Global Action Plan for Prevention and Control of Pneumonia

8/3/2019 Global Action Plan for Prevention and Control of Pneumonia

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Global Action Planfor Preventionand Control ofPneumonia (GAPP)


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Technical Consensus statementUpdated February 2008

The following consensus statement was formulated, and should be used widely for advo-cacy purposes and to help promote the global action plan.

L Pneumonia kills more children than any other illness in the world. Pneumonia is a sig-

nicant problem in communities with a high rate of under-ve mortality, and places

a huge burden on families and the health system. Pneumonia control is therefore a

priority and is essential in achieving MDG4.

L In the context of child survival strategies, countries should address pneumonia con-

trol. The key strategies for treating, preventing and protecting from pneumonia are:

case management at all levels

vaccination

prevention and management of HIV infection improvement of nutrition and reduction of /low birth weight

control of indoor air pollution

L These interventions, if implemented, have the potential to reduce pneumonia mortal-

ity and morbidity by more than half.

Effective case management at the community and health facility levels is an essen-

tial part of pneumonia control. Countries with signicant rates of under-ve mor-

tality should adopt plans to expand adequate case management of pneumonia at

hospital, health facility and community levels to achieve 90% coverage within a

predetermined time frame.

All countries should take steps to achieve Global Immunization Vision and strat-

egy (GIVs) targets for measles and pertussis containing vaccines; countries that

have not yet done so should add Hib and conjugate pneumococcal vaccines to

their national immunization programmes, especially if they have high child mortal-

ity.

Promotion of exclusive breastfeeding and zinc supplementation are an important

element of pneumonia prevention. Strategies to reduce rates of low birth weight

and malnutrition will prevent pneumonia and should be encouraged.

Indoor air pollution increases the risk of pneumonia. New technologies can reduce

indoor air pollution, and additional research is needed to demonstrate the health

benets of these interventions. Strategies to reduce indoor air pollution may pre-

vent pneumonia and should be encouraged.

Strategies to prevent mother-to-child transmission of HIV and to improve the

management of HIV infection and P. jiroveci pneumonia prophylaxis in children

should be promoted in countries where HIV is prevalent.

L Other preventive strategies, such as encouraging hand washing, should be promot-

ed.

L Pneumonia is a common and serious consequence of pandemic inuenza. Prepared-

ness for pandemic inuenza should include prevention and control of pneumonia and

adds urgency to community case management.


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Global action Plan forPrevention and controlof Pneumonia (GaPP)

WHO/FCH/CAH/NCH/09.04


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World Health Organization/The United Nations Childrens Fund (UNICEF), 2009

all rights reserved. Pblitis the Wrld Helth orgizti be btied rm WHo Press, Wrld Helthorgizti, 20 avee appi, 1211 Geev 27, Switzerld (tel.: +41 22 791 3264; x: +41 22 791 4857; e-mil: [email protected]). eqests r permissi t reprde r trslte pblitis whether r sle r r mmer-il distribti shld be ddressed t WHo Press, t the bve ddress (x: +41 22 791 4806; e-mil: [email protected]) r t uncf, ivisi cmmiti, 3 uited ntis Plz, new Yrk 10017, uSa (fx: +1 212 303 7985;

-mil: [email protected]).

he desigtis emplyed d the presetti the mteril i this pbliti d t imply the expressi ypii whtsever the prt the Wrld Helth orgizti r uncf erig the legl stts y try,territry, ity r re r its thrities, r erig the delimitti its rtiers r bdries. tted lies mps represet pprximte brder lies r whih there my t yet be ll greemet.

he meti spei mpies r erti mtrers prdts des t imply tht they re edrsed r re-mmeded by the Wrld Helth orgizti r uncf i preeree t thers similr tre tht re t me-tied. rrrs d missis exepted, the mes prprietry prdts re distigished by iitil pitl letters.

all resble pretis hve bee tke by the Wrld Helth orgizti d uncf t veriy the irmtitied i this pbliti. Hwever, the pblished mteril is beig distribted witht wrrty y kid, eitherexpressed r implied. he respsibility r the iterpretti d se the mteril lies with the reder. evetshll the Wrld Helth orgizti r uncf be lible r dmges risig rm its se.

