Tracking Intervention Coverage for Child Survival

You will find below the word format of a powerpoint presentation of a review article I presented at the department of Family Medicine, Jos University Teaching Hospital, Jos, Nigeria, recently. It borders on the progress the developing world has made so far towards achieving the MDGs. Please read.

• Review article

• 10 researchers from WHO, UNICEF, the World Bank, Johns Hopkins, PMNCH, Universities in Brazil and Pakistan

• Funding for the research provided by these institutions

• Commenced in 2005

Background

• The Millennium Development Goals

• The fourth: achieve 2/3 reduction of under-5 mortality between 1990 and 2015

• Other MDGs relate to Child health: the 5^th calls for reduction of maternal mortality and others eradication of extreme hunger, universal basic education, etc

• Success in one MDG imparts on others

• MDGs adopted worldwide in 2000

Childhood survival strategies: the evolution

• The 2^nd world war and relief provision for children ravaged by war

• Access to health & the Welfare view

• CSDPP: Child Survival Development Protection and Participation policies packaged into GOBIFFF in the 1980s

• The Child Rights Commission (CRC) in the 1990s: health of child a right

• Recently, Integrated Management of Childhood Illnesses (IMCI) and the MDGs

The Essence of tracking

To determine the progress (or otherwise) made so far towards achieving the 4^th MDG especially in resource-constrained countries of the world so as to intervene early for rapid actualization of the 4^th MDG

The Process of Tracking intervention coverage

• In this context, it involves

– Identifying target countries

– Developing profiles for each country

– Identifying essential child survival interventions that are already in place in those countries

– Measuring success of coverage by estimating the annual reduction in under-5 mortality rate

Contd:

– Measuring extent of coverage of essential child survival interventions

– Classifying countries into 3 categories according to progress made towards internationally agreed targets viz: “on track”; “watch and act” and “high alert”

– Feedback

What are the essential Child Survival Interventions?

• There is evidence that a set of about 20 interventions could reduce child mortality by over 60% if made available to all who need them.

• Countries that have good coverage for 6 out of the 20 interventions are rated to be doing well

• The interventions are listed below:

• Note that the figures indicate the median coverage levels (in percentages) of each of the essential interventions in 60 countries with the world highest rates of child mortality; those in parenthesis represent the range

Newborn health

• Skilled attendant at delivery 51(6-97)

• Tetanus protection at birth 59(10-90)

• Postnatal visits within 3/7

• PMTCT 3(0-50)

• Timely initiation of breastfeeding 36(9-72)

Other prevention interventions

• Use of improved sanitation facilities 41(6-80)

• Use of improved drinking water sources 69(13-98)

• Vitamin A supplementation 80(1-98)

• Insecticide-treated bed nets 3(0-44)

Nutrition

• Exclusive breastfeeding at <6mths style="mso-tab-count: 5"> 24(1-84)

• Breastfeeding plus complementary food at 6-9mths of age 66(13-94)

• Continued breastfeeding at 20-23mths of age 54(8-94)

Immunization

• DPT immunization 73(25-98)

• Measles immunization 74(35-99)

• Hib immunization 89(73-98)

Case management

• Care-seeking for pneumonia 47(14-76)

• Antibiotic treatment for pneumonia

• Oral rehydration therapy for diarrhea 38(7-80)

• Antimalarial treatment for fever 45(1-69)

Nigeria and Child Survival Strategies

• Under-5 mortality rate: 230 in 1990

197 in 2004

Estimated annual rate of reduction from 1990-2004: 1.1%

MDG target of under-5 mortality rate by 2015: 77

Average annual rate of reduction needed between 2004 and 2015 to meet target: 8.6%

• Nigeria classified as one of the 60 countries with highest child mortality rates (inclusion criteria: annual child mortality rate >90/1000 live births)

• Out of the 60, Nigeria close to the bottom; those with higher child mortalities than Nigeria are either ravaged by war or natural disasters

• As at 2004, the measles and DPT immunization coverage was less than 50%

• Also, considering each of the other interventions, Nigeria falls below the minimum estimate required to achieve the MDGs by 2015

• Nigeria is not on track to meet the MDGs, going by available data.

Child Survival: state of the world

• Only 7 of the countries with the highest burden of under-5 mortality in 2004 are on track to achieve the MDG-4: Bangladesh, Brazil, Egypt, Mexico, Nepal, Indonesia and the Philippines

• Mortality rates increased between 1990 and 2004 in 14 countries and most of these countries are affected by armed conflicts or and the AIDS pandemic

• Generally, rates of progress in child survival is slow

• Has been directly linked to the low levels of coverage of interventions discussed above

• Though some countries recorded up to 10% increase of access to above interventions within 2 years

• This shows that even the poorest of countries can make when needed resources are made available

Panacea for rapid reduction of Child Mortality

• Strengthen health systems

• Improve management capacities

• Ensure availability, sustainability of commodities needed for the interventions

• Increased, rationalized financial flow

• Human resource development

• Advocacy for political commitment

As regards donor assistance and financial flow

• In a companion article, the following were highlighted:

– The 60 countries with the highest burden of child mortality cannot achieve MDG-4 without external aid

– In 2004, donor assistance for activities related to maternal, newborn and child health was US$1990 million which represents just 2% of total aid disbursements to developing countries

Contd:

• This amounts to US$3.1 per child

• Grossly inadequate

• There is a direct relationship between mortality and Official Development Assistance (ODA) per head

• Recommendation: increase ODA significantly for desired effect

Relevance to Family Medicine

• Family Physician: Frontline doctor

• Tackles undifferentiated illnesses; provides curative, preventive, rehabilitative care from cradle to old age in a coordinated, comprehensive way.

• No one else best suits the position of instituting the childhood survival strategies

• Look through the interventions again

Conclusion

• In 2 years, the Childhood Survival Countdown team will be at work again in Geneva.

• They will come up with newly generated data representing how we have fared.

• Meticulous use of the interventions will produce astounding success and realization of MDG-4

Thanks for listening!