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Opinion16th November 2015

Tackling Childhood Mortality in Zambia: An Interview with Dr. Roma Chilengi, Director of PAED

‘I must have been crazy!’ Dr. Roma Chilengi says as he reflects on his decision in 2011 to return to Zambia and lead the newly launched Programme for the Awareness and Elimination of Diarrhoea (PAED). ‘I was giving up an interesting and rewarding position with Oxford University at the Wellcome Trust Research Programme in Kenya as Head of Clinical Trials. But I decided to take up this new post because of a combination of the potential to have an impact and the opportunity to go back home to make a contribution.’

PAED is a joint initiative between Ark, the Centre for Infectious Disease Research in Zambia (CIDRZ), and the Zambian Ministry of Health. The programme had an ambitious goal: to reduce childhood mortality by 15%. Their primary target to effect this decline? Diarrhoea.

Diarrhoea is often called the “neglected disease.” It kills more children globally than HIV AIDS and measles combined. Yet it is notoriously tough to deal with due to the expense involved in creating healthier sanitations systems and the difficulty of changing public behaviours and norms to reduce transmission. These complex contributing factors and a lack of international awareness have resulted in limited international investment.

‘When we set out to do the programme, we were nervous about a 15% mortality reduction. 15% is huge!’

Nervous but undeterred, the PAED team targeted Lusaka province for its pilot interventions. The PAED model involved three major components:

Four years later, the impact of PAED’s efforts is clear. Almost 250,000 infants in Lusaka Province are now fully immunised against rotavirus and more than 560 health care professionals have been trained in the most effective responses to severe diarrhoea. Early indications show statistically significant increases in key behaviours such as prolonged breastfeeding and proper preparation of diarrhoea medicine.

Most impressive of all, however, is that there has been a 34% decline in childhood mortality rates in Lusaka province since the programme began, surpassing Dr Chilengi’s highest expectations.

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While this decline cannot be fully attributed to PAED, the programme’s emphasis on building the cold storage infrastructure required for the rotavirus vaccine allowed for the expansion of a wider vaccine programme. ‘We’ve had lasting impact on the immunisation programme in Zambia – we put a whole national cold chain system in place.’ Hospitals and clinics around the country are now equipped for other crucial vaccines; a boost to the healthcare system and a definite factor in the childhood mortality rate decline.

The Zambian government has already expanded the roll out of the rotavirus vaccine nationally. ‘The vaccine is the most tangible and most visible part of our contribution to the public health system in Zambia. Because of our programme, the Zambian child in the remote village is receiving rotavirus vaccine today. I’m pretty sure if not for our programme, that child would not have the rotavirus vaccine today.’

PAED has concluded the implementation phase and is now evaluating the impact of its work. ‘Through this pilot, we have determined, beyond reasonable doubt, what works and what doesn’t work. The value of that learning will be useless if it stays in our heads and computers. We’ve got to find a way to use the learning so that it benefits the wider public.’

Dr. Chilengi estimates that there will be at least twelve publications in peer reviewed scientific journals documenting key findings from the PAED programme. It is the hope that the PAED model will be replicated and improved upon not only within Zambia, but also in other developing countries.

Ark’s involvement with PAED comes to an end this year. By all measures, Ark’s investment has been a success not only for diarrhoea prevention but also as a catalyst for systemic change.

‘I’ve had the opportunity to work with a team of amazing young people who were pushed to the limit and learned a lot about not doing things as usual. We strove to do things better than anybody else would do them. To the outside world we can say – we have had a lasting impact on the immunisation programme in Zambia and beyond.’

To find out more about Ark’s work in Zambia, contact Guy Holloway: