A New Model For Child Survival In Africa

“Measles and malaria are the two biggest child killers in Africa,” said UNICEF Executive Director, Carol Bellamy. “If widely implemented, these nation-wide integrated campaigns may become the single most important step towards reducing child deaths in Africa. Creative new approaches like this are the key to ensuring the survival of thousands.”

Togo’s integrated campaign, which runs through to the 19th of December, aims to reach almost one million children around the country, many of whom live in rural areas - some completely inaccessible by road.

“Immunization campaigns can reach almost every child in poor countries,” said Dr LEE Jong-wook, Director-General of the World Health Organization (WHO). “Using them to deliver other life-saving interventions would be a major contribution towards achieving the Millennium Development Goal for reducing child mortality.”

More than US$ 5.4 million has been spent on the campaign of which almost US$ 790 000 has been raised by UNICEF and WHO, through the support of partners such as the UN Foundation, the US Centers for Disease Control and Prevention, the American Red Cross and the Canadian International Development Agency.

In addition, 2680 volunteers and 1910 vaccinators have been recruited to protect all children under five with the four life-saving interventions.

Since 1990, Togo has made substantial efforts in measles mortality reduction. A catch-up campaign carried out in 2001 reached over 95% of children under fifteen years of age. Togo has reduced measles deaths by 99% as compared to the 1996-2001 period. Much of this success is owed to countrywide immunization days mobilizing neighbourhood health committees and religious and traditional leaders to encourage mothers to bring their children for vaccination.

Despite improvements in routine immunization coverage almost half of Togo’s children born since 2001 are still at risk from measles – a completely preventable disease that affects over 30 million children each year and kills over 540 000 worldwide. It is hoped that by combining measles vaccination with the offer of a free mosquito net and other health interventions, many more children will be reached.

In Togo, malaria is a year-round problem that threatens the entire population. It is responsible for thousands of deaths each year and 40% of public health expenditure. Many of these deaths could have been prevented through the use of a long-lasting insecticide-treated net (LLIN).

Yet in 2003, only 15% of Togolese children under-five slept under a mosquito net and barely 2% slept under a LLIN. To date, poverty has been the major barrier to net ownership. Even though the average price of a net is only about two to five US dollars, it is still beyond the reach of poor households.

UNICEF and WHO believe that cost should not be a barrier to making malaria interventions – whether preventative or curative - available to all young children and pregnant women.

Malaria remains the largest killer of children in Africa, taking a child’s life every 30 seconds. Over one million people die from malaria each year, over 900 000 are children under five years of age, with about 90% of malaria deaths occurring in sub-Saharan Africa.

Public health multi-tasking has had remarkable success on a smaller scale, but has never yet been taken to a national level. In addition to a free LLIN and a measles vaccine, Togo’s children will also receive:

* The polio vaccine to protect against poliomyelitis, a highly contagious, incurable viral infection of the nervous system which can cause crippling paralysis or even death * Deworming tablets to expel intestinal worms and ultimately lower the rate of parasites. Intestinal parasites are a significant cause of malnutrition, severe anaemia, delayed puberty and problems with learning and memory.

Measles and malaria prevention and treatment along with these other interventions require the same health infrastructure and, more importantly, target the same vulnerable group – children. By combining all four at one time, governments can save money and lives.

“These health interventions complement each other perfectly,” said Mrs AHO Suzanne, Minister of Health, Togo. “Nothing like immunization has the potential to reach this many children and the prospect of a free mosquito net is a powerful incentive that will increase coverage.”