EU Partnership Paves the Way for Better Nutrition for Children and Women in Ethiopia

By Nardos Birru

ADDIS ABABA, September 2016 – Ethiopia has experienced repeated droughts, particularly in the past few years, which have eroded rural livelihoods, causing increased food insecurity and malnutrition among vulnerable communities. The 2015/2016 El Niño-driven drought, for instance, left 9.7 million people in need of emergency food assistance.

In response to recurrent food insecurity, UNICEF has partnered with the European Union (EU) to contribute to building resilience of the most vulnerable groups, which includes children under five, as well as pregnant and lactating women. Resilience, or the ability of a community to withstand, adapt and quickly recover from shocks such as drought, is a cornerstone of the EU’s humanitarian and development assistance.

To this effect, the EU has provided €10 million to UNICEF-assisted programmes as part of its Supporting the Horn of Africa’s Resilience (SHARE) initiative through a project entitled Multi-Sectoral Interventions to Improve Nutrition Security & Resilience. The project is implemented in collaboration with the Food and Agriculture Organization of the United Nations (FAO) in the drought-affected woredas (districts) of Amhara, Oromia Southern Nations, Nationalities and People’s Region (SNNP) regions, benefiting 285,665 households.

NYHQ2014-3631
As part of the community-based nutrition programme, Binti, a Health Extension Worker counsels a mother on best nutrition practices. ©UNICEF/2014/Nesbitt

How does SHARE work?

The project aims for communities to have access to quality nutrition services in their vicinity and a better understanding of the importance of proper infant and young child feeding (IYCF) practices.

It covers a wide range of interventions including the promotion of exclusive breast feeding and adequate complementary feeding, vitamin A supplementation and deworming of children, as well as the promotion of hygiene and sanitation.

This is complemented by a series of nutrition-sensitive agriculture interventions led by FAO in partnership with the Ministry of Agriculture. This component helps build the capacity of women to improve the variation of their diet through livestock and poultry rearing, as well as backyard gardening. It also brings opportunities for women to collaborate as peer support groups to produce nutritionally valuable complementary foods such as cereal mixtures for sale. This stimulates the local economy by creating jobs and empowering women to ensure the healthy growth of their children.

An evidence-based approach

Launch of document entitled “Situation Analysis of the Nutrition Sector in Ethiopia” from 2000-2015
Left to right: H.E Chantal Hebberecht, Ambassador of the European Union; Birara Melese, National Nutrition Programme Team Coordinator; Gillian Mellsop, UNICEF Representative to Ethiopia; at the launch of the 2000-2015 “Situation Analysis of the Nutrition Sector in Ethiopia” in Addis Ababa, Ethiopia ©UNICEF/2016/Tesfaye

One achievement of the project was an initiative to analyze and document the nutrition situation in the country from 2000 to 2015.  The report was launched in March 2016 and highlights critical gaps in terms of existing policies and programmes which need to be addressed urgently to accelerate nutrition results for women and children. Key findings of the situation analysis report include poor water supply and sanitation as high risk factors for child stunting, educating mothers as a key factor for improving nutrition, as well as the need to improve production diversity, nutrition knowledge and women’s empowerment to ensure that diverse and nutritious foods are available and accessible at all times.

The SHARE project also serves as a platform for multiple non-governmental organizations where they can exchange expertise and best practices to improve implementation and follow a harmonized approach in their respective intervention sites. This way, efforts are combined and the impact on the nutrition status of children and women will be maximized.

UNICEF would like to express its gratitude to the EU for the generous financial contribution to UNICEF-assisted programmes and looks forward to strengthening successful collaboration for children and women in Ethiopia. Thanks to EU support, over 225,000 children under five and over 50,000 mothers will have better access to improved nutrition services. This is in line with the efforts of the Government of Ethiopia to realize the Seqota Declaration to make undernutrition, in particular child undernutrition, history in Ethiopia.

Saving a child too thin to be vaccinated

By Bethlehem Kiros

Fatima Yesuf, 25, brings her 8 months old daughter to the Metiya health center for checkup and to receive the Plumpynuts food supplementsAMHARA REGION, Ethiopia, February 2016 – Moyanesh Almerew, a Health Extension Worker in Arara Kidanemeheret Kebele (sub-district) in Amhara Region can testify to how bad the current drought in Ethiopia is for children. She is one of thousands employed as part of the nationwide Health Extension Programme, a community-based programme bringing basic health services to the doorstep of Ethiopia’s large, rural population. According to Moyanesh, they have had seen many more cases of severe acute malnutrition among children this year as compared to previous years and the cases they are receiving are worse. Among them, six-month-old, Fikir, whom Moyanesh saw during a home visit, stands out.

