Friday , May 14 2021

Diarrhea, pneumonia kills one child every two minutes in India



In 2016, nearly 261,000 Indian children died before the fifth birthday due to diarrhea or pneumonia, both preventive illnesses. This is the highest profit that has taken two diseases worldwide – one fifth of its global burden – according to a report on the progression of pneumonia and diarrhea from 2018, published on November 12, 2018, the day of the world's lungs.

This means that some 735 Indian children have died daily from any illness in 2016 – one child every two minutes. At global level, pneumonia and diarrhea cause a quarter of deaths in children under 5 years of age, and the fight against them can drastically reduce child mortality worldwide.

India has had mixed success in the prevention, control and treatment of diarrhea and pneumonia in the year to 2016: coverage of immunization has improved, but there has been a decline in treatment indicators, according to the International Center for Vaccine Access, Johns Hopkins Bloomberg School of Public Health.

This report analyzes how effectively countries provide 10 key intervention measures for the prevention and treatment of pneumonia and diarrhea – breast-feeding, vaccination, access to care, antibiotic use, oral rehydration solution (ORS) and the addition of zinc.

From 2015, the coverage of Haemophilus influenza type b (Hib) vaccine that prevents lung inflammation increased by 8 percentage points in India, according to the report. The number of children infected with rotavirus that protects against severe diarrhea and introduced in mid-2016 increased by 9 percentage points from last year's report.

In contrast, India's indicators in other treatments have reduced: ORS coverage (13 percentage points), exclusive breastfeeding (10 percentage points) and access to pneumonia (4 percentage points).

In the meantime, there has been a persistent decline in diarrhea and lung fatalities in children under five years of age – almost 7.2 percent each year for diarrhea and 6.8 percent for pulmonary disease – according to data. From 2000 to 2018 diarrheal deaths fell by 69.7 percent – from 339,937 to 102,813 – and fatalities decreased by 67 percent – from 485,094 to 158,176.

India has prevented 1 million deaths among children under the age of five between 2005 and 2015 with interventions such as timely treatment in case of diarrhea, vaccination for tetanus and esophageals and increased parental families, IndiaSpend reported in October 2017.

"India has made tremendous improvements, but it needs to be done a lot more," said Mathu Santosham, a professor, Department of International Health and Pediatrics, Johns Hopkins Universitas. "Currently, only 20 percent of children with diarrhea receive zinc supplements, the rotavirus vaccine is still not available throughout the country and PCV [pneumococcal conjugate vaccine] is developing only in six countries. "

The use of India for a pneumococcal conjugate vaccine (PCV) vaccine – against pneumococcal infections that can cause lung inflammation – started in May 2017 – was also slow, it is only included in six countries so far and no child has yet received the third dose of vaccine, the report says.

Treatment in countries with a majority of five lungs and diarrhea of ​​death

percentage of children under 5 years of age with suspicion of pneumonia

percentage of children under 5 years of age with suspected diarrhea

Global rank

Country

Appropriate health care facilities

Receiving antibiotics

Receiving ORS

Receiving zinc supplements

Goal: 90 percent

1

India

73

ON THE

21

20

2

Nigeria

24

23

37

33

3

Pakistan

64

42

38

1

4

DRC

42

40

39

2

5

Ethiopia

31

7

30

33

Source: 2018 Pneumonia & Diarrhea Progress Report

Preventive and treatment interventions could help India achieve the UN's goal of sustainable development of reducing mortality by five years to 1,000 live births by 2030. The Indian current mortality rate below five years is 39 per 1,000 live births and has a decrease of 30 percent in the number of deaths since 2012, from 1.4 to 989,000 as IndiaSpend reported in September 2018.

Neighboring Bangladesh, along with Tanzania, experienced the biggest positive change in a complex indicator of multiple interventions for controlling pneumonia and diarrhea, the report said.

Immunization, but the treatment is often wrong

India's performance in the Global Action Plan for the Prevention and Control of Lung and Diarrhea (GAPPD) – a compound result based on the aforementioned 10 indicators – has improved by one percentage point from last year to 50 percent. But this is far from the target of 86 percent that none of the 15 countries listed in the action plan has achieved. The above-mentioned nations had the highest number of deaths in diarrhea and lungs in 2016.

India is better than control and prevention of pneumonia than diarrhea: compared to the target of 84 percent for the lung, India has reached 65 percent; in the case of diarrhea, that was 39 percent compared to the target of 82 percent.

Countries with most under five lung and death diarrhea: impact on global action plan for prevention and control

Global rank

Country

2018 GAPPD

The total target value is 86%

Pneumonia * Aim 84%

Diarrhea * Aim 82%

1

India

50

65

39

2

Nigeria

30

33

27

3

Pakistan

50

63

33

4

DRC

49

64

34

5

Ethiopia

52

53

53

Medium among 15 high-load countries

50

59

36

Source: 2018 Pneumonia & Diarrhea Progress Report

This can be attributed to the fact that only 20 percent of children under 5 years of age received diarrhea from ORS salt and 21 percent received zinc – two saved interventions for the treatment of diarrhea, according to the report.

Also, more than 90 percent of diabetes treatment in childhood is not true, as IndiaSpend published on February 18, 2015. Unqualified doctors who are not familiar with relatively simple life saving drugs often prescribe antibiotics and other potentially harmful drugs, the report said.

ORS is a mixture of pure water, salt and sugar that is absorbed in the small intestine and replaces the water and electrolytes lost through the feces. Zinc supplements reduce the duration of the diarrheal episode by 25 percent and are associated with a 30 percent reduction in chairs volume, according to World Health Organization data.

"Overall, it is noticed that the coverage of immunization is increasing, but in the long run, it's not about focusing on vaccines or treatment, we must reduce death due to diarrhea and pneumonia," Santosham said.

India ranks third among children in the 15 countries (77 percent) who were taken to health facilities for the treatment of pneumonia. There were no data on how many Indian children received antibiotics to treat pneumonia.

Coverage of impacts of inequality: Girls from poor homes are the most neglected

The report also analyzes gender, wealth, motherhood and residence data to understand how socio-demographic factors in national data lead to inequality in the coverage of immunization.

This analysis revealed inequities – in India there was a lower vaccination among girls in rural areas and in poor urban areas. For example, in low-income areas in Delhi, 78 women were fully immunized for every 100 males, according to the study.

"We need to find children who are not vaccinated or treated because they are the poorest and most likely will die [of infections], "Santosham said.

However, there are initiatives that work in India. For example, the annual immunization week (April 24th and 30th) is to improve coverage in remote rural areas. Also, successful communication interventions were within the National Health Mission (NHM), India's leading health care program, including initiatives for the development of groups of health workers and community activists – to resolve the gender gap – and compensate travel to health facilities.

"This approach has successfully closed the gender gap from the basics of nearly 6 percent of the coverage coverage of immunization coverage in boys until almost no difference between boys and girls," the report said, citing a study in 2016 that measures the impact on gender and social inequalities rural health missions in Harijana.


(Iadavar is chief correspondent with IndiaSpend)


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