April 2005

Views expressed are those of the authors, not necessarily of the AFSC.

Togo's Child-Health Campaign Saves Thousands

Information from a UNICEF/WHO fact sheet supplemented by a Peacework interview with UNICEF press officer Erica Kochi. To contribute to the worldwide campaign against measles, please visit www.redcross.org/donate/donation-form.asp, or call 800-HELP-NOW.

Most public health interventions are disease-specific. One part of an agency devises strategies against HIV, a second department campaigns against measles, a third counters polio. Ideally, a global public health model would complement these foci with efforts to create a health care infrastructure capable of providing comprehensive preventive care for all who need it.

Worldwide, there are 11 million preventable child deaths each year. The child that dies from malaria also may have been weakened by diarrhea. Mortality has compound causes, so interventions, to be fully effective, also have to be integrated.

In the first nationwide campaign of its kind, in one week in December, 2004, Togo organized an integrated campaign to provide four life-saving interventions at once to one million children under the age of five. The children were given vaccines to prevent measles and polio, mosquito nets to prevent malaria, and de-worming tablets to cure the children of intestinal parasites.

Since 1990, Togo has made substantial efforts in measles mortality reduction. A campaign carried out in 2001 reached over 95% of children under fifteen years of age. As a result, Togo reduced measles deaths by 99% compared to the 1996-2000 period. Much of this success is owed to countrywide immunization days mobilizing neighborhood health committees and religious and traditional leaders to encourage mothers to bring their children for vaccination.

Until the year 2000, over 1 million children died each year worldwide from measles. The global campaign against measles is achieving tremendous results, cutting measles deaths in half in three short years of mass vaccinations. The global plan is to vaccinate 45 million more children and prevent 300,000 deaths in the coming year alone. In Togo, despite improvements in routine immunization coverage, almost half of Togo's children born since 2001 are still at risk from measles. It is hoped that by combining measles vaccination with the offer of a free mosquito net and other health interventions, many more children will be reached.

In Togo, malaria is a year-round problem that threatens the entire population. It is responsible for thousands of deaths each year and 40% of public health expenditures. Many of these deaths could have been prevented through the use of a long-lasting insecticide-treated net (LLIN). The insecticide in an LLIN is effective for three to five years. Yet in 2003, only 15% of Togolese children under age five slept under a mosquito net and barely 2% slept under a LLIN. To date, poverty has been the major barrier to net ownership. Even though the average price of a net is only about two to five US dollars, it is still beyond the reach of poor households.

UNICEF and WHO believe that cost should not be a barrier to making malaria interventions - whether preventative or curative - available to all young children and pregnant women. Malaria remains the largest killer of children in Africa, taking a child's life every 30 seconds. Over one million people die from malaria each year, over 900,000 are children under five years of age. About 90% of malaria deaths occur in sub-Saharan Africa.

Public health multi-tasking has had remarkable success on a smaller scale (vitamin A is now routinely added to polio vaccine, for example, preventing blindness and saving hundreds of thousands of lives). In addition to the measles vaccine and a free LLIN, Togo's children will also receive:

• a polio vaccine (please see accompanying article on page 20)
• De-worming tablets (most commonly, mebendezole) to expel intestinal worms and ultimately lower the rate of parasitic infections. Intestinal parasites are a significant cause of malnutrition, severe anemia, delayed puberty, and problems with learning and memory. Because the results of administering de-worming tablets are visible so quickly, this treatment has been very popular with parents. One treatment is effective for approximately six months.

Measles and malaria prevention and treatment, along with these other interventions, require the same health infrastructure and, more importantly, target the same vulnerable group - children. By combining all four at one time, governments can save money and lives.

Preliminary results from December's campaign in Togo show that it succeeded in reaching 95-97% of kids in the country. There will be the need for a follow-up campaign in two years, and routine immunization needs to be institutionalized by insuring that all health clinics have stocks of vaccines and administer them regularly.

"These health interventions complement each other perfectly," said Suzanne Aho, Togo's Minister of Health. "Nothing like immunization has the potential to reach this many children, and the prospect of a free mosquito net is a powerful incentive that will increase coverage."

"Measles and malaria are the two biggest child killers in Africa," said UNICEF Executive Director, Carol Bellamy. "If widely implemented, these nation-wide integrated campaigns may become the single most important step towards reducing child deaths in Africa. Creative new approaches like this are the key to ensuring the survival of thousands."

Coup Quashed in Togo?

Information from the UN Integrated Regional Information Network, www.irinnews.org.

Gnassingbe Eyadema, who ruled Togo as a dictator for the last 38 years, died on February 5, 2005. Instead of following the constitutional procedure for succession, the military installed Eyadema's son, Faure Gnassingbe, as President.

The local opposition and ECOWAS (Economic Community of West African States) labeled the move a coup, and pressured Gnassingbe to step down. The putative President conceded and agreed to hold interim elections on April 24, 2005.

Six of Togo's opposition parties are calling for a postponement of these elections, saying there is not enough time to insure that elections would be free and fair. Thousands of people marched through the streets of the capital, Lome, calling for a postponement, but since the date has been endorsed by ECOWAS, it is unlikely that the date will be changed.

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