Child mortality rates have declined globally over the past few decades due to improvements in child health programs and social conditions. However, progress has been uneven, and mortality has stalled or increased in some countries and regions. Two main types of child health programs have contributed to declines: short-term disease-specific initiatives and more general primary health care programs. Both program approaches need to evolve to complete the goal of improving child health worldwide, with a greater emphasis on household behaviors and interventions across the life cycle.
The document summarizes MDG 5 on improving maternal health, including progress made, ongoing challenges, and the significance of maternal health for overall development. Globally, the maternal mortality ratio has declined by 47% since 1990 but remains short of the 75% target reduction. While the percentage of births attended by skilled health personnel has increased in developing nations, maternal and newborn deaths are overwhelmingly concentrated in those areas. Barriers to further progress include economic injustices facing women, gender inequality, lack of education, and institutional factors like conflict. Maternal health is foundational for development goals in areas like poverty, hunger, education, empowerment, and disease prevention. Effective interventions require community-based and collaborative approaches that empower local ownership.
This document discusses how economic shifts and natural disasters affect vulnerable populations in low and middle-income countries. While the proportion of people living in extreme poverty has declined globally, nearly 1 billion people still live in poverty. Extreme poverty is concentrated in sub-Saharan Africa and Southern Asia and is worsened by slow employment growth, volatile commodity prices, and natural disasters. Research studies in India, Indonesia, the Philippines, and Bangladesh found that economic downturns and natural disasters increase food insecurity, malnutrition, and lower educational attainment, especially for vulnerable groups. However, certain health, nutrition, and cash transfer programs were shown to help mitigate the effects of poverty and protect vulnerable populations.
PBH101 Group Presentation on MGD-4 Reduce Child MortalityGaulib Haidar
This group presentation discusses child mortality as it relates to Millennium Development Goal 4. It introduces the group members and provides background on the MDGs, defining them as goals established by the UN to be achieved by 2015. It defines child mortality as deaths under age 5 and discusses the main causes. The presentation outlines strategies to prevent child mortality, such as immunization programs and improving access to healthcare. It notes that progress has been made in reducing child mortality but that more work remains to be done to meet MDG targets by 2015.
S13c6 chapter 6- facts and figures on healthShivu P
Health does not mean the 'hospital and the doctors', health is the reflection of nutrition/food, water, environment, air, pollution, society, infrastructure and the leaders intelligence. In this chapter some of the facts and figures related to family and health, various causes for death in various age groups in different locations, food insecurity - hunger - under nutrition, why orphanages are increasing, environment - water supply - sanitation -its impact on health care, doctor - population ratio, money spent on health, measures taken by the government still not able to achieve the satisfactory results, why millennium development goals are not achieved and how these can be handled well with model village and model nation are mentioned.
This report from the UN Inter-agency Group for Child Mortality Estimation provides estimates of under-five, infant and neonatal mortality rates globally and by country/region. It finds that while progress has been made towards reducing child mortality, current rates of reduction remain insufficient to achieve Millennium Development Goal 4 by 2015. Under-five mortality is still highest in Sub-Saharan Africa and Southern Asia. Neonatal deaths now account for over 40% of under-five mortality globally. The report analyzes trends and presents the latest estimates to monitor progress towards improving child survival worldwide.
Universal access to reproductive health is key to achieving the Millennium Development Goals by 2015. Reproductive health is critical for reducing maternal mortality, preventing unwanted pregnancies, curbing STIs including HIV/AIDS, and empowering women. However, progress on MDG 5, which aims to improve maternal health, has been slow. Urgent action is needed to scale up efforts to provide a full package of reproductive health services to all women, in order to meet the 2015 targets and promote sustainable development for all.
Malnutrition is the leading killer of infants and young children in developing countries. In Peru, child malnutrition in coastal and jungle regions is caused by immediate factors like inadequate food consumption and infectious diseases, as well as underlying factors including poor economic conditions, limited healthcare access, and low education levels. Government data shows a reduction in chronic malnutrition nationwide between 2009-2011, though rates remain higher in the jungle and highlands compared to the coast. Reducing malnutrition requires a coordinated effort across government sectors and communities through strategies like breastfeeding promotion, nutrition education, and agricultural support projects tailored to local realities.
Comparative Studies of Knowledge and Perception of Parents on Home Management...inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
The document summarizes MDG 5 on improving maternal health, including progress made, ongoing challenges, and the significance of maternal health for overall development. Globally, the maternal mortality ratio has declined by 47% since 1990 but remains short of the 75% target reduction. While the percentage of births attended by skilled health personnel has increased in developing nations, maternal and newborn deaths are overwhelmingly concentrated in those areas. Barriers to further progress include economic injustices facing women, gender inequality, lack of education, and institutional factors like conflict. Maternal health is foundational for development goals in areas like poverty, hunger, education, empowerment, and disease prevention. Effective interventions require community-based and collaborative approaches that empower local ownership.
This document discusses how economic shifts and natural disasters affect vulnerable populations in low and middle-income countries. While the proportion of people living in extreme poverty has declined globally, nearly 1 billion people still live in poverty. Extreme poverty is concentrated in sub-Saharan Africa and Southern Asia and is worsened by slow employment growth, volatile commodity prices, and natural disasters. Research studies in India, Indonesia, the Philippines, and Bangladesh found that economic downturns and natural disasters increase food insecurity, malnutrition, and lower educational attainment, especially for vulnerable groups. However, certain health, nutrition, and cash transfer programs were shown to help mitigate the effects of poverty and protect vulnerable populations.
PBH101 Group Presentation on MGD-4 Reduce Child MortalityGaulib Haidar
This group presentation discusses child mortality as it relates to Millennium Development Goal 4. It introduces the group members and provides background on the MDGs, defining them as goals established by the UN to be achieved by 2015. It defines child mortality as deaths under age 5 and discusses the main causes. The presentation outlines strategies to prevent child mortality, such as immunization programs and improving access to healthcare. It notes that progress has been made in reducing child mortality but that more work remains to be done to meet MDG targets by 2015.
S13c6 chapter 6- facts and figures on healthShivu P
Health does not mean the 'hospital and the doctors', health is the reflection of nutrition/food, water, environment, air, pollution, society, infrastructure and the leaders intelligence. In this chapter some of the facts and figures related to family and health, various causes for death in various age groups in different locations, food insecurity - hunger - under nutrition, why orphanages are increasing, environment - water supply - sanitation -its impact on health care, doctor - population ratio, money spent on health, measures taken by the government still not able to achieve the satisfactory results, why millennium development goals are not achieved and how these can be handled well with model village and model nation are mentioned.
This report from the UN Inter-agency Group for Child Mortality Estimation provides estimates of under-five, infant and neonatal mortality rates globally and by country/region. It finds that while progress has been made towards reducing child mortality, current rates of reduction remain insufficient to achieve Millennium Development Goal 4 by 2015. Under-five mortality is still highest in Sub-Saharan Africa and Southern Asia. Neonatal deaths now account for over 40% of under-five mortality globally. The report analyzes trends and presents the latest estimates to monitor progress towards improving child survival worldwide.
Universal access to reproductive health is key to achieving the Millennium Development Goals by 2015. Reproductive health is critical for reducing maternal mortality, preventing unwanted pregnancies, curbing STIs including HIV/AIDS, and empowering women. However, progress on MDG 5, which aims to improve maternal health, has been slow. Urgent action is needed to scale up efforts to provide a full package of reproductive health services to all women, in order to meet the 2015 targets and promote sustainable development for all.
Malnutrition is the leading killer of infants and young children in developing countries. In Peru, child malnutrition in coastal and jungle regions is caused by immediate factors like inadequate food consumption and infectious diseases, as well as underlying factors including poor economic conditions, limited healthcare access, and low education levels. Government data shows a reduction in chronic malnutrition nationwide between 2009-2011, though rates remain higher in the jungle and highlands compared to the coast. Reducing malnutrition requires a coordinated effort across government sectors and communities through strategies like breastfeeding promotion, nutrition education, and agricultural support projects tailored to local realities.
Comparative Studies of Knowledge and Perception of Parents on Home Management...inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
The document discusses accountability for women's, children's and adolescents' health in the era of the Sustainable Development Goals (SDGs). It notes that while the Millennium Development Goals (MDGs) significantly reduced maternal and child mortality, rates remain unacceptably high. The SDGs launched in 2015 aim to ensure healthy lives for all at all ages. A new Global Strategy aligned with the SDGs provides a roadmap to end preventable deaths of women, children and adolescents by 2030. The Independent Accountability Panel will prepare annual reports on progress using data from UN agencies and others to ensure accountability. Better data and national leadership are crucial to true accountability.
The document discusses the progress and shortcomings of the UN's Millennium Development Goals (MDGs) and analyzes how the new Sustainable Development Goals (SDGs) aim to address nutrition, food security, and empowerment of women and children. Some key successes of the MDGs include reducing extreme poverty and hunger. However, critics argue that the MDGs lacked attention to issues like obesity, gender disparities, and measuring absolute vs. relative progress. The SDGs propose to take a more holistic approach and address root causes of issues like inequality and human rights. Overall, the document analyzes how the UN aims to empower women and children through pursuing nutrition and food security goals.
1) Rural women play a key role in ensuring child nutrition as primary caregivers, but face numerous challenges including lack of access to resources, education, and social support.
2) Proper nutrition is critical for children in the first 1000 days of life to support growth and development. Empowering women through education and access to healthcare, nutrition information, and social services can help improve child nutrition outcomes.
3) Cultural beliefs and food taboos also impact child feeding practices in some communities, preventing children from receiving essential nutrients. Overcoming social and economic barriers that limit rural women's ability to care for children is important for combating malnutrition.
Haiti has the highest rates of child, neonatal, and maternal mortality in the Western Hemisphere. In 2013, Haiti's neonatal mortality rate was 25 per 1000 live births, infant mortality rate was 55 per 1000 live births, and child mortality rate for those under 5 was 73 per 1000. The maternal mortality ratio in Haiti was 380 per 100,000 live births in 2013. The authors identify poverty, preterm birth, low birth weight, lack of access to care for pneumonia and antibiotics, and complications during childbirth as key contributing factors to these high mortality rates in Haiti. They propose establishing a network of community care and a central referral hospital to improve access to evidence-based interventions and reduce mortality rates.
diarrhoea: why children are still dying & what can be doneChynthya Riiweuh
Diarrhoea remains the second leading cause of child deaths globally, accounting for around 1.5 million under-five deaths per year. The majority of diarrhoea cases and deaths occur in Africa and South Asia. Young children face the highest risk, with the highest incidence in the first two years of life. While diarrhoea mortality has declined significantly in recent decades, strengthened efforts are still needed to control diarrhoea and further reduce child deaths.
This document provides an overview of malnutrition, including different types like acute and chronic malnutrition as well as undernutrition and overnutrition. It discusses how malnutrition can negatively impact individuals and development. The document outlines who is most vulnerable to malnutrition, such as young children, pregnant/breastfeeding women, and those with illnesses. It also summarizes key messages about defining and addressing different forms of malnutrition.
1) The World Health Organization (WHO) report "Health for the world's adolescents" addresses improving health outcomes for the world's one billion adolescents. It highlights both successes, such as declining adolescent pregnancy and maternal mortality rates in some regions, as well as ongoing challenges like HIV mortality among adolescents rising in Africa.
2) Adolescence is a crucial life stage for establishing health behaviors and patterns that affect future adult health. Many major causes of illness and death among adolescents, like road injuries, violence, and mental health issues, have preventable underlying factors.
3) Achieving overall health and development requires a holistic, multisector approach that addresses individual, social, and environmental determinants of adolescent health
This document summarizes evidence on the impacts of family planning on nutrition and food security. It finds that family planning can positively impact nutrition outcomes like birth weight, stunting, and undernutrition. Short birth spacing and adolescent pregnancy in particular are linked to increased risks of malnutrition. Family planning also indirectly benefits nutrition by reducing maternal mortality and empowering women. Smaller family sizes can help ensure food availability and access by supporting sustainable agricultural production and increasing women's labor participation. The document recommends integrating family planning into nutrition and food security programs and policies to help leverage its benefits.
Presentation on the new 2013 child mortality estimates psalama91013unicef_ethiopia
This technical report analyzes global progress in reducing child mortality. It finds that the global under-five mortality rate declined nearly in half between 1990 and 2012, saving 90 million lives. However, 6.6 million children still die each year before age five. Over half of under-five deaths occur in sub-Saharan Africa and South Asia. The leading causes of under-five death are neonatal conditions, pneumonia, diarrhea, and malaria. While progress has been made, accelerated efforts are needed to achieve the MDG target and ensure all children survive to their fifth birthday.
Ghia foundation strategy document v4.dec.17.2015 (ab)Ghia Foundation
GHIA FOUNDATION WAS FOUNDED IN 2013 by a team of kind-heated Professionals.
VISION: A World where women in developing Countries live healthier , longer lives
MISSION – To reduce morbidity and mortality among women in developing Countries by strengthening Health Systems to deliver high quality, comprehensive health services.
