Childhood Pneumonia and Diarrhoea 4 Ending of preventable deaths from pneumonia and diarrhoea:

1. Childhood Pneumonia and Diarrhoea 4 Ending of preventable deaths from pneumonia and diarrhoea: an achievable goal Mickey Chopra, Elizabeth Mason, John Borrazzo, Harry Campbell, Igor Rudan, Li Liu, Robert E Black, Zulfiqar A Bhutta

2. Countries with the largest burden of pneumonia and diarrhoea deaths 15 countries with largest burden of pneumonia deaths 15 countries with largest burden of diarrhoea deaths Afghanistan Angola Burkina Faso Democratic Republic of the Congo Ethiopia India Kenya Mali Pakistan Niger Nigeria Sudan-precession Uganda 13 of the 15 countries with the highest pneumonia mortality are also among the 15 countries with the highest diarrhoea mortality. These 13 countries account for 78% of pneumonia and diarrhoea mortality. 85% of global pneumonia deaths 81% of global diarrhoea deaths Source: Global, regional and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2010. The Lancet, 11 May 2012.

3. Promise Renewed: Target <20 deaths/1000 live births for under five mortality by 2035 Under-5 mortality rate (per 1000) versus percentage of under-5 deaths attributed to pneumonia and diarrhoea in 2010 To reach this target, reducing deaths from pneumonia and diarrhoea will be critical, especially in countries with higher under-five mortality rates.

4. Proposed target: < 3 deaths/1000 from pneumonia and < 1 death/1000 from diarrhoea Target is global average by 2025, all countries by 2035 Aggregate reduction in cause-specific mortality across 74 Countdown countries

5. Four opportunities for further acceleration:

6. New approaches reinvigorate and accelerate progress Diarrhoea Pneumonia • New vaccines for preventing pneumonia and diarrhoea • Hib, pneumococcal conjugate vaccines • Rotavirus vaccines • Improvements in case management • Low osmolarity ORS • Zinc supplementation • Short course antibiotics for non-severe pneumonia • Oral amoxicillin for severe pneumonia • New evidence on other preventive modalities • Reduction of indoor air pollution • Hand washing

7. Action Steps: Strengthen Global and National Leadership Born too soon A Promise Renewed Family Planning Summit Country leadership & Implementation Key advocacy events and catalytic initiatives in support of Every Woman Every Child Decade of Vaccines Innovation Working Group Commission on Live-saving Commodities CoIA independent Expert Review Group

8. Addressing global drivers of mortality is critical Global drivers of pneumonia and diarrhoea mortality in the years 2000 and 2010 Prioritise interventions Foster Intersectoral Collaboration WASH = water supply, sanitation, and hygiene

9. A multi-pronged approach is necessary Pneumonia and diarrhoea are caused by multiple pathogens and no single intervention will address the entirety of the problem. Multiple interventions of proven effectiveness exist, which are complementary but not implemented in a coordinated fashion. Establishing better coordination between existing programmes can lead to synergies and efficiencies that will maximize the benefits of the individual interventions.

10. Strategies for preventing and treating pneumonia and diarrhoea Many interventions and treatment strategies are identical

11. The Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea

12. Protect, Prevent, Treat: a useful framework for an integrated approach

13. Five-step process can be used to translate evidence into policy and action

14. Substantial reductions in deaths due to pneumonia and diarrhoea – but still cause 2 million deaths per year Ending preventable deaths form pneumonia and diarrhoea is possible: Target: < 3/1000 deaths for pneumonia; <1/1000 for diarrhoea Scaling up cost-effective interventions can prevent 95% diarrhoeal deaths and 65% pneumonia deaths by 2025 Key messages Five-step approach to planning and management of programmescan rapidly lead to scale-up The cost to achieve the goal by 2025 is about $6.7 billion