In a 2002 study from Cambodia, households with a dengue patient had to borrow money at high interest rates and lose productive assets (land) to repay debts linked to healthcare costs. Public healthcare cost significantly less than private healthcare but was either not present where people lived or did not have a good reputation.
South-East Asia
Respiratory infections during pregnancy may exert indirect effects on the developing fetus
Respiratory infections during pregnancy may exert indirect effects on the developing fetus through placental function and maternal immune responses. This in turn may lead to pre-term births and reduced growth of the fetus. However, a review of recent studies, researchers show that administration of influenza vaccine during pregnancy adds 200 grams to newborn weight and that PCV7 vaccine given to infants translates into an additional 500 grams of growth in the first 6 months of life. In addition, maternal influenza vaccine led to a 15% reduction in low birth-weight. This indicates that immunization can improve intrauterine growth.
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.
Undernourished children have a higher likelihood for diarrhea and pneumonia but immunization can improve infant growth
Multiple studies show that
- Diarrhea and pneumonia impair children’s growth and that underlying malnutrition is a major risk factor for these conditions.
- “Episodes of diarrhea may predispose to pneumonia in undernourished children” and
- Immunization against influenza (in mothers) and Streptococcus pneumoniae may improve infant growth. In addition, new studies from Bangladesh, Colombia, Ghana, and Israel further support the paradigm that malnutrition is a key risk factor for diarrhea and pneumonia.
Diarrhea is associated with pneumonia in undernourished children
In a recent review of data from developing countries, researchers found that episodes of diarrhea may predispose undernourished children to pneumonia.
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.
Children in communities with higher overall levels of immunization had better nutritional status
In a study of families living on 24 plantations in Indonesia, the community immunization rate was found to be protective against thinness for age in children. In other words, children in communities with higher overall levels of immunization had better nutritional status.
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.