The infant mortality rate (IMR) is the number of infant deaths per 1000 live births. IMR is an important indicator of a country's development level and standard of living. Globally, IMR has significantly declined since 1960 due to improved healthcare, though it remains much higher in less developed countries. Common causes of infant mortality include low birth weight, respiratory issues, SIDS, and lack of essentials like food, shelter and water. Reducing behaviors like smoking during pregnancy and improving literacy, prenatal care, and access to health services can help lower IMR.
This document discusses the links between farming systems and human nutrition. It presents information on obesity and undernutrition patterns around the world. It examines the known and unknown relationships between food security, agriculture, nutrition outcomes, and human development. The document proposes solutions to better integrate public health and food systems, such as bundling interventions and building community capacity. It also emphasizes the need for additional research to understand the impacts of agriculture on equitable and affordable nutrition, and to identify ways to maximize nutrition benefits while minimizing costs. The document argues that policy needs to focus on better, equitable access to a diversity of nutritious foods.
Substantial progress has been made towards achieving MDG Goal on Reducing Child Mortality but still insufficient – The new UN-World Bank child mortality estimates
New child mortality estimates (childmortality.org) show that substantial progress has been made towards achieving the fourth Millennium Development Goal. The estimates were released today by the UN Inter-agency Group for Child Mortality Estimation, which includes UNICEF, WHO, the World Bank and United Nations Population Division.
Influence of Mothers’ Participation in Intra-Household Decision Making on Nut...Hudu Zakaria
The purpose of this paper is to investigate effects of mothers’ participation in intra-household decision making on the nutritional status of their children. The paper relied solely on analysis of data for Northern Region of Ghana, collected as part of United States Agency for International Development (USAID) Feed the Future population baseline survey conducted in 2012. Multiple Linear Regression Model was used in examining mothers’ participation in intra-household decision making on children’s weight-for-age, height-for-age and weight-for-height which were used as proxies for children’s nutritional status. Results of the analysis revealed that, the Region is still far from achieving the MDG 1 target of attaining 1.8% malnutrition prevalence rate, as stunting, underweight and wasting prevalence rates among children in the region were found to be 27%, 25% and 13% respectively. The analysis also found mothers’ participation in intra-household decision making, ownership and control of household resources as significant in influencing positively children’s nutritional status. Increasing participation and power of women in intra-household decision making process are imperative in improving children nutritional status and reducing malnutrition prevalence among children under five years. It is therefore recommended that programmes and projects aimed at promoting sustainable nutritional wellbeing among children should consider empowering mothers of children so as to promote their status and barging power in intra-household decision making process.
The State of the World's Children 2009 examines critical issues in maternal and newborn health, underscoring the need to establish a comprehensive continuum of care for mothers, newborns and children. The report outlines the latest paradigms in health programming and policies for mothers and newborns, and explores policies, programmes and partnerships aimed at improving maternal and neonatal health. Africa and Asia are a key focus for this report, which complements the previous year's issue on child survival.
Child Mortality among Teenage Mothers in OJU Metropolisiosrjce
This study was designed to identify child mortality among teenage mothers in Oju metropolisin
Benue State, Nigeria, specifically, the study determined (i) the cause of child mortality among teenage mothers,
and (ii) rate of child mortality among teenage mothersand (iii) possible ways of reducing child mortality rate,
and it answered three research questions to guide the study. The population of the study comprised of all
medical personnel in Oju metropolis. The sample was purposively selected from medical personnel in the area
of study (Oju metropolis). The instrument of the study was a four-point scale questioner which was dully
validated prior to utilization. Mean was used for data analysis, the findings include seven causes of child
mortality, seven rates of child mortality and eleven possible ways of reducing child mortality rate, based on the
findings, six recommendations were made, which include among others, parent should be made to be aware of
the crisis associatedwith early motherhood through public enlighten programmessuch as counseling agents,
workshops, seminars and radio jingles.
Running head global health case study analysis1 global healtDIPESH30
This research proposal examines how conformity and obedience are impacted by group size and anonymity. It hypothesizes that conformity will increase as group size increases, but decrease when anonymity is removed. The study would randomly assign participants to small or large groups to rate line lengths under anonymous or identifiable conditions. Results could help understand how social influence is impacted by these factors.
Running head: THE EFFECTS OF GROUP SIZE AND ANONYMITY ON CONFORMITY
The Effects of Group Size and Anonymity on Conformity
Introduction
Conformity and obedience to authority are well
Violent conflict in South Sudan has resulted in widespread displacement, destruction of crops and farmland, and separation of children from their families. This has led to high levels of malnutrition among children, especially in areas affected by hostilities. While responding to malnutrition in conflict areas is challenging due to limited resources, disrupted infrastructure, and access issues, World Vision has worked to adapt its nutrition programming. This includes coordinating closely with other humanitarian organizations through the UN Nutrition Cluster to identify and address gaps, while continuing to provide community-based treatment for malnourished children using therapeutic foods. The coordination and multi-sectoral approach helps maximize the effectiveness of the response despite ongoing difficulties in South Sudan.
This research identifies the important determinants of child mortality from 2012-2013 G.C in Arba Minch hospital. Logistic regression method was used to determine the impact of child mortality. The results show that among bio-demographic factors, gender of child, mother age and breast feeding are the important determinants for child mortality. However, breast feeding has a significant impact on child mortality. Among Socioeconomic determinants education, household size are the most important determinants for child mortality. Therefore policies should be revised and implement and health intervention program that focus on mothers and children health should be strong to achieve the Millennium Development Goals of child mortality in the remaining years.
What is the best way to lose weight? The top 10 answer may surprise you. Scientist seeking what is the best way to lose weight now say that the answer is simple: diet and exercise.
This document expresses a love for fast cars and their colors, as well as flowers for their pretty smells. It also mentions enjoying word games on video game consoles like the Xbox 360 and PlayStation 2, and a fondness for tigers due to their orange and black coloring.
The document discusses accountability for women's, children's and adolescents' health in the era of the Sustainable Development Goals (SDGs). It notes that while the Millennium Development Goals (MDGs) significantly reduced maternal and child mortality, rates remain unacceptably high. The SDGs launched in 2015 aim to ensure healthy lives for all at all ages. A new Global Strategy aligned with the SDGs provides a roadmap to end preventable deaths of women, children and adolescents by 2030. The Independent Accountability Panel will prepare annual reports on progress using data from UN agencies and others to ensure accountability. Better data and national leadership are crucial to true accountability.
The document discusses the progress and shortcomings of the UN's Millennium Development Goals (MDGs) and analyzes how the new Sustainable Development Goals (SDGs) aim to address nutrition, food security, and empowerment of women and children. Some key successes of the MDGs include reducing extreme poverty and hunger. However, critics argue that the MDGs lacked attention to issues like obesity, gender disparities, and measuring absolute vs. relative progress. The SDGs propose to take a more holistic approach and address root causes of issues like inequality and human rights. Overall, the document analyzes how the UN aims to empower women and children through pursuing nutrition and food security goals.
1) Rural women play a key role in ensuring child nutrition as primary caregivers, but face numerous challenges including lack of access to resources, education, and social support.
2) Proper nutrition is critical for children in the first 1000 days of life to support growth and development. Empowering women through education and access to healthcare, nutrition information, and social services can help improve child nutrition outcomes.
3) Cultural beliefs and food taboos also impact child feeding practices in some communities, preventing children from receiving essential nutrients. Overcoming social and economic barriers that limit rural women's ability to care for children is important for combating malnutrition.
Haiti has the highest rates of child, neonatal, and maternal mortality in the Western Hemisphere. In 2013, Haiti's neonatal mortality rate was 25 per 1000 live births, infant mortality rate was 55 per 1000 live births, and child mortality rate for those under 5 was 73 per 1000. The maternal mortality ratio in Haiti was 380 per 100,000 live births in 2013. The authors identify poverty, preterm birth, low birth weight, lack of access to care for pneumonia and antibiotics, and complications during childbirth as key contributing factors to these high mortality rates in Haiti. They propose establishing a network of community care and a central referral hospital to improve access to evidence-based interventions and reduce mortality rates.
diarrhoea: why children are still dying & what can be doneChynthya Riiweuh
Diarrhoea remains the second leading cause of child deaths globally, accounting for around 1.5 million under-five deaths per year. The majority of diarrhoea cases and deaths occur in Africa and South Asia. Young children face the highest risk, with the highest incidence in the first two years of life. While diarrhoea mortality has declined significantly in recent decades, strengthened efforts are still needed to control diarrhoea and further reduce child deaths.
This document provides an overview of malnutrition, including different types like acute and chronic malnutrition as well as undernutrition and overnutrition. It discusses how malnutrition can negatively impact individuals and development. The document outlines who is most vulnerable to malnutrition, such as young children, pregnant/breastfeeding women, and those with illnesses. It also summarizes key messages about defining and addressing different forms of malnutrition.
1) The World Health Organization (WHO) report "Health for the world's adolescents" addresses improving health outcomes for the world's one billion adolescents. It highlights both successes, such as declining adolescent pregnancy and maternal mortality rates in some regions, as well as ongoing challenges like HIV mortality among adolescents rising in Africa.
2) Adolescence is a crucial life stage for establishing health behaviors and patterns that affect future adult health. Many major causes of illness and death among adolescents, like road injuries, violence, and mental health issues, have preventable underlying factors.
3) Achieving overall health and development requires a holistic, multisector approach that addresses individual, social, and environmental determinants of adolescent health
This document summarizes evidence on the impacts of family planning on nutrition and food security. It finds that family planning can positively impact nutrition outcomes like birth weight, stunting, and undernutrition. Short birth spacing and adolescent pregnancy in particular are linked to increased risks of malnutrition. Family planning also indirectly benefits nutrition by reducing maternal mortality and empowering women. Smaller family sizes can help ensure food availability and access by supporting sustainable agricultural production and increasing women's labor participation. The document recommends integrating family planning into nutrition and food security programs and policies to help leverage its benefits.
Presentation on the new 2013 child mortality estimates psalama91013unicef_ethiopia
This technical report analyzes global progress in reducing child mortality. It finds that the global under-five mortality rate declined nearly in half between 1990 and 2012, saving 90 million lives. However, 6.6 million children still die each year before age five. Over half of under-five deaths occur in sub-Saharan Africa and South Asia. The leading causes of under-five death are neonatal conditions, pneumonia, diarrhea, and malaria. While progress has been made, accelerated efforts are needed to achieve the MDG target and ensure all children survive to their fifth birthday.
Ghia foundation strategy document v4.dec.17.2015 (ab)Ghia Foundation
GHIA FOUNDATION WAS FOUNDED IN 2013 by a team of kind-heated Professionals.
VISION: A World where women in developing Countries live healthier , longer lives
MISSION – To reduce morbidity and mortality among women in developing Countries by strengthening Health Systems to deliver high quality, comprehensive health services.
The infant mortality rate (IMR) is the number of infant deaths per 1000 live births. IMR is an important indicator of a country's development level and standard of living. Globally, IMR has significantly declined since 1960 due to improved healthcare, though it remains much higher in less developed countries. Common causes of infant mortality include low birth weight, respiratory issues, SIDS, and lack of essentials like food, shelter and water. Reducing behaviors like smoking during pregnancy and improving literacy, prenatal care, and access to health services can help lower IMR.
This document discusses the links between farming systems and human nutrition. It presents information on obesity and undernutrition patterns around the world. It examines the known and unknown relationships between food security, agriculture, nutrition outcomes, and human development. The document proposes solutions to better integrate public health and food systems, such as bundling interventions and building community capacity. It also emphasizes the need for additional research to understand the impacts of agriculture on equitable and affordable nutrition, and to identify ways to maximize nutrition benefits while minimizing costs. The document argues that policy needs to focus on better, equitable access to a diversity of nutritious foods.
Substantial progress has been made towards achieving MDG Goal on Reducing Child Mortality but still insufficient – The new UN-World Bank child mortality estimates
New child mortality estimates (childmortality.org) show that substantial progress has been made towards achieving the fourth Millennium Development Goal. The estimates were released today by the UN Inter-agency Group for Child Mortality Estimation, which includes UNICEF, WHO, the World Bank and United Nations Population Division.
Influence of Mothers’ Participation in Intra-Household Decision Making on Nut...Hudu Zakaria
The purpose of this paper is to investigate effects of mothers’ participation in intra-household decision making on the nutritional status of their children. The paper relied solely on analysis of data for Northern Region of Ghana, collected as part of United States Agency for International Development (USAID) Feed the Future population baseline survey conducted in 2012. Multiple Linear Regression Model was used in examining mothers’ participation in intra-household decision making on children’s weight-for-age, height-for-age and weight-for-height which were used as proxies for children’s nutritional status. Results of the analysis revealed that, the Region is still far from achieving the MDG 1 target of attaining 1.8% malnutrition prevalence rate, as stunting, underweight and wasting prevalence rates among children in the region were found to be 27%, 25% and 13% respectively. The analysis also found mothers’ participation in intra-household decision making, ownership and control of household resources as significant in influencing positively children’s nutritional status. Increasing participation and power of women in intra-household decision making process are imperative in improving children nutritional status and reducing malnutrition prevalence among children under five years. It is therefore recommended that programmes and projects aimed at promoting sustainable nutritional wellbeing among children should consider empowering mothers of children so as to promote their status and barging power in intra-household decision making process.
