child health: how have we been doing; where to now? an update on mdg 4 and 5: maternal and child...
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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
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Overview of presentation
Update on MDG4 and 5 Challenges and gaps What can be done and what is new
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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
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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%
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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.
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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
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Challenges and Gaps
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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
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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)
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Newborn deaths are highest in Sub-Saharan Africa and South Asia
Source: Lawn JE et al Lancet 2005
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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
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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
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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)
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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
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What can be done?
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Some innovation
Community-based case management and care of the newborn
Alternative cadres for obstetric care
Newborn skin/cord cleansing with clorhexidine
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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
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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
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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.
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Thank you for your attention and all your support!!!!