“You would not believe how thin she was when we first found her,” recounts Moyanesh, “She had never been vaccinated so when we tried to give her the vaccines, it was not possible because she was only skin and bones,” explains Moyanesh. When she was first brought to the Arara Kidanemeheret Health Post, the child weighed just 4.5 kg and the measurement of her mid-upper arm circumference – the criteria for identifying severe malnutrition – was 10.5 cm. She was severely acutely malnourished.

Thankfully, after receiving treatment, Fikir has gained 2kg after treatment, which included medicine and therapeutic food for several weeks, and her mid-upper arm circumference grew to 11.8 cm, which puts her in the moderately acutely malnourished range. She continues to receive outpatient treatment at the health post.

Moderately acutely malnourished children are enrolled in the World Food Programme-supported Targeted Supplementary Feeding programme through which they receive fortified blended food and vegetable oil for six months to aid their nutritional recovery. Both this and the UNICEF-supported treatment for severe acute malnutrition are routine responses which are all the more critical in a crisis.

Weynitu Demissie, 34, has a 7 months old daughter who is recovering from acute malnutrition
Weynitu Demissie (far left) walks a long distance to get to Arara Kidanemeheret Health Post where she receives therapeutic food for her seven-month-old malnourished daughter, Mastewal. ©UNICEF Ethiopia/2016/Nahom Tesfaye

Seven-month-old Mastewal is another child who has been treated at the Arara Kidanemeheret Health Post. Her mother, Weynitu, says that the drought has taken quite a toll on her family, especially on Mastewal. The child was extremely emaciated before receiving treatment for severe acute malnutrition. Weynitu walks for more than two hours over steep hilly ground to get to the health post for Mastewal’s treatment but she says it is worth all the hardship since her daughter has shown a lot of progress in the last few of months.

To Moyanesh, it is a relief to see the wonders that therapeutic food treatment does for the children. “I doubt that some of these children would have survived if they didn’t receive this treatment,” she says.

Across the country, 458,000 children are expected to need treatment for severe acute malnutrition in 2016. More broadly, 10.2 million people, 6 million of them children, are in need of emergency food assistance due to the drought. UNICEF, the Nutrition sector lead agency, continues to coordinate the nutrition emergency response. With the support of donors, UNICEF provides supplies for the management of severe acute malnutrition and supports the treatment of malnourished children through the community-based management of acute malnutrition, along with training, quality assurance and monitoring of the nutrition emergency response. UNICEF is also supporting efforts to provide drought-affected communities with access to clean water and health services to address major causes of child illnesses and deaths that have been exacerbated by the drought.

To continue nutrition emergency response activities over the coming months, additional funds of US$5 million are needed, subject to needs-based revisions. A further US$ 42 million is needed over the next four years to strengthen nutrition services and build resilience to future shocks among communities that are worst-affected by the drought.

Leadership matters: The case of community led total sanitation and hygiene

By Araya Mengistu


Ethiopia is a country showing strong progress in achieving global and national goals for WASH services. It has achieved the MDG target 7c for water supply. Although still behind for sanitation targets, considerable progress is made. As of 2012, 37 per cent of communities practiced open defecation, as compared to 92 per cent in 1990[1]

The progress on sanitation is mainly achieved through the national Health Extension Programme (HEP) and the community led total sanitation and hygiene (CLTSH) approach. CLTSH is an approach that helps to mainly rural communities to understand undesirable effects of poor sanitation, and through a process of “triggering” – igniting a change in behaviour – achieve sustained behaviour change leading to spontaneous and long term abandonment of Open Defecation (OD) practices. Since its introduction in 2006/7, CLTSH has remained the only instrument in Ethiopia to induce behaviour change of communities to consider construction of latrines and use them – discouraging the practice of open defecation. Although the achievements in the past decade are significant, the success of the approach varied significantly from place to place.

For example, the Oromia regional state, the largest in the country, consists 265 rural and 39 urban districts or woredas. Out of 6,531 kebeles (sub-districts each with an average population of 5,000) in rural areas, about 16 per cent are open-defecation free (ODF) – meaning no-one, including visitors and passing pedestrians, are openly defecating and all have access to basic latrines with handwashing facilities.

