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  • Meeting Unmet Needs in Child SurvivalUSAIDBureau for Global Health

  • IntroductionSubstantial progress over past few decades in reducing infant and child mortalityDuring the 1990s, decline in child mortality began to decelerate or plateau in many regions

  • Slowing Reduction in Under 5 Mortality

    Source: UNICEF Time Series Estimates, 2000.

  • Objectives of Analysis Are we investing in the correct areas?Is there a need for any strategic program changes?

  • QuestionsAre there additional technical areas that need to be addressed?Are there identifiable geographic areas of greatest unmet need?Are there particular characteristics of children or their families that help predict or identify unmet need?What are the programmatic implications of these findings?

  • MethodologyReview of literatureSpecial study of services and health behaviors using DHS dataConsultation with experts in child survival interventions

  • Are there additional technical areas that need to be addressed?

  • Main Causes of U5M:1990 and 2000HIV4%ARI 20%Others28%Diarrhea12%Malaria8%22%Measles5%Measles11%Neo-natal tetanus6%Malaria7%Diarrhea28%Others29%ARI 15%Whooping cough4%19902000Source: Protecting the worlds children, A call for action, 1990; Evidence and information for Policy/WHO, Child Adolescent Health and Development, 2001 WHO, Child and Adolescent Health and Development. On line www.who.int/child-adolescent-health/inegr.htm

    Perinatal

  • Main Causes of U5M:1990 and 2000HIV4%ARI 20%Others28%Diarrhea12%Malaria8%22%Measles5%Measles11%Neo-natal tetanus6%Malaria7%Diarrhea28%Others29%ARI 15%Whooping cough4%19902000Source: Protecting the worlds children, A call for action, 1990; Evidence and information for Policy/WHO, Child Adolescent Health and Development, 2001 WHO, Child and Adolescent Health and Development. On line www.who.int/child-adolescent-health/inegr.htm

    PerinatalMalnutrition (underlying factor) 60%

  • Increasing Proportion of Neonatal Mortality

    Based on State of the Worlds Newborns, State of the Worlds Children 2001, WHO Publications

    Chart1

    4444

    3825

    Neonatal mortality rate

    Post-neonatal mortality rate

    Deaths per 1000 live births

    Sheet1

    25

    19831999

    Neonatal mortality rate4438

    Post-neonatal mortality rate4425

    Sheet1

    00

    00

    Neonatal mortality rate

    Post-neonatal mortality rate

    Deaths per 1000 live births

    Sheet2

    Sheet3

  • Percentage of Children with Unmet NeedUnmet need for child survival is the percentage of children whose families do not practice healthy behaviors or use services such as immunizations, ORT, breastfeeding, etc.

    Chart1

    26

    28

    40

    58

    25

    52

    32

    Immunization data for 12-23 months children and exclusive breastfeeding for children under 4 months only.Source: DHS, ACC/SCN, Unicef

    Percent of children who did not receive child survival interventions

    u5mr changes by region

    19902000

    Sub-Saharan Africa180172

    South Asia135101

    Middle East and North Africa7662

    East Asia and Pacific5744

    Latin America and Carribean5338

    CEE/CIS and Baltic States4034

    Industrialized countries96

    World8481

    u5mr changes by region

    00

    00

    00

    00

    00

    00

    00

    00

    1990

    2000

    Source: The State of the World's Children, 2002, Unicef

    U5MR (deaths per 1,000 live births)

