In Ethiopia, bringing child pneumonia deaths down to zero

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By Indrias Getachew

OROMIA REGION, Ethiopia, 27 December 2011 – One-year-old Kedir Mudi and his mother, Alemnesh Gerefa, play in the waiting area of the health post in Derer Ebija, a rural village in Oromia Region. Only three months ago, this happy toddler came dangerously close to death after contracting pneumonia, one of the leading killers of children in Ethiopia.

Kedir was diagnosed during a visit to the Derer Ebija health post, where the health extension workers had been trained, with UNICEF support, to detect pneumonia.

“I thought he would die on me,” said Ms. Gerefa. “I was very worried – I am a mother after all.”

Today, Kedir is back to receive the pneumococcal vaccine, which will protect him against meningitis, sepsis and the pneumonia that nearly killed him. It is only the second week that this vaccine has been available in Derer Ebija, and Ms. Gerefa is keen for Kedir to receive it.

Introducing the pneumonia vaccine

According to the 2011 Ethiopian Demographic Health Survey, the under-five mortality rate in Ethiopia has fallen to 88 per 1000 live births, down from 123 per 1000 live births in 2005.

The Government’s efforts to expand community-based care through health posts and community extension workers have contributed to these improvements in child survival. So have the distribution of insecticide-treated mosquito nets to reduce malaria, the promotion of hand-washing to reduce diarrheal diseases, and village-level treatment of severe acute malnutrition.

Now, with the pneumococcal vaccine, Ethiopia hopes to tackle yet another scourge.

“Pneumonia contributes around 28 per cent [of all child deaths]. That’s one of the major contributors to under-five mortality,” said Dr. Tedros Adhanom, Ethiopia’s Minister of Health, at the 16 October launch of the new vaccine. “If we can really address that part, I think it will contribute very significantly to reducing under-five mortality.”

The vaccine was introduced by the Ethiopian Ministry of Health with support from the GAVI Alliance, which includes UNICEF and the World Health Organization.

“This is our biggest country launch so far, and pneumococcal vaccine is our most powerful vaccine,” said Daniel Thornton of the GAVI Alliance. “Pneumonia kills more children than any other disease in the world each year. Pneumonia kills at least 100,000 children each year in Ethiopia, and with the vaccine we believe we can prevent more than 50,000 deaths a year.”

Health extension workers Belainesh Arersa and Shewaye Berhanu speak to parents and children about the newly introduced pneumonia vaccine, at the health post in Derer Ebija, Ethiopia

‘Health is more important’

On 8 December, health extension workers Belainesh Arersa and Shewaye Berhanu prepared for the Derer Ebija health post’s biweekly vaccination programme.

“Pneumonia is an illness that affects many of the children in this area,” Ms. Arersa said. “As a result mothers have to stop doing their work to go to and from hospital. Now that this vaccine has been introduced, children will not die, and mothers will no longer waste their time traveling back and forth between home and hospital.”

A large crowd had gathered outside the vaccination room.

“Today we have a lot of people,” Ms. Arersa explained. “They are here, first because we provide a routine vaccination programme twice a week from here. In addition because the PCV, or pneumonia prevention vaccine, is now available, there is a campaign to mobilize the community by the community health volunteers.”

Temam Ahmed, a farmer, was one of the few fathers in the waiting area. He had come to immunize his 9-month-old son, Hamid. Mr. Ahmed was himself recently diagnosed with pneumonia, and had to travel more than 20 km to be treated. Protecting Hamid from the same fate was a priority.

“I therefore left the farm [to bring him here] because his health is more important,” Mr. Ahmed said.

Scaling up

“With the introduction of the pneumococcal vaccine,” said UNICEF Representative in Ethiopia Ted Chaiban, health extension workers “have added a new weapon in their arsenal of simple preventative measures to fight child deaths.”

The vaccine complements a broader scale-up in community-based treatment of pneumonia with oral antibiotics. Soon, health workers like Ms. Arersa will not only be vaccinating children against pneumonia but also treating the disease.

Today, a staggering number of child deaths are attributable to pneumonia, said Mr. Chaiban, “so with the vaccine and the community treatment of pneumonia, we are bringing that down way to zero.”