Prited i fre


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GlObAl ACTION PlAN FO PEvENTION AN CONTOl OF PNEUmONIA (GAPP)

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Other 9%Congenital anomalies 7%Neonatal tetanus 3%Diarrhoeal diseases 3%Neonatal infections 25%

Birth asphyxia and birth trauma 23%

Prematurity and low birth weight 31%

Neonatal deaths

Noncommunicablediseases

(postneonatal)4%

Injuries(postneonatal)

4%

Neonataldeathsb

37%

Pneumonia17%

Diarrhoealdiseases

(postneonatal)16%

Malaria 7%

Measles 4%

HIV/AIDS 2%

Other infectious& parasitic diseases

9%

Deaths among children under five

Pei the er 1 killer yg hildre

fG 1. cauSS of aH n nonaS an cHn un f n H Wo (2004)

WHo. The Global Burden of Disease: 2004 update. Geev, WHo, 2008. 3% the etl deths re estited t e de t pei. blk et l. mterl d hild dertriti: gll d regil expsres d helth seqees. Lancet, 2008, 371:243

260.

35% of under-e deaths are due to the presence of undernutrition c

1 WHo. World Health Statistics. Geev, WHo, 2009.2 WHo. The Global Burden of Disease: 2004 update . Geev, WHo, 2008.3 his gre ildes pei deths tht r i the etl perid, t t thse tht re ssited with

esles, pertssis d H.4 he peretge ttl pei deths rrig i the 68 tries ws estited sed (yer 2000) dt

rtlity g hildre der ve yers ge de t pei (%) r WHo World Health Statistics 2008 dirths per yer r un pplti divisi 2008 prjetis.

5 uncf. Countdown to 2015. Tracking progress in maternal, neonatal and child survival: the 2008 report . new Yrk,uncf, 2008.

6

uncf d WHo. Pneumonia: the forgotten killer of children. new Yrk, uncf, 2006.

Pei kills re hildre der ve yers ge th y ther illess i every regi the

wrld. o the estited 9 illi hild deths i 2007,1 rd 20% r 1.8 illi,2,3 were de t

pei (see Figure 1). spite its hge tll h lie, reltively ew gll resres

re dedited t tklig this prle.

mrtlity de t hildhd pei is strgly liked t ltriti, pverty d ideqte

ess t helth re. cseqetly, re th 98% pei deths4 i hildre r i

68 tries where prgress i redig der-ve rtlity is st ritil (the ctdwt 2015 tries).5 he rde tht pei ples ilies d the helth syste i

lw-resre tries i tr exertes ieqlities; verwheligly, hildre wh re pr,

hgry d livig i rete res re st likely t e visited y this rgtte killer.6


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GlObAl ACTION PlAN FO PEvENTION ANd CONTOl OF PNEUmONIA (GAPP)

2

his sitti st t tie. at the millei Sit i 2000, the uited ntis meer

Sttes itted t hievig millei evelpet Gl 4 (mG4) t rede the der-

ve rtlity rte y tw thirds y 2015, pred t 1990. Sie the, ssttil prgress hs

ee de i redig hild rtlity, t i the rret tred ties, estited 13.2 il-

li exess deths will r etwee 2010 d 2015 (see Figure 2). mG4 ly e hieved

y itesied ert t rede pei deths. gll pl is t pt i ple, rd

1.8 illi hildre will tie t die r pei every yer. With elerted iplee-

tti key itervetis, eh yer the er pei deths will drp ssttilly,

d y 2015, 67% hild pei deths will e verted. his redti trsltes it 5.3

illi lives sved r 2010 t 2015 (see Figure 3). dditi, p t 860 000 deths de t

dirrhe will ls hve ee verted drig this perid, s reslt the prti exlsive

resteedig iterveti t th diseses.

he Gll ati Pl r Preveti d ctrl Pei (GaPP) hs ee develped i rder

t irese wreess pei s jr se hild deth, ll r slig p the se

itervetis prve eet, d prvide gide hw this e de. he GaPP lls t

ti rd liti gll d til pliy-kers, dr geies d ivil siety.

fG 2. coS of fau o acH mG4

1990 1995 2000 2005 2010 20150

5

10

15

Under5deaths(millions)

13.2 millionexcess deaths

between2010 and 2015

Sre: WHo

fG 3. cH Pnumona aHS Ha cou b Pn P Ya n68 counoWn counS,

Sre: WHo he ipt slig p essetil itervetis r pei ws llted sig the ives Sved l (iS) tl tht hs

ee develped y the ftres stitte i llrti with the child Helth pideilgy eeree Grp (cHG). ethsverted is estited s the dieree etwee seri where verge is sled p t verge 90% i the 68 tries, -pred t seri where verge reis t stt levels.

uncf. Countdown to 2015. Tracking progress in maternal, neonatal and child survival: the 2008 report . new Yrk, uncf, 2008.

