Child Health: How Have We Been Doing; Where to Now?

An Update on MDG 4 and 5: Maternal and Child Health

By Dr. Mickey Chopra, Chief, Health and Associate Director, Programme Division, UNICEF, NYHQ

Presented byDr. Festo P. Kavishe, Deputy Regional Director, UNICEF

East Asia and Pacific, Bangkok9th March 2010

Overview of presentation

Update on MDG4 and 5 Challenges and gaps What can be done and what is new

 

Source: SOWC 2009

MDG 4: Trends in U5MRSignificant declines in under-five mortality rates between 1990 and 2008 in all regions

Significant declines in under-five mortality rates between 1990 and 2008 in all regions

                                                                                                                                                                              

Trends in Immunization Coverage: The Measles Story

Vaccine coverage has increased Measles deaths have declined

Africa

South Asia

0

200

400

600

800

1999 2000 2001 2002 2003 2004 2005 2006 2007

U-5

dea

ths

due

to m

easl

es (t

hous

ands

)

East Asia & Pacific

0

20

40

60

80

100

1980 1985 1990 1995 2000 2005

Mea

sles

(MC

V) im

mu

niza

tion

cove

rage

(per

cent

age)

MDG target coverage 90%

Trends in ITN Use, 2000-2006

Source: UNICEF Global malaria databases 2009, based on 22 countries with trend data for around 2000 and 2006, covering 53 % of children under age five.

Percentage of pregnant women with HIV receiving antiretrovirals for preventing mother-to-child transmission of HIV in low- and middle-

income countries by region, 2004-2007

UNICEF

12%

2%

35%

40%

24%

65%

10%

15%

19%

4%

43%

52%

58%

15%

24%

31%

8%

41%

46%

16%

66%

24%

35%

46%

11%

42%

47%

24%

74%

35%

45%

58%

16%

54% 54%

25%

94%

45%

9% 9%

22%

9%

27%29%

52%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Sub-SaharanAfrica

Eastern andSouthern

Africa

Western andCentral Africa

Latin Americaand the

Caribbean

Latin America Caribbean East, Southand South-East Asia

Europe andCentral Asia

Total low- andmiddle-income

countries

% o

f p

reg

na

nt

wo

me

n l

ivin

g w

ith

HIV

re

ce

ivin

g a

nti

retr

ov

ira

l p

rop

hy

lax

is

2004 2005 2006 2007 2008

The bar indicates the uncertainty range around the estimate.Source: Data reported by countries to WHO, UNICEF and UNAIDS in response to the annual reporting form for monitoring the health sector response to HIV/AIDS, 2009

Challenges and Gaps

Despite overall progress in reducing U5MR, little progress in reducing newborn deaths

Still almost 9 million children dying every year - of which more than 3 million are newborns

Almost no decline in early neonatal mortality in decades

Source: Lawn JE et al, Lancet 2005

Time of Newborn deathsUp to 50%

of neonataldeaths occur in the first 24 hours

Source: Lawn JE et al Lancet 2005, Based on analysis of 47 DHS datasets (1995-2003), 10,048 neonatal deaths)

Newborn deaths are highest in Sub-Saharan Africa and South Asia

Source: Lawn JE et al Lancet 2005

MDG 5 - Trends in Maternal Mortality

Source: UNICEF: Progress for Children 2008

Half a million women continue to die annually from childbirth-related causes

Another 15 million are left with lifelong debilitating effects

HAEMORRHAGE CAUSES MORE THAN ONE THIRD OF MATERNAL DEATHS IN AFRICAPer cent distribution of maternal deaths in Africa, by cause (1997-2002)

Source: UNICEF: Progress for Children 2008

Source: UNICEF: Progress for Children 2008

Maternal mortality is highest in countries of Sub- Saharan Africa and South AsiaMaternal mortality ratios (MMR) per 100,000 live births (2005)

GAP1

GAP2

GAP3

Whilst we know what works, there as coverage gaps along the Continuum of Care for MNH

Source: Lancet Countdown Coverage writing group, Lancet Countdown special issue, 2008

What can be done?

Some innovation

Community-based case management and care of the newborn

Alternative cadres for obstetric care

Newborn skin/cord cleansing with clorhexidine

Some innovation for post-partum hemorhage

Uniject for Oxytocin a prefilled injection device - delivers a specified dose of drug making it possible to be administered by auxiliary midwives

and other cadres of personnel with minimal training

Misoprostol Anti-shock garment

Some innovation for eclampsia and pre-eclampsia

Magnesium Sulphate simple low-cost anticonvulsant A pre-packed kit to facilitate its

application in resource-limited settings Calcium supplementation requires further

operations research to guide application in low-resource

 

In conclusion• We know the epidemiology• We know the evidence-based interventions that need to scaled-up• We know existing delivery modes: eg.

• Immunization to deliver essential child survival interventions• Antenatal care to deliver key interventions including PMTCT

• We also know the coverage gaps

So, What to do?• We need to ensure Health Systems Strengthening results in improved

outcomes for mothers and children• We need to ensure linkages with other programmes such as HIV/AIDS

and malaria control (integrated approach)• We need to use the data to improve access and quality and reach those

who are not being reached (better and strategic use of evidence)• We need to continuously monitor to inform decision-making and focus of

our strategies (track progress and improve feedback loop to decision makers.

Thank you for your attention and all your support!!!!