UNICEF supports 24 woredas in Oromia state between 2011 and 2015. Of the supported woredas, 24 per cent (116 of 477 kebeles) have achieved ODF status. Compared to regional average of 16 per cent, this is a huge achievement. Sire, one of the supported woredas, has recently been graduated in 2015 with 100 per cent performance, declaring all 18 rural kebeles ODF. Other woredas are at various stages. 11 woredas are between 20-50 per cent progresses, while the rest 12 woredas are of 0-10 per cent progress. Compared to these, Sire Woreda shows an outstanding performance.

Such exceptional achievement requires successfully overcoming a number of challenges. A key challenge is lack of thorough understanding of the steps involved in CLTSH and their importance. Usually CLTSH is about training facilitators and triggering communities. However, many practitioners agree that this is the easiest part. Rendering adequate supervision after the triggering stage and providing support that is necessary to sustain the momentum is the difficult part. Other challenges include diffusion of information to neighbouring communities that make the approach ineffective, lack of trainers with actual field experience, high staff turnover, poor coordination among stakeholders, weak commitment of staff and trained people and application of CLTSH without adequate or proper organisation and preparation.

Growing over all these challenges and as a result of four years of effort, Sire Woreda celebrated 100 per cent ODF achievement in April 2015, with all rural villages and kebeles free from open defecation.

Even though, some of these kebeles were declared ODF two or more years ago, , they continued to sustain their status despite the usual trend of falling-back to OD practice noticed as time elapses. This demonstrates an effective post-triggering activity by the Woreda that effectively complimented the planning and triggering activity.

How was this achieved? The Woreda administration leveraged existing structures to sensitize the leadership ladder down to village level on CLTSH and built it in to the regular reporting and evaluation process. This has helped to mobilize the largest possible support to the effort of Health Extension Workers (HEWs) and CLTSH facilitators, including teachers and students under the guidance and support of the Woreda Health Office. It has also avoided diversions of focus (including manpower, logistics, and resources) as CLTSH has become an official woreda priority.

Two notable practices can be praised in the woreda for this success.  (a) the technique of triggering one full kebele at a time in contrast to the usual practice of village by village, and (b) use of different post-triggering follow-up technique suited to context. The advantage of the first technique was twofold. It helped to avoid diffusion of information in to neighbouring communities. Since, focusing in one kebele at a time required more trained people, the coordinators called upon trained and experienced facilitators from adjacent woredas to support, which worked really well. On the other hand, the woreda experts consciously applied different post-triggering follow-up methods. In highland areas, they applied the ‘flag system’, where by communities themselves awarded white flags to households who have constructed basic latrines, and red flags to those who did not. In low land areas, students were organized to alert the community when they see any one defecating in the open, who will then ensure the person buries the excreta.

Currently, the Woreda continues to strengthen the community platforms for monitoring progress and pro-actively works with local leaders to provide the necessary guidance and technical support to sustain the achievement. As a result of this, they are expecting at least two kebeles to achieve secondary ODF, which includes upgrading of basic latrines to improved latrines (with washable slab, vent pipe, hole-cover) with hand washing facility by the whole community. The commitment of leaders, and subsequent effective coordination in the Woreda has benefited the wider community to keep children, women and the society at large healthy.

[1] Joint Monitoring Programme 2014.

Children need communities

Editor’s note: UNICEF‘s Deputy Executive Director for Programmes, Ms. Geeta Rao Gupta, visited UNICEF-supported maternal and child health programmes in Ethiopia ahead of the Ministerial Conference on Immunization in Africa in Addis Ababa. At the conference, African leaders–including health and finance ministers –came together to commit to expanding access to vaccines for children across the continent.

My recent visit to a health post in Ethiopia’s Bassona Worena district allowed me to see routine immunization activities, community case management and child and newborn health care programmes in action. The visit also highlighted one crucial element that characterizes successful child health programmes: community engagement.

I spoke with several community health workers, including Ms. Demem Demeke, 29, who described the full range of services she provides in her one-room, neatly organized health post: “We provide promotive, preventive and basic curative health services including immunization, community case management of diarrhoea, malaria, pneumonia and sepsis, antenatal care, post-natal care and other services to our community.” With handwritten charts plastered across the walls, Ms. Demeke was able to tell me exactly which households in her area had children in need of immunization, and with folders organized by the day of the week, she knew which children were due for a vaccination on that day. I watched as she expertly vaccinated a baby boy and then comforted him and instructed his mother on his care – quality, personalized care provided right there in a remote village in rural Ethiopia.

