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Professional care delivery or traditional birth attendants? The impact of the type of care utilized by mothers on under-five mortality of their children.
Tropical Medicine and Health. 2018; 46(1)Background: Because of the high under-five mortality rate, the government in Zambia has adopted the World Health Organization (WHO) policy on child delivery which insists on professional maternal care. However, there are scholars who criticize this policy by arguing that although built on good intentions, the policy to ban traditional birth attendants (TBAs) is out of touch with local reality in Zambia. There is lack of evidence to legitimize either of the two positions, nor how the outcome differs between women with HIV and those without HIV. Thus, the aim of this paper is to investigate the effect of using professional maternal care or TBA care by mothers (during antenatal, delivery, and postnatal) on under-five mortality of their children. We also compare these outcomes between HIV-positive and HIV-negative women. Methods: By relying on data from the 2013-2014 Zambia Demographic Health Survey (ZDHS), we carried out propensity score matching (PSM) to investigate the effect of utilization of professional care or TBA during antenatal, childbirth, and postnatal on under-five mortality. This method allows us to estimate the average treatment effect on the treated (ATT). Results: Our results show that the use of professional care as opposed to TBAs in all three stages of maternal care increases the probability of children surviving beyond 5 years old. Specifically for women with HIV, professional care usage during antenatal, at birth, and during postnatal periods increases probability of survival by 0.07 percentage points (p.p), 0.71 p.p, and 0.87 p.p respectively. Similarly, for HIV-negative women, professional care usage during antenatal, at birth, and during postnatal periods increases probability of survival by 0.71 p.p, 0.52 p.p, and 0.37 p.p respectively. However, although there is a positive impact when mothers choose professional care over TBAs, the differences at all three points of maternal care are small. Conclusion: Given our findings, showing small differences in under-five child's mortality between utilizers of professional care and utilizers of TBAs, it may be questioned whether the government's intention of completely excluding TBAs (who despite being outlawed are still being used) without replacement by good quality professional care is the right decision. © 2018 The Author(s).
Geneva, Switzerland, WHO, 2017. 184 p. (Interactive Visualization of Health Data)In order to reduce health inequalities and identify priority areas for action to move towards universal health coverage, governments first need to understand the magnitude and scope of inequality in their countries. From April 2016 to October 2017, the Indonesian Ministry of Health, WHO, and a network of stakeholders assessed country-wide health inequalities in 11 areas, such as maternal and child health, immunization coverage and availability of health facilities. A key output of the monitoring work is a new report called State of health inequality: Indonesia, the first WHO report to provide a comprehensive assessment of health inequalities in a Member State. The report summarizes data from more than 50 health indicators and disaggregates it by dimensions of inequality, such as household economic status, education level, place of residence, age or sex. This report showcases the state of inequality in Indonesia, drawing from the latest available data across 11 health topics (53 health indicators), and eight dimensions of inequality. In addition to quantifying the magnitude of health inequality, the report provides background information for each health topic, and discusses priority areas for action and policy implications of the findings. Indicator profiles illustrate disaggregated data by all applicable dimensions of inequality, and electronic data visuals facilitate interactive exploration of the data. This report was prepared as part of a capacity-building process, which brought together a diverse network of stakeholders committed to strengthening health inequality monitoring in Indonesia. The report aims to raise awareness about health inequalities in Indonesia, and encourage action across sectors. The report finds that the state of health and access to health services varies throughout Indonesia and identifies a number of areas where action needs to be taken. These include, amongst others: improving exclusive breastfeeding and childhood nutrition; increasing equity in antenatal care coverage and births attended by skilled health personnel; reducing high rates of smoking among males; providing mental health treatment and services across income levels; and reducing inequalities in access to improved water and sanitation. In addition, the availability of health personnel, especially dentists and midwives, is insufficient in many of the country’s health centres. Now the country is using these findings to work across sectors to develop specific policy recommendations and programmes, such as the mobile health initiative in Senen, to tackle the inequalities that have been identified.
New York, New York, UNICEF, 2017 Jul. 32 p.This report provides compelling new evidence that backs up an unconventional prediction UNICEF made in 2010: The higher cost of reaching the poorest children with life-saving, high-impact health interventions would be outweighed by greater results. This new study combines modelling and data from 51 countries. The results indicate that the number of lives saved by investing in the most deprived is almost twice as high as the number saved by equivalent investment in less deprived groups.
