Tag Archives: World Health Organization

Ebola – the search for a vaccine

LONDON, 27 January 2015 – When Ebola hit West Africa last year, it was a disease with no sign of a vaccine or cure. To those affected that may have been an indication that the wider world didn’t care about them or the diseases that affected them, but in truth there has simply been no incentive for anyone to develop these therapies. Yet now pharmaceutical companies are racing to produce an effective vaccine, and on 23 January the British company GlaxoSmithKline shipped the first 300 doses of its candidate to Liberia to start phase II trials.

At an event in the UK Houses of Parliament to discuss the economics of developing such vaccines, Jon Pender, a vice president of GSK, said he had been surprised, in the circumstances, that companies had any possible candidates at all on their shelves which could be developed and tested. He challenged suggestions that this was just because Ebola epidemics happened in poor countries where there was little scope for profit.

“That isn’t the reason why we don’t have vaccines for Ebola. The reason we don’t have a vaccine is because it wasn’t a priority for anyone, and there are understandable reasons for that…. The number of people affected each year was very small and the overall disease burden, in comparison to other disease like malaria or HIV, is tiny. The fact is that in the forty years that we have known about Ebola, including the present outbreak, there have been about 24,000 known cases. There are that many cases of malaria every hour.”

Now, clearly, it has become a priority. So if it isn’t just about money, how do you persuade the pharmaceutical industry to work on a normally obscure disease like Ebola? Adrian Thomas is a vice-president at Janssen Pharmaceutical Companies, which is also now working to get an Ebola vaccine to market. He says, “The first question is, what is the strength of the science? The second thing is to what extent there is a reward for innovation or a willingness to risk-share. And the third is, will we actually reach people? I think we have to understand what are the clear priorities for global health…

“Some companies do it for the reputation, others do it for the science or for alternative incentives. Other companies do it for direct financial reward, and I think you have to understand what are the different incentives that are necessary across that spectrum.”

Profit may not be everything, but the companies are not setting out to lose money. In this case they have been incentivized with public money – American, Canadian or European – to pay development costs, and assurances from the global vaccine alliance GAVI that there will be a market for any successful vaccine they produce, with up to $300 million available to pay for it.

Médecins Sans Frontières has been campaigning on the high and rising price of vaccines and the lack of transparency in the pharmaceutical industry, and earlier this month it published a new edition of its campaign document, the Right Shot.

Rohit Malpani is director of policy and analysis for MSF’s Vaccine Access Campaign. He told IRIN that despite substantial sums of public money poured into the development of an Ebola vaccine, very little was being demanded of the companies in return. “These vaccines are being developed with full public funding,” he says, “compensating the manufacturers for whatever investments they have to make, and for the cost of the clinical trials. Yet at this stage it is very non-transparent what the costs of development are, and not clear what guarantees there are about the outcomes and how they will ensure affordability. Governments are just writing them blank cheques.”

MSF welcomes the fact that GAVI has earmarked money to buy any successful vaccine, since that sends a signal to the manufacturers that there is a market, but thinks that GAVI should also be more demanding. Malpani says, “We are still not sure at what price it will be sold to GAVI. MSF would prefer that it is sold at or near cost. And if any cost is not covered by public funding, it’s better for that to be compensated directly, rather than through higher prices for the vaccine. The idea would be to de-link the cost of development from the final price.”

GAVI negotiates lower prices for the vaccines it buys for developing countries, but it is likely that the US or European governments will also want to stockpile some of these vaccines for their own use, and they are likely to have pay more. Malpani says MSF accepts that, but remarks that “if these countries have already paid for the development, it does seem inappropriate that they should pay all over again through high prices.”

MSF is certainly not against the development of Ebola vaccines, and intends to take part in some of the phase II clinical trials, probably at its facilities in Guinea. Julien Potet, their policy advisor on vaccines, says that planning the trial has been “a bit of a moving target”.

“Cases are declining a lot, and to demonstrate a protective effect is more difficult in a setting where there are limited or no cases. But we hope to vaccinate two groups – health workers because they are particularly exposed to the virus, and also to ring-vaccinate people who have been in contact or have a case in their neighbourhood. This is the plan today, but of course it could change.”

