Acute respiratory infection (ARI)

One of the most critical unmet health needs of children around the world is the effective prevention and treatment of acute respiratory infection (ARI). Usually in the form of pneumonia, ARI is the leading cause of death in children under the age of five, killing between two and three million children each year. And because, ARI is often compounded by the existence of other afflictions such as measles or malnutrition, many of the deaths attributed to other causes are, in fact, "hidden ARI cases."

Because of the difficulty in tracking acute respiratory infections, there is little reliable surveillance data that can be used to determine the country incidence or mortality from ARI. Most of the data that exists on ARI comes from Demographic and Health Surveys (DHS) which are conducted in a sample of developing countries. Results of these surveys show that there has been only a slight increase in the number of children with symptoms of ARI taken to a health care facility during the last decade. Nearly half of the children in the surveyed countries are not being taken for appropriate health care when they have symptoms of a potentially serious respiratory tract infection. Furthermore, most of the cases of pneumonia that ultimately result in fatality are not seen until very late in the course of the illness.

These results indicate that much of the challenge in effectively dealing with ARI in developing countries comes from the inability of families to recognize the signs and symptoms of respiratory distress. This failure in early detection is often further exacerbated by the lack of an effective clinical infrastructure to quickly treat the infection and bring about a positive outcome.

As is the case with most of the serious childhood afflictions, the negative effects of ARI can be avoided through prevention measures, early diagnosis of infection, improved nutrition, and effective home and clinical treatment. In fact, the majority of pneumonia cases can be effectively treated with low-cost antibiotics.

It is hoped that much of the future reductions in ARI mortality in children under age five will come from primary prevention through more comprehensive immunization. Currently, a number of new vaccines to prevent the most common bacterial causes of pneumonia are being field-tested. Studies of the causes of pneumonia over the past two decades show that haemophilus influenzae (HiB) and streptococcus pneumonia (pneumococcus) account for about two-thirds of all acute respiratory infections. Results from some of the early field tests show conclusively that rates of pneumonia can potentially be decreased by at least 25% with comprehensive immunization programs that include an HiB vaccine alone. Vaccines to prevent pneumococcal infections, approved just last year in the US for infants and toddlers, show even more promise as an effective preventative agent.

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Malaria

Malaria is one of the top five leading causes of death for children under five, killing almost 700,000 every year (over 1 million children in conjunction with another illness). It is spread through the bite of the female anopheles mosquito and persists in over 90 countries across Africa, Asia, and Latin America, putting almost 40% of the world's population at risk. Sub-Saharan Africa remains the most severely endemic, with as many as 9 out of every 10 cases of the disease.

Thriving in warm, humid environments, malaria often occurs in endemic areas during severe emergency and epidemic situations such as wars or migrations, and where there are large population movements and deteriorating sanitary conditions. Outbreak conditions are further exacerbated by weak or failed health systems, unplanned development activities, and severe environmental and climactic conditions, such as monsoons.

Effects of malaria

The effects of malaria can be devastating, especially to young children. Acute cases of malaria are often associated with debilitating flu-like symptoms, while more serious cases can lead to anemia, organ failure, and induced coma. Severe afflictions, which occur most often among children under five, can develop into cerebral malaria potentially leading to brain swelling, convulsions, and death.

For women who are pregnant, the effects of malaria can be especially dangerous, where contracting the disease can lead to miscarriages, stillbirths and severe anemia ­ all of which greatly increase the chances of maternal death. Malaria also accounts for as much as one third of all cases of preventable low birth weight among newborn children, which is the single greatest risk factor for infant mortality.

Malnutrition can contribute greatly to malaria's impact in women and children by increasing the chances that they will contract the disease because of diminished resistance and by reducing the body's ability to limit the severity and recover. Research conducted over the past five years indicates that supplementation of certain micronutrients such as vitamin A and zinc can greatly limit the impact of malaria in women and children and reduce the chances of contracting the disease through increased resistance.

For children, malaria not only puts their health at considerable risk, it impedes their ability to learn and develop. In affected areas, children develop as many as six bouts of malaria every year on average, resulting in a substantial amount missed of school and diminished learning. In fact, malaria is the single most common cause of school absenteeism.

Overall, the social and economic burden of malaria is great. Because of the frequency and intensity of malaria cases, and the resulting absence and impairment of workers, many countries experience significantly diminished productivity and enormous treatment costs. In countries of sub-Saharan African, where the vast majority of cases occur, malaria diminishes gross domestic product (GDP) by more than 1% and accounts for nearly 10% of all health expenditure. A Harvard study showed that Africa's GDP would be 32% greater if malaria had been eliminated 35 years ago.

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Measles

Long forgotten as a significant childhood threat by industrialized nations due to child immunization, measles is among the top ten killers of children in developing countries and remains a significant gap in the unfinished child survival agenda. Causing more than 800,000 deaths every year, measles is responsible for nearly 7% of the worldwide deaths of young children annually and is the world's leading cause of childhood vaccine-preventable death. As one of the most highly contagious diseases known, measles can spread quickly within a household or urban community causing permanent disabilities for many of its survivors, including blindness, hearing impairment, brain damage, and other deadly complications such as pneumonia.

The disparity in regions affected by the disease is significant. About 85 percent of all of measles-related deaths occur in just 20 countries, primarily within Africa and Southern Asia. India itself experiences a third of these deaths, and it is estimated that the African continent suffers as much as 59% of all global cases of the disease

There is no specific treatment for the disease. Vaccination has proven to be the most effective intervention for the virus and is one of the single most important means of protecting children from disease and malnutrition. Since the introduction of the vaccine to a majority of the world's children, annual reported cases has fallen from 4.5 million in 1982 to around 0.5 million in 1998.

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