Title: THE NEW REALITY OF CHILD SURVIVAL: THEY MAY BE IMMUNIZED, BUT THEY ARE STILL DROWNING
Author:
Section/SPIG: International Health
Issue Date:
The IH Section will have an exciting, cutting-edge presentation at its Annual Meeting luncheon on Wednesday, Nov. 12, at 12:30 p.m. It will focus on new directions in child survival based upon just-completed research in six South and East Asian countries.
The Alliance for Safe Children (TASC), an NGO incorporated in Washington, D.C., in 2002, has recently completed national household surveys in six East and Southeast Asian countries (Philippines, Indonesia, Vietnam, Thailand, municipal Beijing, and Bangladesh). These surveys consistently document that the leading cause of child death in these countries is injury. As an example, there are more child deaths in these countries from drowning than all vaccine-preventable diseases combined. On one hand, this is a tremendous tribute to all of us who have worked over the past 40 years in EPI, ORT, ARI, family planning, and nutritional supplements and have witnessed dramatic reductions in child deaths resulting from these interventions.
By the same token, as these enormous reductions in traditional causes of child mortality have progressed, host governments and international health organizations have not focused on the “lesser” causes of child death, such as injuries. As an example, from the Matlab data, TASC researchers noted that there were approximately 26,000 drowning deaths in Bangladesh in 1968. The new household survey documents that there were approximately 26,000 drowning deaths in Bangladesh in 2002 -– virtually no progress in 35 years. Other causes of child death include burns, poisonings, falls, punctures and even intentional injuries. The mortality is matched with a full array of morbidity, much of it resulting in long-term disability, often with a devastating impact on household finances, plunging whole families into poverty.
Mike Linnan, a just-retired epidemiologist from CDC, has been working on this research since 1998 in collaboration with teams of host-country investigators from these six countries. Over this time they have uncovered some interesting mortality patterns. Drowning deaths begin to skyrocket at the age of 14 months –- the age toddlers begin to toddle. The rates then begin to decline, as children become taller -– and can stand up in a drainage ditch -- or learn to swim. By age 10 or 11 drowning phases out as a major cause of child death.
By age three road traffic accidents (RTAs) become a visible cause of child death, initially as pedestrians, then as passengers, such as on a bike. By age eight, RTAs increase significantly as children become bicyclists themselves and more exposed to vehicle traffic. This is offset in some cultural settings, as in Bangladesh. RTAs for boys eight to 10 are much higher than girls because Bangladeshi girls do not ride bicycles. From the age of 12 and up, RTAs become the leading cause of death as children move to motorized vehicles, particularly motorcycles, first as passengers and then as operators.
Linnan will also discuss the realities of gathering and reporting mortality data in developing countries and how this has helped to create a “blind spot” in terms of identifying the full scope of injury deaths. All IH Section members are encouraged to attend this luncheon and learn about this pioneering research which will steer child survival programs in a new direction.