Between 2000 and 2015, malaria mortality rate has fallen by 60% and the number of malaria cases has fallen by 37% globally. As result, 6.2 million lives saved over the last 15 years of which 5.7 million are children under five. Over the last 15 years, the delivery of core malaria interventions has undergone an unprecedented expansion. Since 2000, one billion insecticide-treated mosquito nets have been distributed in Africa. The introduction of rapid diagnostic tests has made it possible to distinguish more quickly between malarial and non malarial fevers – enabling more timely and appropriate treatment. Artemisinin-based combination therapies (ACTs) have been highly effective against Plasmodium falciparum, the most prevalent and lethal malaria parasite affecting humans. And as we have reached more communities and people at risk for malaria with these core interventions, many more lives have been saved.
Despite tremendous progress, malaria remains an acute public health problem in many regions. In 2015 alone, there were 214 million new cases of malaria reported, and approximately 438,000 people died of this preventable and treatable disease, 70 per cent of whom are children under five, still die from this preventable disease every year. 90% of malaria deaths occur in Sub-Saharan Africa. About 3.2 billion people – almost half of the world’s population – are at risk of malaria. The disease also contributes greatly to anemia among children — a major cause of poor growth and development.
Malaria infection during pregnancy is associated with severe anemia and other illness in the mother and contributes to low birth weight among newborn infants — one of the leading risk factors for infant mortality and sub-optimal growth and development. Malaria has serious economic impacts in Africa, slowing economic growth and development and perpetuating the vicious cycle of poverty. Malaria is truly a disease of poverty — afflicting primarily the poor who tend to live in malaria-prone rural areas in poorly-constructed dwellings that offer few, if any, barriers against mosquitoes.
The insecticide treated nets provide a physical barrier against mosquitoes; also, because they are impregnated with insecticide, they can reduce the lifespan of a mosquito, decreasing the chance of it transmitting malaria to another person. Thus, ITNs provide personal protection to those sleeping under them, and once a sufficient number of people are using ITNs, they can also provide a community wide protective effect by reducing the number of mosquitoes in a community. It is therefore desirable to achieve high rates of ITN use in a population.
Immunization saves up to 3 million children each year
Vaccines keep children alive and healthy by protecting them against disease. Immunization is especially important for the hardest to reach families as it can also be a bridge to other life-saving care for mothers and children in isolated communities – such as child nutritional screening, anti-malarial mosquito nets, vitamin A supplements and de-worming tablets. Immunization is one of the most successful and cost-effective public health investments we can make for future generations.
Vaccines are protecting more children than ever before. But, in 2015, nearly one in five infants –19.4 million children – missed out on the basic vaccines they need to stay healthy. Low immunization levels compromise gains in all other areas of health for mothers and children. The poorest, most vulnerable children who need immunization the most continue to be the least likely to get it.
Almost one third of deaths among children under 5 are preventable by vaccine. UNICEF and its partners are working to change these numbers and ensure that the lives of all children are successfully protected with vaccines. But, if immunization is not prioritized, the most marginalized children will not get vaccines, which could mean the difference between life and death.
Acute diarrhoea is still a major cause of child death
Diarrhoeal diseases account for roughly 530,000 deaths a year, 9% of total deaths among children under-five years of age, making them the second most common cause of child deaths worldwide. Over half of the deaths occur in just five countries: India, Nigeria, Afghanistan, Pakistan and Ethiopia. Despite this heavy toll, progress is being made. From 2000 to 2015, the total annual number of deaths from diarrhoea among children under 5 decreased by more than 50 per cent – from over 1.2 million to half a million.
Oral rehydration salts (ORS) and oral rehydration therapy (ORT), adopted by UNICEF and WHO in the late 1970s, have been successful in helping manage diarrhoea among children. It is estimated that in the 1990s, more than 1 million deaths related to diarrhoea may have been prevented each year, largely attributable to the promotion and use of these therapies. Today, however, there are indications that in some countries knowledge and use of appropriate home therapies to successfully manage diarrhoea, including ORT, may be declining. Zinc, in addition to ORS, has shown significant improvement in shortening a child’s current episode of diarrhoea, and helping prevent against subsequent episodes.
