联合国儿童基金会／世界衞生组织：应对肺炎和腹泻的新计划每年可挽救200万名儿童的生命
2013-04-12
日内瓦／华盛顿／香港，2013年4月12日──联合国儿童基金会（UNICEF）与世界衞生组织（WHO）今日推出一项崭新的全球行动计划，预料每年将可避免200万名儿童死于全球5岁以下儿童的头号杀手──肺炎和腹泻。
![Community Health Volunteer Mariam Diarra times eight-month-old Gimbala Keitas eathing, using a WHO/UNICEF timer, during an outreach visit in Kabe Village in the western Kayes Region. The baby has pneumonia. Ms. Diarra has been trained to count a childs eaths to gauge respiratory distress and identify pneumonia. If detected early enough, the illness can be treated with antibiotics and recovery may be swift. Otherwise, the child will be referred to the nearest health facility. Community health volunteers provide basic health services and monthly outreach, helping to manage early childhood diseases in their communities. UNICEF supports community-led initiatives to raise awareness about essential family practices, which include exclusive breastfeeding for babies during the first six months of life, fully vaccinating children under age one, sleeping under insecticide-treated mosquito nets, and washing hands with soap. Each volunteer visits about 35 households (or 250 inhabitants) every month. Ms. Diarra is the eldest of three wives who, all together, have 14 children. [#2 IN SEQUENCE OF THREE] In May 2010 in Mali, the country remains one of the poorest in the world, with more than 47 per cent of the population living on less than US $1.00 a day. Many people lack access to basic health care and safe water, and more than half are without adequate sanitation. Maternal and child health indicators are also among the worlds worst: Eight women die from pregnancy-related causes each day, and nearly 20 per cent of children die before reaching their fifth birthday. Pneumonia, diarrhoea, malaria and neonatal conditions are the primary causes of under-five deaths. Additionally, more than one-third of child deaths are directly related to under-nutrition, and about 38 per cent of Malian children are stunted. Wide economic, gender, geographic and other disparities also persist. Working with the Government and other partners, UNICEF supports health, nutrition, water and sanitation and hygiene (WASH), education and protection interventions, especially in rural areas and among vulnerable populations.](/wp-content/uploads/2015/12/20130415_gappd_1-300x214.jpg)
![A health worker prepares a pentavalent vaccine at a health centre in the community of Corosal in Cobán Municipality, in Alta Verapaz Department. The pentavalent vaccine protects against five common diseases: diphtheria, tetanus, pertussis (whooping cough), hepatitis B and Haemophilus influenza type b (also called Hib, a cause of pneumonia and meningitis). The centre, which is open once a month, serves a population of 1,000, and is run by the Ministry of Health with support from UNICEF. Volunteer health workers provide routine health care and immunizations for pregnant women and children under 5 in five surrounding communities. [#2 IN SEQUENCE OF THREE] In November 2012 in Guatemala, the Government and other partners are continuing to assure sustained routine immunization of children now reaching 92 per cent of all infants against a range of vaccine-preventable diseases. The countrys last endemic