The Ministry of Health is intensifying its fight against childhood diseases by adding a number of vaccines to its Expanded Programme for Immunization (EPI) as it aims to increase life expectancy to 75 by 2015.
In his address to health workers in Region Six recently, Minister, Dr Leslie Ramsammy said Guyana has achieved significant reduction in childhood illnesses (morbidity) and childhood mortality. He also said the ministry is aiming to surpass achieving Millennium Development Goals (MDGs) numbers four and five and is determined to reach targets for child and maternal mortalities that bring Guyana on par with more developed Caricom countries.
In 2008, the last verified year, the under-five mortality rate was 19 for very 1,000 children with a total of 286 recorded deaths of children. In 1990, the under-five mortality rate was estimated at 120; this means that the country has achieved a greater than 80% reduction in childhood mortality. The minister said there are two major causes of childhood illnesses and deaths in Guyana: acute diarrhoeal diseases (ADD) and acute respiratory infections (ARI). Together they account for 8.7 deaths per 1,000 children and 46% of all deaths of children under five in 2008.
ADD caused an average of 5.2 deaths per 1,000 children under-five and accounted for 27% of all deaths in children of the same age range in 2008. “This makes diarrhoea the leading cause of death among our children. ARI was the second leading cause of deaths in Guyana; causing an average of 3.5 deaths per 1,000 children and accounting for 19% of all deaths of children in that age range in 2008.
Globally, ADD and ARI account for more than 40% of deaths in children. “ADD accounts for 17% and ARI accounts for 19% of all under-5 children deaths in the world,” the release said. While the percentage of ARI deaths globally and in Guyana is the same, diarrhoeal deaths in children under five is higher in Guyana.
As regard morbidity (illness) in children, ADD resulted in almost 12,000 recorded childhood illnesses in 2008. “This merely reports those cases of gastroenteritis which were serious enough for the family to take ill children to health care providers,” the minister said. Of the total number of diarrhoeal cases recorded that year, almost 46% of them were among children under five-years-old. There were about 26,000 cases of diarrhoea recorded that year for the whole population. The release said ARI still ranks as the leading cause of illness among children with about 40% of all illnesses among children under five-years-old.
Dr Ramsammy said the ministry is further intensifying efforts to prevent ADD and ARI-related morbidity and mortality as “Most of the deaths due to ADD and ARI are preventable.” The leading ARI diseases are influenza, pneumonia, tuberculosis and bronchiolitis which causes more than two million deaths per year. Pneumonia is the leading ARI, causing more than 5,000 deaths each day in the world. The release also said that Guyana and the Caribbean have virtually eliminated measles and the World Health Organisation is currently conducting an exercise to certify Guyana as measles-free.
Meanwhile, in order to address and stem the prevalence of ARIs, the ministry has undertaken a number of initiatives including the use of vaccines. One of the most important is the pneumococcus vaccine programme (PCV 7) introduced to a target group of children in 2009. “This is a vaccine to fight against pneumococcus-associated ARI, one of the more prevalent forms in Guyana and around the world,” the release said. The vaccine is now part of the universal coverage EPI and is provided to all children. Together with the rotavirus vaccine, the PCV 7 should reduce child deaths in Guyana to between 40 and 50 per cent.
The ministry said even though Guyana is only in its first full year of inoculating children with the PCV7 vaccine, it has already been working with the Pan American Health Organisations/WHO and Global Alliance for Vaccine and Immunization (GAVI) to introduce an even stronger version of this vaccine. “This stronger version has recently been approved by the WHO for use and is called PCV13. Studies have shown that PCV13 provides greater protection against pneumococcus infections,” the release said.
In 2001 Guyana introduced the haeomophilus influenza type b vaccine as part of the pentavalent vaccine (five vaccines in one shot). Currently more than 90% of the country’s children have been vaccinated against Hib. In order to ensure that all children are covered a “sweep” programme has been initiated countrywide.
Periodically, the ministry provides a seasonal influenza vaccine shot. This shot is not a part of its EPI but it is researching whether seasonal flu shots might lead to a reduction of ARI-related deaths. The ministry also said most children under five have been inoculated with the H1N1 vaccine, though it is not certain that the programme will continue next year. “Depending on the H1N1 transmission level in our region, a decision will be made if H1N1 vaccines would be useful on a continuous basis,” the minister said.
Fighting diarrhoea in children
Diarrhoea is “a public health scourge” that affects every country in the world and is responsible for almost two billion episodes of illnesses and almost two million deaths each year among children under the age of five. There are almost 12,000 reported cases of diarrhoeal illnesses and over 280 diarrhoea-related deaths recorded in children under five-years-old in Guyana each year.
The most prevalent causes of diarrhoea in children under five in the world are E.coli (mostly from contaminated food and water) rotavirus (mostly from contaminated food, water and soil) cholera (mostly from contaminated water, but hasn’t been found in Guyana since 2004) salmonella (mostly from contaminated water and food) and the cause of typhoid) shigella (mostly from contaminated food and water) and parasites such as giardia, entamoeba and cryptosporidium (mostly from contaminated food and water).
In order to combat this scourge, the ministry has made available low-osmolarity oral rehydration solution (ORS) and zinc supplementation at all health facilities nationwide; included rotavirus vaccines in its national immunization programme; promote breastfeeding in infants in the first six months of life and promote the use of micro-nutrient supplementation in children.
It said too studies have shown that about 30% of diarrhoea cases in children in Guyana could be attributed to rotavirus infection. The rotavirus vaccine is now included in the EPI and 35,000 doses have been produced for the year. The ministry also called for the ethical use of the vaccine for children accessing it through the private sector. “Like all other vaccines in Guyana, the rotavirus vaccine is free for all children,” Ramsammy said.
The ministry said over the next several months initiatives relating to these interventions will be rolled out. It said too it is currently modifying the ORS regime to include lower sodium content and with zinc supplementation since studies have shown that ORS therapy works more effectively with this component. The addition of the zinc supplementation will add another $10M to the ORS annual budget.
The ministry has also instituted mass behaviour modification programmes for the use of household water treatment and safe storage systems for food and water. It collaborates with PAHO/WHO, UNICEF and USAID to strengthen and expand these responses. In keeping with this the ministry ahs embarked on using PUR, a chemical that is used to treat water and can used use to treat creek water for domestic purposes. It also works with PAHO/WHO and the Central Housing and Planning Authority, it also regulates the building of household toilets in order to reduce and eliminate community-wide open defecation practices.
The ministry also works with the education, local government and Amerindian affairs ministries and local government organs such as the RDCs, NDCs and Amerindian councils to ensure optimal implementation of these programmes.
