Findings of a systematic review evaluating the relationship between pneumonia and malnourishment found that severely malnourished children in developing countries had 2.5 to 15 times the risk of death. For children with moderate malnutrition, the risk of death ranged from 1.2 to 36.
India
Universal immunization in India led to improved child growth
Children enrolled in Universal Immunization Programs observe improvements in terms of age-appropriate height and weight as per results of a study focused on 4 year old children in India. On an average height and weight deficits were reduced by 22-25% and 15% respectively.
Antibiotic resistance in pneumococcal infections is common among Indian children
A systematic review of studies from India found that prior to widespread use of the pneumococcal conjugate vaccine, antibiotic resistance in serious pneumoccocal infections among Indian children has been common. Penicillin resistance was found in 10% of invasive pneumococcal disease (IPD) cases, while trimethoprim/sulfamethoxazole resistance was found in more than 80% of these cases.
Vaccines are most cost-effective in low income countries
An analysis of the impact of rotavirus vaccine in 25 countries found that the rates of vaccination in all countries were highest and risk mortality lowest in the top two wealth quintile’s coverage. Countries differed in the relative inequities in these two underlying variables. Cost per DALYs averted in substantially greater in the higher quintiles. In all countries, the greatest potential vaccine benefit was in the poorest quintiles; however, reduced vaccination coverage lowered the projected vaccine benefit.
Immunization inequity in India was observed based on geography, parental education, gender, and family income
Inequity in vaccination coverage in India was found between states, within states, and in urban vs. rural areas. Lower parental education resulted in lower coverage, girls had lower coverage than boys, and infants born to families with a large number of children also had lower coverage than others. A direct relationship between household wealth and coverage was also found.
Universal vaccination programs can improve health equity in rural and disadvantaged areas
The Indian government childhood immunization program, UIP, designed in the 1980s to reduce the high mortality and morbidity in children, resulted in reduced infant mortality by 0.4% percentage points and under-5 mortality by 0.5%. These effects on mortality are sizable as they account for approximately one-fifth of the decline in infant and under-five child mortality rates between 1985-1990. The effects are more pronounced in rural area, for poor people, and for members of historically disadvantaged groups. The 0.5% reduction each year over 5 years (from 15% under-5 mortality in 1985 to 12.3% in 1990), represents an 18% reduction overall in under-5 mortality.
Vaccine-preventable diarrhea is linked to poor growth
A prospective case-control study conducted in several developing countries found that children with moderate-to-severe diarrhea grew significantly less in length in the two months following their episode compared to age- and gender-matched controls.
Vaccination against measles may also decrease overall child mortality, especially among children in lower castes
An analysis of children aged 12-59 months in rural India showed that children who were not vaccinated against measles vaccine in infancy had a three times higher likelihood of death, with unvaccinated children from lower caste households having the highest risk of mortality (odds ratio, 8.9). However, the results also revealed a nonspecific reducing effect of the vaccine on the overall child mortality in this region. This indicates that vaccination against measles can benefit the overall population, especially those in lower castes who have not received the vaccine in infancy. Thus, making them the group that would receive the highest benefit.
Cholera vaccine programs were found to be cost-effective across three countries
A multi-site study of cholera vaccination programs found that the vaccine was cost-effective in school- and community-based vaccination programs for children in India, Mozambique, and Indonesia.
A women’s empowerment program was associated with higher rates of immunization among children
An impact evaluation for a women’s empowerment program in India found that the children of mothers who participated the empowerment program were significantly more likely to be vaccinated against DTP, measles, and tuberculosis than children of mothers not involved in the program. This study also found that the women’s empowerment program had positive spillover effects: In villages where the program occurred, children of mothers not in the program (non-participants) were 9 to 32% more likely to be immunized against measles than in villages where the program did not occur (controls). Overall, measles vaccine coverage was nearly 25% higher in the program villages compared to the control villages.