Preventing childhood deaths: India performs worse than Bangladesh, "equals" Pakistan

 

A just-released study, “The Pneumonia and Diarrhea Progress Report 2018”, prepared by the International Vaccine Access Centre (IVAC) at the Johns Hopkins Bloomberg School of Public Health, has identified India among 15 other countries which are still far off the mark in achieving the targets of the Global Action Plan for the Prevention of Pneumonia and Diarrhea (GAPPD).

Set by the World Health Organization (WHO) and the United Nations International Children’s Emergency Fund (UNICEF), to be achieved by 2025, GAPPD is as an integrated approach to reduce the incidence of severe pneumonia and diarrhoea, and reduce the number of children under-five who are stunted, and end preventable childhood deaths from pneumonia and diarrhoea.
Calculated by averaging the indicator-specific target scores of all 10 indicators identified in GAPPD, the study finds that, as against the target of 86% coverage for various steps needed to be taken to be taken to achieve the GAPPD, India is just half way, 50%, which is equal to Pakistan but much below Bangladesh’s score of 64%.
The study focuses the world’s 15 countries with the highest number of pneumonia and diarrhea child deaths: India, Nigeria, Pakistan, the Democratic Republic of Congo (DRC), Ethiopia, Chad, Angola, Somalia, Indonesia, Tanzania, China, Niger, Bangladesh, Uganda, and Côte d’Ivoire.
India’s pneumonia prevention score is 65% as against the WHO-UNICEF target of 84% and diarrhea prevention score is 39% as against the target of 82%. Here, while Pakistan performs worse than India (63% and 33% respectively), Bangladesh scores much better (74% and 54% respectively).

Its GAPPD score is based on 10 major indicators -- exclusive breastfeding of infants 0–5 months, 3rd dose of diphtheria-tetanus-pertussis vaccine (DTP3), 1st dose of measles-containing vaccine Hib3 (MCV1), 3rd dose of haemophilus influenzae type b (Hib) vaccine, 3rd dose of pneumococcal conjugate vaccine (PCV3), final dose of rotavirus vaccine (RotaC), children with acute respiratory infection (ARI) taken to a health facility, children under 5 with symptoms of ARI who received antibiotics, children under 5 with diarrhea receiving oral rehydration salts (ORS), and children with diarrhea who received zinc supplements.
The study regrets, “Despite significant reductions of disease in recent years with improvements in access to and use of health interventions, nearly half a million pneumonia and diarrhea deaths still occurred in two countries – India and Nigeria.”
India’s death rate among children under 5 (per 1000 live births) is 6.3 (pneumonia) and 4.1 (diarrhea). It is much higher in Pakistan, at 11.5 and 6.8 respectively, but it is lower in Bangladesh, at 5.5 and 2.3 per 1000 live births respectively.
While the that India is one of the countries where exclusive breastfeeding target of 50% has been achieved (55%), it laments, “Aside from India, of the countries that had introduced PCV, Nigeria was the only country to have PCV3 coverage below half the target, with 33% coverage.”

The study states, “Of the seven countries where rotavirus vaccine has been introduced, the median coverage of complete rotavirus vaccine is 58%. Tanzania was the only country to meet or exceed the target level, with 97% coverage. Among countries that had introduced the vaccine as of 2017, the lowest coverage levels were in Pakistan (12%) and India (13%), both of which had recently started phased national rollouts that had not yet reached all states or provinces.”
Coming to treatment indicators, the study says, while none of the 15 countries met the target, seven of them have “coverage above half the target: Uganda (80%), Indonesia (75%), India (73%), Pakistan (64%), Niger (59%), Tanzania (55%), and Angola (49%).” It adds, “The lowest coverage was reported for Nigeria (24%).”
The study says, “From 2017 to 2018, overall GAPPD scores increased in seven countries but all increases were very small (range 1-4%) – Ethiopia (+4), Pakistan (+2), Nigeria (+2), India (+1), DRC (+1), Tanzania (+1), and Niger (+1) – and scores decreased in China (-2) and Angola (-1).”
It underscores, however, “Pneumonia scores and four countries saw declines: Angola (-5), Nigeria (-3), China (-2), and India (-1).” At the time “diarrhea scores increased in six countries – Nigeria (+8), Ethiopia (+8), Pakistan (+3), Tanzania (+2), India (+1), and DRC (+1) – and decreased in China (-2), Angola (-1), and Bangladesh (-1).”

Commenting on India, the study says, “India’s overall GAPPD score increased by one point, however, this aggregate score masks the drivers of change—both positive and negative—in the individual GAPPD indicators. Coverage for Hib and rotavirus vaccines increased by 8 and 9 percentage points. Zinc coverage was recorded as 20%.”
It further states, “Although this appears to be an improvement and impacts the country's GAPPD scores, data were unavailable last year and do not necessarily reflect a 20 percentage point increase in coverage. In contrast, the other treatment indicators decreased: ORS coverage (-13 percentage points), exclusive breastfeeding (-10), and access to pneumonia care (-4).”
“Across India”, the study underscores, “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 poor areas of Delhi.”