Reducing Under-five Childhood Mortality using IMCI/e-IMCI ...
IMCI Session 1-CS Strategy
Transcript of IMCI Session 1-CS Strategy
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