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Indian Pediatr 2014;51: 957-958

‘Two Birds, One Stone’ Approach – Integrated Action Plan for Pneumonia and Diarrhea

Vijay N Yewale

National President, Indian Academy of Pediatrics, 2014.
Email: vnyewale@gmail.com 

s per the recently released Pneumonia and Diarrhea Report 2014 [1], every 20 seconds a young child under the age of five years succumbs to either of the two major but preventable diseases – pneumonia and diarrhea. Pneumonia contributed to 15% and diarrhea to 9% of the 6.3 million under-five mortality globally in 2013 [1]. Unfortunately, India has the maximum burden of these two diseases in the world.

In the past half century, many vertical programs targeting pneumonia and diarrhea (e.g. Diarrheal Disease Control Program, Acute Respiratory Infections [ARI] Control Program) were implemented by the Government of India (GOI). These programs were designed to improve exclusive breastfeeding, provide oral rehydration solution (ORS) and zinc for treatment of diarrhea, and antibiotics for pneumonia. All three strategies have been scientifically proven to significantly reduce mortality due to both diseases. However, in spite of these extremely cost effective steps designed in the public health sector, the millennium development goal – MDG4 – of reducing child mortality by two-thirds, remains a distant dream. For example, as per the third National Family Health Survey (NFHS-3) data, more than 60% children were taken to a health service for diarrhea in the two weeks prior to the survey, but the percentage who received ORS was dismay at 26.2% [2]. Also, less than 50% infants were exclusively breastfed – an extremely important determinant of child survival. Not exclusively breastfeeding has been proven to be associated with a whopping 566% increase in all-cause mortality in children aged 6-11 months, and a 223% increase in mortality in those aged 12-23 months [3]. Therefore, though the interventions have been scientifically correct, there have been serious lacunae in the health system to be able to implement the same at grass root level, and deliver them to the needy children.

The victims of both these top killers often have common risk factors, thereby making an integrated action plan an ideal choice over single disease-targeted actions. This approach aims to provide coordinated solutions for both the diseases at the same time by strengthening the health system at the same points, particularly at the level of community. Considering the above facts, WHO/UNICEF in 2013 launched the "The Integrated Global Action Plan for Pneumonia and Diarrhea (GAPPD)" aimed at ending preventable child deaths from pneumonia and diarrhea by 2025 – to reduce deaths from pneumonia to fewer than 3 children per 1000 live births, and from diarrhea to less than 1 in 1000. This action plan provides an integrated framework of key interventions to protect, prevent and treat pneumonia and diarrhea in children less than five years of age. It focuses on supporting activities to improve and accelerate the implementation of the existing interventions of proven benefit.

As an adaptation of GAPPD, the GOI along with WHO and UNICEF in September 2014 developed an Integrated Action Plan for Pneumonia and Diarrhea (IAPPD). The plan is being presently targeted in four states – Uttar Pradesh, Bihar, Rajasthan and Madhya Pradesh – which account for more than half of under-five deaths. The progress towards GAPPD goals will be measured via ‘score cards’, and regular reviews of these cards will ensure accountability in the implementation of corrective actions.

The successful implementation of the above action plan requires coordinated and united efforts of all health care providers and thereby the Indian Academy of Pediatrics (IAP) recognises its powerful contribution in this initiative. IAP was invited for the workshop on Approaches for Prevention and Management of Pneumonia and Diarrhea for achievement of MDG4, and to discuss its role and challenges in engagement of pediatricians from the private sector. The Academy has successfully launched the Mission Uday Program which aims to create a pool of skilled personnel to deal with these killers more effectively and efficiently with evidence-based science. The vision of the IAP Mission Uday is that every child is protected against diarrhea, pneumonia and other vaccine preventable diseases, is well nourished, and has access to preventive and treatment measures with ultimate goal to reduce under-five mortality.

The Academy pledges its support to this unique integrated global and national action plan, and will strive in every possible way to achieve the targeted goals in our country.


1. IVAC. Pneumonia and Diarrhoea Progress Report 2014. Available from: http://www.jhsph.edu/research/centers-and-institutes/ivac/resources/IVAC-2014-Pneumonia-Diarrhea-Progress-Report.pdf. Accessed November 18, 2014.

2. GOI. National Family Health Survey (NFHS-3) Factsheet (2005-06). Available from: http://www.rchiips.org/nfhs/factsheet.shtml. Accessed November 18, 2014.

3. Bhutta ZA, Das JK, Walker N, Rizvi A, Campbell H, Rudan I, et al. Interventions to address deaths from childhood pneumonia and diarrhoea equitably: What works and at what cost? Lancet. 2013;381:1417-29.


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