Session 1

Regional Child Survival Strategy

WHO/UNICEF

Learning Objectives

By the end of this session, the students will be able to:

(1)describe the overall health status of children in

the Western Pacific Region;

(2) explain the underlying causes and other related factors against child survival; and

(3) enumerate the essential package of interventions applicable for counties of varying levels of child health status

Trend in Infant Mortality Reduction Towards Target 2015 MDG, WPR

Source: World Health Organization Regional Office for the Western Pacific 2005

Philippines

Cambodia

Papua New Guinea Lao PDR

Marshall Islands

Kiribati

Mongolia

Solomon Islands

Niue

Tuvalu

Samoa

Vanuatu Nauru Tonga Palau China

Micronesia Cook Islands

Viet Nam Fiji

Malaysia

Brunei Darussalam

Australia Singapore

Japan

Republic of Korea

Under-five Mortality Rates of Countries in the Western Pacific Region, 2004 WHO

New Zealand

- male

- female

Immediate Causes of Deaths Among Underfive Children In High and Middle Mortality Areas (WPRO:2000-2003)

High-mortality areas

Neonatal conditions

ARI

Diarrhoea

Measles

HIV/AIDS

Other incl. injuries

Middle-mortality areas

32 %

20 %18%

2%1%

27%

49%

13%

18%

1%

20%

Immediate Causes of Death in Underfive Children, WPR

Source: Child Health Epidemiologist and research group (CHERG) estimates of under-five deaths, 2000-03

Under-nutritio

n53%

Immediate Causes

deaths in perinatal and neonatal periods dominate the U5MR; the perinatal period is also associated with the highest number of disabilities; highest risk is in the first day of birth;

40 - 80% of neonatal deaths are associated with low birth weight;

malnutrition remains the highest attributable causal factor of all childhood deaths in children under 5;

most important immediate causes of death from communicable diseases remain diarrhoea and ARI

Predisposing Factors

Inadequate Care for Women: currently, most women seek antenatal care (ANC) in the 2nd or 3rd trimester

High fertility, poor birth spacing: 2.5 times chance of surviving infancy if >3 years interval;

Community and environment: indoor, outdoor and personal hygiene are major contributors to ARI/CDD; parentless/orphans are 6-7 times greater chance of dying in infancy

Predisposing Factors

Improper infant and young child feeding: the transition between intrauterine and extrauterine life; infants not breastfed have 6-fold increased chance of dying in first two months; protection against infections

Lack of access to safe water, sanitation: WPRO/ EAPRO has 3 of the 10 countries ‘worst off’ for water safety (Cambodia, PNG, Laos); Cambodia worst off in toilet sanitation; 1 billion people in the region live without adequate sanitation = 305,000 metric tons of fresh excreta deposited outside each day

Lack of access to basic social services: pockets of poor immunization rates, poor access to appropriate management of diarrhea and pneumonia

Underlying Causes: Undernutrition

conditions interfering with nutrient absorption that lead to deficiencies prior to and throughout pregnancy (e.g., malaria, hookworm, Tb, UTIs, HIV/AIDS, etc.)

Low Birth Weight: significantly increased mortality risk in the neonatal and early

infancy period; cognitive function impairment; predicts underweight later in life; risk for adult diseases.

Underlying Causes:Poor Intrauterine Nutrition

Stunting: • persists into adulthood; • intergenerational effect: associated with an

increase in surgically assisted births, and birth of LBW babies;

• associated with poor cognitive and motor development

Underlying Causes

Increasing inequity: the poor being marginalized in the delivery of health care;

Policy Environment: lack of supportive laws or poor implementation of the laws;

Constraints Financing for Child Survival. public spending in health is only 1.9 % of GDP in comparison to global average of 3.2 %; policies not driven by concepts of public goods, or of human rights based approaches;

Underlying Causes

Human resource constraints: underpaid, demotivated health workers; inequitably distributed;

Social norms and Gender issues: women are underfed, poorly educated, overworked.

Within-country inequities are often large

23 29

646380

155

0

20

40

60

80

100

120

140

160

Vietnam Philippines Cambodia

Und

erfiv

e m

orta

lity

rate

per

100

0

Richest 20% Poorest 20%

Source: PovertyNet website

Underlying Causes - Inequity

1. Skilled attendance during pregnancy, childbirth and the immediate postpartum

2. Care of the newborn3. Breastfeeding and complementary feeding4. Micronutrient supplementation

5. Immunization of children and mothers

6. Integrated management of sick children

7. Use of insecticide treated bed nets (in malarious areas)

Essential Package of Child Survival Interventions

Skilled attendance. during pregnancy, childbirth and the immediate postpartum would prevent approximately 13% of child deaths

Exclusively breastfeeding for six months, and adequate and safe complementary feeding from six months onwards with continued breastfeeding and micronutrient supplementation would prevent approximately 20% of child deaths

Essential Package of Child Survival Interventions – WHY?

