https://www.hifa.org/dgroups-rss/re-more-half-under-5-deaths-could-be-pr...
Dear Dr Were,
Thank you so much for your reply. We shall now go ahead and update the CHIFA leaflet and I'll send an update to CHIFA when this is done, inviting all CHIFA members to help us publicise CHIFA and invite new members to join us.
You say "the bottom line is that the science, tools, and strategies to prevent these deaths are well known. What’s missing is equitable access, political will, and sustained investment."
Yes, but I would argue that the science, tools and strategies are well known to only a small minority. They are not at all well known to the vast majority, including many parents, caregivers and health workers.
For example if we take the case of child diarrhoea, the WHO website notes:
'Diarrhoeal disease is the third leading cause of death in children 1–59 months of age. It is both preventable and treatable.
Each year diarrhoea kills around 443 832 children under 5 and an additional 50 851 children aged 5 to 9 years.'
https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease
'The most severe threat posed by diarrhoea is dehydration. During a diarrhoeal episode, water and electrolytes (sodium, chloride, potassium and bicarbonate) are lost through liquid stools, vomit, sweat, urine and breathing. Dehydration occurs when these losses are not replaced...'
The above web page does not comment on the quality of care provided for children with diarrhoea.
Regrettably it seems that huge numbers of children with diarrhoea are given *less* fluids to drink when they have diarrhoea, simply because the parents and caregivers do not know that they should give more.
For example, the latest national survey in India just a few years ago found that more than half of children with acute diarrhoea receive less to drink than normal (and one in 20 receive no fluids at all). These basic errors in care appear to contribute to hundreds of child deaths from diarrhoea every day in India alone. https://dhsprogram.com/pubs/pdf/FR375/FR375.pdf
When I worked briefly as a rural volunteer doctor in Peru in 1987, one day a local woman came to my medical post. She was very distressed and carried a bundle in her arms. When we opened the bundle it contained a small lifeless child. What happened? The mother told us that the child, a girl of about 18 months, had died just minutes before reaching the health post. The child had had diarrhoea for the past 2 days, so they *withheld* fluids... The child's death would have been avoided if (1) the parents had known to give more fluids rather than less fluids; and/or (2) the parents had taken earlier action to seek medical care when the child was poorly rather than moribund.
There are many examples across all areas of child health whereby the care of children is ineffective or even harmful. It is especially common that parents make the decision too late to seek help.
The phenomenon has been dubbed the 'know-do' gap - the gap between what is known (by medical science) and what is done in practice. Unfortunately this characterisation doesn't highlight the most important factor: the knowledge of carers. On HIFA we have previously sugggested the 'know-know-do' gap, which may be clumsy but highlights the gap between what is known to science and what is known to the carer. This know-know gap is often huge, with devastating consequences for children.
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org