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HEALTH: Preventable Diseases Claim 11 Million Children Each Year

Katherine Stapp*

NEW YORK, Jul 4 2003 (IPS) - Nearly 11 million children do not live to see their fifth birthday each year due to a lethal combination of malnutrition and mostly preventable diseases, according to a new article in the Lancet journal – a catastrophe that experts say is needless.

“Every single day – 365 days a year – an attack against children occurs that is 10 times greater than the death toll from the World Trade Center,” said Jean-Pierre Habicht, a professor of epidemiology and nutritional sciences at the U.S.-based Cornell University.

“We know how to prevent these deaths – we have the biological knowledge and tools to stop this public health travesty – but we’re not yet doing it,” said Habicht, one of the child health researchers publishing a five-article “call to action” in the Lancet.

Most of the deaths are concentrated in a handful of countries. According to the Lancet, just six countries account for half of worldwide deaths of children younger than five, and 42 countries for 90 percent of deaths.

India, Nigeria, China, Pakistan, the Democratic Republic of Congo and Ethiopia alone suffer 5.5 million child deaths a year.

Altogether, about 41 percent of child deaths occur in sub-Saharan Africa, and another 34 percent in South Asia.

Habicht noted that these children are mostly killed by a few diseases, such as measles, malaria, diarrhea and pneumonia, which can be prevented or at least managed effectively. Nutrition plays a key role, with researchers reporting that malnourished children are up to 12 times more likely to die from these diseases than are well-nourished children.

“These are also the diseases that kill malnourished children, so that dealing with these diseases is a first step for well-fed children and a fall-back step for malnourished children. Preventing deaths from these diseases costs only pennies per year,” Habicht said.

Malaria remains a leading killer, with 500 million new infections every year and more than 1 million deaths annually, according to the Geneva-based World Health Organization.

Children in sub-Saharan Africa, where 90 percent of all malaria deaths occur, are by far the worst off. In fact, malaria accounts for one in five of all childhood deaths in Africa.

While drugs are available to treat the disease, the malaria parasite has evolved resistance to them in many areas. In the absence of a vaccine, health authorities have focused on eliminating the mosquitoes that transmit the malaria parasite to humans through the use of bed nets, extensive spraying of pesticides like DDT, and other methods.

Bernard Muthaka, coordinator of the Nairobi-based Population Service International Programmes, which handles malaria and diarrhoea programmes, says the use of pesticide-treated nets can slash hospital admissions for malaria by up to 40 percent. They can also lower the death rate by 25 percent.

Dr. Eustace Karo, a pediatrician based in Nairobi, agreed that prevention should focus on better nutrition and reducing human/mosquito contact. “Investing in newer research of vaccines is not worthwhile,” he argued. “We have to stress the use of treated bed nets… It is a cheap, available and effective treatment of malaria.”

Angelo D’agostino, founder of the Nyumbani Children’s Home in Nairobi, which provides shelter to abandoned HIV-positive children, supports a multi-pronged approach. “In the case of diarrhoea, good hygiene and clean water are necessary. However, vaccines remain important,” D’agostino said. “Just as vaccines wiped out smallpox and yellow fever, we need others to control the childhood deaths.”

Lancet researchers found that AIDS accounts for more than 10 percent of child deaths in just three of the 42 hardest-hit countries. However, in some smaller countries, such as Botswana and Zimbabwe, AIDS causes more than half of child deaths.

While Africa struggles under the twin burdens of malaria and AIDS, India stands alone in terms of sheer numbers, with a staggering 2.4 million children under five dying in 2000. This is three times the death toll of the second-ranked country, Nigeria.

“India spends less than one percent (of Gross Domestic Product) on health, which is grossly inadequate to meet the basic health needs of half of the country’s population of one billion people who live below the poverty line,” said Mira Shiva, of the Voluntary Health Association of India.

According to Dr. C. Gopalan, president of the Federation of Asian Nutrition Societies, more than half of children in the South Asian region as a whole are stunted.

“While there have been striking improvements with respect to child survival, this has yet to be followed up to the point of achieving optimal child health and nutrition,” said Gopalan, who heads the independent Nutrition Foundation of India.

According to the well-known nutritionist, modern technology makes it possible to “successfully apply death control strategies even in the continuing context of poverty and under-nutrition.”

However, he notes that the result of policies where the chief objective has been “child survival” rather than child health, there has been a growing pool of “substandard survivors”.

Gopalan also cited the generally poor health of pregnant women in South Asia. “Nearly 80 percent of pregnant women in this region are anemic and, even more importantly, nearly one-third of infants born to them are of low birth weight. The diets of pregnant women in poor communities in South Asia are as poor, if not even poorer, than those of non-pregnant women,” he said.

Some of the diseases killing children – such as measles and polio – can be prevented with a simple vaccine.

Japan is a major contributor to eradicating polio from the world, spending 2.5 billion dollars over the past decade on an inoculation campaign to stem the highly infectious virus.

Polio can strike at any age, but it mainly affects children under three – more than half of all cases – according to Polio Eradication, an inoculation project launched in 1988 during the World Health Assembly.

Another virus for which a vaccine exists – measles – kills nearly one million children a year, half in Africa alone. This fact makes measles the single leading cause of vaccine-preventable death among children in Africa – more than AIDS, more than tuberculosis and more than malnutrition, according to the Measles Initiative, a partnership of the American Red Cross and various United Nations agencies.

Measles is often complicated by other illnesses related to poverty. Studies in Bangladesh, the Philippines, and Uganda found that up to 79 percent of measles cases were followed by pneumonia or diarrhea, leading to a higher fatality rate.

Likewise, children with AIDS have increased susceptibility to diarrhoea, pneumonia, tuberculosis and other infections. These diseases are also deadlier for people with AIDS compared with those without AIDS.

This bleak picture could be transformed if governments committed to improving health care delivery systems, an editorial in the Lancet notes, hopefully without creating new bureaucratic structures or provoking political infighting.

“It is, however, naive to think that the research, development and implementation of new strategies can be undertaken without more resources devoted to health care, even if in the long run they will become less expensive as efficiency improves,” Habicht noted in a separate press release.

Unfortunately, international funding for health care in developing countries is flagging, he added, and Washington is proposing to spend one-third less on international maternal and child health in the next federal budget.

One bright spot is Canada, which has lately increased its support for children’s health programmes. The Canadian International Development Agency (CIDA) says it will give 143.6 million dollars to immunisation and vitamin A programmes around the world.

Vitamin A deficiency is the leading cause of preventable blindness in children and raises the risk of disease and death from severe infections. Supplements have been known to reduce mortality 50 percent for acute measles sufferers.

“We know how to prevent the deaths of millions of children,” Habicht concluded. “Now we just have to do it.”

*With contributions from Ranjit Devraj in New Delhi, Joyce Mulama in Nairobe, and Stephen Leahy in Brooklin, Canada.

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