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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.
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.
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.
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)
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.
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.
New York, New York, UNICEF, 2008 May. 54 p.Every year, the United Nations Children's Fund (UNICEF) publishes The State of the World's Children, the most comprehensive and authoritative report on the world's youngest citizens. The State of the World's Children 2008, published in January 2008, examines the global realities of maternal and child survival and the prospects for meeting the health-related Millennium Development Goals (MDGs) - the targets set by the world community in 2000 for eradicating poverty, reducing child and maternal mortality, combating disease, ensuring environmental sustainability and providing access to affordable medicines in developing countries. This year, UNICEF is also publishing the inaugural edition of The State of Africa's Children. This volume and other forthcoming regional editions complement The State of the World's Children 2008, sharpening from a worldwide to a regional perspective the global report's focus on trends in child survival and health, and outlining possible solutions - by means of programmes, policies and partnerships - to accelerate progress in meeting the Millennium Development Goals. (excerpt)
Indian Pediatrics. 2007 Jun 17; 44(6):413-416.Over 10 million children under five years of age die each year and 22% of these deaths occur in India. This proportion is substantially higher than for other countries, the next highest being Nigeria which accounts for 8%. Since India carries the main burden of child deaths globally, India's performance in improving child survival will define whether the Millennium Development Goal 4 will be achieved by 2015 (i.e., global child deaths reduced by two-thirds). Diarrhea and pneumonia account for approximately half the child deaths in India, and malnutrition is thought to contribute to 61% of diarrheal deaths and 53% of pneumonia deaths. In fact, some of the first studies to demonstrate the importance of this synergism between malnutrition and infection emanated from India. Part of the explanation for the important underlying role of malnutrition in child deaths is that most nutritional deficiencies, including vitamin A and zinc, impair immune function and other host defences leading to a cycle of longer lasting and more severe infections and ever-worsening nutritional status. Thus inadequate intake, infection and poor nutritional status are intimately linked. (excerpt)
Bulletin of the World Health Organization. 2006 Mar; 84(3):161-256.In the early hours of the morning, Aurola Ngueve strapped her feverish daughter to her back and walked almost three kilometres to a tiny Angolan government health post, a white concrete structure sitting incongruously amid the mud huts of the village of Muinha in central Bié province. In the rudimentary examination room, Aurola anxiously tells the Bulletin that 18-month-old Rosalina, who is screaming as a nurse takes a tiny blood sample from her finger, has had chronic diarrhoea for days. Fifteen minutes later, Aurola receives the dreaded, if not unexpected, news. Rosalina has malaria. Malaria is believed to be one of the chief culprits behind Angola's appalling child mortality statistics. UNICEF estimates that one child in four in this south-western African country is unlikely to live beyond his or her fifth birthday. Rosalina is one of the lucky ones. At this health post, run by the Health Ministry and supported by nongovernmental organization Médecins Sans Frontières, she has been accurately diagnosed and prescribed medication. Her personal details, symptoms, diagnose sis and treatment have been entered into a logbook, and the nurse is confident that with the right care she will bounce back to health in a few days. (excerpt)
Global HealthLink. 2003 May-Jun; (121):14-15.In 2000, roughly 11 million children died before their fifth birthday, almost all of them in the developing world. An estimated 140 million children under the age of five were underweight, almost half of them living in South Asia. In 1995, 515,000 women died during pregnancy or childbirth, only 1,000 of whom died in the industrialized world. Tuberculosis claimed another 2 million lives. As these numbers might well suggest, death and illness act as a brake on economic growth, and contribute to income poverty: health and demographic variables account for as much as half of the difference in growth rates between Africa and the rest of the world over the period 1965-1990. Nearly half of the Millennium Development Goals (MDGs) concern, directly or indirectly, health, nutrition and population issues. But based on present trends, relatively few low-income countries will achieve these goals. Only 17 percent of countries are on target for the under-five mortality goal (a two-thirds reduction between 1990 and 2015). Also, on present trends, sub-Saharan African as a whole will take 100 years to achieve the under-five mortality MDG. In all regions other than the Europe and Central Asia region, the under-five mortality rate declined faster during the 1980s than it did during the 1990s. The slowdown was particularly pronounced in Africa and the Middle East. In many countries, improvements in child mortality and malnutrition have been smallest among the poor. (excerpt)
BMJ. British Medical Journal. 2003 Apr 12; 326(7393):782.WHO believes that as much as a third of the world’s total burden of disease is caused by environmental factors. Children under 5, who comprise only 10% of the world population, currently bear 40% of the global disease burden. (excerpt)
Child mortality associated with reasons for non-breastfeeding and weaning: Is breastfeeding best for HIV-positive mothers?