Others working on the response to the epidemic have more reservations about the vaccine programme. Mukesh Kapila, professor of global health at Manchester University, has just returned from West Africa. He found the affected countries alive with all kinds of stories and rumours, and he worries that time isn’t being taken to prepare people for the idea of the vaccine trials. “I am afraid they are going to think, ‘Oh, all these companies are coming to test some half-baked vaccines on black people here in Africa’. And the impact might be to put off people at risk from coming to get help, because they think, ‘Oh God, I’m going to be vaccinated’. When we do these trials for antibody response, it’s important that we do them on white people as well as black people, partly because it is important scientifically, but also because it’s important for public perception.”

More widely, Kapila thinks the rush for a vaccine may be counter-productive. “The panic associated with this epidemic has led to a lot of short cuts, with people rushing through the early phases so that human trials can start quickly. Everything may be fine, but we still don’t know how effective the vaccines are going to be. Are they going to give 90 percent protection? 80 percent? Or only 50 percent? That wouldn’t be enough.”

Kapila told IRIN: “People are expecting a vaccine to be the solution to this epidemic and it can’t be. A vaccine is no substitute for the laborious public health measures of identifying index cases, tracing and isolating contacts. By looking to a Promised Land where a vaccine is going to come and solve all our problems, we risk undermining these more important public health efforts. A huge amount of public money is going into vaccines. Once we have started we might as well finish, but I am sceptical whether it is a useful effort, on either public health or social and economic grounds.”

[Courtesy of IRIN]


Mental Health in Africa

As African countries strive to meet the UN Millennium Development Goals (MDGs) by 2015 and plot a new development agenda thereafter, health experts are gathering evidence across the continent to make a case for a greater focus on its millions of mentally ill.

Experts say investing in mental health treatment for African countries would bolster development across the continent, but national health priorities have been overtaken by the existing MDG structure, which has specific targets for diseases like malaria and HIV, placing them higher on countries’ agendas than other health issues.

“Everyone is putting their money in HIV, reproductive health, malaria,” says Sheila Ndyanabangi, director of mental health at Uganda’s Ministry of Health. “They need also to remember these unfunded priorities like mental health are cross-cutting, and are also affecting the performance of those other programmes like HIV and the rest.”

Global experts celebrated the passing of a World Health Assembly action plan on World Mental Health Day in May, calling it a landmark step in addressing a staggering global disparity: The World Health Organization (WHO) estimates 75-85 percent of people with severe mental disorders receive no treatment in low- and middle-income countries, compared to 35-50 percent in high-income countries. The action plan outlines four broad targets, for member states to: update their policies and laws on mental health; integrate mental health care into community-based settings; integrate awareness and prevention of mental health disorders; and strengthen evidence-based research.

In order for the plan to be implemented, both governments and donors will need to increase their focus on mental health issues. As it stands, the US Agency for International Development (USAID), the world’s biggest bilateral donor, will only support mental health if it is under another MDG health priority such as HIV/AIDS. Meanwhile, mental health receives on average 1 percent of health budgets in sub-Saharan Africa despite the WHO estimate that it carries 13 percent of the global burden of disease.

“Mental health hasn’t found its way into the core programmes [in developing countries], so the NGOs continue to rely on scraping together funds to be able to respond,” Harry Minas, a psychiatrist on the WHO International Expert Panel on Mental Health and Substance Abuse and director of the expert coalition Movement for Global Mental Health, told IRIN. “Unless we collectively do something much more effective about NCDs [non-communicable diseases], national economies are going to be bankrupted by the health budgets.”

According to a May report from the UN Secretary-General’s High-Level Panel of Eminent Persons on the Post-2015 Development Agenda, the MDGs have overseen the fastest reduction of poverty in human history. Yet it also acknowledges that they have done little to reach the world’s most vulnerable. The report says the MDGs were “silent on the devastating effects of conflict and violence on development” and focused too heavily on individual programmes instead of collaborating between sectors, resulting in a largely disjointed approach to health. Experts say without a more holistic approach to global health in the new development era, the world’s most vulnerable will only be trapped in that cycle.

“The MDGs were essentially a set of vertical programmes which were essentially in competition with each other for resources and for attention,” said Minas. “We’ve gone beyond that, and now understand we’re dealing with complex systems, where all of the important issues are very closely interrelated.”

Poverty and Mental Illness

In Africa, where many countries are dealing with current or recent emergencies, WHO sees opportunities to build better mental health care.

