…as it pursues life expectancy of 75 years by 2015
The Ministry of Health is intensifying its fight against childhood illnesses, and maternal deaths – the fourth and fifth Millennium Development Goals (MDGs), as it continues to pursue a life expectancy of 75 years by 2015.
Minister of Health, Dr. Leslie Ramsammy, in a statement to the media, said these areas are the most important public health goals of the sector in the next five years to 2015.
The Ministry of Health, according to him, is not contented in meeting the MDGs four and five; rather it is determined to reach targets for child and maternal mortalities that bring Guyana on par with more developed CARICOM countries.
In this context, the Health Minister noted that the Ministry has intensified its efforts to reduce childhood-related morbidity and mortality in Guyana.
In an address to health workers in Region Six (East Berbice/ Corentyne), and again in an address to public health nurses, medex and RHOs during the review of the Maternal and Child Health Programme last week, Ramsammy outlined an aggressive programme to combat the two main causes of deaths and illnesses among children in Guyana.
The programme to reduce child mortality is intended to ensure Guyana has no problem in attaining MDGs four and five by 2015.

Significant Reduction

Ramsammy said Guyana has achieved significant reduction in childhood illnesses and has made progress in the fight against childhood-related morbidity and mortality.
“Indeed, Guyana is on pace to achieve the childhood-mortality related MDG four. For the latest verified year, 2008, the under-5 mortality rate was 19 for every 1,000 children, with a total of 286 recorded deaths of children under 5 years. For comparison sake, the under-5 mortality rate was estimated to be 120 in 1990.  Since 1990, Guyana has achieved a greater than 80per cent reduction in childhood mortality,” he said.
He noted that, in terms of childhood mortality, the two major causes of deaths are acute diarrheal diseases (ADD) and acute respiratory infections (ARI).
ADD and ARI together reportedly account for 8.7 deaths per 1,000 children and together accounted for 46 per cent of all deaths of children under 5 years in 2008.
ADD caused an average of 5.2 deaths per 1,000 children under 5 years, accounting for 27per cent of all deaths of children under-5 years in 2008. This makes diarrhea the leading cause of death among our children.
ARI caused an average of 3.5 deaths per 1,000 children, accounting for 19per cent of all deaths of children under-5 years in 2008. ARI was the second leading cause of deaths in Guyana.
Globally, ADD and ARI are the two leading causes of deaths among children. Together these two causes of children deaths account for more than 40 per cent of all children deaths in the world.
This is similar to the situation in Guyana where these two causes are responsible for 46 per cent of all children deaths. ADD accounts for 17 per cent and ARI accounts for 19 per cent of all under-5 children deaths in the world. While the ARI global contribution to children under-5 deaths (19 per cent) is similar to the contribution of ARI to children deaths in Guyana (1 9per cent), the contribution of diarrhea to children deaths in Guyana (27per cent) is much higher than the average contribution of diarrhea to children deaths globally (17per cent).
In terms of morbidity (illness) among children, ARI and ADD are also major causes of illnesses. ADD resulted in almost 12,000 recorded childhood illnesses in 2008.
“This merely reports those cases of gastroenteritis which were serious enough for the family to take ill children to the health care providers. Of the total number of diarrheal cases recorded that year, almost 46 per cent of them were among children under-5 years. There were about 26,000 cases of diarrhea recorded that year for the whole population,” Ramsammy said.
He pointed out that acute respiratory infection still ranks as the number one cause of illnesses (morbidity) among children, with about 40 per cent of all illnesses among children under 5 years.
The Health Minister said, “Most of the deaths due to ADD and ARI are preventable. The Ministry of Health is further intensifying our efforts to prevent ADD and ARI-related morbidity and mortality.”
Ramsammy, in a wide-ranging address to health workers last week, briefed them on the strengthening and expansion of the various initiatives the sector has been working onto combat childhood illnesses.