Geneva, Switzerland, WHO, 2015. 124 p.The report delivers both promising and disappointing messages about the situation in low- and middle-income countries. Within-country inequalities have narrowed, with a tendency for national improvements driven by faster improvements in disadvantaged subgroups. However, inequalities still persist in most reproductive, maternal, newborn and child health indicators. The extent of within-country inequality differed by dimension of inequality and by country, country income group and geographical region. There is still much progress to be made in reducing inequalities in RMNCH.
Geneva, Switzerland, WHO, 2017. 164 p.In 2015, 26% of the deaths of 5.9 million children who died before reaching their fifth birthday could have been prevented through addressing environmental risks – a shocking missed opportunity. The prenatal and early childhood period represents a window of particular vulnerability, where environmental hazards can lead to premature birth and other complications, and increase lifelong disease risk including for respiratory disorders, cardiovascular disease and cancers. The environment thus represents a major factor in children’s health, as well as a major opportunity for improvement, with effects seen in every region of the world. Children are at the heart of the Sustainable Development Goals, because it is children who will inherit the legacy of policies and actions taken, and not taken, by leaders today. The third SDG, to “ensure healthy lives and promote well-being for all at all ages,” has its foundation in children’s environmental health, and it is incumbent on us to provide a healthy start to our children’s lives. This cannot be achieved, however, without multisectoral cooperation, as seen in the linkages between environmental health risks to children and the other SDGs. This publication is divided by target: SDGs 1, 2 and 10 address equity and nutrition; SDG 6 focuses on water, sanitation and hygiene (WASH); SDGs 7 and 13 call attention to energy, air pollution and climate change; SDGs 3, 6 and 12 look at chemical exposures; and SDGs 8, 9 and 11 study infrastructure and settings.
Addressing the Child and Maternal Mortality Crisis in Haiti through a Central Referral Hospital Providing Countrywide Care.
Permanente Journal. 2016 spring; 20(2):59-70.The neonatal, infant, child, and maternal mortality rates in Haiti are the highest in the Western Hemisphere, with rates similar to those found in Afghanistan and several African countries. We identify several factors that have perpetuated this health care crisis and summarize the literature highlighting the most cost-effective, evidence-based interventions proved to decrease these mortality rates in low- and middle-income countries.To create a major change in Haiti's health care infrastructure, we are implementing two strategies that are unique for low-income countries: development of a countrywide network of geographic "community care grids" to facilitate implementation of frontline interventions, and the construction of a centrally located referral and teaching hospital to provide specialty care for communities throughout the country. This hospital strategy will leverage the proximity of Haiti to North America by mobilizing large numbers of North American medical volunteers to provide one-on-one mentoring for the Haitian medical staff. The first phase of this strategy will address the child and maternal health crisis.We have begun implementation of these evidence-based strategies that we believe will fast-track improvement in the child and maternal mortality rates throughout the country. We anticipate that, as we partner with private and public groups already working in Haiti, one day Haiti's health care system will be among the leaders in that region.
2016 Nov; New York, New York, UNICEF, 2016 Nov. 77 p.Pneumonia and diarrhoea are responsible for the unnecessary loss of 1.4 million children each year. This report highlights current pneumonia and diarrhoea related mortality, and illustrates the startling divide between the children being reached and the considerable number of those left behind. By developing key protective, preventative and treatment interventions, collectively we are now equipped with the knowledge and the tools required to preventing child deaths due to these leading childhood killers. The report also provides recommendations to further accelerate progress in effective interventions and bridge the greatest gaps in equity.
2016 Oct; New York, New York, UNICEF, 2016 Oct. 100 p.This report looks at how children, particularly the most disadvantaged, are affected by air pollution. It points out that around 300 million children live in areas where the air is toxic – exceeding international limits by at least six times – and that children are uniquely vulnerable to air pollution, breathing faster than adults on average and taking in more air relative to their body weight. The report also notes that air pollution is a major contributing factor in the deaths of around 600,000 children under age 5 every year and threatens the health, lives and futures of millions more. It concludes with a set of concrete steps to take so that children can breathe clean, safe air.