“The surge of aid [that usually follows an emergency]combined with sudden, focused attention on the mental health of the population, creates unparalleled opportunities to transform mental health care for the long term,” say the authors of the report Building Back Better: Sustainable Mental Health Care after Emergencies, released earlier this month.

In a study published in the Journal of Affective Disorders in July, researchers in northern Uganda – which, starting in the late 1980s suffered a two-decade long war between the government and the rebel Lords’ Resistance Army – monitored the impact of group counselling on vulnerable groups such as victims of sexual and domestic violence, HIV-infected populations, and former abductees of the civil war. It found that those groups who engaged in group counselling were able to return and function markedly faster than those who did not receive counselling, while reducing their risks of developing long-term psychiatric conditions.

“We need to be mentally healthy to get out of poverty,” Ethel Mpungu, the study’s lead researcher, told IRIN.

The link between mental illness and persisting poverty is being made the world over. According to a 2011 World Economic Forum report, NCDs will cost the global economy more than US$30 trillion by 2030, with mental health conditions alone costing an additional $16 trillion over the same time span.

“It really is around issues of development and economics – those things can no longer be ignored,” says Minas. “They are now so clear that ministries of health all around the place are starting to think about how they are going to develop their mental health programmes.”

Putting mental health on the agenda 

As mental health legislation is hard to come by in most African countries, Uganda is ahead of most on the continent with its comprehensive National Policy on Mental, Neurological and Substance Use Services, drafted in 2010. The bill would update its colonial era Mental Treatment Act, which has not been revised since 1964, and bring the country in line with international standards, but is still waiting to be reviewed by cabinet and be voted into law.

Uganda is also part of a consortium of research institutions and health ministries (alongside Ethiopia, India, Nepal and South Africa) leading the developing world on mental health care. PRIME – the programme for improving mental health care – was formed in 2011 to support the scale-up of mental health services in developing countries, and is currently running a series of pilot projects to measure their impact on primary healthcare systems in low-income settings.

Research shows that low- and middle-income countries can successfully provide mental health services at a lower cost through, among other strategies, easing detection and diagnosis procedures, the use of non-specialist health workers and the integration of mental healthcare into primary healthcare systems.

Although a number of projects have shown success in working with existing government structures to ultimately integrate mental health into primary health care, the scaling up of such initiatives is being hindered by a lack of investment, as the funding of African health systems is still largely seen through donor priorities, which have been focused elsewhere.

“Billions of philanthropic dollars are being spent on things like HIV/AIDS or water or malaria,” said Liz Alderman, co-founder of the Peter C. Alderman Foundation (PCAF), which works with survivors of terrorism and mass violence. “But if people don’t care whether they live or die, they’re not going to be able to take advantage of these things that are offered.”

[Courtesy of IRIN]

Uganda:HIV Study Reveal Rampant Stigma

061511 Health Aids News

Last year, a primary school teacher in Masaka, Florence Najjumba, lost her job after she declared that she was HIV-positive.

Had the media and Uganda Human Rights Commission not intervened, Najjumba would have lost her livelihood. Yet she is only one of the luckier ones. According to the People Living with HIV Stigma Index, 2013, most HIV-positive people are still discriminated against at work.

The study, released last week by the National Forum of People Living with HIV Networks in Uganda (Nafophanu), surveyed 1,110 people living with HIV.

“[Some] 255 of the people living with HIV reported losing jobs or incomes within the past year preceding the survey and 27 per cent of these attributed it to [their] HIV status,” reads the study report.

Among those that reported losing their jobs, more than half were men. Some 288 reported that their job descriptions had changed due to a combination of factors, including poor health.

Some were discriminated against at work by either co-workers or employers. Eight percent of the respondents reported that they had been barred from work in the previous 12 months.

Supported by UNAIDS and Uganda Aids Commission, Nafophanu conducted the survey in 18 districts.

“This stigma prevents people from getting tested for HIV, seeking medical care and adherence to treatment and follow-up. A biased attitude towards people living with HIV must be stopped,” said Stella Kentusi, Nafophanu executive director.

Consequently, the study states that income levels among people living with HIV are relatively low, with 60 per cent of those surveyed earning less than Shs 250,000 every month.

Home, work

Gossiping, according to the survey, was the most prevalent form of stigma, with 60 per cent (666) of people living with HIV, convinced that they had been gossiped about at least once within the previous year. Also, nearly one in five of the surveyed people said they had been subjected to psychological pressure or manipulation by their husband or wife at least once.