ARIs in Children

ARI is the leading cause of global illnesses among children under 5 years. It is also the leading cause of deaths among children under 5 years in the world, causing more than 2M deaths each year. The leading ARI diseases are influenza, pneumonia, tuberculosis and bronchiolitis. But pneumonia is the leading ARI in the world, causing more than 5,000 deaths each day in the world.
ARI is the number one cause of illnesses among children in Guyana and in the world. But it is the number two cause of deaths in children in Guyana, responsible for almost 19 per cent of deaths in Guyanese children.  ARI was responsible for 192 deaths of children under 5 in 2008 in Guyana.
The main ARI in Guyana is pneumonia and influenza.
The main ARI infectious agents are Streptococcus pneumonia, Haemophilus influenza type b (Hib), Stapylococcus aureus and other bacterial species, respiratory syncytial virus (RSV), measles, human parainfluenza viruses, influenza virus and varicella virus.
Guyana and the Caribbean have virtually eliminated measles and the WHO is presently conducting an exercise to certify Guyana as measles-free.
Ramsammy added that Guyana has been addressing the issue of ARI in various ways. Some important initiatives include the use of vaccines. The important vaccines in the programmes to fight ARI are as follows:
* Strengthening and expanding the pneumococcus vaccine program: One of the most important initiatives introduced in late 2009 and being rolled out across the country in the fight against ARI was the introduction of the PCV 7 vaccine. This is a vaccine to fight against pneumococcus-associated ARI, one of the more prevalent forms of ARI in Guyana and around the world. In 2009, this was introduced among a targeted group of children, but in 2010, the vaccine is now part of the universal coverage Enhanced Program for Immunization (EPI) and is intended to be provided to all children. Together with the rotavirus vaccine (see below), PCV7 should contribute to between 40 and 50per cent reduction in child deaths in Guyana.
* Even though Guyana is in the first full year of introduction of the pneumococcus vaccine, Guyana has already been working with PAHO/WHO and GAVI to introduce an even stronger version of this vaccine. This stronger version has recently been approved by the WHO for use and is called PCV13. Studies have shown that PCV13 provides greater protection against pnemococcus infections.
* Ensuring 100 per cent coverage for HIV vaccine: Guyana has since 2001 introduced the Haeomophilus influenza type b vaccine as part of the pentavalent vaccine (five vaccines in one shot). Presently more than 90per cent of the children of Guyana are vaccinated against Hib. But Guyana is making strenuous efforts to ensure that every child is vaccinated against Hib. In this respect aggressive “sweep” programmes are being conducted throughout the country to find children who have not been vaccinated with pentavalent vaccines.
* Periodic influenza vaccine: Periodically, the Ministry of Health provides a seasonal influenza vaccine shot. This is not yet a regular programme, but the MOH is conducting studies to determine if seasonal flu vaccines might lead to reduction of ARI-related deaths in Guyana.
* Continuation of H1N1 Vaccine:  Although Guyana has vaccinated most children under 5 this year, the Ministry is not certain if this programme will continue next year. Depending on the H1N1 transmission level in the region, a decision will be made if H1N1 vaccines would be useful on a continuous basis.
* Fighting Diarrhea in Children:  Diarrhea is a public health scourge that affects every country in the world. It is responsible for almost 2 billion episodes of illnesses and almost 2 million deaths each year among children under 5 years each year. There are almost 12,000 reported cases of diarrhea illnesses and over 280 diarrhea-related deaths recorded in children under 5 years in Guyana each year. There are several causes of diarrhea among children. The most prevalent causes of diarrhea in children under 5 in the world are: E. coli (mostly from contaminated food and water); Rotavirus (mostly from contaminated water, food and soil); Cholera (mostly contaminated water, and last identified in Guyana since 1994); Salmonella (mostly from contaminated water and food) and the cause of typhoid; Shigella (mostly from water and food); and Parasites such as Giardia, Entamoeba and Cryptosporidium (mostly in contaminated water, food and soil).  Cholera is not an important cause of diarrhea in Guyana. However, E.coli, rotavirus, salmonella and shigella are important causes of diarrhea. There are also several other important causes of diarrhea in Guyana. These include Giardia, Entamoeba and Cryptosporidium. The Ministry’s statement said it has expanded its public health initiatives to combat the scourge of diarrhea in children. Some of the interventions include: ensuring the availability of low-osmolarity oral rehydration solution ( New ORS) and zinc supplementation at all health facilities around the country; including rotavirus vaccines in our national immunization programme; promoting breastfeeding of infants in the first 6 months of life to improve immune responses in children; promote the use of micro-nutrient supplementation in children; mass education programmes behavior modification to support improved hygiene in the population; encouraging greater adoption of the Ministry’s programme for the use of household water treatment and safe storage systems for food and water; and supporting sanitation changes in communities to prevent community-wide open defecation practices

Partners

The Health Minister, in his statement, noted that the Ministry has been working with the Pan American Health Organisation / World Health Organisation (PAHO/WHO) and the United National Children’s Education Fund (UNICEF).
These collaborations, according to him, are important in strengthening and expanding these responses.
In addition, the Ministry of Health is working in collaboration with various sister Ministries, such as Water and Housing, Education, Local Government and Amerindian Affairs, and with local government organs such as Regional Democratic Councils (RDCs), Neighbourhood Democratic Councils (NDCs) and the Amerindian Councils, to ensure optimal implementation of several other programmes
Ramsammy stated that these initiatives, if effectively implemented, could mean a further 50per cent reduction in illnesses and deaths among Guyana’s children by 2015.
Minister Ramsammy said, “Our children are more than our most important assets. The determination to have our children grow up to be productive adults is a moral imperative and establishes a chart for a development path that guarantees our country a future of no poverty and a future that is in keeping with our destiny – El Dorado, a land of plenty, a nation in which dreams are a part of every child’s future and every child is guaranteed a long, productive life”.
PULL QUOTE:
Minister Ramsammy said, “Our children are more than our most important assets. The determination to have our children grow up to be productive adults is a moral imperative and establishes a chart for a development path that guarantees our country a future of no poverty and a future that is in keeping with our destiny – El Dorado, a land of plenty, a nation in which dreams are a part of every child’s future and every child is guaranteed a long, productive life”.