by Dr Roma Chilengi
In a recent article, as part of the Best Buys in Global Health series, Seth Berkley, the CEO of GAVI Alliance, pointed out that vaccine preventable diseases, diarrhoea included, has a huge negative impact on individuals in the developing world. Zambia is a perfect example. Currently, diarrhoea is the third leading cause of death and hospitalizations for Zambian children under the age of 5 years.
This means that Zambia’s 2.4 million children under the age of 5 years will experience millions of diarrhoeal episodes leaving them susceptible to premature death and preventing them from experiencing a healthy childhood. The impact on their families and communities is extensive: caregivers are unable to adequately provide for their families because the time they would spend engaging in paid work or in business is spent caring for sick children; community literacy levels are kept on the low end because children with frequent diarrhoeal episodes are unable to access educational opportunities; families have more children than they can support due to the fear of experiencing multiple child deaths; and affected children struggle with chronic malnutrition, stunted growth and general ill health resulting in poor intellectual development. The resulting effects of diarrhoeal disease entrench poverty in the developing world.
Understanding that the causes and factors that propagate diarrhoea and its complications in Zambia are diverse, we came up with a broad range of solutions to address this complex problem.
Leveraging on our long-standing work and success in strengthening the Zambian public health system, CIDRZ, with support from a UK-based charity – Absolute Return for Kids, and in collaboration with the Zambian government created the Programme for Awareness and Elimination of Diarrhoea or PAED. As the Program Director of PAED, I lead a team of researchers and programme managers to identify and implement high impact initiatives that will address diarrhoeal disease in Zambia. Beginning in 2010, we set out to demonstrate a 15% decrease in diarrhoeal-related deaths among children under the age of 5 in Lusaka Province by introducing a comprehensive diarrhoeal control programme, which includes rotavirus vaccination through the national immunization programme, improved clinical care, and community education. Lusaka Province will serve as our proof-of-concept and our successes and lessons learnt will be applied throughout the rest of the country.
Our second goal, which we have partly accomplished, is to accelerate the country-wide introduction of rotavirus and other high-priority childhood vaccines in Zambia through strategic investments in cold chain, commodities management, in addition to policy and protocol development, planning and advocacy.
On the 27thof November 2013, the rotavirus vaccine was rolled out nationally at a launch in Mazabuka District by the Minister of Community Development, Mother and Child Health, Dr Joseph Katema. The result of the roll-out is that any baby can now receive rotavirus and pneumococcal vaccination within any health facility in Zambia.
At the community level, our efforts have resulted in full vaccination of 123,000 babies and training of over 500 frontline health workers in Integrated Management of Childhood Illness. We are also working on a behaviour change campaign that will address attitudes that promote diarrhoeal disease within communities. At the same time, we are conducting both facility and community surveys to determine the impact of our programme.
By working closely with the Zambian government and its partners – and within the public health system in all aspects of implementation – we ensure that our programmes will remain sustainable and will form part of the National Health Strategic Plan for paediatric diarrhoea control.
We will not relent because we know that elimination of diarrhoeal disease is possible. We look forward to the day when no Zambian child, and indeed, no African child dies from severe diarrhoea.
Dr Roma Chilengi is CIDRZ Director of Health Systems and Primary Care