The State of the World's Children 2009 examines critical issues in maternal and newborn health, underscoring the need to establish a comprehensive continuum of care for mothers, newborns and children. The report outlines the latest paradigms in health programming and policies for mothers and newborns, and explores policies, programmes and partnerships aimed at improving maternal and neonatal health. Africa and Asia are a key focus for this report, which complements the previous year's issue on child survival.
Child Mortality among Teenage Mothers in OJU Metropolisiosrjce
This study was designed to identify child mortality among teenage mothers in Oju metropolisin
Benue State, Nigeria, specifically, the study determined (i) the cause of child mortality among teenage mothers,
and (ii) rate of child mortality among teenage mothersand (iii) possible ways of reducing child mortality rate,
and it answered three research questions to guide the study. The population of the study comprised of all
medical personnel in Oju metropolis. The sample was purposively selected from medical personnel in the area
of study (Oju metropolis). The instrument of the study was a four-point scale questioner which was dully
validated prior to utilization. Mean was used for data analysis, the findings include seven causes of child
mortality, seven rates of child mortality and eleven possible ways of reducing child mortality rate, based on the
findings, six recommendations were made, which include among others, parent should be made to be aware of
the crisis associatedwith early motherhood through public enlighten programmessuch as counseling agents,
workshops, seminars and radio jingles.
Running head global health case study analysis1 global healtDIPESH30
This research proposal examines how conformity and obedience are impacted by group size and anonymity. It hypothesizes that conformity will increase as group size increases, but decrease when anonymity is removed. The study would randomly assign participants to small or large groups to rate line lengths under anonymous or identifiable conditions. Results could help understand how social influence is impacted by these factors.
Running head: THE EFFECTS OF GROUP SIZE AND ANONYMITY ON CONFORMITY
The Effects of Group Size and Anonymity on Conformity
Introduction
Conformity and obedience to authority are well
Violent conflict in South Sudan has resulted in widespread displacement, destruction of crops and farmland, and separation of children from their families. This has led to high levels of malnutrition among children, especially in areas affected by hostilities. While responding to malnutrition in conflict areas is challenging due to limited resources, disrupted infrastructure, and access issues, World Vision has worked to adapt its nutrition programming. This includes coordinating closely with other humanitarian organizations through the UN Nutrition Cluster to identify and address gaps, while continuing to provide community-based treatment for malnourished children using therapeutic foods. The coordination and multi-sectoral approach helps maximize the effectiveness of the response despite ongoing difficulties in South Sudan.
This research identifies the important determinants of child mortality from 2012-2013 G.C in Arba Minch hospital. Logistic regression method was used to determine the impact of child mortality. The results show that among bio-demographic factors, gender of child, mother age and breast feeding are the important determinants for child mortality. However, breast feeding has a significant impact on child mortality. Among Socioeconomic determinants education, household size are the most important determinants for child mortality. Therefore policies should be revised and implement and health intervention program that focus on mothers and children health should be strong to achieve the Millennium Development Goals of child mortality in the remaining years.
What is the best way to lose weight? The top 10 answer may surprise you. Scientist seeking what is the best way to lose weight now say that the answer is simple: diet and exercise.
This document expresses a love for fast cars and their colors, as well as flowers for their pretty smells. It also mentions enjoying word games on video game consoles like the Xbox 360 and PlayStation 2, and a fondness for tigers due to their orange and black coloring.
Este documento presenta un informe técnico-económico para determinar los costes de las instalaciones deportivas municipales con el fin de establecer precios públicos actualizados. Se analizan los conceptos de coste del servicio, costes directos e indirectos, y se describen los datos de los años 2012-2013 utilizados para el cálculo. El informe concluye determinando los costes reales de cada instalación deportiva gestionada por el Instituto Municipal de Deportes.
Garanzia Giovani in Lombardia: una opportunità per la rete di Confcooperative...Stefano Radaelli
Una prima presentazione delle opportunità che l'iniziativa Garanzia Giovani offre alle imprese ed in particolare alle imprese cooperative della rete di Confcooperative, attraverso la mediazione delle Agenzie per il Lavoro del Consorzio Mestieri, la prima APL no profit italiana.
The document outlines the US class hierarchy, describing the elite class as the richest and most powerful people who live in their own world. The upper class have significant wealth allowing them to not work much to maintain their status. The middle class are usually salaried white collar workers, while the working class includes blue collar and skilled labor. The poverty class lives below the poverty line, and the underclass lives in destitution outside the system without addresses or phone numbers.
This document provides guidance on planning, designing, and constructing rural markets. It outlines a 10-stage process for identifying the need for a rural market, assessing supply and demand conditions, consulting with farmers and traders, determining space requirements, selecting a suitable site, preparing site plans, deciding on needed buildings and equipment, checking the market's viability, constructing the market, and operating and maintaining it once built. The intended audience includes community planners, rural engineers, and agricultural extension workers seeking to improve access to markets through the development of new rural markets or upgrades to existing ones.
This document discusses noise and radiation and their effects on health. It defines noise and its sources in the environment. Prolonged exposure to noise over 90dB can cause auditory fatigue, temporary or permanent hearing loss. Radiation is classified as ionizing or non-ionizing. Ionizing radiation like X-rays and gamma rays can penetrate tissues and potentially cause health issues. Natural and man-made sources of radiation exposure are discussed. International agencies work to set standards and ensure safe, peaceful use of nuclear technology and radiation.
Bab 2 membahaskan aplikasi kolaborasi PrimaryWall. PrimaryWall adalah alat nota lekat berasaskan Internet yang direka khas untuk kegunaan institusi pengajian bagi membolehkan pelajar dan guru bekerja bersama dalam keadaan masa sebenar. Bab ini juga menjelaskan kelebihan PrimaryWall seperti mengumpulkan idea dan membolehkan kerjasama.
Senarai peribahasa dalam buku teks tingkatan 4Keymah Colonial
Dokumen tersebut berisi senarai peribahasa dalam buku teks tingkatan 4 dan 5 beserta maksudnya. Beberapa peribahasa memiliki maksud yang sama atau hampir sama, seperti "air dicencang tak akan putus" dan "carik-carik bulu ayam akhirnya bercantum jua" yang bermakna perbalahan antara saudara tidak akan berlangsung lama. Dokumen ini juga memberikan contoh peribahasa yang padanan maknanya.
Punca utama obesiti dalam kalangan remaja ialah kurangnya pemakanan seimbang dan aktiviti fizikal, serta sikap ibu bapa dan remaja sendiri yang kurang mengambil berat tentang kesihatan. Ibu bapa perlu meningkatkan pengetahuan tentang pemakanan sihat dan mengawal corak pemakanan anak-anak.
The document discusses planning, including its definition, importance, principles, characteristics, components, types, and steps. Planning involves setting goals and strategies to accomplish goals. It provides direction, reduces risks and waste, and promotes innovation. Key principles of planning include contribution, sound premises, limiting factors, commitment, coordination, timing, efficiency, flexibility, and acceptance. Planning is goal-oriented, looks ahead, involves decision-making, and is a continuous and pervasive process designed for efficiency and flexibility. Components include policies, strategic planning, administrative planning, operational planning, financial planning, marketing planning, and proactive planning.
This document discusses various employment issues faced by professional nurses. It begins by defining key terms like responsibility and accountability. It explains that while one may be responsible for tasks, accountability means answering to others for one's actions. The document then outlines different roles and responsibilities of professional nurses including as caregivers, advocates, counselors, leaders, managers, directors, designers, and coaches. It discusses how nurses are accountable to their profession, clients, healthcare teams, and employing agencies. Several specific employment issues faced by nurses are also mentioned such as discrimination, harassment, affirmative action, diversity management, occupational health and safety issues, recruitment and selection, professional development, performance appraisal, retention, and turnover.
Childhood Mortality and Morbidity Presentation Slide.pptMotahar Alam
Childhood mortality and morbidity are sobering topics that demand our attention and action. In this enlightening video, we delve into the intricacies of childhood health, exploring the heartbreaking realities of young lives lost and the ongoing challenges faced by millions worldwide.
Join us as we examine the root causes behind childhood mortality, ranging from preventable diseases and inadequate healthcare access to socio-economic disparities and environmental factors. Through insightful analysis and compelling statistics, we highlight the staggering toll these issues take on families and communities, particularly in underserved regions.
Moreover, we shed light on the enduring impact of childhood morbidity, which extends far beyond physical health. From developmental delays and disabilities to psychological trauma, the repercussions of illness and injury during childhood can be profound and enduring.
But amidst the grim realities, there is hope. We showcase the remarkable efforts of healthcare professionals, activists, and organizations dedicated to saving young lives and improving child well-being. From vaccination campaigns and maternal health initiatives to educational programs and community interventions, we explore the innovative strategies making a difference on the ground.
Through poignant stories and expert interviews, we emphasize the urgent need for collective action to address childhood mortality and morbidity. Whether it's advocating for equitable healthcare systems, investing in early childhood development, or promoting public health awareness, every individual has a role to play in safeguarding the future of our children.
Informe de la OMS acerca de la salud de los adolescentes en el mundo - en inglésCristobal Buñuel
1) The report highlights that while progress has been made in reducing adolescent deaths from preventable causes like pregnancy complications and measles, HIV now causes more adolescent deaths.
2) Adolescence is a crucial life stage for establishing health behaviors that impact lifelong health. Many mental health disorders and risk factors for noncommunicable diseases emerge during this period.
3) A comprehensive approach is needed to address the diverse determinants of adolescent health across multiple levels, from the individual to policies, and require coordination between health and other sectors.
Según el informe elaborado por la Organización Mundial de la Salud (OMS), la depresión es la principal causa de enfermedad y discapacidad entre los adolescentes de ambos sexos de edades comprendidas entre los 10 y los 19 años.
Las tres principales causas de mortalidad entre los adolescentes a nivel mundial son los traumatismos causados por el tránsito, el VIH/sida y el suicidio. Se estima que en 2012 fallecieron 1,3 millones de adolescentes en todo el mundo.
1) Adolescent health is improving in some areas due to efforts to reduce child and maternal mortality, but challenges remain. While deaths from pregnancy complications and measles have declined, HIV deaths are rising among adolescents in Africa.
2) Adolescence is a crucial period for both short- and long-term health. Health risks established during this time like obesity, substance abuse, and mental health issues can affect overall life-long well-being.
3) Improving adolescent health requires a multifaceted approach that addresses the individual as well as their environments, including families, communities, and policies. Coordinated action is needed across healthcare and other sectors.
[[INOSR ES 11(2)134-147 Evaluation of the Infant Mortality rate at Ishaka Adv...PUBLISHERJOURNAL
Evaluation of the Infant Mortality rate at Ishaka Adventist Hospital Bushenyi District
Mugaaga Paul
Department of Clinical Medicine Kampala International University, Uganda.
________________________________________ABSTRACT
Infant mortality is defined as the death of an infant before his or her first birthday, mainly caused by dehydration, diseases, congenital malformations and infections. The main objective of this study was to establish the determinants of infant mortality in Ishaka Adventist Hospital (IAH) in the months of April- July 2017, in Ishaka municipality in Bushenyi district. A descriptive cross sectional study design was used to determine the determinants of infant mortality in the study area. Majority of respondent (98%) were female and among them, 25.5% reported to have lost at least an infant and most of these respondents (70%) were married while 5% were widowed and among these, 40% reported to have lost an infant. Religiously, majority of the respondents (80%) were Christians, while 13% were Muslim and 7% constituted other religions including paganism, which showed the greatest infant mortality rate (71.4%). Most of the respondents (65%) attained primary level of education while 5% did not go to school at all, and the highest infant mortality rate (40%) was reported among these. The respondents who reported to have had preterm births appeared to have a higher infant mortality rate (65%) than those who did not report preterm births. A higher infant mortality rate (32.2%) was realized among respondents who reported their infants to have had such co-morbidities than those who didn’t report any co-morbidities like malaria and also a higher infant mortality rate (50%) was realized among infants who had not exclusively breastfed. Majority of respondents (80%) did not have children with birth defects while only 20% had children with birth defect, and a higher infant mortality rate of 70% was realized among these. Demographically, infant mortality rate is high among teenagers, the unemployed, the widowed, the pagans, and the uneducated. Direct determinants of infant mortality rate included preterm birth, birth defects, comorbidities and failure to breastfeed exclusively. Proximate determinants associated with infant mortality rate included teenage pregnancies, source of water, means of delivery and irregular immunization. Exclusive breast feeding for 6 months, mass immunization campaign up to grass root, intensive health education on health seeking behaviors and highlighting on dangers associated with risky behaviors and high quality monitoring and evaluation for quick action particularly for emergencies. There is also need for intersectional collaboration and initiation of income generating activities to boost their standards of living.
