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Pneumonia and Diarrhea Progress Report

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Emily Wilson
Senior Research Associate
ewilso28@jhu.edu

Introduction

  • Pneumonia and diarrhea remain leading killers of young children worldwide, responsible for 1.17 million under-five deaths annually.

  • Pneumonia and diarrhea account for approximately 23% of global under-five mortality. 

  • The burden of pneumonia and diarrhea continues to be deeply inequitable, with over 70% of under-five mortality concentrated in just 15 countries.

What are GAPPD indicators?

In 2013, the WHO and UNICEF published the integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhea (GAPPD), a call to action with the goal of achieving a global 75% reduction in the incidence of severe pneumonia and diarrhea in children under 5 by 20251. GAPPD outlines a set of core interventions to successfully prevent, protect, and treat children who are at risk of serious illness or death due to these two diseases. 

A country’s overall GAPPD score reflects the average of all 10 indicators.

  • The Pneumonia Score reflects the average of seven pneumonia-specific indicators
  • The Diarrhea Score reflects the average of five diarrhea-specific indicators
  • Of the 10 indicators, two are effective against both diarrhea and pneumonia

 

View definitions and sources
Number of deaths, Number of deaths per 1,000 live births

Analysis of cause-specific mortality for neonates and children younger than 5 years from 2000 to 2019 published by Perin et al. (2022)1. This is the latest update of global estimates of child causes of death prepared by WHO and the Maternal Child Epidemiology Estimation group (MCEE) 

GADPP Scores

The Overall GAPPD score is calculated as the average of indicator-specific scores for all 10 interventions. The GAPPD Pneumonia score is calculated as the average of scores for the 7 pneumonia-specific interventions. The GAPPD Diarrhea score is calculated as the average of scores for the 5 diarrhea-specific interventions. 

  • Most Recent Update to GADPP scores: 10/1/23
Exclusive breastfeeding

UNICEF’s expanded database on infant and young child feeding (IYCF) provides country-level trends recommended IYCF indicators. All publicly available MICS and DHS (phase 5-7) have been reanalyzed to produce standardized estimates across years and surveys programs. Data reflects the most recently available national point estimates on percentage of infants 0-5 months of age who are fed exclusively with breast milk. 

DTP3, MCV1, Hib3, PCV3, RotaC

Based on country-reported data, the annual WHO and UNICEF estimates of national immunization coverage (WUENIC) provide the world’s largest dataset on immunization coverage trends for 14 antigens across 195 WHO and UNICEF Member States. For 2022, 185 countries reported immunization data; for non-reporting countries the 2021 WUENIC estimated coverage was used.  

Taken to Health Provider

Careseeking for ARI - percentage of children (under age 5) with acute respiratory infection symptoms whom advice or treatment was sought from a health facility or provider. 

Receiving antibiotics

Percentage of children with symptoms of acute respiratory infection who received antibiotics.*

*Concerns have been raised about the validity of antibiotics for suspected pneumonia as an indicator and recommend excluding this indicator in analyses of pneumonia treatment coverage. 

Learn more: Ayede, A. I., Kirolos, A., Fowobaje, K. R., Williams, L. J., Bakare, A. A., Oyewole, O. B., ... & Campbell, H. (2018). A prospective validation study in South-West Nigeria on caregiver report of childhood pneumonia and antibiotic treatment using Demographic and Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) questions. Journal of Global Health, 8(2). doi: 10.7189/jogh.08.020806 

ORS, Zinc

Percentage of children under age 5 with diarrhea who received oral rehydration salts (ORS packets or pre-packaged ORS fluids) / zinc supplements.

Key takeaways

In 2024, all 15 focus countries failed to meet the Overall GAPPD score target of 86%. The mean Overall GAPPD score across all 15 countries was 50%, 2% more than last year. Nearly all focus countries made some progress towards targets and several countries made substantial gains across Overall, Pneumonia, and Diarrhea GAPPD scores. 

    Read the full report here, as well as an executive summary, country profile pages, and past reports: https://www.jhsph.edu/ivac/resources/pdpr/

    • Overall GAPPD Score: 2024 Overall GAPPD scores ranged from 23% (Somalia) to 69% (India). From 2023 to 2024, seven focus countries (Niger, Madagascar, Nigeria, Côte d'Ivoire, Ethiopia, Angola, Chad) experienced an increase greater than 1 percentage point and two focus countries (Democratic Republic of the Congo, Sudan) experienced a decline greater than 1%. 
    • Pneumonia GAPPD Score: Seven focus countries (Niger, Madagascar, Ethiopia, Côte d'Ivoire, Angola, Chad, India) experienced an increase greater than 1 percentage point since the 2023 report and two focus countries (Democratic Republic of the Congo, Sudan) experienced a decline.
    • Diarrhea GAPPD Score: Nine focus countries (Nigeria, Niger, Angola, Ethiopia, Côte d'Ivoire, Madagascar, Chad, United Republic of Tanzania, Cameroon) experienced an increase greater than 1 percentage point. Three focus countries (Democratic Republic of the Congo, Mali, Sudan) experienced a decrease in Diarrhea GAPPD score. 

    For more information

    Value of Immunization Compendium of Evidence (VoICE) study summaries on pneumonia and feature on pneumonia

    IVAC webinar: “The Human Cost of Pneumonia and the Power of the PCV: Stories from Somalia and India”

    Partner resources

    Immunization Agenda 2030 Scorecard

    The Immunization Agenda 2030 (IA2030) scorecard is a publicly available interactive tool displaying data that enables global, regional, and country-level stakeholders to monitor the status of each indicator in the IA2030 Framework for Action. The scorecard supports coordinated operational planning, ownership and accountability, and communication and advocacy. 

    Every Breath Counts Pneumococcal Conjugate Vaccine (PCV) Scorecard

    In a scorecard released in 2022, Every Breath Counts ranks the 40 countries that are home to 94% of the 1.63 million child lives that could be saved with PCV coverage by 2030, according to the Vaccine Impact Modelling Consortium (VIMC). 

    The Rota Council

    Six rotavirus-focused briefs cover epidemiology and disease burden, available vaccine products, the impact of vaccination, economic costs of rotavirus disease and the value of vaccines, safety, and introduction and coverage status. 

     

    References 

    1. World Health Organization & UNICEF. Ending Preventable Child Deaths from Pneumonia and Diarrhoea by 2025 : The Integrated Global Action Plan for Pneumonia and Diarrhoea (GAPPD). World Health Organization; 2013. Accessed October 20, 2023. https://iris.who.int/handle/10665/79200