Over the past decade, Malawi has made significant progress reducing deaths in children under five. Still, pneumonia is the single biggest killer, taking the lives of an estimated 1000 babies and young children in 2010. Diarrhoea is another major threat, causing the deaths of 600 Malawian children per year.

The good news is, these diseases are both preventable and treatable, and Malawi is making good progress tackling them.

New vaccines

Vaccines against pneumococcal bacteria (which can cause pneumonia, meningitis, and other diseases) and rotavirus (the most common cause of severe diarrhoeal disease) are two of the newest tools. Malawi introduced pneumococcal vaccine as part of its regular “routine” childhood vaccination schedule in November 2011, and added rotavirus in October 2012. Only three other countries in the African Region provide both of these vaccines: Ghana, the Republic of South Africa, and Rwanda.

 “Support from WHO, UNICEF and the GAVI Alliance, has ensured we can offer Malawian children protection from two of the biggest killers: pneumonia and diarrhoea,” says Dr Storn Kabuluzi, Director of Preventive Health Services in Malawi’s Ministry of Health.

An integrated approach

While the vaccines are a vital part of prevention for pneumonia and diarrhoea they need to be combined with breastfeeding and nutritious food, and a clean environment. Ensuring that families have access to health services and the right medicines are also essential.

Malawi is pioneering this approach. For example, when mothers-to-be go for antenatal check-ups, they are also given hygiene kits. This simple measure has resulted in a nearly 30-fold increase in good household water treatment practices in just three years. It also resulted in a 15% increase in the number of mothers who deliver in health centres and go for postnatal check-ups.

“WHO is working with the Government of Malawi to show other countries in the region that it is both possible and advantageous to integrate the delivery of interventions that will cut child deaths from pneumonia and diarrhoea,” says Dr Felicitas Zawaira, WHO’s Representative in Malawi. “Over the past 10 years, overall child mortality has been cut in half, and Malawi is one of the few African countries on track to achieve the fourth Millennium Development Goal of reducing the under-five mortality rate by two thirds between 1990 and 2015.”

Reaching children in communities

Since 2008, Malawi has deployed close to 4000 “health surveillance assistants” (HSAs) to identify and care for sick children in hard-to-reach communities and refer them to hospital when necessary. In addition to reducing pneumonia and diarrhoea deaths, there are additional benefits for health. HSAs are trained and equipped with a kit of essential medicines to treat fever, diarrhoea, pneumonia and other common illnesses. They give antibiotics to children with pneumonia, and life-saving oral rehydration salts and zinc in cases of diarrhoea.

New Global Action Plan

On 12 April 2013, WHO and UNICEF launched a Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea. The plan calls for closer integration of efforts to prevent and treat the two diseases and sets ambitious targets to reduce mortality and improve access to life-saving interventions such as vaccines, breastfeeding, improved sanitation and safe drinking water, and treatment: antibiotics for pneumonia and oral rehydration salts and zinc for diarrhoea.

“Too often, strategies to tackle pneumonia and diarrhoea run in parallel,” says Dr Elizabeth Mason, Director of Maternal, Newborn, Child and Adolescent Health at WHO. “But as countries like Malawi are showing, it makes good health sense and good economic sense to integrate those strategies more closely.”