Case management ofpneumonia

Hib vaccineBreastfeeding counselling

Pneumococcal vaccine

Neonatal pneumonia/sepsisdeaths

Postneonatal pneumoniadeaths

2009 2010 2011 2012 2013 2014 2015

Averagecoverageofinterve

ntions

byyear(%)

0

20

40

60

80

100

Child

deathsprevented

annually

0

500 000

1 000 000

1 500 000

2 000 000


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GlObAl ACTION PlAN FOr PrEvENTION ANd CONTrOl OF PNEUmONIA (GAPP)

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GaPPs vision

1 Pneuool vine uptke will be grdul nd in soe ountries it will only be introdued in 2014, thus 90%overge by 2015 will not pply to it.

2 children with difult or fst brething treted with pproprite ntibiotis by trined helth provider.3 here is no globlly set trget for exlusive brestfeeding, but 90% is widely epted.4 he inditors to be used will initilly be the se s those for the countdown to 2015, while proess tkes ple

of developing ore pneuoni-spei inditors.

he ision of the GaPP is tht every hild is proteted ginst pneuoni through helthy envi-

ronent, nd hs ess to preventive nd tretent esures. Spei gols re to:

L edue ortlity fro pneuoni in hildren less thn 5 yers of ge by 65% by 2015 o-

pred to 2000 levels;

L edue the inidene of severe pneuoni by 25% in hildren less thn 5 yers of ge by 2015

opred to 2000 levels.

he following trgets need to be rehed by the end of 2015:

L 90% overge of eh relevnt vine (with 80% overge in every distrit);1

L 90% ess to pproprite pneuoni se ngeent;2

L 90% overge of exlusive brestfeeding during the rst six onths of life;3

Progress towrds these trgets will be esured with dt olleted through ntionl helth infor-

tion systes, eogrphi nd Helth Surveys, nd multiple nditor Surveys, s pproprite.4

ivb/WHo


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GObA ACTION PAN FO PEvENTION AN CONTO OF PNEUmONIA (GAPP)

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fG 4. famWo fo Pnumona cono

POTECT

children y proiding ahealthy enironent

xlsive resteedigr six ths

adeqte triti

Prevet lw irth weight

ede idr ir pllti

Hd wshig

PEvENT

children ecoing illwith pneuonia

iti gist esles,pertssis, Sp d Hi

Preveti H i hildre

ctrixzle prphylxis rH-ieted d expsed hildre

Zi sppleetti rhildre with dirrhe

ucPnumona

moaYan

mobY

TEAT

children who ecoe illwith pneuonia

cse geet i ity,helth etre d hspitl

Prtetig, prevetig d tretig pei

Withi GaPPs isi, the vris itervetis r trllig pei i hildre der ve

re tegrized s llws (see Figure 4):

LProtect hildre y prvidig eviret where they re t lw risk pei;

LPrevent hildre eig ill with pei;

LTreat hildre wh ee ill with pei.

a plete pprh t pei trl ildes ll the itervetis shw i the fre-wrk. hey shld e ipleeted s essetil prt itegrted pkge eetive,

esile d rdle itervetis r hild srvivl tht re reeded gllly, espeilly

r the st vlerle ppltis. Hwever, i develpig pei trl pls, st

tries will eed t priritize r g these itervetis. settigs with high rtlity

r pei, ephsis shld e give t itervetis tht will rede rtlity withi

the mG tie re, while regizig tht every hild hs right t prteti, preveti d

eetive tretet (see Tale 1).

Streptococcus pneumoniae. Haemophilus infuenzae .


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GObA ACTION PAN FOr PrEvENTION ANd CONTrO OF PNEUmONIA (GAPP)

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1 See Bulletin of the World Health Organization, may 2008.2 niesse et al. cparative ipat assesset hild peia itervetis. Bulletin of the World Health Orga-

nization, 2009, 87:472480.

aklig peia i a ew way kwledge it ati

over the past 20 years, evidee the e etiveess spei peia strategies has bee

alatig. t has bee shw that:

L use siple, stadardized gidelies r idetiati ad treatet peia i the

ity, at rst level health ailities ad at reerral hspitals has bee shw t sbsta-

tially rede hild deaths.

L he saety ad eay ew vaies agaist Streptococcus pneumoniae (Sp) ad Haemo-

philus inuenzae type b (Hib), the tw st reqet baterial agets hildhd pe-ia, has bee established.

L aies agaist easles ad pertssis i atial iizati prgraes have bee

shw t sbstatially rede peia rbidity ad rtality i hildre.