    imr map

    2000

    Afghanistan257

    Albania31

    Algeria65

    Andorra7

    Angola295

    Antigua and Barbuda15

    Argentina21

    Armenia30

    Australia6

    Austria5

    Azerbaijan105

    Bahamas18

    Bahrain16

    Bangladesh82

    Barbados14

    Belarus20

    Belgium6

    Belize41

    Benin154

    Bhutan100

    Bolivia80

    Bosnia and Herzegovina18

    Botswana101

    Brazil38

    Brunei Darussalam7

    Bulgaria16

    Burkina Faso198

    Burundi190

    Cambodia135

    Cameroon154

    Canada6

    Cape Verde40

    Central African Republic180

    Chad198

    Chile12

    China40

    Colombia30

    Comoros82

    Congo108

    Congo, Dem. Rep. Of207

    Cook Islands24

    Costa Rica12

    Cote d'Ivoire173

    Croatia9

    Cuba9

    Cyprus7

    Czech Republic5

    Denmark5

    Djibouti146

    Dominica16

    Dominican Republic48

    East Timor-

    Ecuador32

    Egypt43

    El Salvador40

    Equatorial Guinea156

    Eritrea114

    Estonia21

    Ethiopia174

    Fiji22

    Finland5

    France5

    Gabon90

    Gambia128

    Georgia29

    Germany5

    Ghana102

    Greece6

    Grenada26

    Guatemala59

    Guinea175

    Guinea-Bissau215

    Guyana74

    Haiti125

    Holy See-

    Honduras40

    Hungary9

    Iceland4

    India96

    Indonesia48

    Iran44

    Iraq130

    Ireland6

    Israel6

    Italy6

    Jamaica20

    Japan4

    Jordan34

    Kazakstan75

    Kenya120

    Kiribati70

    Korea, Dem. People's Rep. of30

    Korea, Republic of5

    Kuwait10

    Kyrgyzstan63

    Lao People's Dem. Rep105

    Latvia21

    Lebanon32

    Lesotho133

    Liberia235

    Libya20

    Liechtenstein11

    Lithuania21

    Luxembourg5

    Madagascar139

    Malawi188

    Malaysia9

    Maldives80

    Mali233

    Malta6

    Marshall Islands68

    Mauritania183

    Mauritius20

    Mexico30

    Micronesia, (Fed. States of)24

    Moldova, Republic of33

    Monaco5

    Mongolia78

    Morocco46

    Mozambique200

    Myanmar110

    Namibia69

    Nauru30

    Nepal100

    Netherlands5

    New Zealand6

    Nicaragua45

    Niger270

    Nigeria184

    Niue-

    Norway4

    Occupied Palestinian Territory25

    Oman14

    Pakistan110

    Palau29

    Panama26

    Papua New Guinea112

    Paraguay31

    Peru50

    Philippines40

    Poland10

    Portugal6

    Qatar16

    Romania22

    Russian Federation22

    Rwanda187

    Saint Kitts and Nevis25

    Saint Lucia19

    Saint Vincent and Grenadines25

    Samoa26

    San Marino6

    Sao Tome and Principe75

    Saudi Arabia29

    Senegal139

    Seychelles17

    Sierra Leone316

    Singapore4

    Slovakia9

    Slovenia5

    Solomon Islands25

    Somalia225

    South Africa70

    Spain5

    Sri Lanka19

    Sudan108

    Suriname33

    Swaziland142

    Sweden4

    Switzerland4

    Syria29

    Tajikistan73

    Tanzania165

    TFYR Macedonia26

    Thailand29

    Togo142

    Tonga21

    Trinidad and Tobago20

    Tunisia28

    Turkey45

    Turkmenistan70

    Tuvalu53

    Uganda127

    Ukraine21

    United Arab Emirates9

    United Kingdom6

    United States8

    Uruguay17

    Uzbekistan67

    Vanuatu44

    Venezuela23

    Viet Nam39

    Yemen117

    Yugoslavia20

    Zambia202

    Zimbabwe117

    Sheet1

    1960197019801990200020102015

    Rest of World86837769574742

    sub-Saharan Africa14172331435358

    Sheet1

    Rest of World

    sub-Saharan Africa

    Year

    Percent of under-five deaths worldwide

    Sheet4

    199020021.09

    Diarrhea40.9580.194

    Malaria10.4160.105

    Neo-natal tetanus0.790.1550.073

    ARIWhooping cough0.510.1760.061

    ARIMeasles1.520.4530.051

    ARIOther ARI2.20.9640.048

    Others4.21.6530.031

    HIV0.1691.653

    14.224.944

    19902000

    Diarrhea28.12939521815

    Malaria7.03234880457

    Neo-natal tetanus5.55555555563

    Whooping cough3.58649789033

    Measles10.68917018288

    ARI15.471167369919

    Others29.535864978942

    HIV03

    100

    Sheet4

    Malaria7%

    urban slums

    DHS 1998DOH 1993

    Philippines Total36

    Manila City24

    Manila Slum72

    DHS 1993DOH 1993

    Manila Slums72

    Manila City27.1

    Philippines Rural44.3

    Philippines Total38.4

    NFHS 1998-991997 Report on slums in counterpart study

    India (Total)68

    India (Rural)73

    India (Rural Poorest Quintile)108.9

    India (urban)47

    Ahmedabad City76

    Ahmedabad Slums123

    urban slums

    NFHS 1998-99

    1997 Report on slums in counterpart study

    IMR (death per 1,000 births)

    Ahmedabad Slums (India)

    urban underrepr

    DHS 1993

    DOH 1993

    IMR (deaths per 1000 births)

    Manil Slums (Philippines)

    indan states

    PoorestSecondMiddleFourthRichest

    Urban1893882098011,209

    Rural2,9323,0982,6072,3721,22812,237

    0

    Urban20841864321,1581,880

    Rural2,7652,2851,8331,5626719,116

    BangladeshUrban1871766

    Rural2425211910

    KenyaUrban04102362

    Rural302520177

    1524212119

    6919940

    indan states

    Poorest

    Second

    Middle

    Fourth

    Richest

    Bangladesh

    immunization by income

    Poorest

    Second

    Middle

    Fourth

    Richest

    Bangladeshl

    ari deaths

    U5MR

    Kerala18.8

    Goa46.8

    Maharashtra58.1

    Tamil Nadu63.3

    Karnataka69.8

    Gujarat85.1

    Andhra Pradesh85.5

    Bihar105.1

    Rajasthan114.9

    U.P.122.5

    M.P.137.6

    ari deaths

    U5MR

    U5MR (deaths per 1000 births)

    malnutrition

    21.824.921.033.430.625.5

    PoorestSecondMiddleFourthRichest

    Brazil56.674.084.983.173.8

    Peru55.363.863.571.766.0

    Bolivia21.824.921.033.430.6

    Egypt65.172.881.086.692.5

    Bangladesh47.243.760.858.866.7

    India17.121.734.748.265.0

    Zimbabwe71.877.884.681.485.7

    Uganda34.246.049.347.063.1

    Tanzania57.368.866.979.382.5

    17.121.734.748.265.0