[Washington, D.C.], World Bank, 2012 Jun. 4 p. (en breve No. 177)The Latin America and Caribbean (LAC) region fares well on achievement of the MDG targets when compared with other regions, but the region has great disparities between and within countries on these goals. The region is also performing better than the rest of the developing world in relation to child mortality, having achieved more than 70% of the progress needed to reduce under-five mortality by two-thirds. However, LAC still faces serious challenges regarding maternal mortality, achieving good public and individual health and alleviating poverty. For LAC, the MDGs are a historic opportunity to address all forms of inequality and attain the political will needed to achieve these goals. (excerpt)
Maintaining momentum to 2015? an impact evaluation of interventions to improve maternal and child health and nutrition in Bangladesh.
Washington, D.C., World Bank, 2005 Aug.  p. (World Bank Report No. 34462)Improving maternal and child health and nutrition is central to development goals. The importance of these objectives is reflected by their inclusion in poverty-reduction targets such as the Millennium Development Goals (MDGs) and Bangladesh’s Interim Poverty Reduction Strategy Paper, supported by major development partners, including the World Bank and the U.K. Department for International Development (DFID). This report addresses the issue of what publicly supported programs and external assistance from the Bank and other agencies can do to accelerate attainment of such targets as reducing infant mortality by two-thirds. The evidence presented here relates to Bangladesh, a country that has made spectacular progress, but needs to maintain momentum in order to achieve its own poverty-reduction goals. The report addresses the following issues: (1) What has happened to child health and nutrition outcomes and fertility in Bangladesh since 1990? Are the poor sharing in the progress being made? (2) What have been the main determinants of maternal and child health (MCH) outcomes in Bangladesh over this period? (3) Given these determinants, what can be said about the impact of publicly and externally supported programs—notably those of the World Bank and DFID—to improve health and nutrition? (4) To the extent that interventions have brought about positive impacts, have they done so in a cost-effective manner? (excerpt)
New York, New York, UNICEF, 2016 Jun.  p.Every child has the right to health, education and protection, and every society has a stake in expanding children’s opportunities in life. Yet, around the world, millions of children are denied a fair chance for no reason other than the country, gender or circumstances into which they are born. The State of the World’s Children 2016 argues that progress for the most disadvantaged children is not only a moral, but also a strategic imperative. Stakeholders have a clear choice to make: invest in accelerated progress for the children being left behind, or face the consequences of a far more divided world by 2030. At the start of a new development agenda, the report concludes with a set of recommendations to help chart the course towards a more equitable world.
Levels and trends in child mortality. Estimates developed by the UN Inter-agency Group for Child Mortality Estimation (IGME). Report 2015.
New York, New York, United Nations Children's Fund [UNICEF], 2015. 36 p.Child mortality is a core indicator for child health and well-being. In 2000, world leaders agreed on the Millennium Development Goals (MDGs) and called for reducing the under-five mortality rate by two thirds between 1990 and 2015 - known as the MDG 4 target. In recent years, the Global Strategy for Women's and Children’s Health launched by United Nations Secretary- General Ban Ki-moon and the Every WomanEvery Child movement boosted global momentum in improving newborn and child survival as well as maternal health. In June 2012, world leaders renewed their commitment during the global launch of Committing to Child Survival: A Promise Renewed, aiming for a continued post-2015 focus to end preventable child deaths. With the end of the MDG era, the international community is in the process of agreeing on a new framework - the Sustainable Development Goals (SDGs). The proposed SDG target for child mortality represents a renewed commitment to the world's children: By 2030, end preventable deathsof newborns and children under five years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 deaths per 1,000 live births and under-five mortality to at least as low as 25 deaths per 1,000 live births.
Delivering the Millennium Development Goals to reduce maternal and child mortality: a systematic review of impact evaluation evidence.
[Washington, D.C.], World Bank, Independent Evaluation Group, .  p.Interventions that may improve maternal and child health are numerous and spread across many development sectors. Even when such interventions are known to be effective in controlled conditions, however, questions remain about implementation, delivery, and uptake. This review gathers impact evaluation evidence of fielded interventions that aim to improve skilled birth attendance and reduce maternal and child mortality rates. To aid policy makers, it reviews effectiveness evidence from multiple sectors on the distal causes of maternal and child mortality, complementing the body of effectiveness evidence from reviews specific to the health sector (such as the Lancet series on maternal and child health) that focus on proximate interventions for intermediate outcomes. This systematic review by the Independent Evaluation Group (IEG) is a learning exercise that looks beyond World Bank experience. In doing so, it draws on impact evaluations other than those conducted by the Bank or on Bank projects. It is intended to be used as a reference for practitioners in the Bank and elsewhere with an interest in interventions that have demonstrated attributable improvements in skilled birth attendance and reductions in maternal and child mortality. This review also identifies important gaps in the impact evaluation evidence for interventions that may be effective in reducing maternal and child mortality but whose impacts have not yet been tested using robust impact evaluation methods. (Excerpt)
Levels and trends in child mortality. Report 2015. Estimates developed by the UN Inter-agency Group for Child Mortality Estimation.