L other hild srvival itervetis, ildig the prti exlsive breasteedig ad

iprveet the livig eviret t rede the spread gers, have als bee de-

strated t play a iprtat rle i peia trl.

his evidee was reetly reviewed r several the itervetis i the fraewrk, ildig

triti, vaiati, ase aageet ad redig idr air pllti.1 frther wrk2 pr-

vides estiates r the ptetial ipat these itervetis (see Tale 2).

ivb/WHo


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GObA ACTION PAN FO PEvENTION ANd CONTO OF PNEUmONIA (GAPP)

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TAbE 1. PHAING OF INTEvENTION ACCOdING TO UNdE-FIvE mOTAIT ATE

UNdE-FIvE mOTAIT ATE (NO. dEATH


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7

TAblE 2. POTENTIAl rEdUCTIONs IN PNEUmONIA mOrbIdITy ANd mOrTAlITy WITH sElECTEd INTErvENTIONs(AssUmING NEAr-UNIvErsAl COvErAGE)

INTErvENTIONs TO PrOTECT EvIdENCE OF ImPACT

Promote exlusive restfeedig for 6 moths 1523% redutio i peumoi iidee; 13% redutio i ll hilddeths

adequte utritio throughout the rst ve yers oflife, iludig dequte miroutriet itke

6% redutio i ll hild deths for dequte omplemetry feedig (623moths of life)

edue iidee of low irth weight eview i progress

edue idoor ir pollutio eltive risk redutio with liquid fuel stoves; 75% redutio i iidee ispei settigs with improved solid fuel stoves

Hd wshig 3% redutio i ll hild deths whe omied with improved wter dsittio itervetios

INTErvENTIONs TO PrEvENT EvIdENCE OF ImPACT

itio gist mesles, pertussis, Sp d Hi 2234% redutio i iidee for Hi; 2335% redutio i iidee forSp; 4% redutio i ll hild deths with Hi d 1% with mesles

Prevetio of H i hildre 2% redutio i ll hild deths

cotrimoxzole prophylxis for H-ifeted hildre eview i progress

Zi supplemettio i hildre with dirrhoe 1415% redutio i iidee; 45% redutio i ll hild deths sprevetive mesure

INTErvENTIONs TO TrEAT EvIdENCE OF ImPACT

mproved re seekig d demd geertio withiommuities

eview i progress

Helth fility se mgemet for very severe sesd vulerle groups suh s ewors, H-ifetedd mlourished hildre

2945% redutio i se ftlity; 6% redutio i ll hild deths

resig ess to pproprite re throughommuity-sed se mgemet

3450% redutio i eotl se ftlity; redutio i totl mortlity of27%, 20%, d 24% mog eotes, ifts, d hildre, respetively;redutio i peumoi mortlity i the sme groups y 42%, 36%, d36%

niesse et l. comprtive impt ssessmet of hild peumoi itervetios. Bulletin of the World Health Organization,2009, 87:472480. Joes G et l. How my hild deths we prevet this yer? Lancet, 2003, 362:6571. S Szwl, blk . ffet of peumoi se mgemet o mor tlity i eotes, ifts, d preshool hildre: met-lysis of ommuity-sed trils.

Lancet Infecious Diseases, 2003, 3:547556.


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GObA ACTION PAN FO PEvENTION ANd CONTO OF PNEUmONIA (GAPP)

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csts

1 uncf. Countdown to 2015.Tracking progress in maternal, neonatal and child survival: the 2008 report . new Yrk,uncf, 2008.

2 ives Sved l (iS) ws sed t llte ipt (http://www.tresistitte.).3 sk re r vtive tertil fiig r Helth Systes. cstrits t slig p d sts. Wrkig

grp 1. http://www.itertilhelthprtership.et//cmS_les/dets/wrkig_grp_1__reprt_n.pd.4 49 lw-ie tries.5 ll bk mlri Prtership. The Global Malaria Action Plan. Geev, ll bk mlri Prtership, 2008.