Vaccination against common vaccine preventable diseases would prevent approximately 3% of child deaths

Case management of diarrhoea would save approximately 21% of child lives

Case management of pneumonia and neonatal sepsis would prevent an estimated 12% of child deaths

Use of insecticide treated bed nets and prompt treatment of malaria would reduce child mortality by approximately 13%

Essential Package of Child Survival Interventions – WHY?

CAMU5MR

83/1000

CHNU5MR

25/1000

LAOU5MR

107/1000

PNGU5MR

88/1000

PHLU5MR

40/1000VTNU5MR

32.8/1000

Child Survival Actions by Country Group

Group1

Group 2

Group 3

Essential package for child survival Deworming of children 6-59 mos. and pregnant women

Essential package for child survival w/ geographic targeting in underserved areas

Institutional deliveries w/ comprehensive newborn care Deworming of children 6-59 months, and pregnant women Promotion of childhood safety Introduction of new or underused vaccines (HiB, rotavirus,

conjugate pneumococcal vaccine)

Essential package for child survival with targeting of the socio-economically underprivileged and marginalized

Institutional deliveries with newborn care Promotion of child safety Introduction of new or underused vaccines (HiB, rotavirus,

conjugate pneumococcal vaccine)

1. Skilled Attendance During Pregnancy, Childbirth and the Immediate Postpartum

Antenatal care

Skilled attendance at delivery

Immediate postpartum care

Skilled Care Attendance At Birth

0

10

20

30

40

50

60

70

80

90

100

Cambodia China Lao PDR PNG Philippines Viet Nam

Per

cent

2. Care of the Newborn

Early initiation of breastfeeding (within one hour of birth)

Temperature control

Low-birth-weight management

Early Initiation of Breastfeeding (within one hour of birth)

0

10

20

30

40

50

60

70

80

90

100

Cambodia Lao PDR Philippines

Per

cent

3. Breastfeeding and Complementary Feeding

Exclusive Breastfeeding

0

10

20

30

40

50

60

70

80

90

100

Cambodia China Lao PDR PNG Philippines Viet Nam

Perc

ent

<6m

BF<4m

4-5m 21-86%

<6m

8-33

<6m

Timely Complementary Feeding

0

10

20

30

40

50

60

70

80

90

100

Cambodia China Lao PDR PNG Philippines Viet Nam

Per

cent

Vitamin A supplementation (6-59 months-old)

Iron supplementation

Use of iodized salt – iodine supplementation

4. Micronutrient Supplementation

Vitamin A Supplementation

0

10

20

30

40

50

60

70

80

90

100

Cambodia Lao PDR PNG Philippines Viet Nam

Per

cent

5. Immunization of Children and Mothers

Measles Immunization

0

10

20

30

40

50

60

70

80

90

100

Cambodia China Lao PDR PNG Philippines Viet Nam

Perc

ent

Tetanus Toxoid Immunization

0

10

20

30

40

50

60

70

80

90

100

Cambodia Lao PDR PNG Philippines Viet Nam

Perc

ent

6. Integrated Management of Sick Children

Oral Rehydration Therapy for Diarrhoeal Disease

0

10

20

30

40

50

60

70

80

90

100

Cambodia Lao PDR PNG Philippines Viet Nam

Per

cent

Care-seeking for Acute Respiratory Infection

0

10

20

30

40

50

60

70

80

90

100

Cambodia Lao PDR Philippines Viet Nam

Per

cent

7. Use of insecticide treated nets (ITN) in malarious areas

20 % sleeping under ITN (Cambodia)

20.6 % sleeping under ITN (Lao PDR)

35% sleeping under ITN (PNG)

Summary and Conclusion

seven evidence-based intervention areas have been linked with 10 indicators;

countries are implementing many of these child survival interventions, but coverage is low

countries use different indicators for the same intervention, making data comparison and tracking progress towards implementation coverage difficult

The way forward: organize and mobilize

one coordination mechanismone national planone monitoring and evaluation processmobilize for advocacy and communicationmobilize financial resources to accelerate

and sustain progress