India Tops Pneumonia-Diarrhoea Child Deaths, Gender Bias: Report

India has the highest number of pneumonia and diarrhoea child deaths in the world, according to 'Pneumonia and Diarrhea Progress Report' 2018 by the International Vaccine Access Center (IVAC). As many as 158,176 pneumonia deaths and 102,813 diarrhea deaths took place in 2016, the research revealed.

Key highlights

• Report said 70% of the global deaths continue to occur in 15 countries, including India
• Study revealed that access to vaccination and interventions in India varies substantially by gender and income
• The target, across the world, is to reach the unvaccinated and partially vaccinated to reach at least 90% children by December 2018
• India’s scores for exclusive breastfeeding and coverage of oral rehydration solution used to treat diarrhoeal disease have also declined

The report tracks efforts to bring down deaths from the two preventable diseases that killed 1.36 million under-5 children (one in four under-5 child deaths globally). While acknowledging that more children in India are getting immunised against vaccine-preventable illnesses than ever before, the report points that progress remains mixed and a lot more needs to be done to prevent illnesses among poor and marginalised children in both urban and rural areas.

With 26 million births every year, it's not surprising that India had the most pneumonia and diarrhoea deaths with 260,990 children dying in 2016, followed by Nigeria and Pakistan

• India tied with Pakistan for the seventh place among 15 countries in the Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) score.
• The score was set to rank countries on delivering key life-saving interventions such as breastfeeding, vaccination, access to care, use of antibiotics, ORS, and zinc supplementation. Tanzania topped the ranking followed by Bangladesh.

It has to be noted that India has shown improvement in child health with a decrease in under-5 mortality rate (U5-MR), from 43 in 2015 to 39 per 1,000 births in 2016. However, the study surfaced that access to vaccination and interventions in the country varies substantially by gender, geography, mother’s education and income level. 

• The U5-MR data clearly shows a gender gap in in routine immunisation coverage.
• Although there is a 9% annual drop in under-5 deaths, the U5-MR is 37 for boys and 41 for girls. This indicates how more girls continue to die of preventable causes before they turn five. Coming to low-income areas and urban slums in Delhi, only 78 girls were fully immunised for every 100 boys.
• India’s scores for exclusive breastfeeding and coverage of oral rehydration solution used to treat diarrhoeal disease have also declined.

The need to use high-quality data to meet UN’s Sustainable Development Goal

• The report recommends India to use high-quality data to ensure children are not missed. This will enable the country to meet UN’s Sustainable Development Goal target of reducing U5-MR to less than 25 per 1,000 live births by 2030.
• Understanding that vaccines are the most effective way to stop preventable deaths from infections and diseases, India vaccinated at least 106.144 lakh children under Intensified Mission Indradhanush programme in 2017-18, under the universal immunisation programme.
• Apart from the seven vaccines (tuberculosis, poliomyelitis, hepatitis B, diphtheria, pertussis, tetanus and measles) in programme, new vaccines against measles rubella, rotavirus, Hib, PCV and polio have been added along with Japanese Encephalitis vaccine for children under 15 in 112 endemic districts.

“Across India, there is lower vaccine coverage among female children in rural areas and in poor, urban areas. Improvements to full immunization coverage in India have not succeeded in closing the gender gap in coverage, as only 78 females were fully immunized for every 100 males fully immunized in poorer areas of Delhi,” the report said

The report found that even though countries are making progress toward improved vaccine coverage, they are lagging in efforts to treat childhood illnesses. The efforts are derailing especially among populations that are remote and impoverished.

Last year, the IVAC report had commended India for its Mission Indradhanush programme saying its vision towards equitable immunisation demonstrates its commitment to the nation’s health.

In a recent analysis done by Queen Mary University, London, a report revealed that India and Tonga were the only two countries in the world where the under-five mortality rate of girls is higher than boys. The research had compared under-five mortality rates of girls and boys in 195 countries.

The report does not reflect on the pneumonia vaccine introduced by India in 2017 under the universal immunisation programme. “India initiated a phased national introduction in May 2017, but no child had yet received the third dose, given at 9 months of age in 2017; thus, the estimated PCV3 coverage is zero per cent,” the report read.

According to the report, the 15 nations with the highest number of pneumonia and diarrhoea child deaths are: India, Nigeria, Pakistan, the Democratic Republic of Congo, Ethiopia, Chad, Angola, Somalia, Indonesia, Tanzania, China, Niger, Bangladesh, Uganda, and Cote d'Ivoire.

The report was released ahead of the 10th annual World Pneumonia Day on November 12, at the Johns Hopkins Bloomberg School of Public Health.

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