Immunizable and Respiratory Diseases and Child Mortality

Abstract

Neonatal tetanus pertussis measles and acute lower respiratory tract infection (ALTRI) which cause 1/3 of deaths under age 5 years in the developing world can be prevented through immunization. Such prevention would eliminate 3-4 million deaths each year. Many respiratory deaths also can be prevented through low-cost drug therapy. The question of what impedes the application of this technology in the 3rd world requires an understanding of 4 elements: disease-specific mortality; associated risk factors; availability feasibility and acceptability of interventions; and the effectiveness of the interventions. This chapter focuses on these & elements for neonatal tetanus for pertussis measles and ALTROI. Low-cost effective techniques exist for the prevention of neonatal disease pertussis and measles through immunization. In many areas treatment of ALTRI according to a standard treatment algorithm also is feasible. Yet only 10-25% of at-risk developing world population currently are receiving these services. No single explanation for this low coverage is applicable on a global basis. Each area national or subnational must be evaluated as to current level of services potential for expansion and constraint especially in low-density rural areas such as the Sahel in Africa. Without infrastructure and with mobile operations very costly immunization and treatment of respiratory diseases in such areas is not possible without significant and prolonged external support. Of immediate concern is the estimated 50% of the at-risk population that are within reach of the health system but are not currently receiving basic services. The single major difference between programs that are obtaining high coverage and those that are not is commitment in 3 major areas: governments in allocating priority and resources to prevention especially among the rural poor; health services to work with the public to ensure provision of immunization and basic curative services to all accessible populations; and the public to participate in and be responsible for their own health care.