TAbE 3. GObA COT FO CAING UP GAPP INTEvENTION (bEATFEEdING, vACCINATION ANd CAEmANAGEmENT) IN COUNTdOWN COUNTIE, 20102015 (U$ mIION)

68 countries 66 countriesa

2010 2015 20102015 20102015

ies d ijeti spplies 1 321.7 1 697.9 9 661.0 6 660.6

cdities d digstis r pei geet 3.1 23.9 141.0 109.4

csts r deliverig servies 1 621.1 5 383.5 22 653.6 8 070.1

Prgre d systes sts 916.9 987.4 6 507.8 4 006.5

Total 3 862.8 8 092.7 38 963.4c 18 846.5

chi d di exlded r these estites. Servie delivery sts ilde h resres t ility level s well s ity helth wrkers. o this t, uS$ 13 illi is r chi d uS$ 7 illi r di.

he st ipleetig the GaPP itervetis t Prtet (resteedig), Prevet (vi-

tis) d ret (se geet) i the 68 high hild rtlity ctdw t 2015 tries1

will e uS$ 39 illi r the 2010-2015 perid. oe hl the sts re eeded r slig p

these itervetis i chi (uS$ 13 illi) d di (uS$ 7 illi). fr the 68 tries, the

sts will dle ver the 6-yer perid risig r l eed uS$ 3.8 illi i 2010 t

uS$ 8.0 illi y 2015 (see Tale 3). xpressed ther wy, the st ipleetig the GaPP

itervetis represets dditil l ivestet uS$ 12.9 per hild. he stig

the GaPP itervetis hs sed thse shw t e st-eetive i ltiple settigs d

esile t sle p, tgether with stregtheig the verll helth syste. he 68 tries

ilded t r t 98% gll pei deths i hildre der ve. csts tke

it t the eessry vies d dities, servie delivery r prvidig re i ili-

ties d t ity level (see Figure 5), eggig i irti d iti tivi-

ties d prgre spprt t rig verge key itervetis t 90%. While the stig is

sed stdrd liil gidelies, key ssptis ilde iresig pity t deliver

prevetive d rtive re t ity level. With the ipts desried, p t 1.2 illi

pst-etl pei deths e verted lly y 2015, sigitly tritig t

mG4. dditi the slig p these itervetis will prevet ther 0.4 illi deths

de t etl pei/sepsis d dirrhe i 2015.

2

his wrk is sistet with the wrk the sk fre vtive tertil fiig r Helth Systes,3 whih estited

tht dditil uS$ 112uS$ 251 illi is eeded t stregthe the helth syste d sle

p servies4 t prevet 3.94.3 illi der-ve deths der dieret seris. he rd

estites the GaPP sts re siilr t estites r prehesive lri trl.5


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9

fG 5. 68 counS: baoWn of oa coSS 20092015

Sre: WHo

mediies, ijeti terils d digstis. ldes hrri ity helth wrkers (cHWs), d st t til d stil level t rdite the cHW pr-gre

he sts ilde h resres pls verhed sts sh s pitl ivestets, irstrtre itee, eletriity dwter reqired r rig the ility. he sts reet the resres sed y the prvider i prvidig these servies d d tsider wh es these sts, whether this e the gveret, the ptiet r ther etity.

d ldes: ie relted triig d spervisi, d mc triig st.e ldes: riig cHWs, d reglr spervisi. ldes: rti, edti d iti (c) r hild helth; d sil ilizti tivities r iiztis.g ie spei. cld hi d trsprt/vehiles.h tet, itrig d ereet the cde mrketig brest-ilk Sstittes (resteedig spei).i ie spei.

Training and supervision at first-level facilities 5.9%d

Vaccine and injection supplies 24.8%i

Cold chain and logistics 3.8%g

Commodities for pneumonia management 0.4%a

Support and remuneration of CommunityHealth Workers 31.9%b

Service delivery costs 26.3%c

Training and supervision of CommunityHealth Workers 1.6%e

IEC 2.5%f

Code 0.8%hSurveillance, Monitoring, Evaluation 1.6%i

Waste management and overhead 0.4%i

WHo/m.Weber


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10

ctry strtegies

tegrtedmgeet

childhdlless

xpdedPrgre izti

mkigPregy Ser/

Semtherhd

Preveti H eti/

Preveti mther-t-child

rsissi H

viretlHelth

ntriti

fG 6. coaboaon bWn PoGammS an aPPoacHS o aSS Pnumona

he key t redig hildhd pei d hievig mG4 is t rgetly tr rret kwl-

edge it pkge eetive d rdle itervetis. his pkge will prtet hildre

y prvidig eviret where they re t lwer risk pei, will prevet pei

ridity y pplyig prve itervetis, d will eetively tret ses whe they r i

rder t rede rtlity. mst hild pei deths wld e verted i this pkge iter-

vetis were ipleeted rd sle d rehed the st vlerle ppltis.

my the itervetis i the pkge ll withi the spe helth iistries, t se willreqire lse llrti with ther setrs. atis will e rther ehed y prgress i

eliitig pverty d prtetig the qlity the eviret.

mst tries re lredy ipleetig t lest se the itervetis eeded t trl

hildhd pei, thrgh vris prgres d pprhes (see Figure 6).

