Child SurvivalA global overview

ACSD WCARApril 2007

CHILD MORTALITY REDUCTION - A GLOBAL PRIORITY

< 10 million children under 5 die every year globally

Variable progress in reducing child mortality

Few causes account for a large fraction of deaths

TRENDS IN U5 MORTALITY, MDG4

Sub-Saharan Africa

South Asia

Latin America

East Asia

Under-Five

MortalityRate

244

188

171

62

206

129

92

42.6

122

5431

17.8

123

58

36

19.1

1970 1990 2004 2015

}MDG4Goals

Source: The State of the World’s Children, 2006

GLOBAL DISTRIBUTION OF CHILD DEATHS

Source: Black et al., Lancet 2003

(each dot = 5,000 deaths)

Trends in child mortality

Achievement of MDG4

will depend on our success in south Asia and sub-Saharan Africa,

and staying the course in other regions.

60 PRIORITY COUNTRIES FOR CHILD SURVIVAL

Source: The State of the World’s Children, 2006

Accounted for 94% of all U5 deaths in 2004

West and Central Africa CAUSES OF U5 DEATHS, Lancet 2005

Source: Bryce J. et al., Lancet 2005

Diarrhea, 19%

Measles, 2%Pneumonia, 21%

Malaria, 27%

Neonatal, 25%

residual, 1%AIDS, 4%

Malnutrition 50%

CS INTERVENTIONS

Source: Jones G Bryce J. et al., Lancet CS series 2003

1. Promotion of EBF and complementary feeding

2. Use of ITN

3. Handwashing with soap at 4 critical times

4. Care-seeking behaviour (pneumonia, diarrhoea, malaria, HIV/AIDS)

Exclusive Breastfeeding

… for 6 months

Percentage of EBF in WCAR

0

10

20

30

40

50

60

70

Benin

Burkin

a Fas

o

Camer

oun

Cape

Verde

Centra

l Afri

can

Repub

licCha

d

Congo

Bra

zzav

ille DRC

Cote

d'Ivo

ire

Equat

orial

Gui

nea

Gab

on

Gam

bia

Gha

na

Guin

ea

Guin

ea-B

issau

Libe

ria Mal

i

Mau

ritan

iaNig

er

Niger

ia

Sao T

ome

& Prin

cipe

Seneg

al

Sierra

Leo

neTog

o

Why is exclusive breastfeeding recommended for the first 6 months

Water88%

Fat4%

Protein1%

Lactose7%

Other0%

Breastmilk provides all the energy and nutrients that an infant needs during the first six months.

Breastmilk is 88% water; therefore infants do not need extra water even in extremely hot climates

Exclusive breastfeeding for 6 months

Early initiation of breastfeeding (<1 hour after birth)

No prelactal foods, No water +++

Insecticide Treated Nets

… pregnant women and children under 5 sleeping under ITNs

Source: WFFC Statistical Review, Number 6, December, 2007

Target: have halted by 2015 and begun to reverse the incidence of malaria and other major diseasesMDG 6: Combat HIV and AIDS, malaria and other diseases

20

10

1315

1

6

1

6

1

49

22

39

2

7

1

75

38

7

54

48

5857

32

48

52

36

49

6361

4446

33 3334

27

52

48

4042

3

0

10

20

30

40

50

60

70

Benin

Burkin

a Fas

o

Camer

oon

Cape

Verde

CARCha

d

Congo

Congo

, DRC

Côte

d'Ivo

ire

Equat

orial

Guin

ea

Gabon

Gambia

Ghana

Guinea

Guinea

-Biss

au

Liber

iaM

ali

Mau

ritan

iaNige

r

Nigeria

Sao T

ome

and

Princip

e

Seneg

al

Sierra

Leo

neTog

o

Wes

t/Cen

tral A

frica

% under-fives sleeping under an insecticide-treated net (2003–2006)% under-fives with fever receiving antimalarial drugs (2003–2006)

Insecticide Treated NetsOnly 7% of under 5s sleep under an ITN in West and Central Africa

(SOWC 2008)Sleeping under ITNs can prevent

– Infection in pregnancy (low birth weight, Preterm delivery)– 75% of new malaria cases (R Black-Lancet 2003)– Chronic repeated infections leading to anemia– Reduce child deaths by 20%

6 lives per year saved per 1,000 children using ITN

One ITN extends protection to more than one child…to the community(Howley -2003)

Hand washing with soap

….at 4

critical

times

Diarrhoea Risk Reduction

0

10

20

30

40

50

60

70

(a) Sanitation (b) Wateravailability

(c) Waterquality

(d) Hygienepromotion

(e) Handwashing

Red

uct

ion

in

dia

rrh

ea m

orb

idit

y (%

)

Previous reviews Fewtrell et al. (2005)

Previous reviews:

a – d Esrey SA et al. (1991) Bull WHO 69 (5): 609-621

e Curtis V, Cairncross S (2003) Lancet Inf Dis 3: 275-281.

Fewtrell L et al. (2005) Lancet Infect Dis 5(1): 42-52.

Evidence Base – Quick Wins• Hand Washing – Correct hand washing at critical times can reduce

diarrhoea by 47%.

• New evidence shows that it can also reduce ARI’s by 44%

• Impacts on helminth and eye infections, especially trachoma

• The cost-effectiveness of hand washing at the top of child survival interventions

• Hand washing critical at birth for safe delivery (new born infections)• Hand washing and hygien critical against polio

Use of Oral Rehydration Salts

… Any child with diarrhea should receive ORS + continued feeding

• Only 29% of under 5s receiving ORS and continued feeding in West in Central Africa (SOWC 2008)

• In SSAfrica, a child has at least 4 episodes of diarrhea a year= episodes of loosing weight, increased risk of anemia and micro-nutrients deficiency, resulting in higher vulnerability

• Adequate increase fluids, continued breastfeeding, rehydration using New ORS can avoid 90% of diarrhea deaths (R Black Lancet 2003)

• New formula with Zinc…… more adapted to the child, less osmolarity: Quicker adequate rehydration

Use of Oral Rehydration Salts

The 4 Quick Wins• Exclusive Breastfeeding

• Sleeping under ITNs

• Hand Washing

• ORS

– ALL at home, by mother and community, low cost, high impact, – Synergistic effect, – more than 60% of U5 deaths avoided– SOCIAL AND BEHAVIOR CHANGES

– Programme communication is more than crucial in CSD