State of Child Survival in East Africa


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Save the Children Situational analysis of under five mortality across the East African Community, presented at the launch of the East Africa Paediatric Association, Kampala

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State of Child Survival in East Africa

  1. 1. State of Child Survival in East Africa Zaeem Ul Haq, MBBS, MPH
  2. 2. East Africa - demographics total population - over 133 million almost half are under 15; 64 million children under 5; over 21 million U5MR – 105 (2010); was 154 in 2000 LE at birth – 52 (2010); was 49 in 2000 Literacy rate – 60% (2006)Source: EAC Facts & Figures, Oct 2011.
  3. 3. Child survival• Despite a steady global decline in child mortality over the past two decades, many countries remain far from achieving MDG 4*• Pneumonia, diarrhoea and malaria account for 36% of all under five deaths**, yet these conditions can be easily prevented and treated with existing interventions.Source: * Countdown Report 2012 ** Liu et al, May 2012
  4. 4. Causes of under five mortality - globalSource: Liu et all, 2012
  5. 5. Cause-specific u5 mortality
  6. 6. Challenges on child survival• Less than half of children in East Africa have access to first line treatment for pneumonia and ORS for diarrhoea• Coverage is highly inequitable, determined largely by household wealth. Wealthier households are up to 40 percentage points more likely to seek care for childhood pneumonia than poor households.Source: Countdown Report 2012
  7. 7. Access to treatment (%)
  8. 8. Access to prevention (%)
  9. 9. Equity in coverage• Tanzania – Care seeking for pneumonia – 40 % point – Immunization coverage – 10 % point• Kenya – Immunization coverage – 20 % point• Uganda – Smaller gap but equally low coverage for all wealth quintilesSource: Countdown Report 2012
  10. 10. Policies on child survival
  11. 11. SSA – regional comparison U5MR
  12. 12. Progress towards MDG 4insufficient progress; indicates that the under-five mortality rate for 2010 is 40deaths per 1,000 live births or more with an average annual rate of reduction of1%–3.9% for 1990–2010;no progress; indicates that the under-five mortality rate for 2010 is 40 deathsper 1,000 live births or more with an average annual rate of reduction of less than1% for 1990–2010
  13. 13. U5MR trends
  14. 14. Way forward…• Prompt treatment of diarrhoea with ORS and Zinc can reduce diarrhoeal deaths by over 70%• Community delivery of oral antibiotics can reduce under- five mortality from pneumonia by 35%*• In Kenya and Tanzania alone, this could prevent an additional 20,000 child deaths per year**Source: * Theodoratou et al. (2010) ‘The effect of case management.’, IJE. 39:i155-i171** based on LiST projection by Save the Children UK and JHSPH, USA
  15. 15. Child deaths averted
  16. 16. Way forward… Strategies to promote child survival are well-known, evidence-based and have huge potential impact. These must be adopted into national policy with full resourcing and implementation;• integrated management of childhood illnesses (IMCI) can improve health-worker performance, quality of care and promote rational drug use, and is considered an essential strategy for achieving MDG 4*• integrated community case management (ICCM) of pneumonia, diarrhoea and malaria, essentially a simplified adaptation of IMCI which empowers community health workers to prevent and manage childhood illnesses at the community level**Source: * Mason E et al. WHO position statement on IMCI. Lancet 2009; 374: 782–3** Jones et al. (2003) ‘How many child deaths can we prevent this year?’, the Lancet, vol. 362:65-71
  17. 17. Way forward… We have a clearer idea today why and where children are dyingWe also know where they are dying within the countries Combined with effective interventions such as vaccines and breastfeeding, we have the potential to reach the East African children in the most cost-effective manner and avert thousands of child deaths
  18. 18. Comments, Questions ?mail; Save the Children 1 St Johns Lane Farringdon London EC1M 4AR UKemail;