Hwever, ipleetti ths r hs ee eve d servie delivery reis rdited.

oly 54% hildre with pei re reprtedly tke t qlied helth re prvider

i develpig tries. espite the essetil rle tiitis i redig hild deths r

Helth SysteStregtheig


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11

1 uncf d WHo. Pneumonia: the forgotten killer of children. new Yrk, uncf, 2006.2 uncf. The state of the worlds children 2009. Maternal and newborn health . new Yrk, uncf, 2009.3

WHo. Gll dt k it d yg hild eedig. 2009.

pemi, ly 19% der-ve hildre with liil sigs pemi reeived tiit-

is.1

oly 82% hildre reeive their rst rtie dse vie gist mesles.2

here hsee sigit redti i mesles deths ese the prvisi sed pprtity

r mesles viti thrgh mss mpigs. nevertheless, risk exists tht my tries

will ser iresed mers mesles ses less gll erts t trl the disese re

itesied. nt ll tries hve itrded Hi viti, lthgh there hs ee reet

prgress i this re. Sixty-e 72 Ga-eligile tries hve lredy r will itrde Hi

it their rtie immizti shedle i 2009 (see Figure 7). few tries hve yet ilded

the peml jgte vie i their til immizti prgrmmes thgh there

is strg iterest i my tdw tries t d s (see Figure 8). xlsive resteedig

p t six mths is ly prtised y 34.8%3 mthers. w verge previls r ther iter-

vetis ls, d where verge is pr, it is slly the hildre t gretest risk pemi

wh re t vered.

here re mjr prgrmmti hlleges t imprvig this sitti: idetiyig the est pk-

ge itervetis r prtilr try, deig wys t sle them p, esrig tht the

fG 7. counS Ha Ha nouc Hb accn an coaG n nfanS (2008)

(136 countries introduced in infant immunization schedule)

Hib3 80% (102 countries or 53%)

Hib3 < 80% (26 countries or 13%)

Hib vaccine introduced but no coverage data reported (8 countries or 4%)

Hib vaccine not introduced (57 countries or 30%)

Sre: WHo/uncf verge estimtes 19802008, Jly 2009


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12

fG 8. SauS of Goba Pnumococca conJuGa accn noucon (2008)

Yes (26 countries or 13%)

Yes (parts of the country) (5 countries or 3%)

Applied for GAVI support (15 countries or 8%)

Sre: WHo/b dtse, 193 WHo meer Sttes, Jly 2009

highest risk ities re rehed, d itrdig pprprite ew itervetis. cretig

syergy g the ered prgres d deprtets withi iistries helth d

g ther istittis tht prvide helth servies r ipleet pleetry iterve-

tis is prtilr hllege.

bese the eed t t rgetly, pei itervetis st e priritized t the pliy

d il level, t esre tht eviret dive t itervetis is i ple d tht

resres re ville. at the se tie, delivery key itervetis eeds t e itegrted

t the pit re, e.g. resteedig prti, se geet d prevetig issed

pprtities r viti.


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eoendtions for jor tions to betken in ountries

1 Where relevnt, this body y lso be responsible for ny dirrhoe ini titive, s it is the seond ost oon use

of deth in under-ve yer old hildren.

Lesignation of a national action group for pneuonia control

a oordinting body t ntionl level is needed to tke responsibility for forulting nd oor-

dinting the ipleenttion of n tion pln. n soe ountries with high pneuoni or-

tlity, the fortion of new group y be neessry, while in others this group will be prt of

n existing ntionl tsk fore or oittee relted to hild survivl, e.g. mc, iuniztion,

king pregnny sfer, H, environentl helth. Whtever the sitution, it is of ritil

iportne tht there be body with ler responsibility for pneuoni.1 as prt of the

tion pln, this group will dvote for resoures for sling up pneuoni interventions,

nd onitor progress in hieving gols.

LGenerating political will

advoy with poliy- nd deision-kers, inluding those who ke resoure llotion

deisions, is ritil for their understnding of the proble nd neessry tion. he interest

nd willingness of high-level politil gures to dedite ntionl resoures for pneuoni will

be key to ensuring suess.