To prevent diarrhoea mothers and other caretakers should:
– Improve hygiene through hand washing with soap, increase use of improved sources of drinking water and sanitation facilities.
– Prevent dehydration through the early administration of increased amounts of appropriate fluids available in the home, and ORS solution, if on hand
– Provide children with 20 mg per day of zinc supplementation for 10-14 days as part of the diarrhoea treatment
– Promote exclusive breastfeeding and increase breastfeeding and all feeding during and after the episode of acute diarrhea
Recognize the signs of dehydration and take the child to a health care provider for ORS or intravenous electrolyte solutions and familiarize themselves with other symptoms requiring medical treatment (e.g. bloody diarrhoea)
Promoting Public Health
Health care workers should:
- Counsel parents to begin administering suitable available home fluids immediately upon onset diarrhoea in a child.
- Treat dehydration with ORS solution (or with an intravenous electrolyte solution in cases of severe dehydration) and provide children with 20 mg per day of zinc supplementation for 10-14 days as part of the treatment
- Emphasize continued feeding or increased breastfeeding during, and increased feeding after the diarrhoeal episode.
- Use antibiotics only when appropriate, i.e. in the presence of bloody diarrhoea or shigellosis, and abstain from administering anti-diarrhoeal drugs.
- Advise mothers of the need to increase fluids and continue feeding during episodes of acute diarrhoea. Promote hygiene, sanitation and water.
- Promote and ensure adequate vitamin A supplementation.
- Ensure that the child has received the Rota virus vaccine, where available
UNICEF, WHO and other partners support these actions by:
- Leading the Global Diarrhea and Pneumonia Working Group, supporting high mortality countries in their efforts to reduce deaths from diarrhea.
- Advocating, facilitating and investing resources to ensure country adoption and implementation of these revised recommendations.
- Working with governments and the private sector, including non-governmental organizations and businesses, to rapidly disseminate and implement these recommendations.
- Ensuring adequate supplies of new ORS and zinc supplements.
- Helping with communication efforts aimed at enhancing prevention and management of diarrhoea, including promoting routine use of new ORS and zinc supplements.
- Working with countries to build local capacities to introduce and scale up the use of zinc supplementation as part of diarrhoea management.
- Working with governments to introduce Rotavirus vaccines as per GIVS recommendations.
Pneumonia is still a single leading cause of child death, killing 1 child every 35 seconds.
Pneumonia accounts for almost one million deaths every year, 922,000 in 2015 which is 16% of total deaths among children under-five years of age, 5% of which are neonatal. This makes it the single most common cause of child deaths worldwide. Despite having made some progress, a 51% decrease in pneumonia from 2000 to 2015, it is nowhere near the greater than 86% decrease in mortality from malaria-related under five mortality in the same time frame. There is still a significant road ahead to make a marked reduction in the preventable, treatable deaths due to pneumonia.
Pneumonia is the leading infectious disease killer of children worldwide; killing 2,500 children each day – more children than malaria, TB, measles, and AIDS combined. Despite causing 16% of all child deaths, pneumonia receives little attention and a tiny fraction of global public health investment – less than 2% of total global development funding for health. Despite the existence of effective tools to prevent, diagnose and treat pneumonia, most of the countries struggling with high rates of pneumonia-related deaths allocate a tiny portion of their health budgets to fighting child pneumonia. Mortality due to childhood pneumonia is strongly linked to poverty-related factors such as under nutrition, lack of safe water and sanitation, indoor air pollution and inadequate access to health care. An integrative approach to tackle this important public health issue is urgently needed.
Timely care seeking with an appropriate health care provider is one of the most important steps to saving the life of a child from pneumonia; yet, worldwide, only 3 in 5 children receive the necessary help and care. In sub-Saharan Africa, where most pneumonia deaths occur, only 2 in 5 children seek care.
Improved Pneumonia Management
- The roll-out of two recent vaccines, the Haemophilus influenzae type B (Hib) vaccine and the pneumococcal conjugate vaccine (PCV) has been the most recent preventive effort. Measles and pertussis (whooping cough) vaccines are also essential for preventing infections that can lead to pneumonia as a complication.
