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