I also visited the home of Ms. Etenesh Deksiosa, a leader in the Health Development Army, a band of community members who support the work of the community health workers by educating neighbours and encouraging them to use maternal, newborn and child health services. Demonstrating the various tools she uses to educate her neighbours, she proudly told me: “I am always inspired to teach communities about the importance of vaccination and other child health-related issues.”

I was very impressed by professionalism and strong sense of responsibility of the community health workers. By engaging the communities they serve and working in partnership with the leaders in the Health Development Army they create a high level of ownership and a conducive environment to address traditional practices, cultural beliefs and social norms that contribute to hesitancy or even resistance to vaccination. The trust they build also helps to identify and reach children who are the most vulnerable — children who might otherwise never benefit from health services.

A group of women in front of houses.
UNICEF/UN010923/TesfayeMs. Geeta Rao Gupta, accompanied by women in the community on her visit to model household in Bassona Worena District, North Shewa Zone, Amhara Region, Ethiopia.

Ethiopia’s 38,000 health workers are mainly women selected from local communities who are paid by the government as part of the country’s flagship health extension programme. With the help of these committed women Ethiopia has expanded access to and demand for essential health services like immunization, making significant gains in reducing child mortality in less than a generation. By leveraging community engagement for child health Ethiopia reduced under-five mortality by two-thirds between 1990 and 2012 meeting Millennium Development Goal (MDG) 4 ahead of schedule.

Community involvement is a common success factor among countries that are reducing the prevalence of childhood diseases, particularly those that can be prevented with vaccines. Engaging and involving communities directly through community health workers and champions within communities is among the most effective means of promoting immunization in rural or marginalized populations and contributing to broader health goals.

At UNICEF, we have learned that lesson well over the years, most recently through our efforts to eradicate polio in Africa and elsewhere. Involvement and engagement of community leaders by community health extension workers transformed those efforts leading to increased success in reaching vulnerable children previously missed in polio vaccination campaigns.

Despite this experience and evidence, in far too many African countries today, consistent, nation-wide investments in community health programmes are still the exception – not the rule.

To maximize the return on investment in immunization programmes and to strengthen overall health systems, Ministries of Health should allocate adequate resources to support community-based health workers working hand-in-hand with community networks. By educating communities and generating demand, community health workers are key to expanding coverage and sustaining demand. And when community health workers involve community members in planning and monitoring the quality of services, it boosts community ownership, acceptance and accountability – cornerstones of effective health programmes.

During my visit to the health post in Bassona Worena, I was privileged to personally witness what the power of a partnership between a government health system and communities can achieve. With communities by their side, governments can succeed in reducing child mortality through quality and equitable health programmes, allowing children everywhere to reach their full potential. Community health programmes characterized by the full engagement and involvement of communities must become the norm across the African continent. UNICEF stands ready to assist. It is one of the most effective ways to make the right to health a reality for all children.

Geeta Rao Gupta is UNICEFs Deputy Executive Director for Programmes.

In a quiet rural area of Ethiopia, a three year old boy holds the promise of a healthy nation

By Johnny Magdaleno

Moges’ and his family, assisted by a UNICEF-support child health program in Romey Kebele, Deneba Woreda, Ethiopia.
Moges Teshome 3 years old with his mother Kokeb Nigusse in Romey Kebele, Deneba Woreda, Ethiopia. ©UNICEFEthiopia/2015/Michael Tsegaye

Moges dashes across the grass with a herding whip in hand. At three years old he can’t make it crack like his father or the other men in Romey Kebele (sub-district), a pastoralist area a few hours outside Addis Ababa where his family lives. But he smiles proudly as he loops it in wide circles around his head.

Today, Moges is beaming with life and colour. Three years ago, he was close to death as pneumonia and diarrhoea nearly robbed him of his life within months of his birth.

Muluemebet Balcha, one of the Health Extension Workers (HEW) that helped save Moges’ life, remembers how distraught his mother was. Ms. Muluemebet had contacted her to offer postnatal care for Moges through the Ethiopian government’s Health Extension Programme (HEP). “She was desperate. She thought the child would have died,” she said.

“I gave him treatment and on the second day he got well. I was very happy to see him survive,” she remembers.

Prior to becoming this kebele’s first HEW, Ms. Muluemebet says not all new-borns in the area were as lucky as Moges. “Before that training was given so many children who encountered the same problem died,” she said. The HEP has done wonders for families in hard-to-reach rural areas like Moges’ ever since it was established in 2003.

