Childhood Pneumonia: How to

Accelerate Progress in Reducing the

Death Toll
Kate OBrien, MD, MPH
International Vaccine Access Center
Johns Hopkins Bloomberg School of Public
Health

We have made significant progress

A Look at Global Under-five deaths
Global Deaths from 1980 to 2015
25

20

20

15
12.7

10

Global Under-five deaths (in millions)

5

4
0.53

From 1980-2015:

70%

5.9

90%

0.94

Leading Causes of Global Death in 2015

among
Children Aged 1-59 Months*
Diarrhea and
Pneumonia
together
accounted for 1.3
million (39%) of
global deaths
among this
population
Liu, Li, et al. Global, regional, and national causes of under-5 mortality in 200015: an updated systematic analysis
with implications for the Sustainable Development Goals, The Lancet, 2016. DOI:
http://dx.doi.org/10.1016/S0140-6736(16)31593-8
1

Pneumonia & Diarrhea still account

for 1.5M deaths in children <5 a year
Pneumonia and diarrhea continue to be leading infectious killers
of children under the age of 5 worldwidemore than HIV, TB,
Zika, Ebola, and malaria combined.
People of any age, in any country, are at risk, but the vast
majority of all childhood deaths occur in poor countries.
We know how to protect, prevent, and treat pneumonia and
diarrhea. We must ensure existing strategies are implemented.

The Integrated Global Action Plan for the

Prevention and Control of Pneumonia and
Diarrhea (GAPPD)

Strategies for Preventing

and Treating Pneumonia

Protection

Protection

Breast feeding promotion

Hand washing promotion
Zinc supplementation
Adequate nutrition
Reduce indoor air pollution

Prevention
Vaccination

Breast feeding promotion

Hand washing promotion
Vitamin A and Zinc supplementation
Adequate nutrition
Safe water and sanitation

Many interventions
and
Prevention
treatment strategiesare
identical
Vaccination

New: Pneumococcal, Hib,

Routine: Measles, pertussis

HIV prevention

Treatment

Strategies for Preventing

and Treating Diarrhea

Improve care seeking behavior

Community case management
Health facility case management
Antibiotics

New: Rotavirus
Routine: Measles

HIV prevention

Treatment

Improve care seeking behavior

Community case management
Health facility case management
Low-osmolarity ORS
Zinc

2016 Pneumonia and Diarrhea Progress Report:

Reaching Goals Through Action and Innovation
Methodology:
Collectively, 10 interventions are evaluated and summarized into
an overall GAPPD score, developed by IVAC.
GAPPD scores are used to assess and compare progress over time
in the 15 countries with the greatest number of pneumonia and
diarrhea deaths in children under the age of 5 years.
GAPPD scores are a calculated average of national coverage levels
for 10 GAPPD interventions, using the most recent data available.

2016 Pneumonia and Diarrhea Progress Report:

Reaching Goals Through Action and Innovation
Key Findings:
72% of the global burden of pneumonia and diarrhea child deaths
occur in just 15 countries, even though they are home to only 55%
of the worlds under-5 population
12 out of 15 countries improved their GAPPD scores since 2015
Only 6 of the highest-burden countries (Angola, Ethiopia, India,
Niger, Sudan and Tanzania) have introduced rotavirus vaccines in
their routine immunization program
5 of the highest pneumonia burden countries (India, Indonesia,
Chad, China and Somalia) are still not using PCV in their routine
immunization programs

Overall GAPPD Intervention Scores

(Countries shown in decreasing order of child pneumonia and
diarrhea deaths)
2016 Overall GAPPD Intervention Score
0

10

20

30

40

50

41

India

DRC
Democratic Republic of the Congo

90

Countries with 3+ missing data values

48
48

Angola

53

Ethiopia

43

Indonesia

Overall GAPPD
Target 86%

25

Chad

51

Afghanistan

49

Niger

32

China

65

Sudan

58

Bangladesh

Tanzania, United Republic of

80

Countries with 1 missing data value .

46

Pakistan

Somalia

70

Countries with no missing data values

30

Nigeria

60

20
74

The pace of progress must be

accelerated

100

How do we reduce the death toll?

Fully introduce and use PCV, Hib, measles and other vaccines
Improved management of cases using pulse oximetry and access to
oxygen therapy
Reduce indoor air pollution
Increase access to amoxicillin dispersible tablets
Bubble c-pap for in-hospital care
New vaccines (e.g., RSV, influenza for infants/pregnancy)
Improved etiologic diagnosis for pneumonia
Ultra-sound of chest
Biomarkers to distinguish bacterial from non-bacterial causes
Health systems strengthening

Global Hib Vaccine Introductions: 191 Universal, 1

Subnational

: PCV

Source: International Vaccine Access Center (IVAC), Johns Hopkins Bloomberg School of Public Health. VIEW-hub Global
Vaccine Introduction and Implementation Report, March 2016.

Global PCV Introductions: 129 Universal, 4 Subnational, 5

Risk-based

: PCV

(as of November
2016)

Global PCV Introduction Status

Source: International Vaccine Access Center (IVAC), Johns Hopkins Bloomberg School of Public
Health. VIEW-hub Global Vaccine Introduction and Implementation Report, September 2016.

Stopping pneumonia supports the

Sustainable Development Goals
To achieve the Sustainable Development Goals (SDGs), the world
must address pneumonia and diarrhea.
The Prevent, Protect and Treat interventions clearly overlap with
the SDGs

Conclusions
Globally, enormous strides have been made in reducing pneumonia and
diarrheal mortality and morbidity.
But over 1.5 million children continue to die each year and millions of
children are hospitalized, resulting in enormous economic and social
burden.
Many powerful strategies are available but coordinated and
comprehensive approaches are required for optimal results.
We need political will, accountability, and community engagement and
mobilization to implement these powerful strategies.

We call on all countries to protect their

childrens health and well-being through action
and innovation to accelerate progress in
combatting pneumonia and diarrhea.

For more
information,
please visit:
StopPneumonia.or
g
Twitter: @Stop_Pneumonia
Facebook: /StopPneumonia