New York, New York, UNICEF, 2015 Sep. 36 p.New estimates in Levels and Trends in Child Mortality Report 2015 released by the UN Inter-agency Group for Child Mortality Estimation (UN IGME) indicate that although the global progress has been substantial, 16,000 children under five still die every day. And the 53 per cent drop in child mortality is not enough to meet the Millennium Development Goal of a two-thirds reduction between 1990 and 2015. Between 1990 and 2015, 62 of the 195 countries with available estimates met the Millennium Development Goal (MDG) 4 target of a two-thirds reduction in the under-five mortality rate between 1990 and 2015. Among them, 24 are low- and lower-middle income countries. The remarkable decline in under-five mortality since 2000 has saved the lives of 48 million children under age five -- children who would not have survived to see their fifth birthday if the under-five mortality rate from 2000 onward remained at the same level as in 2000. Most child deaths are caused by diseases that are readily preventable or treatable with proven, cost-effective and quality-delivered interventions. Infectious diseases and neonatal complications are responsible for the vast majority of under-five deaths globally. An acceleration of the pace of progress is urgently required to achieve the Sustainable Development Goal (SDG) target on child survival, particularly in high mortality countries in sub-Saharan Africa. This new report is accompanied by a Lancet paper available online (Global, regional, and national levels and trends in under-5 mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Inter-agency Group for Child Mortality Estimation).
New York, New York, UNICEF, 2015.  p.This report from A Promise Renewed – a global partnership initiative aimed at ending preventable child and maternal deaths – features updates and analyses of global, regional and national child mortality levels and trends. It also provides current information on causes of child and maternal deaths, and coverage of key interventions to prevent them, as well as projections for the 2015-2030 period. The report highlights impressive progress towards our commitment to increase child survival during the Millennium Development Goals era, which has saved the lives of some 48 million children under the age of 5 since 2000. Finally, it calls for intensified action in the context of the Sustainable Development Goals.
Monitoring health inequality: an essential step for achieving health equity. Illustrations of fundamental concepts.
Geneva, Switzerland, WHO, 2014.  p. (WHO/FWC/GER/2014.1)This booklet communicates fundamental concepts about the importance of health inequality monitoring, using text, figures, maps and videos. Following a brief summary of main messages, four general principles pertaining to health inequalities are highlighted: 1. Health inequalities are widespread; 2. Health inequality is multidimensional; 3. Benchmarking puts changes in inequality in context; and 4.Health inequalities inform policy. Each of the four principles is accompanied by figures or maps that illustrate the concept, a question that is posed as an extension and application of the material, and a link to a video, demonstrating the use of interactive visuals to answer the question. The videos are accessible online by scanning a QR code (a URL is also provided). The next section of the booklet outlines essential steps forward for achieving health equity, including the strengthening and equity orientation of health information systems through data collection, data analysis and reporting practices. The use of visualization technologies as a tool to present data about health inequality is promoted, accompanied by a link to a video demonstrating how health inequality data can be presented interactively. Finally, the booklet announces the upcoming State of inequality report, and refers readers to the Health Equity Monitor homepage on the WHO Global Health Observatory.
The African Development Bank, structural adjustment, and child mortality: a cross-national analysis of Sub-Saharan Africa.
International Journal of Health Services. 2013; 43(2):337-61.We conduct a cross-national analysis to test the hypothesis that African Development Bank (AfDB) structural adjustment adversely impacts child mortality in Sub-Saharan Africa. We use generalized least square random effects regression models and two-step Heckman models that correct for selection bias using data on 35 nations with up to four time points (1990, 1995, 2000, and 2005). We find substantial support for our hypothesis, which indicates that Sub-Saharan African nations that receive an AfDB structural adjustment loan tend to have higher levels of child mortality than Sub-Saharan African nations that do not receive such a loan. This finding remains stable even when controlling for selection bias on whether or not a Sub-Saharan African nation receives an AfDB structural adjustment loan. We conclude by discussing the methodological implications of the article, policy suggestions, and possible directions for future research.