Keywords: Infant mortality, Breastfeeding, Morbidity, Determinants, Respondents.
This document provides an overview and analysis of progress towards universal access to reproductive health and family planning based on key indicators. Some key points:
- Globally, contraceptive use has increased to two-thirds of married women, but 12% still have unmet need. The most common methods are female sterilization and IUD.
- Over 80% of married women's family planning needs are satisfied globally, but less than half in Africa.
- 15.3 million adolescent girls give birth each year. Adolescent contraceptive use and access to family planning services lag behind other age groups.
- Disparities exist based on location, education, and wealth. Rural, less educated and poorer
6Health and SafetyJupiterimagesStockbyteThinkstockLe.docxalinainglis
This document discusses health and safety issues affecting children worldwide and throughout development. It covers major global health concerns like early childhood mortality and efforts to prevent it through immunizations and access to clean water. Specific safety risks for older children and adolescents discussed include homicide, suicide, and unintentional injuries which remain leading causes of death. The importance of preventative measures to reduce accidents is emphasized.
This document summarizes a case study on infant mortality rate (IMR) and malnourishment in Satna, Madhya Pradesh, India. It begins with definitions of IMR from organizations like UNICEF and WHO. It then provides background on worldwide and Indian IMR trends, noting that Satna has a higher IMR than most other Indian states and countries globally. The document describes conducting surveys of local officials and residents in Satna to understand factors contributing to high IMR and malnourishment. Key factors identified include lack of access to healthcare, sanitation issues, and poverty. The document concludes by suggesting steps like improving nutrition programs and healthcare access to help reduce IMR and malnourishment in Satna.
S9c1 chapter 1-facts and figures on health.Shivu P
Health is a continuous state of physical, mental and social well being and not merely the absence of disease or infirmity, and the person should be able to lead socially and economically productive life (WHO definition). It is very much essential to maintain the health of all the people all the time to keep ourselves healthy, happy and long living. For example you cannot fly peace fully in the flight if someone tells that some people in the same flight is having H1N1 infection. Whether it is communicable disease or non communicable it is necessary to keep all the people healthy. For example a young driver getting painless myocardial infarction can consume the life of all the passengers of his bus or the bus can hit the VIP's car travelling in the same road. So the leaders of the nation / world should not have the attitude that why should I bother if someone is sick somewhere. I feel the leaders of the nation and the world will understand the importance of maintaining the health of all the people with this simple examples. In this chapter some of the facts and figures related to the health is mentioned and it tells that we have not achieved the goals in health, that, what we can achieve for whatever the reasons. The reason may point towards anything like the doctor, minister, staff of the hospital, availability of the facility, roads, infrastructure, transportation facility and so on. Let us try to make all the people healthy, young and energetic.
This document proposes solutions to reduce malnutrition globally. It states that malnutrition affects billions and contributes to millions of child deaths daily from lack of essential nutrients. It recommends providing affordable vitamin/mineral supplements to vulnerable people and encouraging communities to improve food production/consumption. The proposed solutions aim to integrate health services, ensure quality care, alleviate cost barriers, and receive funding from eliminating user fees and establishing cash transfer systems. However, challenges include lack of political will due to funding issues, lack of awareness, and orthodox societies.
Running head MATERNAL, INFANT AND CHILD HEALTH .docxcowinhelen
Running head: MATERNAL, INFANT AND CHILD HEALTH 1
MATERNAL, INFANT AND CHILD HEALTH 9
Maternal, infant and child health
Name
Institution
Abstract
Maternal, infant health is very essential for the progress of any country since they form the pillar of our future generations. United States has made significant strides towards securing the maternal and child health through various initiatives and programs within the country and around the globe. Despite the existence of health care initiatives to promote maternal, infant and child health, maternal and infant mortalities are still recorded on a daily basis in the U.S. Risk factors to maternal, infant and child mortalities include poor and a lack of a antenatal care attendance, unskilled birth attendants,ce and childhood illnesses. More than a quarter of every single maternal mortality is because of postpartum hemorrhaginge, for the most part after labor.
Infant mortality is another prevalent case that contributes to the worsening situation in child and maternal health, because of untimely births represent more than a quarter of infant mortalities, trailed by mortalities during births and neonatal sepsis. Maternal and child health (MCH) programs concentrate on medical problems concerning related to mothers, children, and families – such as , for example, access to suitable pre-natal and child welfare services, baby mortality mitigation initiatives, emergency medical services, prevention of injuries, infant screening, and administrations to kidschildren children with unique health care needs. The United States is working to prevent maternal deaths, infant mortalities, and child mortalities, and to reduce the prevalence of these incidences. It calls for a multidisciplinary approach in order to eliminate this issue affecting the mothers and children. Reinforcing referral systems and linkages between various levels of hospital-based patient care, and between healthcare organizations providers and the general population, must be a top needpriority.
1- (the things in red is the corrections, if its underline means this is the correct world and if its cross off means you have to delete it)
2- ( the things in yellow you have to delete it and write the topic and the purpose of the paper and I will write it for you at the end of the first paragraph).
3- Change anything about child health and just focus on mortality maternal unless there is something related to the child health so then you can mention that.
4- Scoop of the problem
5- Associated factors
6- solutions
Maternal child and infant health
Enhancing the prosperity of mothers, newborn children, and young children is a vital public health objective for the United States and the entire globe. Their prosperity dictates the strength of the people in the future and can anticipate future public wellbeing challenges for fam ...
Malnutrition is a global health issue that contributes to over 1/3 of child deaths worldwide. Prolonged malnutrition can lead to stunted growth and development. Healthcare systems can work collaboratively to address malnutrition by increasing food availability and quality of health environments, as well as improving women's education and status which impacts childcare. International organizations provide aid to developing nations where food insecurity and limited resources contribute to high rates of malnutrition.
This document provides a summary of the under five children's health situation in Bangladesh. It discusses the leading causes of under five mortality, including preterm birth, pneumonia, and diarrhea. It also reviews vaccination rates, treatment of common childhood illnesses, breastfeeding practices, vitamin A supplementation, and childhood nutrition status. Several ongoing government and non-government programs aimed at improving child health in Bangladesh are also outlined, including the National Nutrition Services and Expanded Programme on Immunization. The document concludes by noting that Bangladesh has made progress in reducing under-five mortality but more efforts are still needed.
Wereldwijd hebben kinderen het beter dan ooit. Vergeleken met een paar decennia geleden overlijden er per dag minder jonge kinderen, leven er minder kinderen in armoede en gaan meer kinderen goed gevoed naar school.
Dit bemoedigende nieuws blijkt uit een nieuw rapport van UNICEF en Save the Children - voorbereid in samenwerking met het Overseas Development Institute. Nog beter nieuws is dat we weten hoe we nog meer vooruitgang moeten boeken; met meer nadruk op de meest kwetsbare kinderen. Daar waar kinderen het grootste gebrek hebben aan basale voorzieningen, kan op een kosteneffectieve en efficiënte manier snel vooruitgang worden geboekt.
Casestudies in het rapport laten zien dat verschillende factoren bijdragen aan de vooruitgang voor kinderen: sterkere en expliciete nationale wil om te investeren in kinderen, ondersteunende programma's en meer ontwikkelingssamenwerking gericht op kinderen.
Het volledige rapport verschijnt binnenkort.
1. Select a health problem in your society (Saudi) 2. Write a para.pdfomarionmatzmcwill497
1. Select a health problem in your society (Saudi)
2. Write a paragraph regarding why you have chosen this problem (it includes significance of
the problem which contains statistical data national and international related to this problem)
3. How can educating the people with the health problem may help in tackling.
4. Also, the weekly assignment answers should be supported by references.
Solution
1.Ans-Health Problems in Saudi- As Saudi Arabia is well developed country but still it is
suffering from several health problems. A major cause of disease is malnutrition, leading to
widespread scurvy, rickets, night blindness, and anemia, as well as low resistance to tuberculosis
and AIDS.
2.Ans-I have choosen this problem because today most of the people in different countries are
suffering from malnutrition and other diseases like tuberculosis, malaria and many more.
Statistical data national and international-
In 1960, life expectancy at birth was 43 years, but it averaged 75.46 years in 2005. During the
same time period, infant mortality fell from 185 to 13.24 per 1,000 live births. The maternal
mortality rate was 22 per 100,000 live births. As of 2002, the crude birth rate and overall
mortality rate were estimated at 37.2 and 5.9 per 1,000 people, respectively. Birth control was
used by 21% of married women. Almost 97% of the population had access to health care
services. Total health care expenditures were estimated at 8% of GDP.
Immunization rates for children up to one year old were tuberculosis, 93%; diphtheria, perteusis,
and tetanus, 97%; polio, 97%; and measles, 94%. The rates for DPT and measles were 96% and
91%, respectively.
Dysentery attacks all ages and classes and trachoma is common. A government campaign was
successful in eradicating malaria. Typhoid is endemic, but acquired immunity prevents serious
outbreaks of this disease. Approximately 95% of the population had access to safe drinking
water and 100% adequate sanitation. The HIV/AIDS prevalence was 0.01 per 100 adults in 2003.
3.Ans-Educating the people with the health problem may help in tackling-
Nutritional problem in the developing countries can\'t be solved only by the government
interventions. Besides, Non-government Organizations (NGOs) have to play strong role in
spreading knowledge and training. More emphasis is needed in the child and maternal mortality.
If women can be treated properly during the pregnancy, the child will have proper development.
So it starts from the family. Government should have strong monitoring on this maternal health
and child health. Nutritional problem can be treated if we can educate the mother. Besides,
fortified foods can also benefit children to get rid of malnutrition.
Focus needs to be given to those groups who had not benefited from the development that many
others had enjoyed over the last twenty years or so, including the resource poor, low income,
socially excluded, economically marginalized, food insecure and nutritional vulnerab.
Infant mortality is defined as the death of an infant before their first birthday. The infant mortality rate is the number of infant deaths per 1,000 live births. Leading causes of infant mortality include preterm birth, low birth weight, congenital abnormalities, Sudden Infant Death Syndrome, infectious diseases, malnutrition, and lack of access to basic healthcare. Factors that contribute to higher infant mortality rates include socioeconomic challenges, environmental conditions like air pollution, and lack of policies supporting maternal health and early childhood development. Reducing infant mortality requires improved access to prenatal care, nutrition, sanitation, immunizations, and social support systems.
This document provides an executive summary of the 2018 Global Nutrition Report. It finds that while malnutrition is a global issue and progress has been slow, opportunities now exist to address it through commitments like the UN Decade of Action on Nutrition and the Sustainable Development Goals. The burden of malnutrition remains high in multiple forms among children and adults worldwide. However, countries are increasingly establishing policies and targets to tackle malnutrition, though financing remains a challenge to deliver on these commitments. Data and understanding of effective solutions are improving but must be translated into urgent, comprehensive action to achieve nutrition goals.
This document summarizes a thesis paper examining the socioeconomic impact of malaria control and eradication in Venezuela. It provides background on the malaria situation in Venezuela prior to a DDT campaign launched in 1945. Venezuela had the highest malaria mortality rate in Latin America before extensive control efforts. The campaign introduced DDT over four years between 1945-1948, varying by region. Exposure to the campaign during childhood is used to classify cohorts and analyze the impact on educational and economic outcomes like years of schooling, literacy rates, and income. Results found exposure in childhood led to better outcomes, indicating malaria negatively impacts development.
The document discusses strategies for improving child survival, with a focus on children under 5 years old. It defines key terms and outlines the Sustainable Development Goals' targets for reducing child mortality. The major causes of under-5 deaths are preventable conditions like pneumonia, diarrhea, and malaria. Interventions discussed include integrated management of childhood illness, immunization, breastfeeding promotion, vitamin A supplementation, insecticide-treated nets, skilled birth attendance, and growth monitoring. The document also provides country-specific child mortality data for Kenya and guidelines on pediatric HIV treatment.
Claudia Llanten, MD, MPH of CMMB describes the importance of immunization in protecting the health of children and adults and how CMMB partners with other organizations to deliver vaccines at the CCIH 2018 conference.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Mercurius is named after the roman god mercurius, the god of trade and science. The planet mercurius is named after the same god. Mercurius is sometimes called hydrargyrum, means ‘watery silver’. Its shine and colour are very similar to silver, but mercury is a fluid at room temperatures. The name quick silver is a translation of hydrargyrum, where the word quick describes its tendency to scatter away in all directions.
The droplets have a tendency to conglomerate to one big mass, but on being shaken they fall apart into countless little droplets again. It is used to ignite explosives, like mercury fulminate, the explosive character is one of its general themes.