- Ambient and household air pollution are significant contributing factors to pneumonia mortality. Household air pollution (HAP) leads to 4.3 million deaths globally, and 13% (534,000) of these are deaths of children under 5. (WHO, CCAC, 2015). 12% of which are due to pneumonia. HAP ranks fourth in terms of the risk factors that contribute to disease and death. Exposure to household air pollution almost doubles the risk for childhood pneumonia.
- Exclusive breastfeeding for the first six months of life is an effective way to protect children from pneumonia; resulting in a 23% reduction in incidence. There is a 15.1 times greater risk of death from pneumonia if not breastfed in first 6 months.
- In addition, good nutrition for older children, adequate Vitamin A supplementation, hand-washing, clean water and good sanitation can also help protect children from pneumonia.
- Diagnosis is a key missing element in the triad, which has to be taken into consideration. Childhood pneumonia is very difficult to diagnose, especially in rural settings with limited equipment. The current WHO-recommended diagnostic sign, amongst other symptoms of fever and cough, is a rapid respiratory rate (using an AIR timer, watch or counting beads). Prompt careseeking and early, accurate diagnosis is pivotal to preventing the untimely death of children from pneumonia. Saving children from pneumonia requires urgent action and recognizing danger signs – including chest indrawing –is an important step.
- Early diagnosis and correct treatment saves children from pneumonia. According to the WHO and UNICEF Integrated Management of Childhood Illness (iCCM/IMCI) guidelines, pneumonia cases classified by a health worker should be treated with antibiotics, specifically Amoxicillin dispersible tablets (DT). In settings without adequate diagnostic tools, the WHO/UNICEF guidelines provide a common standard by which health workers can assess and classify bacterial pneumonia illness requiring antibiotic treatment. Despite the disproportionately high pneumonia-related mortality amongst the poor, there is a big gap between the rich and the poor in treatment of symptoms of pneumonia: The poorest children in the poorest countries are least likely to receive treatment when ill. This gap is particularly wide in sub-Saharan Africa and South Asia.
- The latest WHO recommendations advise for community based management of childhood pneumonia with Amoxicillin DT. Evidence shows that properly trained and supervised community healthcare workers (CHW) are capable of accurately identifying, diagnosing and treating fast breathing and chest indrawing pneumonia with antibiotics. As most primary health facility locations are relatively far apart, enabling CHWs to treat pneumonia within the community enables quicker identification and treatment. If danger signs are identified and referral is necessary, time is of the essence and the presence of oxygen therapy at the referral site is essential to saving a child from severe pneumonia.
- 36.9 million people globally were living with HIV in 2017.
- 21.7 million million people were accessing antiretroviral therapy in 2017.
- 1.8 million people became newly infected with HIV in 2017.
- 940 000 people died from AIDS-related illnesses in 2017.
- 77.3 million people have become infected with HIV since the start of the epidemic.
- 35.4 million people have died from AIDS-related illnesses since the start of the epidemic.
- Tuberculosis remains the leading cause of death among people living with HIV, accounting for around one in three AIDS-related deaths.
- Globally, adolescent girls and young women face gender-based inequalities, exclusion, discrimination and violence, which put them at increased risk of acquiring HIV.
- HIV is the leading cause of death for women of reproductive age worldwide.
- AIDS is now the leading cause of death among adolescents (aged 10–19) in Africa and the second most common cause of death among adolescents globally.
- Over 6.2 million malaria deaths have been averted between 2000 and 2015, primarily of children under five years of age in sub-Saharan Africa. The global malaria incidence rate has fallen by an estimated 37 per cent and the mortality rates by 58 per cent.
- “AIDS can be prevented. Antiretroviral drugs can extend life for many years… seldom has history offered a greater opportunity to do so much for so many.” – Former President George W. Bush, 2003 State of the Union Address, announcing the creation of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR)
What We need to do
- We can start by promoting and protecting your own health and the health of those around you, by making well-informed choices, practicing abstinence, safe sex and vaccinating your children.
- We can raise awareness in your community about the importance of good health, healthy lifestyles as well as people’s right to quality health care services.
- Take action through schools, clubs, teams and organizations to promote better health for all, especially for the most vulnerable such as women and children.
- We can also hold your government, local leaders and other decision-makers accountable to their commitments to improve people’s access to health and health care.