New York, New York, UNICEF, 2013 Sep.  p.Despite rapid progress in reducing child deaths since 1990, the world is still failing to renew the promise of survival for its most vulnerable citizens. Without faster progress on reducing preventable diseases, the world will not meet its child survival goal (MDG 4) until 2028 -- 13 years after the deadline -- and 35 million children will die between 2015 and 2028 who would otherwise have lived had we met the goal on time. Of the 6.6 million under-five deaths in 2012, most were from preventable causes such as pneumonia, diarrhoea or malaria; around 44% of deaths in children under 5 occurred during the neonatal period. Accelerating progress in child survival urgently requires greater attention to ending preventable child deaths in sub-Saharan Africa and South Asia, which together account for 4 out of 5 under-five deaths globally. West and Central Africa in particular requires a special focus for child survival, as it is lagging behind all other regions, including Eastern and Southern Africa, and has seen virtually no reduction in its annual number of child deaths since 1990.The good news is that much faster progress is possible. Country experience shows that sharp reductions in preventable child deaths are possible at all levels of national income and in all regions. A Promise Renewed is a movement based on shared responsibility for child survival, and is mobilizing and bringing together governments, civil society, the private sector and individuals in the cause of ending preventable child deaths within a generation. (Excerpts)
Releve Epidemiologique Hebdomadaire. 2013 Apr 26; 88(17):173-80.Add to my documents.
BMJ. British Medical Journal. 2012; 345:e6229.New figures show that the number of children dying before the age of five has significantly fallen since 2000, but this progress needs to accelerate if the United Nationsâ€™ millennium development goal of reducing child mortality is to be reached. A report released by the UNâ€™s Childrenâ€™s Fund (Unicef), the World Health Organization, the World Bank and the UN Population Division provides statistical analyses of annual child mortality and its global concentrations; the highest rates of child mortality are still in sub-Saharan Africa. The report warns that securing accurate estimates of child mortality is a considerable challenge because many developing countries lack a registration system. It also warns that the decline in neonatal mortality rates has been slower than the decline in mortality rates among children overall.
The Millennium Development Goals and the road to 2015: Building on progress and responding to crisis.
Washington, D.C., World Bank, 2010.  p.The Millennium Development Goals provide a multidimensional framework for attacking poverty in a world of multipolar growth. By focusing on measurable results, they provide a scorecard for assessing progress toward mutually agreed targets. And by enlisting the support of national governments, international agencies, and civil society in a development partnership, they have brought greater coherence to the global development effort. In this way they take us beyond the old, sterile opposition of “developed” and “developing” or “north” and “south.” The evidence from the last 20 years, documented in the statistical record of the MDGs, is that where conditions and policies are right for growth with equity, rapid and sustainable progress toward improving the lives of the poorest people can take place. Not every country will achieve the global MDG targets in the time allowed. Success has not been distributed evenly and there have been serious setbacks. Some countries are still burdened by legacies of bad policies, institutional failures, and civil and international conflict. For them, progress toward the MDGs has been delayed, but the examples of good progress by others point the way for their eventual success.
New York, New York, UNICEF, 2012.  p.Across the world, the number of deaths among children under 5 has been on a continuous decline for over two decades, says the 2012 Progress Report on Committing to Child Survival: A Promise Renewed. Data released today by UNICEF and the United Nations Inter-agency Group for Child Mortality Estimation show that the number of children under the age of 5 dying globally has dropped from nearly 12 million in 1990 to an estimated 6.9 million in 2011. The report combines mortality estimates with insights into the top killers of children under 5 and the high-impact strategies that are needed to accelerate progress. The report shows that all regions of the world have seen a marked decline in under-5 mortality since 1990. Neither a country’s regional affiliation nor economic status need be a barrier to reducing child deaths; low-, medium- and high- income countries all have made tremendous progress in lowering their under-5 mortality rates. But under-5 deaths are increasingly concentrated in sub-Saharan Africa and South Asia. One in every nine children in sub-Saharan Africa dies before reaching the age of 5. And progress in lowering child mortality rates lags behind among disadvantaged and marginalized people, around the world. Undernutrition is a factor in one third of all under-5 child deaths. If disease and undernutrition are to be tackled successfully, broader issues such as water supply, sanitation and hygiene and education will also have to be addressed. The report provides further impetus for a renewed global movement to end preventable child deaths.