1. Special Theme — Child Mortality
The evolution of child health programmes in
developing countries: from targeting diseases
to targeting people
Mariam Claeson1 & Ronald J. Waldman2
Mortality rates among children and the absolute number of children dying annually in developing countries have
declined considerably over the past few decades. However, the gains made have not been distributed evenly:
childhood mortality remains higher among poorer people and the gap between rich and poor has grown. Several poor
countries, and some poorer regions within countries, have experienced a levelling off of or even an increase in
childhood mortality over the past few years. Until now, two types of programmes — short-term, disease-specific
initiatives and more general programmes of primary health care — have contributed to the decline in mortality. Both
types of programme can contribute substantially to the strengthening of health systems and in enabling households
and communities to improve their health care. In order for them to do so, and in order to complete the unfinished
agenda of improving child health globally, new strategies are needed. On the one hand, greater emphasis should be
placed on promoting those household behaviours that are not dependent on the performance of health systems. On
the other hand, more attention should be paid to interventions that affect health at other stages of the life cycle while
efforts that have been made to develop interventions that can be used during childhood continue.
Keywords: child welfare; child health services, trends; communicable diseases, prevention and control; delivery of
health care; infant mortality, trends; models, theoretical.
Bulletin of the World Health Organization, 2000, 78: 1234–1245.
Voir page 1243 le resume en francais. En la pagina 1244 figura un resumen en espanol.
´ ´ ¸ ´ ˜
Introduction 50 countries the mortality for children under 5 years
was greater than 100 deaths per 1000 live births. In
For the past 35 years, the steep decline in deaths 12 countries (11 of them in Africa), one in every
among infants and children has provided evidence of five children born alive did not survive to the age of
an important success story in international develop- five years (1). Of the nearly 11 million children who
ment. Mortality has declined steadily at an average of will die before their fifth birthday this year, 70% will
about 1% per year. The absolute number of children die from a disease, a combination of a few diseases,
under the age of 5 years dying has fallen from an or a condition for which safe and effective
estimated 15 million in 1980 to about 11 million at the interventions are readily available in industrialized
end of the 1990s (1). Remarkably, this decline has countries: acute respiratory infections, diarrhoea,
occurred in the face of increased births, spreading measles, malaria, and malnutrition (2).
resistance to commonly used antibiotics and anti- Better access to basic health services —
malarial drugs and, most menacingly, the growth of including vaccinations, oral rehydration therapy,
the AIDS pandemic. and antibiotics for pneumonia — together with
A closer look at this favourable trend, improvements in social conditions — including
however, reveals that progress has been distributed higher standards of living and smaller families living
unevenly. Recently, the decline in mortality among on larger incomes — have been important factors in
children under 5 years has stalled in a number of improving the survival rate of children. As deaths
countries and in some the trend has reversed and among children under 5 years have declined in many
mortality seems to be rising. In 1998, in more than developing countries, contributing to both demo-
graphic and epidemiological transitions, the propor-
1
tional mortality accounted for by some conditions
Principal Public Health Specialist, Health, Nutrition, and Population, has increased: this problem has been relatively
Human Development Department, World Bank, Washington, DC,
20433, USA (email: mclaeson@worldbank.org). Correspondence ignored by the international health community. For
should be addressed to this author. example, the greatest decline in childhood mortality
2
Professor of Clinical Public Health and Director, Program on rates has occurred among children in the post-
Forced Migration and Health, Center for Population and Family Health, neonatal period; this has led to a relative increase in
Joseph L. Mailman School of Public Health, Columbia University, the importance of neonatal and perinatal mortality.
New York, USA.
Also, gender-specific issues have emerged in some
Ref. No. 00-0762
1234 # World Health Organization 2000 Bulletin of the World Health Organization, 2000, 78 (10)
2. The evolution of child health programmes in developing countries
parts of the world, notably on the Indian subconti- programmes must, when possible, promote com-
nent where girls aged between 1 month and 5 years munity involvement while contributing to the on-
still experience considerably higher mortality and going development and strengthening of national
morbidity than boys (3, 4). And, although this paper health systems (6).
does not deal with it specifically, increases in deaths Similarly, a debate over the degree to which the
from AIDS in Africa are already slowing or reversing objectives of primary health care can be translated
these downward trends. Without a major assault on into effective programmes resulted in the emergence
AIDS throughout local health systems and in the of ‘‘selective primary health care’’ (7). This new
community, childhood mortality, whether from strategy, which targeted the control of diseases
infection or from the increased risks associated with identified as the most important contributors to
being orphaned, can be expected to increase in some increased mortality, was intended to be more focused
parts of the world. and more feasible. A number of specific, more
In this paper, we examine the roots from which vertical programmes (so named because of the self-
current child health programmes have grown, some of contained way they appear on organizational charts
the causes behind the apparent slowing of progress in and, more importantly, in budget lines of health
many parts of the world, and we suggest ways in which ministries) were promoted to channel relatively
the nature of these programmes must change if meagre resources into areas in which demonstrable
continued gains are to be made throughout the world. success could be achieved in the medium-term.
Furthermore, the emphasis was clearly put on
programmes that would contribute to achieving
decreases in mortality among infants and children,
Trends and milestones since children were considered to be the most
Global strategies for reducing childhood mortality vulnerable segment of the population because they
have been of two basic types. The first were have the highest rates of preventable death.
ambitious disease-specific, technologically depen- The World Health Organization, for example,
dent strategies aimed at achieving dramatic, albeit first developed the Expanded Programme on
narrow, successes in a relatively short time. The Immunization and subsequently the Programme
notable failure of the most ambitious programme of for the Control of Diarrhoeal Diseases. UNICEF
this type — the malaria eradication programme (not chose four specific interventions on which to focus:
exclusively a child health programme, but one that growth monitoring, oral rehydration therapy, breast-
was expected to make a major contribution to feeding promotion, and immunization, known by the
reducing child mortality) launched in the 1950s and acronym GOBI. It later added three more (food,
abandoned in the 1970s — contributed strongly to a family planning, and female education). Bilateral
shift in thinking (5). donors followed, channelling funds into what came
The more people-centred, community-based to be called ‘‘child survival’’ programmes; these
strategy typified by primary health care, with its goal retained their roots in community-oriented, popula-
of health for all by the year 2000, was adopted by the tion-based, primary health care, but at the same time
World Health Assembly in 1977. Primary health care had the appeal of using relatively inexpensive medical
sought to broaden the focus of health services by technologies to reach specific, stated objectives.
emphasizing programmatic areas instead of specific Although the two strategies, at different ends
diseases. Accordingly, the provision of universal of the intervention spectrum, have been able to
services for maternal and child health, family coexist relatively peacefully, they have never quite
planning, improved water supplies, and environ- coalesced. Currently, several attempts at rapproche-
mental sanitation became objectives; these were to be ment are under way. For example, the multi-agency
achieved through an equitable distribution of Roll Back Malaria movement includes components
resources, community involvement, an emphasis on aimed at health systems and at the community.
prevention instead of clinic-based curative interven- Reduced rates of morbidity and death from malaria, it
tions, and a multisectoral approach. suggests, should be viewed as markers of improved
Neither strategic approach ever totally eclipsed health systems. Similarly, the Integrated Management
the other. Although attempts to eradicate malaria of Childhood Illness initiative explicitly incorporates
failed, the ensuing smallpox eradication programme a component of community development; this
is probably the most successful large-scale public programme evolved from selective primary health
health programme in history, with the last case of care programmes that aimed to control diarrhoeal
smallpox acquired by human-to-human transmission diseases and acute respiratory infections in childhood
having occurred in 1977. Important lessons have by working with health workers and strengthening
been learnt from both the failed malaria eradication health systems. Both of these efforts, and many
programme and the successful smallpox programme; others currently being implemented (including the
these lessons have been applied to current attempts poliomyelitis and dracunculiasis eradication pro-
to eradicate dracunculiasis and poliomyelitis, two grammes) emphasize the need for community
programmes which are on the verge of success. To an participation, for strong and effective partnerships
important degree, the appeal of these programmes is between public and private sectors, for intersectoral
rooted in the acceptance that disease-specific links, and the need to combine medical technology
Bulletin of the World Health Organization, 2000, 78 (10) 1235
3. Special Theme — Child Mortality
with behavioural interventions. That is, they recog- reviews influenced the direction of global efforts in
nize these needs in rhetoric, if not in practice. This preventing and controlling childhood acute respira-
reflects current thinking as to how programmes to tory infections and diarrhoea.
improve children’s health should be implemented, In the 1990s, research priorities have evolved
not necessarily how resources are being invested. as efforts to develop a more integrated approach to
Although emphasis on community-level interven- case management both in the home and within the
tions is generally recognized to be a desirable and health system have intensified. The success of case-
effective approach to implementing successful management strategies depends only in part upon
programmes, activities still tend to focus on improv- the availability of services provided by trained health
ing the delivery of services through an organized care workers. Equally important, if not more so, are
health system, rather than on effecting behavioural the behaviours of the carer in the home and in the
change. community. Case management in the home, care-
seeking practices (including the extent to which
available health services are used), and compliance
The past: research and action with counselling provided by health workers all have
an important impact on children’s health. Research
The recognition that there were multiple technical priorities have therefore focused increasingly on
and operational challenges to the implementation of promoting and maintaining household and commu-
child health and nutrition programmes over the past nity support for the home management of childhood
20 years led to an evolution of research priorities (8). illnesses (with appropriate referral when indicated)
Before 1985, microbiological, epidemiological, im- through interventions designed to encourage com-
munological, and clinical research contributed to the munication and change behaviour. Ethnographic
development of both preventive and therapeutic research, participatory rural appraisal, and other
interventions for the control of common diseases in qualitative methods have been the tools that have
childhood. A prototypical example is the finding that guided the development, local adaptation, and imple-
treatment of acute, watery diarrhoea did not depend mentation of many of these effective, community-
on the etiological agent and that oral rehydration level interventions (11).
therapy with a single, standard solution is safe and To a considerable extent, the progress in
effective in almost all cases; this finding shaped global reducing childhood mortality rates is the result of
treatment policies for childhood diarrhoeal diseases. efficient interactions between research, analysis,
Similarly, the identification of Streptococcus pneumoniae policy development, and programme evaluation.
and Haemophilus influenzae as the leading bacterial The cycle — which includes the dissemination of
causes of mortality from pneumonia led to the research findings, implementation of programmes
development of a universal case-management strat- based on those findings, and feedback regarding
egy based on symptomatic diagnosis and standar- successes and failures — has involved the research
dized antibiotic treatment. After the development of community, bilateral and international donors, health
these technical approaches, research priorities shifted ministries, and nongovernmental organizations in
from focusing on incidence, etiology, and other developed and developing countries. WHO has
descriptive research to focusing on analytical research played a critical part in the analysis and formulation
that was directed at designing, monitoring, and of policy and has provided guidance in implementing
evaluating the impact of priority interventions. and evaluating efforts in various countries.
For example, in the mid-1980s, the World
Health Organization commissioned a review of
research that might contribute to determining the
potential effectiveness, feasibility, and cost of 18 sug-
The present: new initiatives
gested preventive interventions for childhood diar- and programmatic approaches
rhoea (9). The most promising were found to be For much of the past few decades, the international
promoting breastfeeding, improving water supplies, health agenda has been dominated by strategies and
modifying sanitation and hygiene behaviours, in- programmes aimed at reducing mortality in child-
creasing measles vaccination coverage and, after hood. Reich proposes a number of reasons why this
development of the appropriate technologies was was the case. For one, it was important that children’s
ensured, vaccinating against rotavirus infections and health problems were being addressed by large,
cholera. Similar reviews were done for the Pro- influential organizations, including UNICEF, WHO,
gramme on Acute Respiratory Infections in the 1990s and public–private coalitions, such as the Task Force
(10). This process identified eight potential interven- for Child Survival and Development. They also had
tions, each with the ability to prevent at least 5% of symbolic power in the emotional appeal of being able
deaths from pneumonia. These were vaccinating to save children’s lives with simple, cheap interven-
children against measles, S. pneumoniae, H. influenzae tions. Also, with the exception of the infant formula
type B, and respiratory syncytial virus; minimizing industry, children’s health issues posed no competi-
indoor air pollution; reducing the rates of children tion to vested corporate interests. Additionally,
born at low birth weight; and exclusively breastfeed- science was on its side: the use of infant mortality
ing until the child was aged 4–6 months. These rates as a proxy for national health status and
1236 Bulletin of the World Health Organization, 2000, 78 (10)
4. The evolution of child health programmes in developing countries
development called attention to the causes of early supervision, monitoring, training, and supplying
deaths and to the interventions that could be aimed at drugs or vaccines. Without the technical and
them. Finally, for the most part, the agenda setters — programmatic support to which they have become
that is, the politicians — found that child health is a accustomed, and which cannot be made available at
readily accepted cause that meets with little opposi- the provincial or district level in most developing
tion when proposed as a subject for social investment countries, child health services are at risk of levelling
(12). It should also be mentioned that childhood off or even declining in both quantity and quality.
illnesses make a substantial contribution to the global At the same time, child health programmes,
burden of disease (the Integrated Management of especially vaccination programmes, have benefited
Childhood Illness strategy alone, at the time it was from major new funding from non-traditional sources.
formulated, addressed conditions that accounted for Although it seems as if some of the activities being
as much as 14% of disability-adjusted life years) (13), pursued may be contradictory, the potential for each
and high mortality rates in children under 5 years of activity to help reduce childhood mortality is evident. A
age are an important contributor to reduced life few of the more prominent initiatives currently being
expectancy in developing countries. implemented around the world are discussed below.
