to:

1 out of 10 childhood deaths were due to diarrhoea in 2015 This

translates to: 526,000

childhood deaths per year

1400childhood deaths perday

60 childhood deaths per hour

1 childhood death per 60 seconds

1 in 4 deaths

among children under 5 is caused by either pneumonia or diarrhoea

NO CHILD NEEDS TO DIE FROM PNEUMONIA AND DIARRHOEA

Pneumonia

Diarrhoea

Malaria

Sepsis

Pertussis, tetanus,meningitis

Measles

AIDS

1.7

1.2

0.7

0.5

0.5

0.5

0.2

0.9

0.5

0.3

0.4

0.2

0.1

0.1

20152000Percentage declineDeaths of children

under age 5 in millions

20152000

58%

25%

59%

85%

61%

47%

57%Deaths from these two diseases declined by nearly half between 2000 and 2015, from 2.9 million deaths to the current 1.4 million. But this rate is still low compared with declines in other common childhood illnesses during this time.

PROTECT

children by

establishing good

health practices

from birth

PREVENT

children becoming ill

from pneumonia and

diarrhoea

TREATchildren who are

ill from pneumonia

and diarrhoea

REDUCE pneumonia and diarrhoea morbidity and mortality

Exclusive breastfeedingfor 6 months

Adequate

complementary feeding

Vitam

in A

supp

lemen

tation

Vaccines: pertussis, measles,

Hib, PCV and rotavirus

Handwashing with soap

Safe drinking water and sanitation

Reduce household air pollutionHIV prevention

Co-trimoxazole prophylaxis for

HIV-infected and exposed children

Continued feeding (including breastfeeding)

Supplies: low-osmolarity ORS,

zinc, antibiotics and oxygen

Case management at the health facility

and community level

Improved care seeking and referral

Pneumonia and diarrhoea deaths are dropping – but not quickly enough

We can end most diarrhoea and pneumonia deaths with a set of tried and tested interventions

Reductions in child mortality for common childhood illnesses, 2000-2015Source: WHO and Maternal and Child Epidemiology Estimation Group (MCEE) estimates 2015

Around half of childhood pneumonia deaths are associated with air pollution. The effects of indoor air pollution kill more children globally than outdoor air pollution. At the same time, around 2 billion children 0-17 live in areas where outdoor air pollution exceeds international guideline limits.Source: Clean the air for children, UNICEF, 2016

FACT:

Protect, Prevent and Treat Framework: The Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea sets forth an integrated framework of key interventions.

FOCUS ON PNEUMONIA

Child pneumonia deaths are concentrated in the poorest regions

0

25

50

75

100

World^Least developed countries

West and Central Africa

Sub-Saharan Africa

Eastern and Southern Africa

Middle East and North Africa

South Asia* East Asia and the Pacific**

Poorest

Richest

6367

72 70 70 72

6569

32

39

47 49

5661

4247

Per

cen

t

Globally, children in the richest households are most likely to be taken for care for their pneumonia symptoms

Percentage of deaths among children under age 5 attributable to pneumonia, 2015Source: WHO and Maternal and Child Epidemiology Estimation Group (MCEE) provisional estimates 2015

Percentage of children with symptoms of pneumonia taken for care to a health provider, by wealth quintile and region, 2015Source: UNICEF Global databases 2016 based on DHS and MICS. *Excludes India, **Excludes China, ^Excludes India and China. Estimates for year 2015 include data for the 2010-2015 period. Global estimates include 49 countries covering 56% of the underfive population in 2015 (excluding China and India for which data was not available).

FOCUS ON DIARRHOEA

World^Least developedcountries

East Asia andthe Pacific**

South Asia*West andCentral Africa

Eastern andSouthern Africa

Sub-SaharanAfrica

0

25

50

75

100

Per

cen

t Rural

Urban

36

42

26

35

42

48

30

40 33

41

22

31

53 55

45 42

33

38

32

45

31

52 49

44 43

39

49

41

2000

2015

2000

2015

2000

2015

2000

2015

2000

2015

2000

2015

2000

2015

Diarrhoea claims the lives of the world’s most vulnerable children

Percentage of deaths among children under age 5 attributable to diarrhoea, 2015Source: WHO and Maternal and Child Epidemiology Estimation Group (MCEE) provisional estimates 2015

Diarrhoea treatment with ORS is becoming more equal between urban and rural households – but coverage levels are still unacceptably low across almost all regions

Percentage of children under 5 with diarrhoea receiving oral rehydration salt solution, by residence. 2000 and 2015Source: UNICEF global databases 2016 based on MICS, DHS and other nationally representative sources. Note: Global estimates are based on a subset of 70 countries, covering 50% of population under five 2015 in urban areas and 79% in rural areas. Regional estimates represent data from countries covering at least 50% of regional under five population.

