An eight-month-old boy with pneumonia is examined by a doctor at Amana Hospital in Dar es Salaam, Tanzania. Credit: Kristin Palitza/IPS

By Lucy Westcott
UNITED NATIONS, May 22 2013 (IPS)

PATH, a Seattle-based global health development organisation, is aiming to save two million lives by 2015 by jointly tackling diarrhea and pneumonia, the leading killers of children globally.

Steve Davis, president and CEO of PATH, delivered the message at the ninth annual PATH Breakfast for Global Health held in Seattle on Tuesday.

“Today we placed a bold stake in the ground, with partners around the world, to save two million lives by the end of 2015,” Davis told IPS.

PATH will begin its efforts in India, Cambodia and Ethiopia, where intervention is most urgently needed and PATH has resources. While all three countries have seen their child mortality rates from diarrhea drop, India’s pneumonia death rate remains stagnant, accounting for 24 percent of deaths of children under five, the same as in 2000, according to 2013 World Health Organisation statistics.

“No parent should have to bury a child because of something we can help prevent or treat,” Davis said.

Diarrhea and pneumonia are two diseases that overwhelmingly affect children in African and Asian countries, Davis said, with diarrhea claiming around 760,000 lives a year. And while the number of children dying in Africa before the age of five has decreased, it still vastly outnumbers all other parts of the world, according to the 2013 WHO statistics.

Melinda Gates, philanthropist and founder of the Bill and Melinda Gates Foundation, which helps fund health development and vaccines world wide, spoke at the breakfast of the importance of vaccinating children as well as “appropriate” science that meets the needs of communities in the developing countries.

“[The] developing world is littered with pilot programmes,” Gates said.

As he took to the stage, Davis pointed to a tool belt around his suit jacket. A visual aid, the belt allowed Davis to show and carry some of the tools that can prevent the deaths of so many children from diarrheal disease, tools that will be used to achieve PATH’s life-saving goal.

Clean water, soap, zinc tablets for oral rehydration therapy and the rotavirus vaccine, which stops some diarrheal diseases before they start, were all included.

But it’s not just science and vaccines that can improve the lives of communities ravaged by diarrhea. Deeply held cultural traditions and ideas about the disease have to be altered as well.

Dr. Alfred Ochola, PATH’s Technical Advisor for Child Survival and Development in Kenya, spoke about educating Kenyans on how to reduce the risk of diarrhea in their communities through hygiene practices like hand washing.

But Ochola, who lost a brother and sister to a diarrhea outbreak in Kenya as a child, has found that at first, people are reluctant to embrace change.

“A big [challenge] is combatting old beliefs that diarrhea is a curse and not an infection, and that the death of a child is an inevitable part of life. ‘God will give you another one’ is a common saying in Kenya,” Ochola said.

Many people believe a child who has diarrhea is cursed, Ochola said. Vomiting and diarrhea are welcomed because it rids the body of the evil inside it, while it should be taken as a sign that something is seriously wrong.

Poverty is another challenge in combatting the diseases. Although heart disease and diabetes are becoming the new illnesses of poverty, according to Davis, diarrhea and pneumonia still adversely affect children of developing countries in Africa and Asia.

In Africa and Southeast Asia, the percentage of child deaths are higher than the global average and have not significantly decreased in 10 years. Both regions have seen child mortality from diarrhea fall from 13 percent to 11 percent of deaths from 2000 to 2010, but in Africa, the rate of death from pneumonia has actually increased, from 16 percent to 17 percent.

“Too many people lack the financial means to seek care when it’s most needed, like paying for transportation to get to a health facility far from home… We often reach women and their children too late,” Ochola said.

Ochola told the story of Jane Wamalwa, a Kenyan woman who came to understand the reasons behind making a change in long-held practices in treating and preventing diarrhea. Wamalwa lost three children to the disease, and has now become a trusted source of information on good anti-diarrhea practice in her community, Ochola said.

“It has become her calling,” he added.

An eight-month-old boy with pneumonia is examined by a doctor at Amana Hospital in Dar es Salaam, Tanzania. Credit: Kristin Palitza/IPS

By Carey L. Biron
WASHINGTON, Apr 13 2013 (IPS)

The United Nations has unveiled a major framework aimed at, for the first time, coordinating worldwide efforts to work simultaneously to end childhood pneumonia- and diarrhoea-related deaths by 2025.

