Report: Pneumonia and Diarrhea Continue To Kill Hundreds of Thousands of Young Children in Many Countries

New report highlights need for additional resources and innovations to prevent and treat two common illnesses

A new report finds some progress in combatting pneumonia and diarrhea among young children in the nations most severely impacted by the two diseases, but they remain responsible for hundreds of thousands of preventable deaths around the world.

In 2015, pneumonia and diarrhea together led to one of every four deaths globally that occurred in children under five years old. These two diseases are largely preventable with vaccines and simple and inexpensive treatments.

Of the 15 countries profiled in the report – those with the highest rates of death globally due to the two diseases – seven have mortality rates of 25 per 1,000 live births or higher due to pneumonia and diarrhea alone. This translates into an estimated 450,000 deaths among children under age five in these countries.

The 2016 Pneumonia and Diarrhea Progress Report: Reaching Goals Through Action and Innovation is being issued by the International Vaccine Access Center (IVAC) at the Johns Hopkins Bloomberg School of Public Health today ahead of World Pneumonia Day, which takes place every year on November 12. IVAC began publishing its annual report in 2010 with the goal of highlighting two diseases that would, if more children received vaccinations and/or treatment, lead to fewer deaths. 

“Pneumonia and diarrhea fly under the radar,” says Kate O'Brien, MD, MPH, a professor in the Bloomberg School’s Department of International Health and IVAC’s executive director. “These illnesses are so common that many people and organizations fail to recognize the need to step up efforts and identify creative solutions to fight them. Although most cases are easily prevented and treated, they often prove deadly when families cannot access basic health services such as vaccines and antibiotic treatment.”

In the report, IVAC identifies the 15 countries with the greatest number of deaths from pneumonia and diarrhea among children under the age of five in a given year. IVAC then uses a scoring method based on the Global Action Plan for the Prevention of Pneumonia and Diarrhea (GAPPD) developed by the World Health Organization and UNICEF. A country’s “GAPPD score” measures the use of interventions that protect against, prevent and treat pneumonia and diarrhea. The higher the score, the more interventions are being used.

These interventions include vaccination, exclusive breastfeeding, access to care and use of antibiotics, oral rehydration solution and zinc to treat the illnesses. These measures are known to prevent childhood deaths due to pneumonia and diarrhea and could help achieve the United Nations’ Sustainable Development target goal of reducing under-five mortality to at least 25 per 1,000 live births by 2030.

Key report findings include:

• Overall GAPPD scores in 2016 varied widely from a low of 20 percent (Somalia) to a high of 74 percent (Tanzania), with all 15 focus countries falling below the 86 percent target for the overall GAPPD score.  In 2015, the scores varied from 20 percent (Somalia) to 72 percent (Tanzania), virtually unchanged compared to this year’s scores.
• Twelve countries improved their GAPPD scores since 2015, with Niger making the biggest gain, up 11 points. In 2015, seven countries improved their score.
• Only six of the highest-burden countries (Angola, Ethiopia, India, Niger, Sudan and Tanzania) have introduced rotavirus vaccines in their routine immunization program to help prevent a substantial portion of diarrhea deaths and hospitalizations. India introduced rotavirus vaccines in four states in 2015.
• Fifteen years after pneumococcal conjugate vaccines’ first introduction globally in 2000 (the United States was first to implement the vaccine), five of the highest pneumonia burden countries (India, Indonesia, Chad, China and Somalia) are still not using the vaccine in their routine immunization programs. India recently announced a partial introduction in five states, beginning in 2017.
• Antibiotic use to treat pneumonia in the 15 highest-burden countries varies greatly, from seven percent in Ethiopia to 64 percent in Afghanistan.
• Rates of exclusive breastfeeding during a child’s first six months of life remain low. Currently, 10 of the 15 countries with the most child pneumonia and diarrhea deaths have exclusive breastfeeding rates that still fall short of the 50 percent GAPPD target. There is strong evidence demonstrating that about half of all diarrhea episodes and about a third of respiratory infections could be averted by breastfeeding.   

The rate of death from all causes in children under the age of five years has been cut by more than half worldwide since 1990, from 91 deaths per 1,000 live births to 43 in 2015.

“The report highlights incredible progress in child health since 1990, but cautions against complacency in fighting the two leading killers of children,” O’Brien says. “We can do better, we can make better use of the tools in hand and we have great opportunities to create innovations that will save lives.”

The report was funded by the Bill & Melinda Gates Foundation. 

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Media contacts:
International Vaccine Access Center: Margaret Miller at 443-287-7812 or mmill195@jhu.edu.
Johns Hopkins Bloomberg School of Public Health: Barbara Benham at 410-614-6029 or bbenham1@jhu.edu.