Child mortality estimation: Methods used to adjust for bias due to AIDS in estimating trends in under-five mortality.
PLOS Medicine. 2012 Aug; 9(8):e1001298.In most low- and middle-income countries, child mortality is estimated from data provided by mothers concerning the survival of their children using methods that assume no correlation between the mortality risks of the mothers and those of their children. This assumption is not valid for populations with generalized HIV epidemics, however, and in this review, we show how the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) uses a cohort component projection model to correct for AIDS-related biases in the data used to estimate trends in under-five mortality. In this model, births in a given year are identified as occurring to HIV-positive or HIV-negative mothers, the lives of the infants and mothers are projected forward using survivorship probabilities to estimate survivors at the time of a given survey, and the extent to which excess mortality of children goes unreported because of the deaths of HIV-infected mothers prior to the survey is calculated. Estimates from the survey for past periods can then be adjusted for the estimated bias. The extent of the AIDS-related bias depends crucially on the dynamics of the HIV epidemic, on the length of time before the survey that the estimates are made for, and on the underlying non-AIDS child mortality. This simple methodology (which does not take into account the use of effective antiretroviral interventions) gives results qualitatively similar to those of other studies.
PLOS Medicine. 2012 Aug; 9(8):e1001303.Monitoring development indicators has become a central interest of international agencies and countries for tracking progress towards the Millennium Development Goals. In this review, which also provides an introduction to a collection of articles, we describe the methodology used by the United Nations Inter-agency Group for Child Mortality Estimation to track country-specific changes in the key indicator for Millennium Development Goal 4 (MDG 4), the decline of the underfive mortality rate (the probability of dying between birth and age five, also denoted in the literature as U5MR and 5q0). We review how relevant data from civil registration, sample registration, population censuses, and household surveys are compiled and assessed for United Nations member states, and how time series regression models are fitted to all points of acceptable quality to establish the trends in U5MR from which infant and neonatal mortality rates are generally derived. The application of this methodology indicates that, between 1990 and 2010, the global U5MR fell from 88 to 57 deaths per 1,000 live births, and the annual number of under-five deaths fell from 12.0 to 7.6 million. Although the annual rate of reduction in the U5MR accelerated from 1.9% for the period 1990-2000 to 2.5% for the period 2000-2010, it remains well below the 4.4% annual rate of reduction required to achieve the MDG 4 goal of a two-thirds reduction in U5MR from its 1990 value by 2015. Thus, despite progress in reducing child mortality worldwide, and an encouraging increase in the pace of decline over the last two decades, MDG 4 will not be met without greatly increasing efforts to reduce child deaths.
MMWR. Morbidity and Mortality Weekly Report. 2011 Dec 2; 60:1611-4.Rotavirus disease is the leading cause of childhood morbidity and mortality related to diarrhea in Latin America and the Caribbean (LAC), where an estimated 8,000 deaths related to rotavirus diarrhea occur annually among children aged <5 years. After two safe and effective rotavirus vaccines became available, the World Health Organization (WHO) in 2007 recommended inclusion of rotavirus vaccine in the immunization programs of Europe and the Americas, and in 2009 expanded the recommendation to all infants aged <32 weeks worldwide. This report describes progress in the introduction of rotavirus vaccine in LAC, where it was first introduced in 2006 in Brazil, El Salvador, Mexico, Nicaragua, Panama, and Venezuela; by January 2011, it was included in the national immunization schedules of 14 countries in LAC. Estimated national rotavirus vaccine coverage (2 doses of the monovalent vaccine or 3 doses of the pentavalent vaccine) among children aged <1 year in 2010 ranged from 49% to 98% (median: 89%) in the 11 LAC countries with vaccine introduction before 2010. Of the 14 countries that had introduced rotavirus vaccine into their national immunization programs, 13 participate in a hospital-based rotavirus surveillance network. Data from some countries in this network and from other monitoring efforts in LAC countries have shown declines in hospitalizations and deaths related to severe diarrhea after rotavirus vaccine introduction. The rapid introduction of rotavirus vaccine in LAC demonstrates the benefits of the early commitment of national decision makers to introduce these vaccines in low-income and middle-income countries at the same time as in high-income countries.