Recently, however, the primacy of child health
concerns has been challenged, although most
advocates of adolescent and adult health pro- Vaccination strategies
grammes agree that it is not useful to promote
competition between intiatives that target other age Vaccine-preventable diseases are responsible for a
groups and and those aimed at child health problems significant proportion of the approximately 11 mil-
(14). Yet, unless careful attention is paid to lion deaths that occur annually among children under
consolidating the gains made to date and to reversing 5 years of age (Table 1). Yet, nowhere is the contrast
emerging negative trends in some parts of the world, between short-term disease-specific programmes
the gap in life expectancy between richer and poorer and long-term developmental programmes more
nations, and between rich and poor within nations, evident than in the area of childhood vaccination.
may continue to grow. Preventing this situation will Two contemporary vaccination strategies have
require continued emphasis on controlling commu- received massive support from both the public and
nicable diseases, especially those diseases that affect private sectors. The highest profile public health
children disproportionately (15). programme is the initiative to eradicate poliomyelitis.
Supported by a 1988 resolution of the World Health
Assembly (16) and by a major coalition of interna-
tional agencies and private organizations, the drive to
Health sector reforms eradicate poliomyelitis is a direct descendant of
Even if resources for child health are maintained at previous eradication programmes. Based on a
current levels or increased, strategies will have to be strategy of multiple national mass immunization days
adapted to current trends. Presently, many health accompanied by intensified surveillance, poliomyeli-
activities in a large number of developing countries tis has been eliminated from industrialized countries
are unfolding in an environment of health sector and is on the verge of being eradicated worldwide.
reform. Donor support seems to have shifted from The concept of poliomyelitis eradication is
specific programmes to the development of leaner laudable. If successful, it will rid the world of a disease
and potentially more efficient administrative and which causes permanent disability and it will allow for
managerial structures. Typical features of most health the cessation of the production, distribution, and
reform efforts are the decentralization of budgetary administration of poliomyelitis vaccine. It will give
and, sometimes, programmatic authority to provin- public health workers around the world a tangible
cial or district levels and the administrative integra- success and, perhaps, provide strong motivation for
tion of centralized programmes. These reform achieving comparable success in other health pro-
processes and sectorwide approaches can provide grammes. However, poliomyelitis does not contribute
opportunities to identify priority problems and more substantially to the global burden of disease, and its
cost-effective and affordable interventions. Addi- eradication will not appreciably affect childhood
tionally, they may aid the development of sustainable mortality rates. Furthermore, despite the heroic
health systems that are capable of devising local mobilization efforts that have been undertaken for
solutions for local problems. However, there has mass immunization days to be successful, eradication
been less emphasis put on maintaining the quality of is ultimately dependent upon the ability of a health
the more traditional, technically dependent pro- system to organize special campaigns for the delivery
grammes such as those dealing with childhood of services. A strong partnership between commu-
diseases, including the Expanded Programme on nities and the health system is a fundamental
Immunization, the Control of Diarrhoeal Diseases requirement but, unless it is made an explicit goal,
programme, the Programme on Acute Respiratory there is little transfer of responsibility to parents and
Infections, and nutrition. For example, decentraliza- communities. So, in some countries, although im-
tion has often been accompanied by a reduction in munization days have been successful, vaccination
support for essential programme activities such as coverage with antigens other than those for polio-
Bulletin of the World Health Organization, 2000, 78 (10) 1237
5. Special Theme — Child Mortality
Table 1. Annual deaths due to vaccine-preventable diseases (21 ) eradication initiative, the global alliance is a public–
private consortium whose principal members are
Disease No. of preventable WHO, UNICEF, the World Bank, national govern-
annual deaths ments, public health and research institutions, the
Rockefeller Foundation, the International Federation
Poliomyelitis 720 of Pharmaceutical Manufacturers Associations, and
Diphtheria 5000 the Bill and Melinda Gates Foundation.
Pertussis 346 000 The global alliance reports that although
Measles 888 000
children in developing countries are scheduled by
Tetanus (including 215 000 neonatal deaths) 410 000
their national immunization programmes to receive six
Haemophilus influenzae type b 400 000
or seven antigens as part of their routine series of
Hepatitis Ba 900 000
vaccination, children in the wealthier countries in
Yellow fevera 30 000
Total 2 979 720 Europe and North America can expect to receive
protection against more than 10 vaccine-preventable
a
Most deaths do not occur in childhood. diseases. This ‘‘vaccine gap’’ is another example of the
inequitable distribution of health services that con-
tributes to the growing difference in mortality between
myelitis, delivered through the routine health services, rich and poor. Incorporating newer, safe, and effective
is declining. Additionally, it is apparent that those vaccines into routine immunization programmes and
countries with the weakest health systems will be the increasing coverage for all vaccines in a consistent and
last to achieve eradication. As a result, as the deadline sustainable manner for all segments of the population
for eradication approaches, there will be increased will require a long-term commitment to developing
pressure on these countries to focus only on the and implementing programmes. Additionally, the
narrow goal of eradicating poliomyelitis and to development and maintenance of the infrastructure
abandon the accompanying objectives related to required to support vaccination programmes will be
strengthening their health systems. Accordingly, there important as new vaccines against diseases that are
is a real potential that the gap in the ability of countries major contributors to both childhood and adult
to carry out other programmes that are dependent on mortality, including malaria, AIDS, and tuberculosis,
their health systems, including those directed toward are developed and marketed.
improving child health, will continue to grow. There is no obvious reason why both types of
As the drive toward poliomyelitis eradication programmes — shorter-term eradication initiatives and
nears its successful end, plans are being made to longer-term developmental programmes — should not
embark upon a global initiative to eradicate measles. coexist. If funding is available, if personnel and other
Unlike poliomyelitis, measles is an important cause of non-monetary resources are sufficient to support both
childhood mortality, and its eradication would make kinds of efforts as well as other programmes for which
an important contribution towards reducing child- health ministries are responsible, and if demonstrable
hood mortality. Technical and programmatic argu- benefits to the target populations can be shown,
ments have been advanced, both in favour of and eradication programmes — which appeal to politicians,
against devoting major resources to eradicating donors, and the public — could not only contribute to
measles. The potential operational, technical, epide- reducing mortality but could also serve as a leading edge
miological, and financial problems that such a to prepare countries for longer-term programmes.
programme might face have been discussed (17, 18). However, it might be important to make develop-
While poliomyelitis eradication efforts have mental goals more explicit in order to ensure that
been progressing, and while measles elimination is eradication-type programmes are held accountable for
being pursued in several regions, vaccination coverage their achievements in all countries, both richer and
with the standard six antigens of the WHO Expanded poorer. This might be accomplished by setting longer-
Programme on Immunization has, in fact, fallen over term goals — for example, by deciding what ought to
the past decade (19). UNICEF estimates that, despite be achieved over the next 25 years — and allowing
the proclaimed success of its Universal Childhood countries to pursue those globally agreed goals at their
Immunization programme efforts in the 1980s, which own pace in accordance with their own priorities. The
sought to achieve 80% vaccination coverage with the advent of public health endowments, such as the
antigens described in the WHO programme by the Global Alliance for Vaccines and Immunization, may
second half of the 1990s, 44 countries had measles allow for longer-term planning, as the urgency to raise
vaccine coverage of less than 65% for children aged funding for short-term programmes may be somewhat
1 year. Populous countries, such as Nigeria, are alleviated in the future.
included in this category; India had an estimated
measles vaccine coverage of 67% (20). The new
Global Alliance for Vaccines and Immunizations is Case-management: the trend towards
responding to this negative trend and is a major
promoter of vaccination and immunization. The
integrating and packaging services
organization seeks to provide more vaccines to more To conform to the changing characteristics of health
children in more countries (21). Like the poliomyelitis ministries, which have undergone substantial reorga-
1238 Bulletin of the World Health Organization, 2000, 78 (10)
6. The evolution of child health programmes in developing countries
nization and reform, including a reduction in the income is a contributing factor to ill-health and
emphasis on technical programmes, efforts have been malnutrition, so are poor health, malnutrition, and
made to incorporate disease-control programmes in large family size key determinants of poverty. In
more integrated and manageable packages of basic targeting health interventions at poorer people, there
services. The Integrated Management of Childhood are two formidable challenges: to lower the incidence
Illness programme is one example of this approach. of outcomes associated with adverse health and poor
Developed jointly by WHO and UNICEF, this nutrition and to protect households against poten-
programme has been embraced by more than tially impoverishing effects when adverse outcomes
60 countries and has attracted support from a large do occur.
number of donor agencies, including more than It is not only that poor people are in ill-health:
25 projects supported by the World Bank. ill-health causes poverty. In Voices of the poor, a recent
The conditions included in the package include World Bank study, ill-health emerged as one of the
major communicable diseases (pneumonia, diar- principal reasons why households become poor and
rhoea, malaria, and measles). The package also remain poor (23). Explanations are numerous: they
emphasizes addressing malnutrition, which has been include the burden of health care expenditures
shown to contribute to more than half of all incurred by caring for sick household members
childhood deaths (22). To a greater extent than many (24), the lost income of the sick, and the lost income
earlier strategies, this package includes both treat- of other household members who care for the sick.
ment and prevention interventions. In addition to Nationally, although data relating the impact of
training health workers in standard case-management health indicators to poverty rates are scarce, evidence
protocols for treating all five diseases, the package is emerging about the impact of health on economic
urges the promotion of breastfeeding, improvements growth. One study estimated that health and
in feeding practices, the use of micronutrient demographic variables accounted for half of the
supplements, and vaccines. difference in growth rates between Africa and the rest
Even more importantly, the package calls of the world from 1965 to 1990 (25).
attention to the need not only to train health Malnutrition is also known to be an important
professionals but also to strengthen existing health determinant of poverty through its direct effects on
systems to ensure the availability of drugs and loss of earnings: the chronically malnourished work
supplies and widespread access to them. Supervision, less and earn less (26, 27). In addition, malnutrition
monitoring, and evaluation activities are also empha- exerts indirect effects on health status, cognitive
sized. The third, and essential, component of the development, and the productivity of workers.
package is the promotion of improved prevention Numerous examples can be cited: non-breastfed
and care-seeking behaviours in the community and babies have a 14-fold increased risk of dying from
the family. diarrhoea (28); iodine deficiency disorder has been
Diseases that contribute directly to childhood estimated to reduce intelligence quotient (IQ) by an
mortality are not the only subjects of these new average of 13.5 points (29); and in Chile, iron-
initiatives. Increased attention is being paid to early deficient children who were successfully treated
childhood development, emphasizing the psychologi- performed 10–400% better on standardized tests
cal and intellectual growth of the child. Interventions than anaemic children (30).
in childhood development are traditionally focused on Improving health and nutrition especially
the family and community and are not delivered among people living in poverty or close to poverty
through the health system. Nevertheless, certain is thus likely to pay dividends by contributing to rises
aspects of the care of young children have recently in household income and raising incomes will help
been added as an option in adapting the Integrated lower mortality. Because of the gross health inequal-
Management of Childhood Illness package for ities between rich and poor both within and between
countries that want early childhood development to countries it seems reasonable to encourage a change
be incorporated as an integral part of recovery from in health programming. If mortality rates, especially
childhood illness. Similarly, just as early childhood in childhood, are to be further reduced and stagnating
development programmes combine interventions in or reversed trends are to be corrected, it may be more
nutrition, health, and psychology to achieve improved important in the future to address the needs of
outcomes overall, recent interagency efforts (between specific families and households rather than to
WHO, UNICEF, and the World Bank) combine the emphasize the development of programmes aimed
teaching of life skills with the provision of appropriate at specific diseases, wherever they might occur. This
health services at schools, including adequate water people-oriented approach may be more difficult, and
and sanitation facilities. it may entail the development and application of
sociological rather than biomedical research. But it is
increasingly clear that reducing poverty can be
The link between poverty and child achieved by introducing policies and applying
programmes that protect households from the
health outcomes impoverishing effects of ill health, malnutrition, and
It is increasingly understood that the relation between high fertility.
health and poverty is bi-directional. Just as low
Bulletin of the World Health Organization, 2000, 78 (10) 1239
7. Special Theme — Child Mortality
The future of child health efforts Box 1. A list of key household behaviours for
in a changing political environment reducing childhood mortality (11 )
To a certain extent, the easiest part of achieving lasting Reproductive health behaviours
reductions in childhood mortality has occurred in Women of reproductive age should delay age of first
some countries. In others, the strategies that have been pregnancy, practise birth spacing, limit family size.
used — strengthening health systems and training Pregnant women should seek antenatal care at least twice
health care providers in the appropriate use of safe, during pregnancy.
effective, affordable technologies — have been Women should take iron supplementation during
inadequate or not sustainable. In these countries, pregnancy.
mortality rates have stagnated or are rising. In all cases, Infant and child feeding practices
further improvements will depend to a large extent on Mothers should breastfeed their children exclusively
what happens in the household and community and to for about six months.
what extent the health system is responsive and will From six months mothers should give children appropriate
play a supportive part. The promotion of a limited set complementary feeding and continue to breastfeed for
of household behaviours that have direct links to the 24 months (if testing positive for human immunodeficiency
prevention and cure of common childhood illnesses virus, current recommendations should be followed).
needs to become the centrepiece of intensified activity
Immunization practices
(see Box 1). Since the ability and willingness of
All infants should be taken for measles vaccination at nine
families to adopt new behaviours are influenced by a months of age.
variety of factors, it will need to be determined locally Infants should be taken for routine vaccinations even when
how best to promote these behaviours. Factors sick.
influencing the adoption of new behaviours include Pregnant women and other women of childbearing age
the household’s resources, attitudes in the community; should seek tetanus toxoid vaccine at every opportunity.
and the price, quality, and availability of services and
goods such as food, energy, transport, water, and Home health practices
Prevention
sanitation facilities.