AIDS. 2003 Apr 11; 17(6):879-885.Objective: To estimate child mortality associated with reasons for the non-initiation of breastfeeding and weaning caused by preceding morbidity, compared with voluntary weaning as a result of maternal choice. Methods: Demographic and Health Surveys were analysed from 14 developing countries. Women reported whether they initiated lactation or weaned, and if so, their reasons for non-initiation or stopping breastfeeding were classified as voluntary choice or as a result of preceding maternal/infant illness. Rates of child mortality and survival analyses were estimated, by reasons for non-breastfeeding or weaning. Results: Mortality was highest among never-breastfed children. Child mortality among women who never initiated breastfeeding was significantly higher than among women who weaned. Preceding maternal/infant morbidity was the most common reason for not breastfeeding (63.9%), and the mortality of children never breastfed because of preceding morbidity was higher than in children not breastfed as a result of maternal choice; 326.8 per 1000 versus 34.8 per 1000, respectively. Mortality among breastfed children who were weaned because of preceding morbidity was higher than among those weaned voluntarily; 19.2 per 1000 versus 9.3 per 1000, respectively. Failure to initiate lactation was significantly more frequent among women reporting complications of delivery and with low birthweight infants. Conclusion: Child mortality as a result of the voluntary non-initiation of breastfeeding or voluntary weaning was lower than previously estimated, and this should be used as a benchmark when counselling HIV-positive mothers on the risks of non-breastfeeding or weaning to prevent mother-to-child transmission of HIV. (author's)
WHO Programme in Maternal and Child Health and Family Planning. Report of the second meeting of the WHO Programme Advisory Committee in Maternal and Child Health, Geneva, 21-25 November 1983.
[Unpublished] 1984. 95 p. (MCH/84.5)The objectives of the 2nd meeting of the Program Advisory Committee (PAC) for the World Health Organization's (WHO's) Program in Maternal and Child Health, including Family Planning (MCH/FP) were to 1) assess the MCH/FP program's achievements since the 1st PAC meeting in June, 1982, 2) determine the level of scientific and financial resources available for the program, and 3) to examine the role of traditional birth attendants (TBAs) in the delivery of MCH/FP services. The committee reviewed the activities and targets of the program's 4 major areas (pregnancy and perinatal care, child health, growth, and development, adolescent health, and family planning and infertility), and developed a series of recommendations for each of these areas. Specific recommendations were also made for each of the major program areas in reference to the analysis and dessimination of information and to the development and use of appropriate health technologies. Upon reviewing the role of TBAs in the delivery of MCH/FP services, PAC recommended that all barriers to TBA utilization be removed and that training for TBAs should be improved and expanded. PAC's examination of financial support for MCH/FP activities revealed that for a sample of 26 countries, the average annual amount allocated to MCH activities was less than US$3/child or woman. This low level of funding must be taken into account when setting program targets. International funding agencies did indicate their willingness to increase funding levels for MCH programs. The appendices included 1) a list of participants, 2) an annotated agenda, 3) detailed information on the proposed activities of the program's headquarters for 1986-87, and 4) a description of the the function, organizational structure, and technical management of the MCH/FP program. Also included in the appendices was an overview of the current status of MCH and a series of tables providing information on infant, child, and maternal health indicators. Specifically, the tables provided information by region and by country on maternal, child, and infant mortality; causes of child deaths; maternal health care coverage; contraceptive prevalence; infant and child malnutrition; the number of low weight births; adolescent health; teenage births; breast feeding prevalence and duration; and the proportion of women and children in the population.
