Preventing child deaths in Uganda

Dr. Addy Kekitiinwa's phone will not stop ringing. And as the executive director of Baylor College Medicine Children's Foundation in Uganda and seated at the Paediatric Infectious Disease Institute at Mulago, it is no wonder. Five minutes and as many interruptions into our interview she gets up to close the door to her office, takes her desk phone off the hook, silences her mobile phone, and sits down again with a smile and at full attention. "Now which study did you want to talk about?" she asks. Her question is indicative of the scale and scope of her work. She is an author of a study recently published by the World Health Organization (WHO) that found the Hib bacteria (Haemophilis influenzae type b) has been virtually eliminated in Uganda thanks to the introduction of the Hib vaccine in 2002. But the study was completed in 2006 and Dr. Kekitiinwa now has numerous other projects on her plate, all devoted to improving the health of children in Uganda.
Though now relatively old news, the findings from the WHO report are impressive. Widespread use of the Hib vaccine in Uganda now prevents over 30,000 cases of severe meningitis and pneumonia and over 5,000 child deaths each year. The study also found that the Hib vaccine, added to the standard DPT (diphtheria, pertussis, and tetanus) vaccine recommended for all children in 2002, is over 90 per cent effective after just two of the required three injections. Uganda's successful immunization campaign is a promising sign for other countries hoping to reduce the prevalence of this deadly bacterium.
The elimination of Hib is good news, but bacterial meningitis and pneumonia are just two of the many preventable diseases children face in Uganda, explains Dr. Kekitiinwa. Other major threats include malaria, pneumonia, diarrhoeal disease, and malnutrition -- the leading causes of morbidity and mortality in Ugandan children. Vaccine coverage for common childhood illnesses in Uganda is generally high, but there is room for improvement. According to the Uganda Bureau of Statistic's 2006 Demographic and Health Survey (DHS), approximately 90 percent of children in Uganda receive the tuberculosis (BCG), DPT (which now includes Hib), and polio vaccines. However, only about 70 percent of children receive the measles vaccine, and only about 46 percent receive and complete all four of the recommended vaccinations.
What accounts for lack of immunization in these cases? "It is not about access," says Dr. Adeodata Kekitiinwa, as all vaccines are free of charge and paid for by the government of Uganda. "I think people don't see the immediate incentive even when the vaccines are readily available." Therefore, she says, "It is upon us health workers to really show them, to really educate them to appreciate that it is an investment – look at it as an investment to health." Dr. Kekitiinwa also hopes to educate the government on the benefits of preventative care. One of the goals of the WHO surveillance study, she says, was to provide evidence-based facts to the government of Uganda that it is actually cheaper to invest in preventative care of diseases like meningitis than to pay for treatment after the disease has spread.
Diarrhoeal disease is another major threat to children's health that can often be prevented. Rotavirus, for which there now exists a vaccine, is the most common cause of severe diarrhoea in children and is responsible for around 600,000 child deaths worldwide each year. According to the 2006 DHS, the incidence of diarrhoea in children is lowest in Kampala (approximately 17 percent) and highest in IDP camps in the north (approximately 44 percent). Rotavirus vaccines have been developed and tested in the west and have been found to provide 90 to 100 percent protection against severe rotavirus disease. Current research in Africa and Asia is being used to determine the vaccines' efficacy in these regions and results are expected by 2009, according to a recent report by the Rotavirus Vaccine Program. Dr Kekitiinwa is hopeful that the rotavirus vaccine will be readily available in Uganda in less than two years.
In the meantime her phone is unlikely to stop ringing. Her most recent research has shown the positive effects on growth of antiretroviral treatment in paediatric HIV/AIDS patients and the decrease in incidence of malaria for HIV/AIDS patients who use insecticide-treated bed nets. While she is keeping busy, Dr. Kekitiinwa says the government of Uganda should keep up the good work in the area of vaccine coverage and provision. "They are doing well," she says, "and they need to be encouraged to do even better." Parents, who are ultimately responsible for their children's health, must also recognize the value of preventative care. It will take the resolve and coordination of all players – researchers, doctors, government and parents – to reduce the childhood morbidity and mortality from the preventable diseases that claim thousands of lives each year.

Melina Platas
The Independent