Major effort to reduce child mortality not enough
Ghana has taken a major step towards reducing its under-five mortality rate by becoming the first African country to introduce two new vaccines for rotavirus and pneumococcal disease. But a United Nations Children’s Fund (UNICEF) official in the West African country says this measure will not be sufficient to meet the fourth United Nations Millennium Development Goal (MDG) to reduce the under-five mortality rate by two thirds by 2015.
Currently, 80 children out of 1,000 do not make it past the age of five in Ghana. According to UNICEF, Somalia has the highest infant mortality rate, at 180 deaths per 1,000 live births, and Sweden and Finland have the lowest at three deaths per 1,000 live births. (source: http://www.childinfo.org/mortality_ufmrcountrydata.php). In order to achieve the fourth MDG, Ghana would have to cut its under-five mortality rate down to 40 deaths per 1,000. "Ghana is doing a lot, but I don’t think it’s enough," said Dr. Anirban Chatterjee, UNICEF’s chief of health and nutrition in Ghana. He was referring to this country’s efforts with the new vaccines and the Health Service’s campaign to educate mothers on nutrition. "I think there is definitely scope and need for more improvement."
Rotavirus and pneumococcal disease are the leading causes of diarrhoea and pneumonia in young Ghanaian children. Together they account for close to 25 percent of under-five mortality and are behind only malaria as the leading causes of child deaths here. Now both the vaccines for rotavirus and pneumococcal disease are being given to young children before they reach four months of age. The measure is currently being rolled out across the country and to select hospitals in Accra. The GAVI Alliance, a public-private global health partnership, has helped fund the vaccines, which will be available for free to all Ghanaian children. More than 400,000 children in this country of 25 million people are expected to be immunised against both diseases. The two new vaccines are expected to prevent 12,000 pneumonia-related deaths and another 10,000 deaths from diarrhoea, said Dr. Antwi Adjei, head of the expanded programme on immunisation at the Ghana Health Service.
On Apr. 26, Ghana’s Health Minister Alban S. K. Bagbin said in a press statement that the new vaccines would give this country the extra push it needs to meet the fourth MDG by 2015. But for UNICEF, efforts to improve the nutritional health of children and provide them with vaccinations need to happen in tandem to reduce the under-five mortality rate. Chatterjee said malnourishment can sometimes double or triple the chances of dying from a condition like diarrhoea or pneumonia. "Malnourished children are more susceptible to contracting the disease, having severe forms of the disease, and also dying from the disease," he said.
Exclusive breastfeeding for the first six months of a child’s life is one way to prevent malnourishment in that crucial period. UNICEF has promoted the practice because it also helps create immunity to early childhood killers like pneumonia and diarrhoea. In Ghana, 63 percent of children are exclusively breastfed during that period, which is relatively high compared to other developing countries. However, many women do not breastfeed their children because they are not aware of the benefits, or they work in an environment – such as the informal sector – where it is difficult to do so.
Adjei said that the Ghana Health Service has regular cooperation between departments such as vaccinations and nutrition. The service’s various departments are currently meeting for Child Health Promotion Week to develop new strategies and programmes related to child health. One big challenge for the Ghana Health Service will be to reach all children with the rotavirus and pneumococcal disease vaccines. About 87 percent of children under one in Ghana have been immunised for tuberculosis, poliomyelitis, tetanus, hepatitis B, measles and several other childhood diseases. But reaching the last 13 percent has proven difficult. "Wherever a person is, we have a responsibility to reach them and vaccinate them," said Adjei. "Rising costs also make it more and more difficult." Some isolated communities around Lake Volta in central Ghana, for instance, can only be reached by boat. It is much more expensive for the Ghana Health Service to reach these small communities than to serve urban populations.
A small number of Ghanaians also do not take vaccinations due to religious or traditional beliefs. Adjei said, for example, that the local Twi dialect has only one word for "medicine," and it does not differentiate between preventative vaccines and drugs used to treat diseases. He said it is difficult to overcome such beliefs. "Fortunately for us these are isolated cases," he said.
La General Hospital in Accra was one of the first institutions to offer the vaccines in the capital on Friday, May 4. About 40 mothers were gathered at the hospital with their crying infants in tow, as they waited for their turn for their children to be inoculated. Gladys Otabil was at La General Hospital with her two-month-old son Gabriel. "All I understand by the addition of the two vaccines is that they will protect my child from any disease and sicknesses," she said. Otabil added that she was also advised to breastfeed her son for the first six months of his life. The roll out will expand to other hospitals in Accra, and across Ghana, in the coming weeks.
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