4 children standing in line youngest to oldest; one child holds a toddler on her hip.

Targeting the Persistent Killers

Across Africa, children under the age of 5 face a greater risk of death from pneumonia that from more commonly recognized diseases like malaria and AIDS.

By Jackie Powder

For infants and children in Africa, diarrhea and pneumonia remain persistent killers—despite the existence of inexpensive, effective treatments, including zinc supplementation, an underused therapy for both illnesses.

The situation "isn't logical" for Robert Black, MD, MPH, chair of International Health and a leader in developing strategies and treatments for child survival. After a concerted public health effort in the '80s and early '90s to control the spread of the illnesses—contributing to a decrease in annual diarrhea-related deaths from 4 million to 2 million—they seem to have fallen beneath the radar in the global health community. 

"I think there's been some complacency, some thinking that we've solved the problem and it's gone away, but it hasn't gone away," says Black, whose research over the past decade has demonstrated that the micronutrient zinc is a treatment and prevention tool for episodes of severe diarrhea and pneumonia.

From 2000 to 2003, according to the WHO, pneumonia and acute diarrhea were responsible for 21 percent and 16 percent, respectively, of the deaths of children under 5 in Africa. Malaria accounted for 18 percent of the region's child mortality burden, and child deaths from AIDS totaled 6 percent.

Recently, however, there have been signs of renewed interest in the toll of diarrhea and pneumonia on children in the developing world, partly as a result of a 2003 child survival series in The Lancet that Black coauthored. Last year, the Bloomberg School received a nearly $1 million grant from the Bill and Melinda Gates Foundation to coordinate the work of international agencies, governments and private companies to accelerate the use of zinc to reduce child deaths caused by acute diarrhea. And Black is overseeing an initiative with Peter Winch, MD, MPH '88, associate professor in International Health, to promote the use of zinc to treat and prevent severe diarrhea in Mali, Pakistan and India.

Revised WHO guidelines, issued in May 2004, endorsed zinc supplementation to treat diarrhea, in addition to the standard treatment of oral rehydration therapy. Zinc supplements given during an episode of acute diarrhea reduce the severity and duration of the illness, and supplements taken for 10 to 14 days after an episode lower the incidence of diarrhea for up to three months.

Research has also found zinc to be an effective adjunct treatment for pneumonia in conjunction with antibiotics, and according to recent studies, is beneficial in preventing the acute respiratory illness as well. In addition, work continues at the Bloomberg School on the development of two new vaccines for pneumonia.

Despite some attempts to focus more attention on child deaths associated with diarrheal illnesses and pneumonia, Black says there remain significant obstacles to progress in Africa, including poverty and insufficient funding of health services in areas with high rates of death from diarrhea and pneumonia. "Clearly both national governments and international donors could do more to support the delivery of proven and highly cost-effective interventions to reduce deaths from the two biggest killers of children."