Children under 5 years of age bear the greatest burden of indirect conflict-associated mortality (indirect mortality results from disruption of health services including immunization, food insecurity, and high risk living conditions such as those found in refugee camps). The leading causes of child death in these circumstances include respiratory infections, diarrhea, measles, malaria, and malnutrition.
Diarrhea
Rotavirus hospitalizations are costly and result in longer hospital stays compared to non-rotavirus diarrhea
Children with rotavirus experience longer hospital stays than children with non-rotavirus diarrhea. In a study looking at the direct and indirect costs of treating rotavirus in Malaysia, rotavirus hospitalizations cost families 26% of their average total monthly household income, which was significantly higher than the cost for non-rotavirus diarrhea hospitalizations.
Frequent or longer episodes of diarrhea in infancy can lead to chronic health issues in adulthood
Those who experienced more frequent or longer episodes of diarrhea as an infant were more likely to have metabolic syndrome as adults. A longitudinal study in Guatemala found that diarrhea episodes in early infancy are associated with chronic health issues later in life. Each 1% increase in diarrhea burden in children 0-6 months was associated with a 3% increased prevalence in high blood pressure in adulthood. Similarly, a 1% increase in diarrhea burden in older infants 6-12 months was associated with a 4% increased prevalence in elevated waist circumference in adulthood.
Immunization can prevent families from facing financial hardship due to expensive medical treatments
Costs for treatment for rotavirus at a large urban hospital in Malaysia led one third of families to experience catastrophic health expenditures (CHC). When direct and indirect costs of treating rotavirus were considered, almost 9 in 10 families spent more than 10% of their monthly household income on treating rotavirus. In addition, 6% of families were pushed into poverty after paying for treatment.
Immunization can prevent common illnesses that strain hospital resources
In a Bangladeshi study, pneumonia and acute diarrhea were the first and third most common reasons for childhood hospital admission with over half (54%) of the acute diarrhea admissions caused by rotavirus. One in four children taken to this large pediatric hospital were refused admission because all beds were occupied. Vaccination could have prevented children with rotavirus from requiring essential hospital resources when one in four children refused admission had symptoms of pneumonia.
Immunization can help reduce the risk of stunting caused by diarrhea in children
A pooled analysis of nine studies assessing the effects of diarrhea on stunting prior to the age of 24 months showed that the odds of stunting were significantly increased with each diarrheal episode. Each day of diarrhea prior to attaining 24 months of age also contributed to the risk of stunting. For each five episodes of diarrhea, the odds of stunting increased by 13%. In addition, once a child becomes stunted, only 6% of those stunted at 6 months of age recovered by 24 months of age.
Integrated community health interventions targeting high-risk populations can improve maternal and child health outcomes
Through use of local Maternal Child Health (MCH) incentives, along with the use of locally appointed Health Activists, India’s National Rural Health Mission (NRHM) multiple-strategy community intervention program was able to achieve household level improvements reflected as an increase in all of the following indicators for women and children over the 7 year program:
– the proportion of pregnant women having 3 or more ante-natal check-ups (from 43% to 74.5%)
– those receiving at least one Tetanus Toxoid injection (from 83.5% to 93.6%)
– institutional deliveries (from 35.7% to 77%)
– post-natal check-ups within 2 weeks of delivery (from 49% to 67.2%) and
– children who received ORS for diarrhea from (32.3% to 44.8%).
Integrated community health interventions targeting underserved populations can lead to reductions in socioeconomic inequalities
In India, a multi-strategy community intervention, the National Rural Health Mission (NRHM) was successful in reducing disparities between pregnant women who had an institutional delivery in urban and rural areas. Geographic inequities reduced from 22% to 7.6% and socioeconomic disparities declined from 48.2% to 13%. Post the NRHM period, the difference between the number of children with full vaccination i.e., Bacillus Calmette Guerin (BCG) vaccine for tuberculosis, 3 doses of Diphtheria Pertussis and Tetanus vaccine (DTP), 3 doses of Oral Polio Vaccine (OPV), and measles vaccine, in urban and rural areas was observed to be non-significant.
Immunization with rotavirus vaccine may also reduce severe gastroenteritis cases in unimmunized children through herd immunity
A meta-analysis of studies measuring the impact of rotavirus vaccine (RVV) on severe gastroenteritis morbidity and mortality, found a 22% herd immunity effect for severe rotavirus gastroenteritis in children less than one year of age in US and El Salvador. In Latin America, severe gastroenteritis due to any cause was reduced by 25%.
Immunization against rotavirus has led to significant decreases in hospital admissions and gastroenteritis cases
Several countries have seen a significant decrease in the number of rotavirus-related hospital admissions in rotavirus unvaccinated children ages 2-5 years who were not age eligible to receive the vaccine post introduction. The US had a 41-92% decrease, Australia had a 30-70% decrease, Belgium had a 20-64% decrease, Austria had a 35% reduction and El Salvador had a 41-81% decrease. In addition, there was a reduction in hospitalizations due to gastroenteritis of any cause by 17-51% in the US and 40% in Australia.