India's under-5 pneumonia-diarrhea deaths go up, action plan far off target: Report

By Rajiv Shah
A high-profile report prepared to mark the World Pneumonia Day (November 12) by a well-known US-based institute has revealed that, over the last year, there is an increase, albeit marginal, in the number of under-five deaths among children because of pneumonia and diarrhea.
Titled “Pneumonia & Diarrhea Progress Report: Reaching Goals Through Action and Innovation”, and prepared and published by the International Vaccine Access Center, at the Johns Hopkins Bloomberg School of Public Health, the 2016 report reveals that have been 296,279 deaths, as against 297,114 deaths mentioned in the 2015 report.
This suggests a considerable improvement in pneumonia and diarrhea deaths in children under five – it was 436000 deaths in the 2013 report and 318,000 deaths in the 2014 report – the report regrets, between 2015 and 2016, “The ranking of the 15 countries (including India) accounting for the greatest number of pneumonia and diarrhea deaths remain unchanged.”

No doubt, the report says, the Global Action Plan for Pneumonia and Diarrhea (GAPPD) scores improved for 12 countries out of 15 countries, with six countries realizing “an improvement of five or greater percentage points (India, Angola, Ethiopia, Indonesia, Niger, and Bangladesh)”, India’s GAPPD score remains poor.
It regrets, “India increased its (GAPPD) score by seven percentage points, although still remains with a score below 50.” India’s GAPPD score, according to the report, is 41%, which is lower than as many as 10 other countries out of 15. The countries which score better in GAPPD include Pakistan (46%), Afghanistan (51%), and Bangladesh (58%).

Under-5 deaths 15 top countries: 2016 report

“In 2016, only five of the 15 countries had overall GAPPD scores of at least 50% (Afghanistan, Sudan, Bangladesh, Ethiopia and Tanzania), and none met the 86% target for the overall GAPPD score, which would be achieved if a country met the minimal coverage targets for GAPPD interventions”, the report states, adding, “India achieved an improvement of seven percentage points, but still remained below the threshold of 50%.”
“Improved GAPPD scores were largely driven by new vaccine introductions and ongoing country rollouts”, the report says, adding, “India, the country that leads the world in under-5 pneumonia and diarrhea deaths, increased their GAPPD score by seven percentage points by continuing to roll out Hib vaccine (pentavalent) and improving exclusive breastfeeding rates.”
“It is increasingly evident that without significant gains in GAPPD scores in countries with large birth cohorts, such as India, Nigeria, Pakistan, and Democratic Republic of the Congo (DRC), reduction in global pneumonia and diarrhea mortality in children will not be achieved”, the report underlines.
“The pace of progress must be accelerated to make a difference in reducing global totals, which will occur through both the increased use of recommended interventions and treatment innovations”, it adds.
“The top 15 countries contributing to the global burden of child pneumonia and diarrhea deaths were unchanged between 2015 and 2016”, the report says, adding, “These 15 highest burden countries consist of (1) India, (2) Nigeria, (3) Pakistan, (4) DRC, (5) Angola, (6) Ethiopia, (7) Indonesia, (8) Chad, (9) Afghanistan, (10) Niger, (11) China, (12) Sudan, (13) Bangladesh, (14) Somalia, and (15) United Republic of Tanzania.”
“The pattern noted in previous editions of the Progress Report persists in 2016”, the report notes, adding, “Countries with the greatest absolute burden of child deaths from pneumonia and diarrhea have among the lowest GAPPD scores. Those countries with the largest number of under-5 pneumonia and diarrhea disease deaths, represented by the largest bubbles, are India, Nigeria, Pakistan, and the DRC. All of these countries have overall GAPPD scores below 50%.”