Session 1

Regional Child Survival Strategy WHO/UNICEF

Learning Objectives
By the end of this session, the students will be able to: (2)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

Under-five Mortality Rates of Countries in the Western Pacific Region, 2004 WHO
Cambodia Papua New Guinea Lao PDR Kiribati Marshall Islands Mongolia Solomon Islands Niue Tuvalu Samoa

Philippines
Vanuatu Nauru Tonga Palau China Micronesia Cook Islands Viet Nam Fiji Malaysia Brunei Darussalam New Zealand Republic of Korea Australia Singapore Japan

- male - female

Immediate Causes of Deaths Among Underfive Children In High and Middle Mortality Areas (WPRO:2000-2003) High-mortality areas
27% 1% 2% 18% 20 % 32 % 1% 18% 13% 49%

Middle-mortality areas
20%

 Neonatal conditions

 ARI

 Diarrhoea
 Measles

 HIV/AIDS
 Other incl. injuries

Immediate Causes of Death in Underfive Children, WPR

Undernutrition

53%

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

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.

Underlying Causes - Inequity
 Within160

Richest 20%

Poorest 20%

155

country inequities are often large

Underfive mortality rate per 1000

140 120 100 80 60 40 20 0

80 63 23 29 64

Vietnam

Philippines

Cambodia

Source: PovertyNet website

Essential Package of Child Survival Interventions
1. Skilled attendance during pregnancy, childbirth and the immediate postpartum 2. Care of the newborn 3. Breastfeeding and complementary feeding 4. 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 – WHY?

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%

CHN U5MR 25/1000 LAO U5MR 107/1000 VTN U5MR 32.8/1000

PHL U5MR 40/1000

CAM U5MR 83/1000

PNG U5MR 88/1000

Child Survival Actions by Country Group
Group1 Group 2
 

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)

    

Group 3

   

During Pregnancy, Childbirth and the Immediate Postpartum

1. Skilled Attendance

Antenatal care Skilled attendance at delivery Immediate postpartum care

Skilled Care Attendance At Birth
100 90 80 70 Percent 60 50 40 30 20 10 0

2. Care of the Newborn
 Early

initiation of breastfeeding (within one hour of birth) control

 Temperature

 Low-birth-weight

management

Early Initiation of Breastfeeding (within one hour of birth)
100 90 80 70 Percent 60 50 40 30 20 10 0 Cambodia Lao PDR Philippines

3. Breastfeeding and
Complementary Feeding

Exclusive Breastfeeding
100 90 80 70 Percent 60 50 40 30 20 10 0 Cambodia China Lao PDR PNG Philippines Viet Nam

BF<4m

<6m

4-5m

<6 m 21-86%

<6m 8-33

Timely Complementary Feeding
100 90 80 70 Percent 60 50 40 30 20 10 0 Cambodia China Lao PDR PNG Philippines Viet Nam

4. Micronutrient Supplementation
 Vitamin

A supplementation (6-59 months-old) supplementation

 Iron  Use

of iodized salt – iodine supplementation

Vitamin A Supplementation
100 90 80 70 Percent 60 50 40 30 20 10 0 Cambodia Lao PDR PNG Philippines Viet Nam

5. Immunization of Children and
Mothers

Measles Immunization
100 90 80 70 Percent 60 50 40 30 20 10 0 Cambodia China Lao PDR PNG Philippines Viet Nam

Tetanus Toxoid Immunization
100 90 80 70 Percent 60 50 40 30 20 10 0 Cambodia Lao PDR PNG Philippines Viet Nam

6. Integrated Management of Sick
Children

Oral Rehydration Therapy for Diarrhoeal Disease
100 90 80 70 Percent 60 50 40 30 20 10 0 Cambodia Lao PDR PNG Philippines Viet Nam

Care-seeking for Acute Respiratory Infection
100 90 80 70 Percent 60 50 40 30 20 10 0 Cambodia Lao PDR Philippines Viet Nam

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 mechanism  one national plan  one monitoring and evaluation process  mobilize for advocacy and communication  mobilize financial resources to accelerate and sustain progress