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Chapter 4 of 16

Most infectious disease deaths are avoidable at a low cost

• Most infectious disease deaths can be prevented
• Low-cost interventions are available, but not always used
  • Integrated Management of Childhood Illnesses
  • (IMCI) Childhood vaccination
  • Directly Observed Treatment, Short-course
  • Impregnated bednets
  • Availability of essential drugs
  • Prevention strategies for HIV/AIDS
  • Other strategies

Graphs:

• Preventable deaths
• Affordable health services for developing countries

Initiative: Stopping TB

Unfortunately for a number of reasons they are not being used. Inadequate funding of health care in developing countries is one reason. Government failure to prioritize, lack of cross-sectoral collaboration and the inability of weak health service delivery systems to reach the entire population - particularly the most vulnerable and difficult-to-reach - are contributing factors.

Integrated Management of Childhood Illnesses (IMCI)
This radical, low-cost strategy can dramatically reduce the 70% of deaths from pneumonia, diarrhoea, malaria, measles, malnutrition and other infectious diseases such as meningitis.

Seriously ill children are often suffering from more than one condition at the same time - making exact diagnosis difficult. For these children combined therapy can be life-saving. Treatment may include oral rehydration salts to treat diarrhoea, low-cost antibiotics to treat pneumonia, antimalarial drugs, and vitamin and mineral supplements. Another key focus is prevention through promoting immunization, breastfeeding and better feeding practices.

Millions of lives could be saved every year through the IMCI approach. Correct management of pneumonia and diarrhoeal diseases alone could prevent up to three million deaths a year.

Childhood vaccinations
More widespread use of low-cost vaccines could prevent 1.6 million deaths a year among children under the age of five. Yet today, one in five children are still not fully immunized against the six major killer diseases: diphtheria, whooping cough, tetanus, polio, measles and TB.

DOTS
Millions of TB deaths could be averted through the use of DOTS (Directly Observed Treatment, Short-course) - an inexpensive strategy for the detection and treatment of TB. This highly-effective health care package involves detection of TB cases through low-cost sputum smear tests, followed by 6-8 months of treatment with a combination of inexpensive drugs. A key component is regular ongoing support to the patient. This includes observation to ensure that patients follow the treatment correctly and follow-up sputum tests to determine whether it has been successful. The strategy can detect and cure disease in up to 95% of infectious patients, even in the poorest countries.

Impregnated bednets
One in four child deaths from malaria could be prevented if children at risk slept under bednets at night to avoid mosquito bites. Bednets dipped in an insecticide cost about $10 each and $0.50 to $1 a year for a supply of insecticide to re-treat the net. Dip-it-yourself kits are now available for re-treating the nets at home. The cost of a net and one year's supply of insecticide is less than one hour's parking in New York, Paris or Tokyo.

Availability of essential drugs
Millions of people in developing countries are dying needlessly from diseases that could be easily treated with safe, inexpensive drugs. More than one-third of the world's population lack regular access to essential life-saving drugs. Drugs may be too expensive for those on the lowest incomes, or they may not be available.

In Africa, where many of the poorest countries have no more than $1 per capita each year to spend on drugs, fewer than half have access to the basic drugs they need.

User-friendly packaging of drugs is a low-cost way of increasing compliance with antimalarial drug therapy. Studies in Ghana show that over 80% of patients given a course of antimalarial drugs packaged in a numbered blister pack finished the course of treatment. Of those receiving loose, unpackaged drugs - the way they are usually dispensed in developing countries - only 65% completed the treatment.

A simple packet of fast-acting drugs made widely available to parents - together with training to recognize malaria symptoms - could save the lives of many children with severe malaria.

Prevention strategies for HIV/AIDS
While expensive antiretroviral drug therapy for HIV/AIDS is still way beyond the means of most developing countries, well-targeted, low-cost HIV prevention and care strategies can have a major impact on the spread of HIV.

Millions of new infections could be prevented through low-cost interventions including:

- access to cheap condoms and, where necessary, safe drug injecting equipment
- use of essential drugs to treat other sexually transmitted infections (which amplify the risk of subsequent infection with HIV)
- HIV testing and counselling (which can lead to safer sex)
- counselling and support for HIV-positive mothers along with antiretroviral drugs and - counselling on safe alternatives to breastfeeding
- promotion of safe injection practices
- sex education at school and beyond.

Other important strategies
Inexpensive vitamin and mineral supplements can also save lives. As many as one in four child deaths from infectious diseases - mainly from measles and diarrhoea - could be prevented by giving children vitamin A supplements. Malaria deaths among children could be reduced through the use of iron supplements to treat anaemia. Yet these inexpensive remedies are not always available where they are needed most.

Effective health education can also save countless lives - by promoting safe sex, good nutrition and hygiene, immunization and ensuring parents know what to do when a child is sick.