All children should sleep under insecticide-treated bednets
A graphical depiction of the relation between
when indicated.
the household or the community and the health
Wash hands with soap at appropriate times.
system is shown in Fig. 1 (31). The Pathway to All infants and children should consume enough vitamin A,
Survival is a guide that distinguishes between by whatever means available.
prevention behaviours, such as breastfeeding, that All families should use iodized salt.
can be implemented entirely in the home and those,
such as vaccination, that require more direct support Treatment
from the health system. Similarly, it shows how the Continue feeding and increase fluid intake during illness;
management of childhood illness can also be carried increase feeding after illness.
Mix and administer oral rehydration salts, or an appropriate
out in the home in many instances, with mothers
home-available fluid, correctly.
responsible for making the critical decision of when
Administer treatment and medications according to
external support is required. One of the most
instruction.
attractive features of the pathway is that it can be
used as a quantitative tool for measuring problems in Care-seeking practices
home care, health care-seeking behaviour, the Seek appropriate care when an infant or child is recognized
delivery of primary and secondary health care, as being sick.
counselling patients, and the compliance of carers.
In fact, a distribution of causes of death can be
established on the basis of ‘‘social autopsies’’ taken nutrition and population) sourcebook of the World Bank
from mothers whose children have recently died. includes the more distal role of government policies
One study in the periurban area of El Alto, near La and actions (Fig. 2). The Mosley–Chen framework
Paz, the Republic of Bolivia, where childhood included both social and biological variables. It
mortality was high, found that considerably more assumed that all influences on childhood mortality
than half of the deaths could be ascribed to at the individual, household, and community levels
inadequate knowledge or incorrect behaviour, or operate through a set of common mechanisms, such
both, occurring in the household or community. as maternal factors, environmental contamination,
Findings such as these support the notion that further nutrient deficiency, injury, and control over personal
progress in child survival can only be made by making illness; these were the more proximate determinants.
greater investments in communities and families. In the revised framework, the links between policy
A recent adaptation of the strategic framework formulation and health outcomes have been made
first presented by Mosley & Chen in 1984 adds an more explicit. The revised framework includes health
additional dimension to the Pathway for Survival systems interventions and the promotion of appro-
model (32). In addition to showing the relation priate household and community behaviours as
between the health system and the household and essential intermediate steps between policy and
community, the recent Poverty reduction strategy (health, outcome. It recognizes that integrated packages of
1240 Bulletin of the World Health Organization, 2000, 78 (10)
8. The evolution of child health programmes in developing countries
Bulletin of the World Health Organization, 2000, 78 (10) 1241
9. Special Theme — Child Mortality
interventions, such as the Integrated Management of for a new generation), takes into account four basic
Childhood Illness, the Integrated Management of principles: that health interventions have a cumulative
Pregnancy and Childbirth, school health pro- impact — the costs and benefits of interventions later
grammes, nutritional interventions, and control of in life are partially dependent upon those that occurred
both communicable diseases (such as HIV/AIDS, earlier; that sustaining improved outcomes at any stage
tuberculosis, and malaria) and noncommunicable of the life cycle depends on interventions occurring
diseases, constitute one set of influences on house- during several stages; that interventions in one
hold behaviours. Yet policies that determine the generation can influence outcomes in later genera-
availability of health services and the financing of tions; and that clearly identifying the different stages of
those services and others — such as food supply, the life cycle facilitates the identification of risks for
water, sanitation, and other related commodities and both individuals and families.
services — are equally important. Finally, it explicitly Identifying the major risks to good health at
recognizes that what happens in the household and each stage of the life cycle allows appropriate
community is the most proximate determinant of interventions to be selected. These interventions
favourable health outcomes (33). could be implemented either exclusively within the
Implicit in this approach to achieving good health sector or, consistent with the modified
health outcomes is the recognition that childhood Mosley–Chen framework, through other mechan-
mortality, for example, does not depend only on isms for influencing household behaviours (34). The
interventions in childhood. The health of mothers notion that interventions throughout the life cycle
and fathers, siblings, grandparents, and other house- must be implemented to achieve the maximum
hold members also influences the health of children. reduction of deaths occurring in childhood will
Similarly, interventions during childhood can have an hopefully promote collaboration within the health
important influence on health in adulthood. It is sector and between sectors and help ensure that
increasingly recognized that interventions in one available resources are used more efficiently and
generation can affect health outcomes in the next. effectively.
Ensuring adequate nutrition among girls during A discussion of current approaches to reducing
childhood and adolescence, for example, can reduce childhood mortality would not be complete without
the incidence of low birth-weight babies, an mentioning the legal dimensions of this effort. The
important risk factor for early mortality. Convention on the Rights of the Child, adopted by the
In order to account for these multiple and cross- General Assembly of the United Nations in 1989 and
cutting influences, and to organize them in a way that subsequently ratified by all but a small number of
can be easily translated into health programmes, the countries, explicitly recognizes a child’s right to health
World Bank and its partners have participated in the and health services. Article 24 of the convention
elaboration of a life cycle approach (Fig. 3). This obligates all ratifying parties to ‘‘pursue full imple-
framework, which includes interventions to be mentation of this right and, in particular, [to] take
implemented throughout life (and gives special appropriate measures...to diminish infant and child
consideration to the reproductive period for women, mortality.’’ Guidance regarding implementation and
which includes pregnancy and the start of a new cycle monitoring of the actions called for by the convention
has been developed and disseminated (35).
Conclusions
We have attempted to present briefly the traditions
from which child survival efforts have developed, a
concise description of some of the more prominent
current initiatives and a few of the ideas being
proposed for ensuring continued or resumed
progress towards reducing childhood mortality.
Although many of the technological tools necessary
to address the principal biomedical causes of child-
hood mortality in developing countries are available,
they have been used in a patchy and inequitable
fashion: access to health services and to these tools
has been restricted for large parts of the population in
many countries. It is increasingly recognized that the
health of children is integrally related to poverty, and
that there is a strong correlation between high
mortality and poverty.
Perinatal, neonatal, and early childhood mor-
tality have become relatively more important in areas
where reductions in mortality have already been
1242 Bulletin of the World Health Organization, 2000, 78 (10)
10. The evolution of child health programmes in developing countries
substantial. More effective technical interventions order for substantial new reductions in mortality to
and strategies for implementing them still need to be be made, disease-specific programmes and those that
developed for many of the potentially fatal conditions address the determinants of common causes of
that occur earlier in life. But technological advances mortality should be designed to complement each
notwithstanding, an increased emphasis on improv- other. Research into new technologies and into new
ing health behaviours in households and in commu- ways of influencing household behaviours should be
nities must occur if sustainable improvement in strongly and effectively managed, and solutions to
outcomes related to children’s health is to be problems of implementation should be disseminated,
achieved across all segments of society. Research, widely applied, and evaluated. Strategic approaches,
and especially social science research, can contribute such as the Pathway to Survival model, the modified
to the development of appropriate behavioural Mosley–Chen framework, and the life cycle ap-
interventions but only if the close collaboration proach, should be further developed to provide
between the research and the programmatic com- guidance to policy-makers, health service providers,
munities can be strengthened. and community leaders. These approaches that are
Poverty is an important contributing factor to more community-driven are necessary because the
childhood mortality, and economists and international pattern and trends of childhood mortality have
financial institutions are beginning to recognize that changed. Although impressive in some places, the
adverse health outcomes are an important contributor apparent reductions over the past 20 years sometimes
to poverty. Accordingly, it is important that strategies mask the fact that the rate of decline has stalled for
aimed at reducing poverty take into account the many people and especially for those who are poor.
determinants of poor health outcomes at all stages of Improving children’s survival is an unfinished task,
the life cycle. The formulation of policies and but by using innovative multisectoral approaches that
programmes that use a broad range of interventions recognize that health outcomes can be influenced in
implemented in an integrated manner can result both ways that have not yet been adequately explored, and
in improved health and improved standards of living. especially by moving the centre of attention from the
The future of child health programmes in health system to the household, additional gains can
developing countries depends upon bridging gaps. In be made rapidly and effectively. n
Resume
´ ´
L’evolution des programmes de sante infantile dans les pays en developpement :
´ ´ ´
on cesse de cibler les maladies pour cibler les gens
Au cours des 30 dernieres annees, les taux de mortalite
` ´ ´ subsaharienne et en Asie du Sud-Est, compromet
chez les nourrissons et les enfants ont baisse dans ´ serieusement la poursuite des progres.
´ `
presque tous les pays. En outre, le nombre de deces ´ ` Le present article examine les tendances observees
´ ´
d’enfants est passe d’environ 15 millions a environ
´ ` dans les programmes visant a promouvoir la sante des
` ´
11 millions, malgre une augmentation du nombre des
´ enfants au cours des dernieres decennies et avance des
` ´
naissances, une resistance croissante aux antibiotiques
´ propositions sur la meilleure facon de concevoir les
¸
et antipaludiques courants et la propagation – difficile a ` programmes futurs. Il passe en revue les differentes ´
enrayer – du syndrome d’immunodeficience acquise
´ approches adoptees dans le passe : les initiatives a court
´ ´ `
(SIDA) dans une grande partie du monde. Plusieurs terme et a objectifs etroits, dirigees contre des maladies
` ´ ´
maladies et problemes de sante, dont les infections
` ´ determinees, comme les premieres campagnes d’eradi-
´ ´ ` ´
respiratoires aigues, les maladies diarrheiques, le
¨ ´ cation du paludisme (un echec) et de la variole (un
´
paludisme, la rougeole et la malnutrition, ont toujours succes), et les strategies de grande envergure, axees sur
` ´ ´
ete les principales causes d’une mortalite infantile
´ ´ ´ le developpement a long terme et sur les communautes,
´ ` ´
elevee, bien qu’il existe contre chacun d’eux des
´ ´ comme les soins de sante primaires. Les programmes
´
interventions sans danger et efficaces. modernes d’eradication de maladies telles que la
´
Nul ne peut garantir que les progres continueront.
` poliomye lite et la dracunculose et les strate gies
´ ´
D’abord, les succes enregistres a ce jour n’ont pas ete
` ´ ` ´ ´ « selectives » de soins de sante primaires, comme le
´ ´
uniformes. Beaucoup de pays pauvres et de regions ´ programme de prise en charge integree des maladies de
´ ´
pauvres de nombreux pays n’ont pas obtenu les memes ˆ l’enfant, essaient de combiner des elements de chacune
´ ´
resultats que les pays prosperes. Ensuite, a mesure que
´ ` ` de ces demarches.