Together, these two diseases account for around 30 percent of all deaths of children under five years old, around two million every year. According to new data released by the World Health Organisation (WHO) and the U.N. Children’s Fund (UNICEF), most such deaths are taking place due to “piecemeal” services that are failing to reach the most at risk.

“Children who are poor, hungry and living in remote areas are most likely to be visited by these ‘forgotten killers’,” a new WHO/UNICEF report stated Friday, “and the burden placed by pneumonia and diarrhoea on families and health systems aggravates existing inequalities.”

The report comes as the agencies, backed by more than 100 global NGOs and civil society organisations, are announcing a new roadmap for national and international cooperation on the subject, called the Integrated Global Action Plan for the Prevention of Pneumonia and Diarrhoea (GAPPD). (A special issue of the medical journal The Lancet, also released Friday, covers the issue and the new action plan in depth.)

“With the release of the [GAPPD], we have a tool in place to combat these preventable illnesses once and for all,” Dr. Julio Frenk, dean of the Harvard School of Public Health, said Friday. “If we do this right, the ripple effects for equity, education and poverty reduction could be monumental.”

The new initiative goes to the heart of one of the Millennium Development Goals (MDGs), the internationally agreed development metrics. While MDG 4 requires that under-five child mortality be reduced by two-thirds by 2015 (compared to 1990 levels), progress has been deemed insufficient in several areas, including sub-Saharan Africa and South Asia.

Forgotten killers

While the action plan does not necessarily unveil any new techniques or funding mechanisms to battle pneumonia and diarrhoea, it does provide an approach that would integrate the use of already widespread interventions by multilateral, national and local actors.

“Although effective interventions have been well established, they are not always promoted together to achieve maximum benefit,” the report states.

“It is now clear that pneumonia and diarrhoea must be addressed in a coordinated manner. The determinants are often the same, hence preventive strategies and delivery platforms via health care facilities, families, communities and schools are similar.”

It is commonly known in the health field, for instance, that breastfeeding can cut down dramatically on rates of childhood diarrhoea. But new data suggests that just 39 percent of infants below six months of age are exclusively breastfed.

Likewise, slightly less than a third of children suspected to have pneumonia receive antibiotics, while only slightly more of those with diarrhoea receive cheap oral rehydration salts.

“The interventions are there already, but we now have to focus on reaching the poor and very vulnerable – those at highest risk who are often living in the hardest-to-reach areas,” George Armah, a University of Ghana researcher into causes of diarrhoea, told IPS by telephone.

“Importantly, these are things that can be done without much cost – for instance, improving vaccination coverage to these areas and improving sanitation.”

Yet while the new action plan aims at a minimum of 90 percent vaccine coverage by 2025, some are warning that high vaccine costs could make this integral part of the GAPPD approach untenable in the long term.

“Even at reduced prices, the [diarrhoea-causing] rotavirus and [pneumonia] vaccine together amount to 75 percent of the skyrocketing cost to fully vaccinate a child today. The price of the basic vaccines package has risen by an astronomical 2,700 percent over the last decade,” Dr. Jennifer Cohn, the medical director for the Access Campaign at Medecins Sans Frontieres (MSF), a humanitarian agency, said Friday.

“We are concerned that countries where we work will have the rug pulled out from under them when donor support to pay for vaccines tapers off and they are expected to foot the bill themselves. Because of the high price of new vaccines, countries may be forced to make difficult choices about which vaccines they can and can’t afford to use in order to protect children from killer diseases.”

Frontline focus

The WHO and UNICEF emphasise that the GAPPD framework puts particular focus on frontline health-care providers, particularly those operating in the smallest or remotest communities. The University of Ghana’s Armah likewise notes that much of the work necessary under the action plan will depend on those who staff community-level health posts.

“Here in Ghana, the medical programmes are now not only top-to-bottom but also bottom-to-top, and it will be important to recognise that those within the community are best placed to identify people in need of vaccinations,” he says.

“Further, while interventions are being done we absolutely have to work with people to change their habits – and recognise that we in developing countries have an important role in this. After all, if we increase vaccinations but don’t change people’s [habits], then we aren’t going to be able to bring down these problems. So we have to look at all of these things together.”

UNICEF and the WHO have set extremely ambitious goals, including reducing childhood pneumonia mortality to fewer than three per 1000 live births and diarrhoea mortality to just one per 1000 live births, both by 2025.

Yet the framework also offers a secondary set of broader goals that adhere closely to the holistic suggests Armah makes. If these were reached, their effects would go far beyond the immediate aims of ending childhood pneumonia- and diarrhoea-related deaths.