case of measles was in 1997. In the entire Americas Region (covering North, Central and South America), the last endemic measles case was in 2002 and the last endemic case of rubella was in 2009 part of global efforts to eradicate these diseases. Worldwide, measles remains a leading cause of death among young children: In 2010, an estimated 139,300 people mainly children under the age of 5 died from the disease. Nevertheless, these deaths decreased by 71 per cent from 2001 to 2011, thanks in part to the Measles & Rubella Initiative, a global partnership led by the American Red Cross, the United Nations Foundation, the United States Centers for Disease Control and Prevention (CDC), WHO and UNICEF. In Guatemala, despite this success, significant other challenges for children remain, much of it related to poverty levels that affect more than half of all children and adolescents. Poverty also contributes to chronic malnutrition affecting half of all under-5 children (with higher rates among indigenous populations); an average national education level of under six years of primary school (under three years for the rural poor); and high, though decreasing, rates of violence. Guatemala is also one of the worlds most vulnerable countries to climate change, suffering a major climate-related emergency every year since 2008. On the positive side, birth registration is improving, with more than 95 per cent of newborns now being registered. UNICEF is working with the Government and other partners to sustain achievements in health, address the high levels of malnutrition, strengthen responses to crimes against children and increase protection services for children throughout public services.](/wp-content/uploads/2015/12/20130415_gappd_4-300x214.jpg)
「预防及控制肺炎和腹泻的综合性全球行动计划」（Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea）唿吁各界人士群策群力，共同防治这两种疾病，又同时确立降低死亡率、改善儿童享用拯救生命干预措施服务的宏远目标。
WHO孕产妇、新生儿、儿童和青少年衞生司司长伊莉莎白．马松（Elizabeth Mason）博士表示：「应对肺炎和腹泻的策略方案往往各自为营。然而，孟加拉、柬埔寨、埃塞俄比亚、马拉维、巴基斯坦和坦桑尼亚等国家的经验已经证明，更紧密地整合这些策略方案，在改善健康和提升经济效益方面都很有意义。」
由于可导致肺炎和腹泻的原因很多，单一的干预措施並不能有效地防治或控制肺炎或腹泻。较富裕的国家已经证明，有些因素对减少这两种疾病造成的感染及死亡个案至关重要。例如，良好的营养和干净的环境，有助保护儿童避免感染肺炎和腹泻；正获采用的新型疫苗，亦可以保护儿童免受疾病感染；良好的医疗服务和正确用药，可以确保儿童得到所需治疗。但是，低收入与中等收入国家，在目前多项应对肺炎和腹泻的工作上，仍未充分顾及到这些因素。
UNICEF健康计划全球负责人米奇．乔普拉（Mickey Chopra）博士表示：「这是一个关乎均衡的问题：虽然低收入国家的贫困儿童，他们面临因肺炎或腹泻死亡的风险最大，但是却更难获得所需的干预措施服务。」他补充道：「我们非常清楚我们的目标。如果我们在死亡率最高的75个国家，为所有人提供仅20%最富有家庭享有的基本干预措施服务，我们最快就可以在2015年实现《千禧发展目标》的最后期限内，挽救200万名儿童的生命。」
WHO／UNICEF的新行动计划，明确地确立了到2025年前要实现的全球目标：将因严重肺炎和腹泻造成的5岁以下儿童死亡率，在2010年的水平上减少75%，基本上根除这两种疾病造成的5岁以下的儿童死亡个案。此外，将全球5岁以下儿童患上发育迟缓的数目减少40%。
这项行动计划的目标水平较当前水平显着为高。例如，这项计划唿吁让90%的儿童获取肺炎抗生素，以及治疗腹泻的口服补液盐，即在当前水平上分別增加31%和35%；计划的中期目标，是致力让至少半数6个月以下婴儿接受纯母乳餵养──在2012年这一数值只有39%；让所有儿童获得改善的衞生设施和安全的饮用水──目前相关的获取比率分別为63%和89%；基于一些国家在采用新型肺炎球菌以及轮状病毒疫苗方面，已经取得良好进展，计划目标到预定日期前，实现90%的疫苗接种覆盖率。 这项行动计划唿吁各国政府及其他持分者，优先考虑援助最难以获得防治肺炎和腹泻服务的人群。在目前因肺炎和腹泻导致的儿童死亡个案中，近90%发生在撒哈拉以南的非洲地区和南亚地区。
正当国际社会加紧实现《千禧发展目标》中有关衞生的目标（其中包括降低儿童死亡率的目标）之际，这项行动计划适时推出。国际社会的行动包括联合国秘书长发起的「每个妇女每个儿童」倡议（Every Woman Every Child initiative）及其旗下的「重申承诺．致力儿童生存」全球运动（Committing to Child Survival: A Promise Renewed）。该运动由UNICEF发起，目前已有170多个国家承诺，到2035年根除所有可避免的儿童死亡。
要扩大和改善保护儿童免患腹泻和肺炎的工作，以及为患病儿童提供适切治疗，更紧密地整合现有各项计划，以及各类执行者（其中包括社区和私营部门）之间的协作将十分关键。此外，亦必需确保所有工作能够长期执行。
