India Among 15 Nations Tops in Child Pneumonia Deaths: IVAC Study – Breastfeeding for six months, early diagnosis and medicine, effective health delivery and smoke-free cooking could prevent the deaths in developing countries Hyderabad ,Nov 21: India, an emerging economic superpower along with China in Asia, but with below 1 per cent of its GDP spending on public health, registers the highest number of child pneumonia deaths in the world.

Yet, it has not yet introduced the new generation anti-pneumonia vaccinations (PCV 10/PCV13) in its immunization programme along with China, Indonesia and Burkina Faso which also had competed with India in recording high pneumonia related deaths.

“As many as 3- 4 million child deaths could be prevented by accelerating use of pneumococcal vaccines in all developing countries over the next decade,” says A Pneumonia Progress Report-2011 released recently by the International Vaccine Access Centre(IVAC) under the John Hopkins Bloomberg School of Public Health(USA).

The report, based on a study of 15 developing countries with disturbing incidence of Pneumonia, had also suggested a 4-pronged strategy to augment the drive to save more children from the scourge.
1. Promoting exclusive breastfeeding of the kids during their first six months of life to boost immunity to infection;
2. Facilitating early detection of symptoms to administer appropriate anti-biotics on time;
3. Strengthening health delivery systems and care on routine basis; and
4. Limiting exposure to indoor smoke by increased use of smoke free stoves.
While the governments had been making all efforts to promote breast feeding through public spending, the early detection of Pneumonia, leave alone other diseases, has become increasingly difficult in the developing world, mostly due to illiteracy, negligence and lack of awareness even among the literates until the situation goes out of hand.
The rich could afford going to the costly corporate hospitals for treatment whereas the poor approach the mostly ill-equipped government hospitals at the eleventh hour, risking the life of the kids, resulting in increasing mortality.
Notably, Indian health minister Ghulam Nabi Azad had recently announced increase of the health budget to 2 – 3 per cent of the GDP during the 12th Five Year Plan (2012-17) keeping in mind the demand for the sector as a social welfare measure.
Another major problem, also admitted by the WHO, is use of smoke emitting traditional stoves for cooking that work on fossil fuel in a majority of the rural areas in the 15 countries studied by the IVAC.
Some regional governments in India,, like Andhra Pradesh, had introduced schemes to offer gas stoves and LPG connections free of cost or on subsidies to the poor. But it had become a major burden to the exchequer in the hydrocarbon controlled economies.
India recorded the highest 371,605 child pneumonia deaths in 2008 followed by Nigeria (177,212), Congo (112,655), Pakistan (84,210), Afghanistan (80,694) and China (62,229).
Yet, there was “no action” till date on the introduction of the new generation PCV10 and PCV13 Pneumococcal Vaccines in India, China, Indonesia and Burkina Faso into the national immunization program.
Only Congo, Ethiopia and Kenya had introduced the vaccines, Nigeria, Afghanistan and Bangladesh had applied while Pakistan, Angola, Niger, Uganda and Tanzania had approved.

“The speed at which PCV10 and PCV13 are being introduced in low-income countries is unprecedented and is expected to have tremendous health impacts. It is estimated that by 2013, 11 of the15 countries profiled will have introduced the pneumococcal vaccines into their national immunization programs,” the IVAC report says.

The study also noted that only 69 per cent of children with suspected pneumonia, on par with Pakistan, were hospitalized while 13 per cent got antibiotics and only 46 per cent got exclusive breast feeding in the first six months.
Ethiopia has registered the lowest 19 per cent of its children with pneumonia sent to a health facility as also 5 per cent getting antibiotics whereas their breastfeeding rate was 49 per cent, more than India.
Uganda topped the list of 15 nations under study with 60 per cent of their kids getting breastfed in the first six months. Niger recorded the lowest 10 per cent followed by Angola 10 per cent and Nigeria 13 per cent.
China however tops the list of countries with 99 per cent of children immunized for Pertusis as also Measles in 2010, followed by Angola (91, 93) and Burkina Faso(95,94) as against India(72,74) respectively.
Quoting WHO, the IVAC report said every year, pneumonia claims more than one million children before their fifth birthday – accounting for more young deaths than AIDS, Malaria and Tuberculosis combined. This loss of life is especially tragic because pneumonia is preventable and treatable.
The World Health Assembly in 2010 resolved that all countries should make the Global Action Plan for the Prevention and Control of Pneumonia (GAPP) of the WHO and UNICEF a national priority. The IVAC had been monitoring and reporting the progress of the implementation of the interventions to combat pneumonia.
While the report noted steady increase in coverage of vaccines against Pertusis (17 per cent) and Measles (21 per cent) since the year 2000 among the 15 focus countries including India and China as against the target of 90 per cent reach, it regretted that four of these countries have yet to introduce HiB vaccine against deadly Influenza in the 20 years since its introduction.
By introducing PCV vaccines in low-income countries, faster than HiB vaccine, 158 million additional children in these countries get protected over the next decade, with hectic efforts being made through GAVI Alliance.
In December 2010, Nicaragua became the first country in the developing world to introduce the newest formulation of PCV(13), less than a year after it was introduced in the USA. Since World Pneumonia Day 2010, 23 more countries introduced it, the report claimed.
Surprisingly, India, China, Indonesia, and Burkina Faso had not yet taken any “action’ for the introduction of the new generation PCV vaccines, while Congo, Ethiopia and Kenya had already introduced them.
So is the status with India, Nigeria, China and Indonesia in non-introduction of HiB Vaccine till 2010.
“By tackling pneumonia in these 15 countries alone, we can help eliminate up to three-quarters of the world’s Pneumonia burden, and take one of the biggest steps yet toward achieving Millennium Development Goal 4, a two-thirds reduction in child mortality,” the report observed.
Source: Pneumonia Progress Report 2011.