Leeloping a situation analysis for pneuonia

he infortion needed for the developent of sitution nlysis for pneuoni is usully

lredy present in regionl nd ntionl hild survivl strtegies nd plns. t needs to be

opiled nd ted upon. f it is not vilble, then the ntionl tion group will be responsi-

ble for gthering neessry dditionl dt. he sitution nlysis should review estites of

popultion overge by pneuoni intervention (e.g. exlusive brestfeeding rtes, vin-

tion overge, perentge of hildren reeiving pproprite se ngeent for pneuoni)

nd the support vilble for sling up interventions. his proess provides n opportunity to

disuss the pproprite ix of interventions to be ieditely sled up, given the ountrys

irustnes.

LInoling other prograes

mny helth progres re lredy ting in pneuoni prevention nd ontrol. he tion

group will work with the to see how they n revitlize their roles. n ddition, the involve-

ent of relevnt non-helth progres (suh s environent for housing onditions, wter

supply nd snittion, publi trnsporttion for ess to re) will be enourged.

LIdentifying areas of haronization and collaoration

an iportnt role of the tion group is to help vrious progres to hronize efforts in

res suh s poliy, guidelines nd tools, supervision nd onitoring, nd nd wys of ol-

lborting to optiize use of resoures. any helth systes strengthening inititives should

be tken into ount, nd stff involved y ke vluble ontributions to this proess.


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14

LIncreasing coerage for accination, access to case anageent and prootion of exclusie

reastfeedingnerly ll tries will eed t tke ti i t lest the three ritil res viti,

se geet d resteedig. bsed resre vilility, the til ti grp

will develp rete pl hw t irese verge r these key itervetis i eqi-

tle er. hey will tke it t the t tht rpid redtis i pei rtlity

re re likely t e r esrig ess t itervetis i res r ppltis tht re

rretly the st der-served, therey redig ieqity. Pliy isses, sh s iprvig

ess t re y epwerig ity-level wrkers i pei se geet, will

eed t e reslved i rder t reve rriers t slig p. Helth systes stregtheig

iititives y help t highlight ther pliy isses hiderig ipleetti d help i their

reslti.

LTracking progress

he til pei pl will ti llly-pprprite gls, trgets d iditrs r

esrig whether the trgets re eig rehed, s well s hw eeded dt will e de

ville. he til ti grp will e respsile r esrig prgress, d sig the

irti r diyig the til pl, dvy d resre ilizti. pidei-

lgil d prgrti dt is rlly lleted thrgh the til helth irti

syste d peridi srveys, sh s egrphi d Helth Srveys d mltiple di-

tr clster Srveys. as prt the sitti lysis, r the wrk spei s-grp,

ssesset will e reqired wht dt will e ville whe, d, i eessry, hw ddi-

til dt y e lleted.

LEngaging the United Nations agencies and donors in countries

WHo d uncf prvide tehil spprt i y tries, sh s prvisi gide-

lies d tls r dtig sitti lysis d develpet pei ti

pl. he til ti grp will p these geies d ther pssile drs t -

try level, t see hw existig resres e est sed, d, where pssile, hw dditil

resres e ilized.

avecc/Hv

incent


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15

Glbl le Prters

he hieveet the glbl bjetives r pei preveti d trl will reqire r-

diti g the ered idividl prgres t try d regil level d expd-

ed spprt r develpet geies.

as exple iprved erts t rditi, re grp itertil prters r

uited ntis geies d tehil istittis hs sperheded the develpet the

GaPP. his grp, pprpritely expded, will t s Glbl sk fre d tie t pr-

vide pltr r perti g vris stkehlders. t will pririly wrk t:L rese wreess pei s the ledig se deth g hildre less th

ve yers ge i develpig tries, ildig the idetiti hpis t spprt

iprtt essges;

L Spprt the ipleetti r slig p hild srvivl itervetis with s el-

ertig the redti rtlity r hildhd pei;

L Prpse set pririty tivities t hieve the trgets eh seleted iterveti;

L filitte itrig, evlti d srveille tivities t esre prgress i hievig

the bjetives the GaPP;

L mbilize resres i spprt the ipleetti hild srvivl itervetis t redertlity r hildhd pei i lw-ie tries.

he prters, rdig t their expertise d iterest, will tke respsibility i ledig spei

tivities idetied by the sk fre d y ssig dedited st r these tivities. Withi

the uited ntis syste, WHo d uncf hve ledig respsibility bsed their -

bied expertise d experiee hild srvivl erts.

my itertil gveretl d -gveretl rgiztis re lredy prvidig,

r plig t prvide ssiste t develpig tries t help bild d ssti til

pity r trl pei i yg hildre. hese tivities re slly itegrted it

tis desiged t ddress the mG4 trget. Sh spprtive tivities st be itied

d ehed with, where eessry, spei ephsis pei.

egil d itertil geies will be lled p t prvide tehil ssiste r -

try tivities. hese tivities re likely t ilde: revisi, dptti d develpet teh-

il, pertil d geril pliies; tiered priig vies, drgs d eqipet; d

presetig ise tehil prgre, st d te prjetis.


