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A step towards achieving MDG 4- IAP Mission Uday

Nov 15, 2012

On the occasion of World Pneumonia Day, celebrated on 12th November every year, paediatricians CP Bansal and Naveen Thacker, President Elect and past President of the Indian Academy of Pediatrics ( IAP) respectively, argue for a comprehensive approach to tackling pneumonia, that accounts for 18 of every hundred children dying from the ailment.

High under-five childhood mortality in India exists despite a series of national health programs committed to improve child survival. It is estimated that India contributes to over 20 per cent of the world'sunder-five deaths. This is further compounded by the fact that decline in child mortality has not been uniform across all states over the years.

Why does child mortality continue to be high? The main causes of deaths in low-income countries are pneumonia, diarrhoea, Measles, malaria, HIV/AIDS,and for deaths among the neonates asphyxia, pre-term delivery, sepsis and tetanus. Pneumonia (18 per cent), diarrhoea (15 per cent) and malaria (eight per cent) remain the biggest killers.

The term pneumonia and Acute Respiratory Infection (ARI) are often interchangeably used to describe lower respiratory infection in many studies. India's National Family Health Survey reports an overall ARI prevalence of 5.8 to 19.0 per cent among children aged below five years. A research paper estimates as many as 44 million cases a year in India alone. WHO and UNICEF have estimated that approximately 408,000 under-five deaths in India are contributed by pneumonia . The modelling analysis of data from 193 countries calculated that pneumonia contributes 18 per cent of a total of 8.795 million under-five deaths. In India, pneumonia is the single most important cause of death among children in the post-neonatal period, contributing as much as 27.5 per cent of total under-five mortality according to one estimate.

On May 25, this year, the World Health Assembly (WHA) discussed the Global Vaccine Action Plan (GVAP) and its accompanying resolution. At the end of the discussion, all 194 member states voted to endorse the GVAP resolution.They committed to apply the GVAP vision and the strategies to develop thevaccines and immunization components of their national health strategy and plans, to allocate adequate human and financial resources to achieve the immunization goals, and to report back every year to the Regional Committees on progress made. Two other resolutions related to immunization (one to formally designate the last week of April each year as World Immunization Week and another to declare the completion of Polio virus Eradication a Programmatic Emergency for Global Public Health) were also both endorsed by the Assembly.

In a bold move to build global political will, boost support and identify clear and practical solutions for child survival, the governments of US,India and Ethiopia convened a global meeting "Call to Action - Child Survival Summit" on the 14-15 June, Washington DC.

This meeting was a part of a broader global partnership with the US government, UN Secretary General, UNICEF and others to lead a call to action to end preventable child deaths in a generation. At this meeting,governments around the world, civil society including faith-based groups,the private sector all committed to the goal of ending preventable child deaths and committed to working in collaboration and coordination with each other.

Indian Academy of Pediatrics ( IAP ) is launching IAP Mission Uday to address issue of child survival in India. The Vision of the IAP Mission Uday is that every child is protected against Diarrhoea, Pneumonia and other VPDs, is well nourished and has access to preventive and treatment measures,with ultimate goal to reduce Under-five mortality to achieve Millennium Development Goal 4.

The project aims to create a pool of Resource Persons who can update the knowledge and enhance skills required in child survival interventions of pediatricians and other concerned Health Care Personnel to deal with these killers more effectively and efficiently with evidence based science.

If we join the strategies of controlling Diarrhoea and Pneumonia then we will have many clear advantages of saving our resources and making them more focused and targeted. Most of the Preventive, Protective and Treatment strategies of both these killer diseases are similar hence combining the two will avoid duplication of resources. Similar advantage may be achieved in combining the strategies for Elimination of Measles and improving Routine Immunization coverage (by massive measles immunization campaign coupled with routine immunization - where elimination of Rubella and CRS follows automatically without extra efforts), finally strengthening awareness and management guidelines of Nutritional Anaemia and Severe Acute Malnutrition. IAP Mission Uday expected to have major impact and  help to achieve MDG 4 in India by strengthening hands of Govt of India.

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