[World Health Report shows children as the tragic losers. Almost 10 million AIDS orphans can be expected] Weltgesundheitsreport zeigt Kinder als traurige Verlierer. Bald zehn Millionen AIDS-Waisen zu erwarten.
FORTSCHRITTE DER MEDIZIN. 1995 Dec 10; 113(34):18-9.According to 1994 WHO statistics, about 51 million people died in the world, 40% of them from contagious diseases, most of which could have been prevented by improved hygiene and vaccinations. In the developing countries the average life expectancy is only 43 years and it may even decline, while in the industrialized countries it has reached more than 78 years. 12 million children under the age of 5 die every year. Pulmonary inflammation and other respiratory infections kill 4 million children annually; diarrhea is responsible for 3 million child deaths, malaria for another million, and tetanus for 500,000 deaths. Even measles, which is considered to have been subdued, kills 1.2 million children in the developing world. One-third of all children, 200 million worldwide, are undernourished, therefore particularly vulnerable to all kinds of infectious diseases. Nevertheless, in the past decade 80% of children were vaccinated against diphtheria, measles, neonatal tetanus, whooping cough, and tuberculosis. From 1985 to 1993 the number of deaths from these diseases among children under age 5 dropped from 3.7 million to 2.4 million. On the other hand, 5 million children will be infected with HIV by the year 2000 and another 5-10 million will be orphaned by AIDS. Infectious and parasitic diseases are the leading cause of death worldwide, claiming 16.4 million victims, followed by cardiovascular diseases with 10 million deaths per year and cancer which took the lives of 6 million people in 1994. Poor hygiene and life style factors account for or contribute to more than three-fifths of all mortality. In 1994 there were 3 million deaths caused by smoking; by 2020 an estimated 10 million people will die because of it. Morbidity is also alarming, with about 2 billion people being ill every minute. 200 million people suffer from schistosomiasis, 18 million are affected by river blindness, 600 people die from work-related accidents every day and another 33,000 are injured.
[Measuring infant and child mortality by cause and by all causes: memorandum of a WHO / UNICEF meeting] Mesure de la mortalite infantile et juvenile, par cause et toutes causes: memorandum d'une reunion OMS / UNICEF.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1995; 73(2):149-56.In December 1992, physicians, demographers, statisticians, and other professionals from various regions attended an informal joint meeting of WHO and UNICEF to discuss ways to measure infant and child mortality by cause and all factors contributing to the cause of death. The participants developed recommendations to help countries and international organizations provide more reliable and more frequent data on child mortality by all contributing causes, to lay out a general profile of child mortality by cause, to arrive at a classification of major causes of death, and to keep an eye on achieving the objectives agreed upon at the World Summit on Children to reduce mortality. Verbal autopsy is a technique to measure mortality by cause of death. It can be used to evaluate various situations--surveys, longitudinal surveys, health services, and civil registration. It has the potential to provide estimations of cause of death at the national level. Techniques to measure mortality by contributing causes are the technique of preceding birth and other indirect estimation techniques. Countries and programs can use them when there are only minimal data.
