Dr. Elizabeth Mason: Ending of preventable deaths from pneumonia and diarrhoea: An achievable goal. Director, Department of Maternal and Child Health WHO As presented at Launch of The Lancet Series on Childhood Pneumonia and Diarrhoea, at the Royal College of Pediatrics and Child Health - 12 April 2013 In support of the UNICEF & WHO Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea View the film accompanying the presentation at: www.wateraid.org/news/news/global-action-plan-for-pneumonia-and-diarrhoea

1. Childhood Pneumonia and Diarrhoea 4
Ending of preventable deaths from pneumonia and diarrhoea:
an achievable goal
Mickey Chopra, Elizabeth Mason, John Borrazzo, Harry Campbell, Igor Rudan,
Li Liu, Robert E Black, Zulfiqar A Bhutta

2. Countries with the largest burden of
pneumonia and diarrhoea deaths
15 countries with largest burden 15 countries with largest burden
of pneumonia deaths of diarrhoea deaths
Afghanistan
Angola
Burkina Faso
Democratic Republic
of the Congo
Ethiopia
India
Kenya
Mali
Pakistan
Niger 13 of the 15 countries with the highest pneumonia
Nigeria mortality are also among the 15 countries with the
85% of global pneumonia deaths
Sudan-precession 81% of global diarrhoea deaths
highest diarrhoea mortality. These 13 countries account
Uganda for 78% of pneumonia and diarrhoea mortality.
Source: Global, regional and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2010. The Lancet, 11 May 2012.

3. Promise Renewed: Target <20 deaths/1000 live births
for under five mortality by 2035
Under-5 mortality rate (per 1000) versus percentage of under-5
deaths attributed to pneumonia and diarrhoea in 2010
To reach this
target, reducing
deaths from
pneumonia and
diarrhoea will be
critical, especially
in countries with
higher under-five
mortality rates.

4. Proposed target: < 3 deaths/1000 from pneumonia and
< 1 death/1000 from diarrhoea
Target is global average by 2025, all countries by 2035
Aggregate reduction in cause-specific mortality across 74 Countdown countries

5. Four opportunities for further acceleration:
New
Increased
products
financial
and
resources
technology
Integrated A health
service system
delivery approach

6. New approaches reinvigorate and accelerate progress
• New vaccines for preventing pneumonia
and diarrhoea
– Hib, pneumococcal conjugate vaccines
– Rotavirus vaccines
• Improvements in case management
– Low osmolarity ORS
Diarrhoea
– Zinc supplementation
– Short course antibiotics for non-severe pneumonia
Pneumonia
– Oral amoxicillin for severe pneumonia
• New evidence on other preventive modalities
– Reduction of indoor air pollution
– Hand washing

7. Action Steps: Strengthen Global and National Leadership
Country leadership & Implementation
Key advocacy events and catalytic initiatives in support of
Every Woman Every Child
A Promise Family Planning
Born too soon
Renewed Summit
Decade of Vaccines
Innovation Working Group
Commission on Live-saving Commodities
CoIA independent Expert Review Group

8. Addressing global drivers of mortality is critical
Global drivers of pneumonia and diarrhoea mortality in the years 2000 and 2010
Prioritise
interventions
Foster
Intersectoral
Collaboration
WASH = water supply, sanitation, and hygiene

9. A multi-pronged approach is necessary
• Pneumonia and diarrhoea are caused by
multiple pathogens and no single intervention
will address the entirety of the problem.
• Multiple interventions of proven effectiveness
exist, which are complementary but not
implemented in a coordinated fashion.
• Establishing better coordination between
existing programmes can lead to synergies and
efficiencies that will maximize the benefits of
the individual interventions.

10. Strategies for preventing and treating
pneumonia and diarrhoea

11. The Integrated Global Action Plan
for the Prevention and Control
of Pneumonia and Diarrhoea

12. Protect, Prevent, Treat: a useful framework
for an integrated approach

13. Five-step process can be used to
translate evidence into policy and action
Understand disease epidemiology and intervention
packages
Understand the health system context
Understand existing investments and barriers
Establish an enabling environment
Be accountable for progress

14. Key messages
Substantial reductions in deaths due to pneumonia and diarrhoea –
but still cause 2 million deaths per year
Ending preventable deaths form pneumonia and diarrhoea is possible:
Target: < 3/1000 deaths for pneumonia; <1/1000 for diarrhoea
Scaling up cost-effective interventions can prevent 95% diarrhoeal
deaths and 65% pneumonia deaths by 2025
Five-step approach to planning and management of programmes can
rapidly lead to scale-up
The cost to achieve the goal by 2025 is about $6.7 billion