"We may not be able to eliminate all these risk factors, but making sure children are immune to the disease is the one variable we actually can change."
Maputo, 5 April 2013 – Immunization is among the most successful and cost-effective public health interventions, helping to reduce the child mortality rate in Mozambique by half in less than 15 years. But more needs to be done for the country to fulfil its Millennium Development Goal of 73 deaths per 1000 live births by 2015. UNICEF EPI Specialist Onei Uetela’s job is to help make sure each and every last child in Mozambique is reached with life-saving vaccines. We caught up with him during a busy week of preparing for the introduction of a major new vaccine.
Q: We are launching a new pneumococcal vaccine together with the Ministry of Health and other partners on April 10, why is this vaccine so important for children in Mozambique? Onei Uetela: Globally, pneumonia causes 18% of all deaths of children under the age of 5. In Mozambique, this number is 10%. In real terms, this means that roughly 10,000 children in the country die of pneumonia every year. There are various reasons for this tremendous loss of life, various risk factors that an average Mozambican child is exposed to. For instance, being under the age of 5 is a risk factor in itself, because the immune system is still developing at that age, and the disease is most fatal for this age group, and even deadlier for those under the age of 2. This becomes worse if the immune system is further compromised by undernutrition or HIV. Children in Mozambique are also often exposed to dangerous fumes from coal or firewood used for cooking or heating, which increases the likelihood of pneumonia, and they generally live in crowded spaces where disease spreads easily. Children here are therefore very prone to pneumonia for these various reasons. The lack of access to health care and treatment is also a major problem. We may not be able to eliminate all these risk factors, but making sure children are immune to the disease is the one variable we actually can change.
Q: What can you tell us about the vaccine itself? How is it given, and whom is it meant for? OU: The pneumococcal vaccine or PCV is designed to specifically target the main type of bacteria that causes pneumonia. It is injected in three doses to children under the age of 12 months, and can give up to 80% protection for 4 to 6 years, so for a really critical period in a child’s life. PCV will become part of the routine immunization schedule, and will not change the number of times that parents need to bring their children to a health facility. It will be available at immunization sites starting April 10, and will save many, many lives.
Q: We know that under-5 mortality rates in Mozambique have decreased in the past 15 years, what more needs to be done to make sure we end preventable child deaths? OU: Since 1997, the rate of under-5 child mortality has decreased by more than 50%. It is now at 97 deaths per 1000 live births. This is a very good development, but it needs to be sustained. Routine immunization programmes are definitely one of the reasons for this decrease, as is malaria prevention, a disease that remains the number one killer of children under the age of 5 in Mozambique. We have national health weeks in place twice a year that target children in this vulnerable age category, offering them a range of life-saving health services, and that is important, as well. But we need to do more.
Q: Such as what? OU: For the mortality rate to continue decreasing, the number of health facilities that provide routine immunization must increase and spread more widely throughout the country. Today, we only have 1372 such facilities, and with nearly one million children to immunize, that is clearly way too few. The quality of health care has to improve as well. The delivery system to transport and stock vaccines, the so-called cold chain, needs to be strengthened to make sure the vaccines themselves are still good once injected. The Ministry of Health has a proper strategy for this, which we have helped develop, so we are moving in the right direction. Ultimately, by improving human development and literacy rates, preventable deaths of children under the age of 5 will also drop. We have a good momentum right now globally and in-country. By introducing the new pneumococcal vaccine, we stand a good chance of saving the lives of 10,000 children in Mozambique every year. The MoH intends to introduce another vaccine in 2014 or 2015, this time targeting the rotavirus, the main culprit behind diarrhea, one of three main killers of children under 5 in the country, malaria and pneumonia being the other two. I think we will continue to see very noticeable progress in the next 3-4 years.
Q: What is UNICEF doing to help Mozambique achieve Millenium Development Goal 4 by 2015 on reduction of child mortality? OU: UNICEF is a partner of the Ministry of Health, and we assist in the formulation of policies that affect the wellbeing of children, such as nutrition, malaria prevention and treatment, immunization, and prevention of HIV transmission from mother to child, as well as treatment of children with AIDS. All of these issues are relevant to child mortality. One of our programmes, for example, trains and fields community health workers, bringing diagnosis, treatment and referral closer to the community. In short, we offer technical and financial support, and help make sure that policies become actions or interventions, and that these in turn help save and improve the lives of children.