Africa: Fighting Children's Silent Killer

29 August 2008
guest column

An important conference which culminates in Gabon today could help save the lives of millions of children by bridging the gap which often separates efforts to improve health and save the environment.

The meeting – the First Inter-Ministerial Conference on Health and the Environment in Africa – has brought together government ministers, donors and civil society to discuss the impact of the environment on health. It ended with a ministerial declaration emphasizing the urgency of overcoming institutional, scientific and political divides between health and the environment.

On Monday, when the delegates return to their workplaces, it will hopefully be with a renewed openness to the opportunities that linking up experts from different disciplines can create for the people of Africa.

A whole-hearted commitment to reducing child deaths from diarrheal disease would provide a tremendous opportunity to start the challenging task. Diarrheal disease, the second leading cause of child death worldwide, is caused by environmental factors—dirty water and lack of sanitation. But despite its dangers, diarrhea remains a largely overlooked crisis, falling low on the health priority lists of many leaders both within Africa and the global health community.

This week’s conference could provide the momentum and synergy necessary to address this silent killer.

The opportunity is real, chiefly because we have many of the tools in hand to eliminate death, suffering, and economic losses from diarrhea. Cost-effective and readily available interventions, like point-of-use water treatments and low-cost latrines, can provide clean drinking water and access to improved sanitation. When diarrhea does strike, it can be remarkably well treated through oral rehydration salts, a simple mixture of sodium and salt, as well as zinc therapy. Both cost mere pennies per course.

Breastfeeding, one of the world’s oldest and most effective health interventions, can both prevent and treat diarrhea in young children. And current rotavirus vaccines and research into other enteric vaccines hold great promise for significantly bolstering prevention efforts.

With all of these solutions, why does diarrhea still kill more than a half million African children each year? One answer lies in the challenges that this week’s conference addressed – the traditional divisions between environmental and health efforts.

Most environmental improvements and health initiatives are trapped in separate worlds—housed in different buildings, ministries, mindsets and money flows. The water and sanitation professionals mind their own business, and the health experts mind theirs. Donors often channel funding toward uncoordinated prevention or treatment interventions without tackling the problem as a whole. Efforts have been diced and divided; as a result, children have died.

The ministers and experts who gathered in Gabon have the opportunity to reverse the deadly course of this disease and others in Africa.

Increasing political will to address diarrheal disease in a coordinated fashion could spur major progress on Millennium Development Goals 4 and 7—reducing child mortality and improving environmental sustainability—resulting in success for both the environmental and health sectors, and a major win for the children of Africa.

Flexible funding, improved cross-ministry collaboration, and stronger voices from civil society are all needed to tackle one of Africa’s great, but ignored, health crises.

Dr. Richard Walker is project director of the Enteric Vaccine Initiative of PATH, the Program for Appropriate Technology in Health, a global health NGO headquartered in Seattle in the United States.

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