Some 21 percent said they had experienced sexual rejection at least once in the last 12 months before the survey. About 10 per cent had been excluded from family activities such as eating together or sharing rooms.

The study suggests fear of stigma and discrimination are major reasons why people are unlikely to declare their status in public, let alone taking an HIV test.

“This means that disclosure is done selectively or not done at all. People are not free to seek and take up treatment,” Kentusi says, adding that victims of stigma soon develop internal stigma – negative feelings about oneself.

UNAIDS Country Director Musa Bungudu says to reduce such stigma and discrimination, people living with HIV should enjoy economic empowerment and receive updated education about HIV.

Bungudu proposes “a cascade of training of trainers workshops” not only to address attitudes and practices but also to meet information needs and HIV-related supplies.

On his part, the acting programme manager, Aids Control Programme, Dr Joshua Musinguzi, wants more resources dedicated towards access to anti-retroviral drugs for all HIV-positive people.

Today, 566,000 people have access to ARVs out of the 745,000 expected to be put on treatment by the end of this year.

“We need to disseminate the findings to the lowest level so that the health ministry and stakeholders may roll out programmes, reducing new infections and fighting for the rights of people living with HIV effectively, efficiently and transparently,” Musinguzi says.

Somalia: Polio Outbreak Thwarts Global Eradication Effort

The global community came tantalizingly close earlier this year to ridding the world of polio. But then in May, the eradication effort took a powerful blow. The virus turned up again in the Horn of Africa, first in Somalia.

The Banadir region of Somalia, which includes a Mogadishu refugee camp, is thought to be the so-called “engine” of the Horn of Africa polio outbreak.

In June, three-year-old Mohamed Naasir became ill. His mother, Khadija Abdullahi Adam, said soon after one leg became permanently disabled.

“My son was fine, but he started having a high fever which lasted for almost four days,” she explained. “I gave him medicine, but there was no change. The following morning he said to me ‘Mom, I can’t stand up.'”

The virus has spread at a rapid pace, triggering massive vaccination efforts.

Earlier in 2013, polio was confined to three so-called “endemic countries” — Nigeria, Afghanistan and Pakistan — where the virus has never been snuffed out. Combined there were fewer than 100 cases in those three countries.

Since the virus re-emerged in the Horn of Africa, there have been at least 160 polio cases in Somalia alone, and the virus has spread to Kenya and Ethiopia.

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NIGER: Cholera Outbreak

NIAMEY, 22 May 2013:

Cholera has struck 248 people in Ayorou in the Tillabéry Region of northwestern Niger, killing six, two of them Malian refugees.

Among the sick are 31 Malian refugees who are living in Tabareybarey and Mangaize camps near the Mali border, according to the Tillabéry health services and the UN Refugee Agency (UNHCR).

In the camps and in surrounding villages, UNHCR has upped the supply of clean water to refugees, is distributing oral rehydration solution, soap, and disinfectant tabs to clean water, but more drugs are urgently needed, it said in a 21 May communiqué. NGO Médecins sans Frontières is treating those who have contracted cholera in camps.

UNHCR is worried that cholera could spread quickly due to the high concentration of refugees in the region.

Most of the cases were inhabitants of the town of Ayorou, which hosts a Sunday livestock market frequented by people from all across the region. The Ministry of Health is trying to temporarily shut down the market, which is just next to the River Niger, the suspected source of the contamination. The Health Ministry has also banned anyone from using, or drinking, water from the river, though this is very difficult to monitor.

The World Health Organization is supporting local health authorities to contain the disease’s spread.

Last year 5,785 people contracted cholera in Niger, and 110 of them died, according to UNHCR.

[Courtesy of IRIN]

Iraq War leaves lasting impact on Healthcare

IRAQ 5 May – Of all the areas of Iraq’s development that were affected by the US-led invasion 10 years ago, healthcare has probably taken the biggest hit.

The impact of the 2003 invasion and subsequent conflict on Iraq’s healthcare system has been well-documented.  The conflict shattered Iraq’s primary healthcare delivery, disease control and prevention services, and health research infrastructure. Attempts to resurrect Iraq’s healthcare system remain hindered by a number of factors, including fragile national security and lack of utilities like water and electricity.

