Vaccinations are crucial for children’s health

The total number of deaths in children under the age of five witnessed a substantial decrease from approximately 13 million in 1990 to five million in 2020, as reported by the World Health Organization (WHO). This means a 60 % reduction in the mortality rate for children under five worldwide, declining from 93 deaths per 1000 live births (1990) to 37 (2020). The global aim of bringing the mortality rate for children under five below 25 deaths per 1000 live births in the next six years is aligned with the 3rd UN Sustainable Develop­ment Goal (SDG3): good health and well-being.

Several factors are important for the continued improvement of children’s health and a further decline in mortality rates. SDG2, focused on achieving “zero hunger” by 2030, aims to address malnutrition, which the WHO identifies as linked to about 45 % of all child deaths. Despite a steady global reduction in stunted children under five years old from 1990 to 2020, approximately 149 million children were estimated to be stunted in 2020, emphasising the ongoing impact of malnutrition.

The WHO recommends exclusive breastfeeding for the first six months of life, as it provides all the nutrients necessary for infant growth and development. In low-income countries, mothers are often malnourished themselves. In this case, it is more cost-effective and healthier to provide the mother with more food to restore breastfeeding than to expose the infant to the risks associated with breastmilk substitutes. Later, a balanced diet of fruits, vegetables, whole grains, lean proteins, low-fat dairy products and healthy fats is critical for ­physical growth, cognitive development and the immune system. Only with a healthy diet are children able to learn, to be productive and create opportunities to gradually break the cycle of poverty and hunger.

Moreover, hygiene practices play a vital role in preventing the spread of infectious pathogens. Teaching proper hygiene habits early on, such as covering the mouth and nose with a tissue or an elbow when coughing or sneezing and washing hands regularly with soap and water, can reduce the risk of common childhood infections, including diarrhoea. Diarrhoeal diseases are the second most common cause of death – after pneumonia – in children under the age of five. Outbreaks of cholera and typhoid are also preventable through good hygiene.

Global health threat

This in turn depends on access to clean water and sanitary facilities. Safe water supply and sanitation can furthermore help lower the risk of antibiotic-resistant pathogens by not only reducing the need for antibiotics, but also the risk of spreading infectious ­diseases in the community. The global ­prevalence of bacterial antimicrobial ­resistance (AMR) is alarming and now ­recognised as a global public health threat.

Early detection of signs of illness in children is crucial to prevent complications and improve health outcomes. This can also help identify underlying health issues that may not be immediately apparent, such as developmental delays or behavioural problems, and allow for timely intervention. In this context, the Integrated Management of Childhood Illness (IMCI) strategy formulated by WHO and UNICEF focuses on the care of children under the age of five. The strategy aims to reduce missed opportunities for early detection and treatment while incorporating prevention and health promotion as an integral part of care. Among other things, it helps to increase vaccination coverage and improve health knowledge as well as home care practices for small children.

Caregivers are key

The strategy relies on the knowledge and socio­-economic skills of the caregivers. Care­givers can be parents, other family members or professionals. The interaction between caregiver and child is a key factor for the healthy growth and development of children. Positive relationships with care­givers are vital for brain development, well-being and mental health of young children. Caregivers must therefore be provided with the necessary resources to offer children a nurturing environment from the outset.

This includes, for example, ­knowledge about the benefits of immunisations so that children are vaccinated on time and the vaccination schedule can be adhered to. Vaccines stimulate the immune system to produce immune molecules, such as anti­bodies, that fight the specific infections we are immunised against. This helps to protect children from vaccine-preventable diseases (VPDs) such as measles, polio and diphtheria. Globally, there are currently vaccines available to prevent around 25 diseases. Some of these VPDs can be fatal, especially for young children.

Vaccination is therefore particularly important for children under the age of five, as they are more prone to infectious ­diseases due to their developing immune system. A two-dose measles vaccination is highly effective. Effectiveness of the vaccine to prevent measles has been reported to reach up to 94 % according to a paper published in the Journal of Infectious Diseases.

Despite the documented benefits of vaccination, regional disparities in access remain a problem that affects the reduction of under-five mortality rates. 

This is compounded by other factors such as socioeconomic conditions, healthcare infrastructure and cultural beliefs. The Covid-19 pandemic further exacerbated the problems by disrupting health services, straining healthcare systems and diverting scarce resources. The same applies to conflicts and the impact of the climate crisis. According to a UNICEF report, 12.7 million children in Africa alone have missed one or more vaccine doses in three years, with 8.7 million of them not having received a single dose. Nigeria and Ethiopia are the two countries with the highest number of children who do not receive the basic routine vaccinations every year, with more than 2.2 million and 1.1 million children respectively.

In conclusion, while various factors contribute to children’s health, vaccination stands out as a key factor, providing long-term protection, preventing the spread of infectious diseases and ultimately saving lives. In addition, vaccines contribute to cost savings in the healthcare system as they prevent expensive treatments and reduce resistance to antimicrobial agents. If there are concerns or questions about vaccination, consulting with a healthcare provider is critical.

Benjamin M. Kagina is an Associate Professor and Director of the NITAGs Support Hub (NISH) and also serves as the Co-Director of the Vaccines for Africa Initiative (VACFA) at the University of Cape Town’s School of Public Health and Family Medicine.
benjamin.kagina@uct.ac.za