CEE/CIS

Latin America andthe Caribbean

East Asia andthe Pacific

South Asia

Middle East andNorth Africa

West andCentral Africa

Eastern andSouthern Africa

-

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

0 25 50 75 100

Per

cen

t o

f u

nd

er-fi

ve d

eath

s d

ue

to d

iarr

ho

ea

Per cent of population with improved sanitation facilities

Relationship between population with improved sanitation facilities and under-5 deaths due to diarrhoea

About the graph:• The size of each bubble represents the number of deaths caused by diarrhoea annually among children under 5 in the given

country or area in 2015. The horizontal axis shows the percentage of population using improved facilities. The vertical axis shows the percentage of under-five deaths caused by diarrhoea in the given country.

WE KNOW WHAT WORKS: PROTECT, PREVENT AND TREAT

Improveddrinking

water

Improvedsanitation

facilities

Careseekingfor pneumonia

Measlesimmunization

Vitamin A supplementation

Exclusivebreastfeeding

World

CEE/CIS

Latin America andthe Caribbean

East Asia andthe Pacific

South Asia

Middle East andNorth AfricaSub-SaharanAfrica

Diarrhoeatreatmentwith ORS*

Hib3immunization

DTP3 immunization

250 50 75 100

PREVENT

PROTECT

TREAT

PCV3

43

69

86

85

64

37

68

91

63

41

Per cent

Countries with improved sanitation facilities have fewer childhood diarrhoea - related deaths

Yet, too few children are benefiting from the key protective, preventative and treatment interventions that save lives

Global coverage of effective interventions, 2015Source: UNICEF global databases 2016, WHO/UNICEF estimates of immunization coverage 2015, WHO/UNICEF JMP estimates 2015

THERE IS GREAT POTENTIAL TO SAVE LIVES WITH HIGH COVERAGE OF THE MOST EFFECTIVE INTERVENTIONS

Over 12 million children’s lives could be saved by 2030 by scaling up protect, prevent and treat interventions to 90 percent

We need greater targeted financial investments to make this happen; yet pneumonia and diarrhoea continue to receive only a fraction of global health investments

0

3

6

12

9

15

Total U5 pneumonialives saved

Total U5 diarrhealives saved

Total U5 livessaved

TreatPreventProtect

Mill

ion

s

0

5000

10000

15000

20000

25000

30000

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Mill

ions

of

cons

tant

201

3 U

SD

Estimated disbursements for diarrhoea & pneumonia

Child health disbursements

ODA+ to health

Estimated lives saved (2015 to 2030) from scaling up protect, prevent and treat interventionsSource: Johns Hopkins University, Lives saved estimates using the Lives Saved Tool (LiST), October 2016

Trends in disbursements targeting diarrhoea and pneumonia relative to child health disbursementsSource: Estimates based on the Countdown to 2015 dataset on ODA+ for reproductive, maternal, newborn, and child health.

• Healthy children are the foundation of robust economies and thriving communities and nations; they are the lifeblood of sustainable development. But without greater investments from governments and partners, two of the most preventable and easily treatable childhood illnesses will thwart the achievement of the SDGs, particularly Goal 3 on ending preventable child deaths and reducing mortality.

• Targeted funding to scale up effective in-country programme implementation will be critical in driving progress towards the 2030 SDG agenda.

Implement protect, prevent and treat interventions and allocate targeted national and donor financing.

Invest in front line health services, including community management, to reach vulnerable populations and ensure rapid assessment and treatment.

Improve household survey data collection, health management information systems

TOWARDS A WORLD WHERE NO CHILD DIES OF PNEUMONIA AND DIARRHOEA

© 2016 United Nations Children’s Fund (UNICEF)

data@unicef.org | www.unicef.org

For the full report including references, indicators and definitions, please visit: uni.cf/oneistoomany

This brochure was prepared by UNICEF’s Data & Analytics Section, Division of Data,

Research, and Policy in collaboration with Health Section, Programme Division.

We need coordinated efforts to:and vital registration to better estimate the burden of diarrhoea and pneumonia and monitor treatment.

Guarantee access to essential commodities – such as ORS and zinc for diarrhoea; and medical oxygen and Amoxicillin dispersible tablets for pneumonia.

Leverage tools and innovations to increase coverage in hard to reach places.

Faster progress to end pneumonia and diarrhoea deaths is critical to achieving the Sustainable Development Goals

© U

NIC

EF/

UN

I991

08/D

OR

MIN

O