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16

esearh

1

nserink m. Global health: Soe negleted diseases are ore negleted than others.Science

, 2009, 323(5915):700.

he neglet o researh in the eld o pneuonia over the past deade has let any iportant

linial and epideiologial questions unanswered.1 Pneuonia prevention and ontrol eorts

are unlikely to be eetive unless supported by strong researh, both operational and ore

basi. hereore, eorts to ontrol pneuonia in hildren ust be underpinned by an expanded

researh eort, inluding building researh apaity in the ountries ost aeted. While oun-

try prograes ove orward to sale up, there will be a need or researh on delivery strategies

and nding better ways or ipleentation. However, the need or this researh is no reason to

delay the ipleentation o e etive interventions now.

ey areas that an be addressed through researh are:

L main barriers to health are seeking and health are aess or hildren with pneuonia in

dierent ontexts and settings in developing ountries;

L finding ore eetive ethods o diagnosing pneuonia and its auses in the ounity

and rst level ailities;

L nvestigating new treatent regiens in the ae o inreasing antiirobial resistane o res-

piratory baterial pathogens, and shits in prevalent pathogens post Hib and pneuooal

vaine introdution and H prevalene;

L continued and expanded vaine developent to produe iproved versions o existing va-

ines and new vaines or inetions that are not yet vaine preventable.

he new tools should not only be eetive, but also aordable, sustainable and aeptable to

health workers and to the population. he Global ask fore will reate a oru to ailitate

ouniation between researh groups to exhange inoration on on-going studies, provide

inoration about unding soures, disuss results ro reently onluded studies and onvene

workshops to standardize researh ethodologies, address key gaps in knowledge, organize

ulti-entre studies and generate resoures. he Global ask fore will also ailitate the iple-

entation o proising new interventions at the ountry level.


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opprtunities 20092015

n the cntext f the size f the glbl prble f childhd pneuni, the resurces required

t prvide prven interventins re dest. he mGs hve built cnsiderble entu nd

strengthened pliticl citent t ddressing child rtlity. he signicnt reductin in

under-ve rtlity tht hs been chieved since 1990 hs resulted in sving illins f yung

lives in the pst tw decdes. t is strng incentive t intensify effrts becuse st f this

prgress hs been the result f increses in the dptin f bsic helth interventins. With less

thn six yers left t chieve mG4, the GaPP presents wy t enhnce prgress n reducing

the tp child killer. his pprtunity t dvcte fr nd prvide incresed investent in pneu-

ni shuld nt be issed.

a further pprtunity is the generl recgnitin tht success in the reductin f glbl helth

prbles requires ctive invlveent f ffected cunities supprted by effective intern-

tinl prtnership nd cllbrtive effrts. Plicies nd ctins re recgnizing nd lying the

grundwrk fr this cunity-bsed pprch.

belalHoSS

ain,cHrf,dSH,dHaka


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conlusion

he globl mG4 trget to redue hild ortlity by two thirds is still out o reh or ny o the

poorest ountries o the world. his trget will not be hieved without urgent tion on pneu-

oni ro ntionl governents nd inistries o helth nd supporting prtners t the globl

level. foused, oordinted nd integrted interntionl nd ntionl tion on pneuoni on-

trol, s oreseen in the GaPP, is needed. his douent lls on ll onerned groups to express

their politil oitent to suh tion, nd to llote resoures to hieve the trgets.

WHo/P.virot


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WHO and UNICEF have developed the Global Action Plan for Pre-

vention and Control of Pneumonia (GAPP) to support countries. TheGAPP provides a global framework for action around which partnerscan coordinate their efforts.

Pneumonia kills more children than any other illness more thanAIDS, malaria and measles combined.

Effective interventions to reduce pneumonia deaths are availablebut reach too few children.

More than a million lives could be saved if prevention and treatment

interventions were implemented universally. Preventing children under ve from developing pneumonia in the

rst place is key.

WORLD HEALTH ORGANIZATION

Avenue Appia 20, 1211 Geneva 27, Switzerland

UNITED NATIONS CHILDRENS FUND

3 UN Plaza, New York, New York 10017 USA

November 2009

For further information, please contact:Department of Child and Adolescent Health and Development

([email protected])

Documents

Global Action Plan for Prevention and Control of Pneumonia