Much of the damage incurred in the first few years of the invasion continues to have an impact today.

Lasting legacy

Iraq had prioritized healthcare at least since the 1920s, when the Royal College of Medicine was formed to train doctors locally. By the 1970s, Iraq’s health care system was “one of the most advanced” in the region, according to researcher Omar Al-Dewachi, a medical doctor who worked in Iraq during the 1990s before emigrating to the US. Health indicators improved quickly and significantly in the 1970s and 1980s, only to deteriorate again after the first Gulf War of 1991, which destroyed health infrastructure, and during a decade of sanctions, which drastically reduced government spending on health and led to a brain drain in the medical profession.

After the 2003 invasion, the healthcare situation deteriorated considerably, and Mac Skelton, a contributor to the Costs of War project, fears it may never recover. Between 2003 and 2007, half of Iraq’s remaining 18,000 doctors left the country, according to Medact, a British-based global health charity. Few intend to return.

“Getting back to that robust, excellent standard [of healthcare] is not going to happen anytime soon,” Skelton said. “Unlike buildings that can be rebuilt, migration patterns aren’t reversed easily.”

In 2011, according to the World Health Organization (WHO), Iraq had 7.8 doctors per 10,000 people – a rate two, if not three or four times lower, than its neighbours Jordan, Lebanon, Syria and even the Occupied Palestinian Territory. In the Muslim world, Iraq’s doctor-patient ratio is higher only than Afghanistan, Djibouti, Morocco, Somalia, South Sudan and Yemen.

In a recent article in the Lancet, the aid group Médecins sans Frontières (MSF) said that “until now, it is extremely difficult to find Iraqi medical doctors willing to work in certain areas because they fear for their security.”

According to MSF, many remote areas were excluded from state reconstruction and development efforts, “leaving thousands of Iraqis without access to essential healthcare to this day.”

Nearly all families – 96.4 percent – have no health insurance whatsoever and 40 percent of the population deems the quality of healthcare services in their area to be bad or very bad, according to the Iraq Knowledge Network (IKN) survey of 2011.

As a result of the poor quality of care in their country, many Iraqis now seek healthcare abroad, increasingly selling homes, cars and other possessions to afford to do so, according to Skelton, who interviewed Iraqis seeking healthcare in Lebanon.

And researchers are still questioning the degree to which white phosphorus and depleted uranium, the armour-piercing, radio-active metal used in British and American ammunition, has increased cancer rates and caused birth defects.

The environmental damage caused by the war – degradation of forests and wetlands, wildlife destruction, greenhouse gases, air pollution – will also have a longer-term impacts on health, according to the Costs of War project.

Mental health

A 2007 survey by the government and WHO found that more than one-third of respondents had “significant psychological distress” and presented potential psychiatric cases. A 2009 government mental health survey concluded that mass displacement and a climate of fear, torture, death and violence have contributed to the high ratio of mental illness in the country.

In a new report released last month, MSF said mental health continues to be a major problem in the country.

“Many Iraqis have been pushed to their absolute limit as decades of conflict and instability has wreaked devastation,” Helen O’Neill, MSF’s head of mission in Iraq, said in a statement.

“Mentally exhausted by their experiences, many struggle to understand what is happening to them. The feelings of isolation and hopelessness are compounded by the taboo associated with mental health issues and the lack of mental healthcare services that people can turn to for help.”


The statistics, as always in Iraq, tell a story that is less clear-cut.

The number of fully immunized children, for example, dropped from 60.7 percent in 2000 to 38.5 percent in 2006, then rose to 46.5 percent by 2011 – still less than pre-invasion levels, according to the Multiple Indicator Cluster Surveys (MICS) conducted by the government and the UN Children’s Fund (UNICEF). Acute and chronic malnutrition trends for children under five also showed a slight regression.

However, other indicators show some improvement over pre-2003 levels – unsurprising, some say, if you consider the “semi-starvation diet” of many Iraqis during the sanctions.
According to the UN’s Human Development Reports, life expectancy at birth rose from 58.7 before 2000 to 69.6 in 2012. (These figures are quite similar to those of WHO, but differ significantly from those of the World Bank, which show a regression from 70 to 71 years during the mid-1990s and early 2000s, to 69 years in 2011)

The last decade undoubtedly saw a great reduction in infant mortality rates, not only over pre-invasion levels, but even compared to the early 1980s, when about 80 infants died per 1,000 live births. By the year 1990, this figure was down to 50, and decreased further to 31.9 in 2011, according to a 2012 government report monitoring progress towards the Millennium Development Goals (MDGs).

