Putting Children First in the Fight Against Pneumonia

Putting Children First in the Fight Against Pneumonia

By: Leith Greenslade

An important new report released today by the Institute for Health Metrics and Evaluation (IHME), Pushing the Pace: Progress and Challenges in Fighting Childhood Pneumonia, sheds light onto why pneumonia is still killing an estimated one million children every year, making it the leading infectious disease killer of children under five.

The report finds that international development assistance targeting pneumonia has been a very small portion of overall global health financing.

Taking a snapshot, in 2011 just 2% ($US670 million) of the estimated $US30.6 billion spent on international development assistance for health was allocated to pneumonia. Taking a longer view over the life of the Millennium Development Goals, the proportion is even lower.

According to the IHME analysis, the vast majority (80%) of the relatively small amount of pneumonia spending in 2011 was allocated to vaccines, leaving even smaller amounts to tackle the leading pneumonia risk factors for small children – low or no breastfeeding and exposure to indoor air pollution – and to improve access to better diagnostic tools, antibiotics and oxygen treatment.

These low levels of investment are in stark contrast to the proportion of all under five deaths caused by pneumonia – 14% in 2013 and up to 20% over the life of the Millennium Development Goals.

The report suggests that this underinvestment in fighting childhood pneumonia is one of the reasons child pneumonia deaths have not fallen fast enough to achieve the two-thirds reduction in child deaths required by the Millennium Development Goals and why pneumonia mortality reductions have lagged behind other disease areas, especially measles and diarrhea.

According to the IHME, child pneumonia deaths fell from an estimated 2.2 million in 1990 to 905,059 in 2013, a 58% reduction. In contrast, child deaths from measles and diarrhea fell 83% and 68% respectively, over the same period.

But the report also reveals a much lower rate of reduction across sub-Saharan Africa, which reduced child pneumonia deaths by just 14% over the period. Nigeria only saw a 4% decline in child pneumonia deaths and a number of countries including the Democratic Republic of Congo, Chad, and Cameroon actually experienced increases in child pneumonia deaths.

Why this lack of progress fighting pneumonia in so many of the African countries that have recorded child mortality reductions of up to 80% for measles, up to 70% for diarrhea, and dramatic progress in reducing mother to child transmission of HIV/AIDS?

The fact that many of the countries that have performed so poorly in reducing child pneumonia deaths have achieved remarkable reductions in reducing child deaths from other causes suggests that level of investment and disease prioritization are critical factors, and also imply a lack of integration in managing the major childhood killers in these countries.

In light of this evidence, it is clear we need a new investment strategy for the leading infectious disease killer of small children – pneumonia.

We need to mobilize more resources to protect children from contracting pneumonia by increasing vaccine, breastfeeding and clean cooking coverage, and we need to identify and treat the children who contract pneumonia with the right diagnostic technologies, antibiotics such as the amoxicillin dispersible tablet and oxygen therapy where necessary, all of which are still unavailable to the majority of children with severe pneumonia in most low resource settings.

And critically, because we know that seven out of every ten child pneumonia deaths now occur in just 15 countries, new investments need to prioritize the sub-populations of children in these 1 countries, with a special focus on sub-Saharan populations where child pneumonia deaths are actually increasing.

As the global health community debates the development of a new Global Financing Facility to mobilize the significant additional financing that is required to achieve the new goal of ending preventable maternal, newborn and child deaths by 2030, there is a major opportunity to achieve a better alignment between the major causes of child death and the allocation of development assistance for health.

If we want to close the significant MDG4 achievement gaps by 2015 and get ourselves on the right path to end preventable child deaths, we need a much closer alignment between global health financing and disease burden.

We have 400 days to course-correct. Let’s get it right for children.

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Leith Greenslade is Vice-Chair at the MDG Health Alliance, a special initiative of the UN Special Envoy for Financing the Health Millennium Development Goals in support of Every Woman, Every Child, an unprecedented movement spearheaded by the United Nations Secretary-General to advance the health of women and children.