´
les taux de mortalite baissent, differentes affections
´ ´ Le role traditionnellement preponderant des
ˆ ´ ´
jouent un role plus determinant : les maladies peri-
ˆ ´ ´ programmes de sante infantile semble s’amenuiser. Cela
´
natales et neonatales, contre lesquelles des interventions
´ peut s’expliquer, entre autres, par le fait que le
appropriees pouvant etre appliquees sur une grande
´ ˆ ´ mouvement de reforme du secteur de la sante s’est
´ ´
echelle n’ont pas encore ete mises au point, sont
´ ´ ´ davantage preoccupe de considerations administratives
´ ´ ´
desormais la cause d’une proportion plus elevee de deces
´ ´ ´ ´ ` et financieres que des programmes techniques ou
`
chez les enfants de moins de cinq ans. Les questions ensembles de programmes. La de centralisation a ´
sexospecifiques doivent aussi etre abordees et la
´ ˆ ´ entraıˆne dans de nombreux pays une deterioration des
´ ´ ´
propagation continue du SIDA, notamment en Afrique fonctions d’appui aux systemes de sante, telles que la
` ´
Bulletin of the World Health Organization, 2000, 78 (10) 1243
11. Special Theme — Child Mortality
formation et l’encadrement du personnel et le suivi et Quatre modeles sont examines. Le guide de la
` ´
l’evaluation des programmes. Toutefois, les strategies
´ ´ survie et une adaptation du cadre de Mosley-Chen
techniques, comme celles qui sont appliquees dans le
´ illustrent la relation entre la communaute et le systeme
´ `
cadre des programmes de vaccination et des initiatives de sante, mais sous un angle different. La nouvelle
´ ´
de prise en charge des cas, continuent de s’affiner pour approche du cycle biologique decrit au moyen de
´
ameliorer la prestation des services, renforcer les
´ graphiques comment la sante de l’enfant depend des
´ ´
systemes de sante et, par-dessus tout, favoriser la
` ´ risques et des interventions sanitaires a des ages ` ˆ
participation communautaire. differents et des influences entre generations. Enfin, il
´ ´ ´
L’accent est mis de sormais sur la relation
´ est fait mention de la Convention relative aux droits de
bidirectionnelle entre la pauvrete et la sante. De grandes
´ ´ l’enfant, et notamment du droit a la sante et aux services
` ´
inegalites en matiere de sante existent entre riches et
´ ´ ` ´ de sante. ´
pauvres, entre pays, au sein des pays et au sein des Bien que l’on dispose dans une large mesure des
communaute s. A l’avenir, il peut e tre important
´ ˆ outils technologiques permettant de reduire davantage
´
d’accorder plus d’attention aux menages et aux familles
´ la mortalite infantile, les strategies de mise en œuvre
´ ´
dans lesquels, a cause de la pauvrete ou d’autres
` ´ doivent s’adapter au contexte local. La recherche en
facteurs, les enfants sont davantage exposes au risque de
´ sciences sociales, qui vise a trouver des moyens
`
mourir. Le message essentiel contenu dans cet article est d’atteindre les communautes et les familles a haut
´ `
que la reduction de la mortalite infanto-juvenile pourrait
´ ´ ´ risque, en particulier celles dont l’acces aux services de
`
bien dependre davantage de ce qui se passe dans les
´ sante est entrave par la pauvrete, devient de plus en plus
´ ´ ´
communautes et les menages que de ce qui se passe a
´ ´ ` importante.
l’interieur d’un systeme de sante.
´ ` ´
Resumen
La evolucion de los programas de salud infantil en los paıses en desarrollo: el punto
´ ´
de mira se desplaza de las enfermedades a las personas
Durante los 30 ultimos anos, las tasas de mortalidad de
´ ˜ pasado, a saber: iniciativas a corto plazo y con objetivos
lactantes y ninos han disminuido en casi todos los paı´ses.
˜ muy concretos contra enfermedades especı´ficas, como
Ademas, el numero de defunciones infantiles ha
´ ´ las primeras iniciativas de erradicacion del paludismo (un
´
descendido de unos 15 millones a cerca de 11 millones fracaso) y de la viruela (un exito), y estrategias amplias, a
´
a pesar del aumento del numero de nacimientos, de
´ largo plazo, de desarrollo, orientadas hacia la comuni-
la resistencia creciente a antibioticos y antipaludicos
´ ´ dad, como la de atencion primaria de salud. Los
´
comunes y de la propagacion relativamente incontrolada
´ programas modernos de erradicacion de enfermedades
´
del SIDA en gran parte del mundo. Un numero limitado
´ como la poliomielitis y la dracunculosis y las estrategias
de afecciones medicas, como las infecciones respiratorias
´ «selectivas» de atencion primaria, como la de lucha
´
agudas, las enfermedades diarreicas, el paludismo, el integrada contra las enfermedades de la infancia, tratan
sarampion y la malnutricion, han constituido sistemati-
´ ´ ´ de combinar diversos elementos de cada uno de esos
camente las principales causas de mortalidad infantil enfoques.
pese a que existen intervenciones seguras y eficaces La importante funcion que han desempenado
´ ˜
contra cada una de ellas. tradicionalmente los programas de salud infantil parece
El progreso continuo no esta asegurado. Primero,
´ estar disminuyendo. Una de las razones podrı´a ser que el
hasta la fecha el exito no ha sido uniforme. Muchos
´ impulso hacia la reforma del sector de la salud se ha
paı´ses pobres, y zonas pobres de muchos paı´ses, no han centrado mas en consideraciones administrativas y
´
conseguido resultados tan buenos como los mas ricos.
´ financieras que en programas o conjuntos de programas
Ademas, a medida que disminuyen las tasas de
´ tecnicos. La descentralizacion ha dado lugar en muchos
´ ´
mortalidad, otras afecciones adquieren mas importancia;
´ paı´ses a un deterioro de las funciones de apoyo a los
la mortalidad perinatal y neonatal, para la cual todavı´a sistemas, como la capacitacion, la supervision y la
´ ´
no se han desarrollado intervenciones que puedan vigilancia y la evaluacion de los programas. Sin embargo,
´
implantarse de forma generalizada, contribuye aun mas
´ ´ las estrategias tecnicas, como las de los programas de
´
que antes al numero de defunciones de menores de
´ vacunacion y las iniciativas de gestion de casos, siguen
´ ´
5 anos. Tambien es necesario abordar las cuestiones
˜ ´ evolucionando para mejorar la prestacion de servicios,
´
relacionadas con la paridad entre los sexos, y la fortalecer los sistemas de salud y, lo que es mas ´
propagacio n continua del sı´ ndrome de inmuno-
´ importante, promover la participacion comunitaria.
´
deficiencia adquirida (SIDA), especialmente en el Africa´ Se destaca la relacionbidireccional entre la pobreza y
´
subsahariana y en Asia Sudoriental, amenaza seriamente la salud. Existen grandes desigualdades de salud entre ricos
la continuidad de los progresos. y pobres, entre los paı´ses, dentro de los paı´ses y dentro de
En este artı´culo se examinan las tendencias de los las comunidades. En el futuro quiza sea importante dirigir
´
programas de promocion de la salud de los ninos en los
´ ˜ los esfuerzos hacia los hogares y familias en los que, debido
ultimos decenios y se formulan sugerencias sobre la
´ a la pobreza u otros factores, los ninos corren mayor peligro
˜
mejor manera de disenar programas en el futuro. Se
˜ de morir. El mensaje clave de este artı´culo es que los futuros
analizan los diferentes enfoques adoptados en el avances en la reduccion de la mortalidad de lactantes y
´
1244 Bulletin of the World Health Organization, 2000, 78 (10)
12. The evolution of child health programmes in developing countries
ninos bien pueden depender de lo que suceda en las
˜ la Convencion sobre los Derechos del Nino, que reconoce
´ ˜
comunidades y los hogares, y no tanto de lo que suceda en el derecho a la salud y a servicios de salud.
el sistema de salud. Aunque en gran medida se dispone de herra-
Se examinan cuatro modelos. El modelo «La Vı´a mientas tecnologicas para seguir reduciendo la morta-
´
de la Supervivencia» y una adaptacion del marco de
´ lidad infantil, es necesario adaptar las estrategias de
Mosley-Chen muestran la relacion entre la comunidad y
´ aplicacion a los contextos locales. Las investigaciones
´
el sistema de salud, pero de forma diferente. El nuevo sociologicas encaminadas a identificar maneras de llegar
´
enfoque del ciclo de vida ilustra graficamente la manera
´ a las comunidades y familias de alto riesgo, especial-
en que la salud de los ninos depende de los riesgos e
˜ mente aquellas cuyo acceso a los servicios de salud se
intervenciones sanitarios a distintas edades y de halla limitado por la pobreza, estan cobrando una
´
influencias intergeneracionales. Por ultimo se menciona
´ importancia creciente.
References
1. UNICEF. The state of the world’s children report 2000. New York, 18. Cutts FT, Henao-Restrepo A, Olive JM. Measles elimination:
UNICEF, 2000: 83. progress and challenges. Vaccine, 1999, 17: 47–52.
2. Tulloch J. Integrated approach to child health in developing 19. Vaccine preventable diseases monitoring system, global summary,
countries. Lancet, 1999, 354: 16–20. 1999. Geneva, World Health Organization, 1999.
3. Kurz KM, Johnson-Welch C. Gender bias in health care among 20. UNICEF. The state of the world’s children report 2000. New York,
children 0–5 years: opportunities for child survival programs. UNICEF, 2000: 92–95.
Arlington, VA, United States Agency for International 21. The Global Alliance for Vaccines and Immunization.
Development, the BASICS Project, 1997. A partnership for child health (available on the Internet at
4. Claeson M et al. Reducing child mortality in India in the new http://www.vaccinealliance.org).
millennium, Bulletin of the World Health Organization, 2000, 22. Pelletier DL et al. The effects of malnutrition on child mortality
78: 1192–1199. in developing countries. Bulletin of the World Health Organization,
5. Newell KW. Selective primary health care: the counter revolution. 1995, 73: 443–448.
Social Science and Medicine, 1988, 26: 903–906. 23. Narayan et al. Voices of the poor: can anyone hear us?
6. Aylward RB et al. Disease eradication initiatives and general New York, Oxford University Press for the World Bank, 2000.
health services: ensuring common principles lead to mutual 24. Ettling M et al. Economic impact of malaria in Malawian
benefits. In: Dowdle WR, Hopkins DR, eds. The eradication households. Tropical Medicine and Parasitology, 1994,
of infectious diseases. Chichester, UK, John Wiley, 1998: 61–74. 45: 74–79.
7. Walsh JA, Warren KS. Selective primary health care: an interim 25. Bloom DE, Sachs JD. Geography, demography and economic
strategy for disease control in developing countries. New England growth in Africa. Brookings Papers on Economic Activity, 1998,
Journal of Medicine, 1979, 301: 967–974. 2: 207–295.
8. The evolution of diarrhoeal and acute respiratory disease control 26. Levin H. A benefit–cost analysis of nutritional programs
at WHO. Geneva, World Health Organization, Department for anemia reduction. World Bank Research Observer, 1986,
of Child and Adolescent Health and Development, 1999 1: 219–246.
(WHO/CHS/CAH/99.12). 27. McGuire JS, Austin JA. Beyond survival: children’s growth
9. Feachem RG. Preventing diarrhoea: what are the policy for national development. New York, UNICEF, 1987.
options. Health Policy and Planning, 1986, 1: 109–117. 28. Feacham R, Koblinsky M. Interventions for the control of
10. Kirkwood BR. Potential interventions for the prevention diarrhoeal disease among young children: promotion of breast-
of childhood pneumonia in developing countries: a systematic feeding. Bulletin of the World Health Organization, 1984,
review. Bulletin of the World Health Organization, 1995, 62: 271–291.
73: 793–798. 29. Bleichrodt N, Born MP. A meta-analysis of research on iodine
11. Murray J et al. Emphasis behaviors in maternal and child health: and its relationship to cognitive development. In: Stanbury JB, ed.
focusing on caretaker behaviors to develop maternal and child The damaged brain of iodine deficiency: cognitive, behavioural,
health programs in communities. Arlington, VA, United States neuromotor and educative aspects. New York, Cognizant
Agency for International Development, the BASICS Project, 1997. Communication, 1994: 195–200.
12. Reich MR. The politics of agenda setting in international health: 30. Walter TI et al. Iron deficiency anemia: adverse effects on infant
child health versus adult health in developing countries. Journal psychomotor development. Pediatrics, 1989, 8491: 7–17.
of International Development, 1995, 7: 489–502. 31. Waldman RJ et al. Overcoming remaining barriers: the pathway
13. World development report 1993 — Investing in health. to child survival. Arlington, VA, United States Agency for
Washington, DC, Oxford University Press for the World Bank, International Development, the BASICS Project, 1996.
1993. 32. Mosley WH, Chen LC, eds. Child survival: strategies for research.
14. Feachem RGA, Phillips MA, Bulatao RA. Introducing adult New York, Population Council, 1984 (Population and Develop-
health. In: Feachem RGA et al, eds. The health of adults in ment Review, supplement vol. 10).
the developing world. Washington, DC, The World Bank, 1992. 33. Health, nutrition, and population sourcebook for the poverty
15. Gwatkin DR, Guilot M. The burden of disease among the global reduction strategy paper. Washington, DC, Health Nutrition, and
poor: current situation, future trends, and implications for strategy. Population Division, The World Bank, 2000.
Washington, DC, Human Development Network/Health, 34. Simon J, Rosen S. The family health cycle: creating a context
Nutrition, and Population, The World Bank, 2000. for maternal and child health (MCH) interventions. Paper
16. Global eradication of poliomyelitis by the year 2000. Resolution Presented at World Bank Human Development Learning Week,
WHA41.28, 41st World Health Assembly, May 1988. Handbook Washington, DC, 22 February 2000.
of Resolutions and Decisions, Vol.III, 2nd ed. Geneva, World 35. Hodgkin R, Newell P, eds. Implementation handbook for
Health Organization, 1990: 55–56. the convention on the rights of the child. New York, UNICEF,
17. Omer MI. Measles: a disease that has to be eradicated. Annals 1998: 315–340.
of Tropical Paediatrics, 1999, 19: 125–134.
Bulletin of the World Health Organization, 2000, 78 (10) 1245