1

Group Presentationon

Child MortalityMillennium development goals : goal #4

2Introducing Us

Alvi EhsanMaimuna Mahmud

Taslima Khanam LimaGaulib Haidar

Sudipto Bala(L)Sunzida Haque

151-2614-630 151-0609-630 132-0225-020 151-0898-630 151-0885-630 151-2131-030

3Millennium Development Goals (MDGs)

• What are MDGs?

MDGs are basically 8 international development goals established by the United Nations (UN).

• When were MDGs established?

MDGs were established in year 2000 following the Millennium Summit of the UN.• How many states committed to achieve the MDGs?

All the UN member states including Bangladesh and at least 23 international organizations.• When are the MDGs aimed to be achieved?

By the year 2015.

4What are the MDGs?

5What does it mean by Child Mortality?

The death of infants and children under the age of five.

Also known as-Under-5 MortalityBaby death

The child mortality rate is the number of children who die by the age of five, per thousand live births per year

The 4th Millennium Development goal is to Reduce Child Mortality by two thirds, between 1990 and 2015

6What causes Child Mortality?

Pneumonia13%Other group 1 Conditions

10%Congential Anomalies and other non-communicable

diseases7%

Injuries5%

HIV/AIDS2%

Malaria7%Measles

2%Diarrhoea

9%

Prematurity2%

Prematurity15%

Other4%

Neonatal Tetanus1%

Congential Anomalies4%

Neonatal Sepsis7%

Intrapartum-related Complica-tions, including birth asphyxia

11%

Pneumonia2%

Post neonatal(1-59 months)

Neonatal0-29 days

7What causes Child Mortality?

Pneumonia13%Other group 1 Conditions

10%Congential Anomalies and other non-communicable

diseases7%

Injuries5%

HIV/AIDS2%

Malaria7%Measles

2%Diarrhoea

9%

Prematurity2%

Prematurity15%

Other4%

Neonatal Tetanus1%

Congential Anomalies4%

Neonatal Sepsis7%

Intrapartum-related Complica-tions, including birth asphyxia

11%

Pneumonia2%

Post neonatal(1-59 months)

Neonatal0-29 days

8Where does Child Mortality take place?

Underdeveloped Countries

Developing

Countries

Developed

Country

9

10What Can we do to prevent Child Mortality?

• Reaching the MDG on reducing child mortality will require universal coverage with key effective, affordable interventions: care for newborns and their mothers; infant and young child feeding; vaccines; prevention and case management of pneumonia, diarrhea and sepsis; malaria control; and prevention and care of HIV/AIDS. Ensure full coverage of immunization programs.• Scale up vitamin A supplementation.• Pursue exclusive breast-feeding for children <6 months. and

breast-feeding with complementary feeding for children 6-24 month.

11What Can we do to prevent Child Mortality?

• Provide adequate nourishment for poor children.• Target the underlying socioeconomic causes of

child mortality (ex: mother’s access to employment)• Prevent and provide effective treatment of

pneumonia, diarrhea, malaria and other infectious diseases.• Promote comprehensive and universal coverage of

primary health-care systems (with the engagement of community health workers) accompanied by sustained delivery of health services and women’s education programs.

12WHO Strategies-

To deliver these interventions, WHO promotes four main strategies:• Appropriate home care and timely treatment of

complications for newborns;• Integrated management of childhood illness for all

children under five years old;• Expanded program on immunization;• Infant and young child feeding.

13Most of all we will need to have

Better & Cheaper National Health Care System

14Where is child mortality found the most?

Children born to poorer households, to mothers with no education and living in rural areas face a higher risk of dying in the first 28 days of life

Neonatal mortality rate by household wealth quintiles, mother’s education and residence, 2005-2013

15

16Which are the most vulnerable countries towards Child Mortality?

• About half of under-five deaths occur in only five countries:

1. India

2. Nigeria

3. Democratic Republic of the Congo

4. Pakistan

5. China.

• India (22 percent) and Nigeria (13 percent) together account for more than a third of all under-five deaths

17Variation of Child Mortality Ratein the 3 Worlds:

DevelopedCountries

Name of Country Mortality Rate

Germany 3.46

United Kingdom 4.44

United States 6.17

DevelopingCountries

Name of Country

Mortality Rate

Bangladesh 45.67

Equatorial Guinea 71.12

Nigeria 74.09

Underdeveloped Countries

Name of Country

Mortality Rate

Niger 86.27

Somalia 100.14

Afghanistan 117.23

Measures taken by United States to reduce Child Mortality

1. PROMOTING ACCESS TO PRENATAL AND INFANT CAREThe Healthy Start program: Provides prenatal health care in

more than 100 communities nationwide. Medicaid & State Children's Health Insurance Program

(SCHIP): Provides prenatal care for eligible mothers and health coverage for millions of infants from low-income families.

