Child Survival A global overview ACSD WCAR April 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 Mortality Rate } MDG4 Goals Source: The State of the Worlds 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 Worlds 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

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

Why is exclusive breastfeeding recommended for the first 6 months 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 diseases MDG 6: Combat HIV and AIDS, malaria and other diseases

Insecticide Treated Nets Only 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 )

Hand washing with soap ….at 4 critical times

Diarrhoea Risk Reduction Previous reviews: a – dEsrey SA et al. (1991) Bull WHO 69 (5): eCurtis V, Cairncross S (2003) Lancet Inf Dis 3: Fewtrell L et al. (2005) Lancet Infect Dis 5(1):

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 ARIs 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