Regional Child Survival Strategy: Who And Unicef

Subject: FCM III Topic: Regional Child Survival Strategy WHO/UNICEF Shifting /Date: August 1, 2008 Trans group: Paolo Paraiso

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

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

Trend in Infant Mortality Reduction Towards Target 2015 MDG, WPR

Immediate Causes of Death Children, WPR

in Underfive

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

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;

MARY YVETTE ALLAIN TINA RALPH SHERYL BART HEINRICH PIPOY TLE JAM CECILLE DENESSE VINCE HOOPS CES XTIAN LAINEY RIZ KIX EZRA GOLDIE BUFF MONA AM MAAN ADI KC PENG KARLA ALPHE AARON KYTH ANNE EISA KRING CANDY ISAY MARCO JOSHUA FARS RAIN JASSIE MIKA SHAR ERIKA MACKY VIKI JOAN PREI KATE BAM AMS HANNAH MEMAY PAU RACHE ESTHER JOEL GLENN TONI

Subject: FCM III Topic: Regional Child Survival Strategy Page 2 of 6

 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  Improper infant and young child feeding: - the transition between intrauterine and extrauterine life; infants not breastfed have 6fold 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: A. 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. B. 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 C. Others  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;  Human resource constraints: -underpaid, demotivated health workers; inequitably distributed;  Social norms and Gender issues: -women are underfed, poorly educated, overworked.

Subject: FCM III Topic: Regional Child Survival Strategy Page 3 of 6

•

•

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 Child Survival Actions by Country Group Group 1 • Essential package for child survival • Deworming of children 659 mos. and pregnant women Group 2

•

• • 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 • Vaccination against common vaccine preventable diseases would prevent approximately 3% of child deaths • Case management of diarrhoea would save approximately 21% of child lives

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Group 3

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• • •

Essential package for child survival w/ geographic targeting in underserved areas Institutional deliveries w/ comprehensive newborn care Deworming of children 659 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 socioeconomically underprivileged and marginalized Institutional deliveries with newborn care Promotion of child safety Introduction of new or underused vaccines (HiB, rotavirus, conjugate

Subject: FCM III Topic: Regional Child Survival Strategy Page 4 of 6

pneumococcal vaccine)

1. Skilled Attendance During Pregnancy, Childbirth and the Immediate Postpartum  Antenatal care  Skilled attendance at delivery  Immediate postpartum care The Philippines fared better than Lao and Cambodia with regard to early initiation of breastfeeding. It must be noted though that the current level is still far below than the 80% set by the DOH for early iniation of breastfeeding. Skilled Care Attendance At Birth 3. Breastfeeding and Complementary Feeding 100

Exclusive Breastfeeding

80 60

t n c r e 20 P

100

40 e

0 Cambodia China

Lao PDR

PNG

PhilippinesViet Nam

In the Philippines, the proportion of deliveries attended by a health professional is about 60%, which is lower that that in China and Vietnam. It is higher though than Cambodia, Lao and PNG. 2. Care of the Newborn  Early initiation of breastfeeding (within one hour of birth)  Temperature control 100Low-birth-weight management Early 80 Initiation of Breastfeeding (within one hour of birth) 60

50 t n e c r e P 0 Cambodia China

Lao PDR

PNG

PhilippinesViet Nam

Comparing the proportion of infants exclusivelybreastfed among the different countries, the Philippines reported only about a third of infants who were breastfed exclusively. It has better coverage of exclusively breastfed infants than Vietnam, PNG and Laos.

100

Timely Complementary Feeding

80

t n e c r e 40 P

60

20

20

0

0

t n e 40 rc e P

Cambodia

Lao PDR

Philippines

Cambodia

China

Lao PDR

PNG

PhilippinesViet Nam

Subject: FCM III Topic: Regional Child Survival Strategy Page 5 of 6

Timely provision of complementary feeding means that the infant has been introduced to semi-solid or solid food to complement nutrients at age 6 months, not later or earlier.

4. Micronutrient Supplementation  Vitamin A supplementation (6-59 months-old)  Iron supplementation  Use of iodized salt – iodine supplementation Vitamin A Supplementation

WHO recommends immunization of children against measles. The Philippines is better off than PNG, LAO and Cambodia in terms of measles vaccination coverage. In 2004, the DOH conducted a nationwide Follow-up Measles Campaign where all children were given measles vaccination. That nationwide immunization covered about 95% children.

Tetanus Toxoid Immunization 100 80

100

60 t

80

n e c r 40 e P

60 t

20

n e c r 40 e P

0

20 Cambodia

Lao PDR

PNG

Philippines

Viet Nam

Coverage of Vitamin A supplementation in the Philippines has improved in the past 5 years. This improvement is attributed to the conduct of Garantisadong Pambata (GP) sponsored by the DOH twice a year. The GP allows the 6-71 months old children to avail of the Vitamin A supplementation twice a year. In 2006, the DOH began to integrate the provision for deworming drugs to the same age group of children.

0 Cambodia Lao PDR

PNG

Philippines Viet Nam

The WHO recommends that women should have at least two injections against TT to prevent their babies from being infected with neonatal tetanus. It is lamentable that the Philippines has the least proportion of women with at least TT 2 Plus vaccination. 6. Integrated Management of Sick Children 100

5. Immunization of Children and Mothers 100

Measles Immunization

Oral Rehydration Therapy for Diarrhoeal Disease 80 60 t n e c r e 40 P

t 50 n e c r e P

20

0 Cambodia China

Lao PDR

PNG

PhilippinesViet Nam

0 Cambodia

Lao PDR

PNG

Philippines Viet Nam

Subject: FCM III Topic: Regional Child Survival Strategy Page 6 of 6

The indicator refers to the number of diarhea cases who were given ORT

Care-seeking for Acute Respiratory Infection 100

t 50 n e c r e P

0 Cambodia

Lao PDR

Philippines

Viet Nam

As shown in the slide, there is poor seeking behaviour among mothers with children suffering from ARI. Although the coverage is lower than Vietnam, it is still below the 80% target set by the DOH. 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 o seven evidence-based intervention areas have been linked with 10 indicators; o countries are implementing many of these child survival interventions, but coverage is low o countries use different indicators for the same intervention, making data comparison and tracking progress towards implementation coverage difficult