Health Extension Worker checks baby Moges's breathing to determine improvement of pneumonia
Health Extension Worker Haimanot Hailu checks two month old Moges Teshome’s breathing to determine if his pneumonia has improved. © UNICEF Ethiopia/2012/Getachew

With help from UN agencies like UNICEF, it continues to grow. As of 2015 there were more than 38,000 HEWs like Ms. Muluemebet working in over 16,000 health posts across the country. Each health post serves around 5,000 people, meaning the vast majority of Ethiopia’s population of 99 million are within reach of free, basic health care.

Teshome Alemu, Moges’ father, says he owes his child’s life to the HEWs. “To go to [the nearest hospital] you may not even afford the transportation cost,” he said. “If you don’t have money, you can suffer a lot. The children will also suffer.”

“The provision of this service in our Kebele is very beneficial,” he added.

In September 2013 Ethiopia turned heads around the world by announcing it had achieved Millennium Development Goal 4, which pushed for a reduction of child mortality rates by 67 percent, three years ahead of its 2015 deadline. What started as 205 deaths for every 1,000 children in 1990 tapered off to 59 deaths per 1,000 in 2015. While developments in technology and new levels of political support are partially responsible for this drop, the HEP was a key driver in making this improvement a reality.

Meeting MDG 4 was a milestone in the country’s history, but HEWs aren’t claiming “mission accomplished” quite yet.

“The size of kebeles and their population means they cannot be covered by one HEW. I am the only health worker serving this community so it is very tough to reach all the households,” says Ms. Muluemebet, outlining challenges she and the program at large still faces.

Moges’ and his family, assisted by a UNICEF-support child health program in Romey Kebele, Deneba Woreda, Ethiopia.
Moges’ and his family, assisted by a UNICEF-support child health program in Romey Kebele, Deneba Woreda, Ethiopia. ©UNICEF Ethiopia/2015/Tsegaye

Because she balances so many patients, she’s not always able to put in the time to make sure health education sticks. “Given the awareness of the community, it takes a long time to implement some of the activities. Families are getting the education needed, but sometimes it takes them a while to put it into practice,” she says.

Moges’ mother, Kokeb Nigusse, admits that while the community is grateful for the free services they provide, not everyone follows their advice to the fullest.

“They give the children medicinal drops, injections and syrup when they are sick,” she said. “They check up on the children. They also follow up and give injections to pregnant women. More significantly they advise us to deliver in health institutions and not at home.” Despite this last suggestion, she says, house deliveries still occur.

With more support from Ethiopia and UNICEF, that is beginning to change. “Before I started work, most mothers delivered at home. But now, if you take this year’s data, out of 171 pregnant mothers only 20 delivered at home,” said Ms. Muluemebet. The rest delivered at the local HEP health centre.

There have also been gains in building confidence in mothers like Ms. Kokeb, who are reluctant to vaccinate their children. “Vaccination of children was very low previously but now almost all children get vaccinated,” says Ms. Muluemebet. “I informed her that if the child gets sick he should get treatment even before baptism, because the community believes they shouldn’t get anything before baptism.”

Moges’ and his family, assisted by a UNICEF-support child health program in Romey Kebele, Deneba Woreda, Ethiopia.
Moges’ and his family in Romey Kebele, Deneba Woreda, Ethiopia. ©UNICEF Ethiopia/2015/Tsegaye

Pneumonia, diarrhoea and malaria are three of the five most common life-threatening conditions that new-borns face in Ethiopia. These threats have curtailed with the debut of the integrated community case-based management of common childhood illnesses (ICCM) regime. So far, more than 28,000 HEWs like have been trained in ICCM.

With help from the financial support of its donors, UNICEF has guided development of the ICCM and HEP programs, given technical assistance to Ethiopia’s Ministry of Health, and delivered 10,000 health kits to HEP health posts throughout the country. Ms. Muluemebet says the change from this support has been enormous.

“I am a witness to seeing mothers die while giving birth,” she says. “But with the HEP we can easily detect mothers who need help, or who need to get service at health centres, and if it is beyond their capacity they call the ambulance and they take the mother to health centre and they can be easily saved.”

Moges and Ms Kokeb were saved from having to travel great lengths to get basic care. Today they walk hand-in-hand across the bright green plains that surround their vast plot of land, happy, at ease and part of a complete family. As the HEP continues to grow, success stories like theirs will become a shared experience for millions more Ethiopians.