By 2030, for instance, the framework undertakes to offer universal access to basic drinking water in all homes and health care facilities. And by 2040, all homes are to have “adequate” sanitation.

In addition, the GAPPD pledges to provide universal access to clean energy technologies (smoky indoor cooking technologies being a major driver of pneumonia), as well as the “virtual elimination” of paediatric HIV, long considered one of the world’s neglected diseases.

“Implementation … will require focused interventions that make safe drinking water, sanitation, hygiene, nutrition, primary health care and health information and education available to everyone,” Harvard’s Frenk says. “The GAPPD is a key piece of the puzzle, and now is the time to make it matter.”

Nearly 2.5 billion people around the world don’t have access to sanitation. Credit: Charles Mpaka/IPS

By Isolda Agazzi
GENEVA, Nov 18 2012 (IPS)

Organisers of this year’s World Toilet Day, which falls on Nov. 19, are using the slogan ‘I give a shit – do you?’ to break the silence around the crucial issue of sanitation and remind the international community that 2.5 billion people around the world don’t have access to clean and private toilets.

Improving these figures, and achieving the Millennium Development Goal (MDG) of halving the number of people without basic sanitation by 2015, needs a change of mindset and strong political will, not financial resources, campaigners say.

“(One and a half) billion people, or 15 percent of the world’s population, are still defecating in the open. Of the MDG targets for 2015, sanitation is the furthest off track… (At) the current rate it will only be reached in 2026,” Saskia Castelein, advocacy and communications officer at the Water Supply and Sanitation Collaborative Council (WSSCC) told IPS.

This Geneva-based organisation, created by a United Nations resolution, was responsible for making sanitation an MDG target at the 2002 Johannesburg Summit on Sustainable Development.

“In the last ten years, sanitation has made a lot of progress in terms of awareness and community approaches,” Castelein continued. An increasing number of “people and organisations are working around the issue and (are using) the MDG framework to lobby governments. Now there is more money, but challenges are still enormous.”

Jack Sim, founder of the World Toilet Organisation and initiator of World Toilet Day, is of the opinion that “What we don’t discuss, we can’t improve.”

Sim has been instrumental in putting the issue of sanitation on the international agenda.

“Over the last 12 years, World Toilet Day has become an amazing movement for everyone to support better toilets and sanitation conditions around the world. It has also become a day of creativity as people all over the globe celebrate it in their own style,” he added.

Much progress has been made in India, China and other parts of East Asia, with China being the most likely to meet the goal on time.

But most of Asia and sub-Saharan Africa are still riddled with problems, with only three countries – Botswana, Cape Verde and Angola – on track.

Various studies have shown that each dollar spent on sanitation brings a return of five dollars, yet the world has been slow to make progress because, according to Castelein, the issue is surrounded by taboos.

She argues that policymakers are reluctant to bring such an “unglamorous topic” into the limelight and governments are hesitant to interfere in this most private aspect of people’s lives.

Meanwhile cultural customs and habits are compounding the problem.

“In some places, it is a social tradition to defecate in the open,” a practice that often leads to the spread of diseases like cholera and typhoid, she said.

Diarrhoeal diseases, a direct consequence of poor sanitation, are the second most common cause of death among young children in developing countries, killing more than HIV/AIDS, malaria and measles combined, and resulting in one death every 20 seconds.

Thus, experts argue, improving sanitation in the developing would also expedite the fourth MDG – improving child health and reducing under-five mortality by two-thirds in the next three years.

Reluctance to embrace modern sanitation can be solved by “a community-driven approach,” Castelein said, with development practitioners going from village to village and “training the trainers” on the importance of proper sanitation.

According to Castelein, there is no need to invest millions of dollars into building water-flush toilets all over the world – all that is needed is a global effort to promote basic hygiene by educating people about simple steps like washing their hands with ash, which is a good disinfectant.

Many people, particularly in the developing world, are unaware that sanitation was proclaimed a basic human right by the U.N. general assembly in 2010. Increased awareness of this right could push people to pressure their governments to provide proper facilities.

Campaigners also point out that proper sanitation facilities are crucial for women and girls during menstruation; according to a study by Plan India, 23 percent of Indian girls drop out of school when they reach puberty. World Toilet Day demands safe and appropriate toilet facilities to keep them in school, thus overlapping with the MDG of eliminating gender disparities in primary and secondary education.

(END)