Toll-free prenatal care hotline: Assists pregnant women and others seeking information on prenatal care, including referrals to local clinics and physicians.

Childhood immunization initiative: Has increased immunization rates among children, with 90 percent or more of America's toddlers receiving the most critical doses of vaccines by the age 2.

18

19Measures taken by United States to reduce Child Mortality

2. PROMOTING HEALTHY CHOICES TO REDUCE MORTALITY RISKS Reducing mother-to-child HIV transmission Maternal and Child Health (MCH) Services: In an average year, about 60

percent of U.S. women who give birth receive services through MCH programs.

Reducing teen pregnancy: Infants born to teenage mothers have a higher mortality rate. HHS directly funds teen pregnancy prevention programs in more than 2,200 communities - about 47 percent of all communities nationwide.

3. PROMOTING RESEARCH TO REDUCE INFANT MORTALITYHHS supports a wide range of medical research to prevent and treat birth defects, premature birth, SIDS and other life-threatening conditions.

20Bangladesh fighting Child Mortality

21What measures has Bangladesh taken to reduce Child Mortality?

• Successful programs for immunization• Control of diarrheal diseases• Vitamin A supplementation • Creation of awareness• Establishment of free health care center in different districts, towns, villages for mothers and children

22What was achieved from MDG-4?

Under-5 deaths have continued to decline from 11.6 million in 1990 to 7.2 million deaths in 2011. • In 2011, • 2.2 million were early neonatal (0 to 6 days)• 0.7 million were late neonatal (7 to 28 days) • 2.1 million were post-neonatal (29 to 364 days) • 2.2 million were during post-neonatal childhood (1 to 4

years)

Comparing rates of decline from 1990 to 2000 with 2000 to 2011 shows that 106 countries have accelerated declines in child mortality over the past decade.

2.2 million childhood deaths106Countries

23What was achieved from MDG-4?

Currently, the world is reducing under-five mortality than at any other time during the past two decades.

Encouragingly, neonatal mortality is on the worldwide. Between 1990 and 2012, the world neonatal mortality rate fell by almost one third, from 33 to 21 deaths for every thousand live births

decline

The global annual rate of reduction in under five mortality has accelerated steadily from 1.2 per cent between 1990 and 1995 to 3.9 per cent between 2005 and 2012.

faster

24What was achieved from MDG-4?

Neonatal Infant Under-50

10

20

30

40

50

60

70

80

90

20

34

4633

63

90

Global Child mortality rates (1990-2013)Deaths per 1,000 live births

2013 1990

40% 46% 49%Declined By Declined By Declined By

25What was achieved from MDG-4?

Th

e n

um

ber

of

un

der-

five

death

s is

fa

llin

g s

tead

ily

Global under-five and neonatal deaths, 1990-2013 (in millions)

26We achieved, but?

Progress on reducing maternal and child mortality is accelerating in most countries, most developing countries will take many years past 2015 to achieve the targets of MDGs 4,despite overall progress

Four countries show increases in under-5 mortality 

While many proven intervention strategies are available for children, bottlenecks in health systems may prevent these strategies from being implemented.

27Where is Bangladesh about MDG-4?

Bangladesh has already met the target of reducing under-five mortality rate: against the target of achieving 48 per 1,000 live births in 2015, she has already achieved 44 per 1,000 live births in 2011 & 41 per 1,000 live births in 2012

0

20

40

60

80

100

120

140

1601990144

Target within2015

482011 44

201241

1990 Target within 2015 2011 2012

28Concluding for a new start!

The overall discussion depicts the picture that almost:

• Two third of the child deaths are preventable with low-tech, evidence based ,cost effective measure . Some of these can be related to medical side and some of these can be socio economic perspective, like-empowering women, removing financial and social barriers, educating women, improving family care etc…

However, there are lots of difference between what should be done and what is actually happening:

• Mortality rates are falling but not fast enough to meet the aim of reducing the rate by two-thirds by 2015, the MDG deadline.

• Low-tech, evidence-based, cost-effective measures can be taken.

• Medical related measures: • Vaccines, antibiotics, micronutrient supplementation, insecticide-treated bed nets, breastfeeding

practices, and oral rehydration therapy

• Socio-economic Measures:• Empowering women, removing financial and social barriers, educating women, improving family care

29