Ethiopia’s reduced child mortality rate

Not so very long ago Ethiopia had one of the worst child mortality rates in Africa but it’s managed to slash the death toll by two-thirds, three years ahead of the Millennium Development Goal’s (MDG’s).

On a recent interview with CCTV, UNICEF Representative to Ethiopia, Ms. Gillian Mellsop, said “The key heroes in reducing child mortality by two third in Ethiopia are the 38,000, mainly women government salaried, health extension workers in addition to the political commitment and the vision of the government and sustainable funding.”

See the full programme which was aired on CCTV below:

In Ethiopia, pneumonia is a leading single disease killing under-five children

Kokeb Negussie and her husband Teshome watch their two month old son Moges rest in Romey Village-Amhara Region
Kokeb Negussie and her husband Teshome watch their two month old son Moges rest in Romey Village-Amhara Region ©UNICEF Ethiopia/2012/Getachew

NEW YORK/Addis Ababa, 12 November 2014 – Significant declines in child deaths from pneumonia prove that strategies to defeat the disease are working, UNICEF said on the fifth World Pneumonia Day. But much more is needed to stop hundreds of thousands of children from succumbing to this preventable illness each year.

Pneumonia is still among the leading killers of children – accounting for 15 per cent of deaths, or approximately 940,000 children per year – but deaths from the disease have declined by 44 per cent since 2000, according to figures released recently by UNICEF.

“Pneumonia is still a very dangerous disease – it kills more children under five than HIV/AIDS, malaria, injuries and measles combined – and though the numbers are declining, with nearly 1 million deaths a year, there is no room for complacency,” said Dr. Mickey Chopra, head of UNICEF’s global health programmes. “Poverty is the biggest risk factor, and that means our efforts need to reach every child, no matter how marginalized.”

Deaths from pneumonia are highest in poor rural communities. Household air pollution is a major cause of pneumonia, so children from households which rely on solid fuels such as wood, dung or charcoal for cooking or heating, are at high risk. Overcrowded homes also contribute to higher pneumonia levels. In addition poor children are less likely to be immunized against measles and whooping cough, which are also among major causes of the disease.

Health Extension Worker Shewaye Berhanu administers the PCV vaccine
Health Extension Worker Shewaye Berhanu administers the PCV vaccine ©UNICEF Ethiopia/2011/Lemma

In Ethiopia, pneumonia is a leading single disease killing under-five children. It is estimated that 3,370,000 children encounter pneumonia annually which contributes to 20 per cent of all causes of deaths killing over 40,000 under-five children every year[1]. These deaths are easily preventable and treatable through simple and cost effective interventions. Immunization, good nutrition, exclusive breast feeding, appropriate complementary feeding and hand washing are among the preventive while administration of amoxicillin dispersible tablets and other antibiotics are among the curative methods which can save lives.

With the objective of increasing access to these lifesaving interventions, Ethiopia has made a policy breakthrough of introducing community based treatment of pneumonia through health extension workers in 2010[2]. Since then over 38,000 health extension workers from nearly 15,000 health posts are equipped with the skills and supplies to treat pneumonia at community level using the integrated community case management (iCCM) approach.[3]

Early diagnosis and treatment of pneumonia, and access to health care, will save lives, thus strategies must target low income communities.

The increased use of pneumonia vaccines, particularly in low income countries has led to progress against the disease, but inequities exist even in countries with wide coverage.

 “Closing the treatment gap between the poor and the better off is crucial to bringing down preventable deaths from pneumonia,” Dr Chopra said. “The more we focus on the causes and the known solutions, the faster we will bring this childhood scourge under control.”

UNICEF’s Supply Division has today put out a call to innovators for new, improved and more easily affordable respiratory rate timers to aid in the timely recognition and management of pneumonia.

One simple treatment has had great success: trained community health workers give sick children the antibiotic amoxicillin in a child-friendly tablet form, as part of an integrated case management programme at the community level. Scaling up the availability of similar inexpensive medicines will help to reduce the treatment gap especially among hard to reach populations.

Simple measures such as early and exclusive breastfeeding; handwashing with soap; vaccination; and provision of micronutrients will also reduce the incidence of pneumonia.

[1] Fischer Walker, 2013

[2] National plan on Integrated Community Case management of common childhood illness, FMOH, 2010

[3] UNICEF, Ethiopia Central Data Base, October 2014