Still, this rate remains more than double the national target of 17 per 1,000 by 2015; and while Iraq’s rate in the early 1980s was among the best compared to other countries in the region, today, it is among the worst.

The mortality rate of children under five also dropped from 42.8 per 1,000 births in 2000 to 37.2 in 2011, well ahead of 1960s levels, but far off the national target of 21 by 2015, according to the government report, which monitored MDG indicators at the governorate level. The percentage of births attended by skilled personnel also rose from 72.1 percent in 2000 to 90.9 percent in 2011, according to the MICS.

(WHO shows a similar trend of decrease in mortality rates, but its statistics are quite different, showing a much larger drop in infant mortality from 108 deaths per 1,000 in 1999 to 21 per 1,000 in 2011, and a decrease in child mortality from 131 in 1999 to 25 in 2011.)

Government expenditures on health have increased in the last decade. From a high point in 1980s, they dropped significantly due to the 1991 Gulf war and sanctions. But spending jumped from 2.7 percent of GDP in 2003 to 8.4 percent in 2010, according to the World Bank. According to Yasseen Ahmed Abbas, head of the Iraqi Red Crescent Society, government allocations for health spending have risen from $30 million a year under former president Saddam Hussein to $6 billion a year today.

[Courtesy of IRIN]

Uganda to Save Children’s Lives With Pneumonia Vaccine Drive

Pneumonia kills thousands of Ugandan children every year. A new vaccination programme aims to defeat the illness.

Uganda is rolling out the immunisation against pneumonia using a new vaccine called Pneumococcal Conjugate Vaccine (PCV 10). The vaccine has been introduced to mitigate the high infant and childhood death rate and illnesses due to lung infections.

Pneumococcal Conjugate Vaccine was first introduced in sub-Saharan Africa two years ago.

In Kenya and Ethiopia the vaccine was introduced in 2011.

Madagascar and Mozambique started using this vaccine in 2012.

Uganda and Zambia are introducing the vaccine in their routine immunisation programme this year.

Pneumonia is the second leading cause of infant mortality in Uganda after malaria with 18,000 children below the age of five dying of pneumonia every year.

Children under one year are most at risk of getting pneumonia. Factors that expose a child to the lung infection are lack of exclusive breastfeeding, indoor air pollution, poor nutrition and inadequate ventilation.

The health ministry’s director general of health services, Dr Jane Ruth Aceng, says the introduction of PCV 10 into the routine immunisation programme will prevent more than 94,071 new cases and save more than 10,796 lives per year.

“Children have been suffering from pneumonia without any measure of prevention, and we are happy that the government of Uganda in collaboration with GAVI [a coalition of children’s health NGOs] in introducing this new vaccine free of charge for all children under one year age” she says.

Children will get three doses. Infants will receive the first dose at six weeks, another at 10 weeks and the last dose at 14 weeks after birth.

Unicef’s Dr Irene Mwenyango says the drug is safe, free and effective against diseases caused by pneumococcus bacteria. It will offer immunity against infection of the brain covering (meningitis), infection of the lungs (pneumonia), bacteria in blood (bacteraemia), ear infections among others.

A total of 1,521,061 children are expected to be immunised this year across the country.

Administration of this vaccine was set to start on Saturday 27 April in the eastern district of Iganga and then rolled out throughout the country in all health centres

Uganda has low immunisation coverage with only 52 per cent of children fully immunised, so half the child population at a greater risk of being wiped out by preventable killer diseases.

This is attributed to inadequate community sensitisation and mobilisation.

And a sect calling itself 666 is reported to be campaigning against immunisation in rural areas, telling parents and guardians it is not safe. The government has vowed to deal with them since their message is confusing parents.

It is estimated that 17,216,000 euros will be spent on the new drug. Under the cost-sharing arrangement, the government of Uganda will contribute 919,000 euros while GAVI is contributing 16,296,000 euros.

According to the World Health Organisation (WHO) pneumonia is the world’s leading cause of child deaths, killing an estimated 1.2 million children under the age of five every year, more than Aids, malaria and tuberculosis combined.

[Courtesy of All Africa News]