Measurement of overall and cause-specific mortality in infants and children: memorandum from a WHO / UNICEF meeting.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1994; 72(5):707-13.A joint World Health Organization/UNICEF informal consultation on the "Measurement of overall and cause-specific mortality in infants and children" was held in Geneva on 15-17 December 1992. The participants included physicians, demographers, statisticians and program personnel from different regions. The recommendations were aimed at helping countries and international organizations to produce more frequent and more reliable data on overall child mortality and to estimate broad patterns of child mortality by cause of death, especially for ranking the major causes of death and monitoring progress towards the achievement of mortality reduction goals of the World Summit for Children. The verbal autopsy method was reviewed to assess its potential for use in different situations--surveys, longitudinal surveillance, health services and civil registration--and its capacity to provide national estimates of cause of death. Documented national and international experiences and validation studies were examined together with other methods already being used. The potential of the preceding birth technique and other indirect methods to estimate mortality in childhood--for use by countries and programs more frequently and with as much disaggregation as possible--was evaluated. (author's)
CENTRAL AFRICAN JOURNAL OF MEDICINE. 1992 Jul; 38(7):314-5.Participants at a 1992 WHO/UNICEF consultation meeting on HIV transmission and breast feeding weigh the risk of death from AIDS with the risk of death from other causes. Breast feeding reduces the risk of death from diarrhea, pneumonia, and other infections. Artificial or inappropriate feeding contributes the most to the more than 3 million annual childhood deaths from diarrhea. The rising prevalence of HIV infection among women worldwide results in more and more cases of HIV-infected newborns. About 33% of infants born to HIV-infected. Some HIV transmission occurs through breast feeding, but breast feeding does not transmit HIV to most infants HIV-infected mothers. Participants recommend that, in areas where infectious diseases and malnutrition are the leading causes of death and infant mortality is high, health workers should advise all pregnant women, regardless of their HIV status, to breast feed. The infant's risk of HIV infection via breast milk tends to be lower than its risk of death from other causes and from not being breast fed. HIV-infected women who do have access to alternative feeding should talk to their health care providers to learn how to feed their infants safely. In areas where the leading cause of death is not infectious disease and infant mortality is low, participants recommend that health workers advise HIV-infected pregnant women to use a safe feeding alternative, e.g., bottle feeding. Yet, the women and their providers should not be influenced by commercial pressures to choose an alternative feeding method. Health care services in these areas should provide voluntary and confidential HIV testing and counseling. Participants stress the need to prevent women from becoming HIV-infected by providing them information about AIDS and how to protect themselves, increasing their participation in decision-making in sexual relationships, and improving their status in society.
[Unpublished] 1991. Presented at the 119th Annual Meeting of the American Public Health Association [APHA], Atlanta, Georgia, November 11-14, 1991. 7,  p.Maternal health affects child survival in many ways. For example, and infant in Bangladesh whose mother has died during childbirth has a 95% chance of dying in the 1st year. Further children <10 years old in Bangladesh, especially girls, who have lost their mother are 4 times as likely to also die. In addition, there is a relationship between protein energy malnutrition in mothers and low prepregnancy weight and meager wait gain during pregnancy which retards fetal growth resulting in a low birth weight (LBW) infant, LBW infants die at a rate 30 times that of adequate weight infants. In fact, child survival depends on maternal health even before the mother is able to conceive. Daughter as well as mothers in developing countries often eat last and smaller amounts of food than male family members. Females who remain poorly nourished often experience obstructed labor which causes several complications for the infant such as respiratory failure. Maternal infections such as malaria and sexually transmitted diseases are also closely linked to LBW. Some can also bring about preterm birth and congenital infections. Pregnancy and labor complications are responsible for about 500,000 maternal deaths annually. Hemorrhage, sepsis, eclampsia, and obstructed labor cause most of these deaths. A woman's fertility pattern also contributes to child survival. The high risk birth categories include too young, too old, too many children, and too closely spaced. In fact, the median mortality rate for infants born <2 years after the older sibling is 71% greater than that for those born 2-3 years apart. The World Bank recommends improved community based health care, improved referral facilities, and an alarm and transport system to improve maternal health. The World Bank, UNDP, UNFPA, UNICEF, WHO, IPPF, and the Population Council support the Safe Motherhood Initiative which aims to reduce maternal morbidity and death by 50% by 2000.
Oxford, England, Oxford University Press, 1988. , 86 p.The 1988 UNICEF report on the world's children contains chapters describing the multi-sectorial alliance to support child health, the current emphasis on ORT and immunization, the effect of recession on vulnerable children, family rights to knowledge of basic health facts, and support for women in the developing world. Each chapter is illustrated by graphs. There are side panels on programs in specific countries, including Senegal, Syria, Colombia, Bangladesh, Turkey, India, Honduras, Japan and Southern Africa, and highlighted programs including immunization, AIDS, ORT, breast-feeding and tobacco as a test of health. The SAARC is a new regional organization of southern Asian countries committed to immunization and other health goals. Tables of health statistics of the world's nations, divided into 4 groups by "Under 5 Mortality Rate" present basic indicators, nutrition/malnutrition data, health information, education, literacy and media data, demographic indicators, economic indicators and data pertaining to women. The absolute numbers of child deaths had fallen to 16 million in 1980, from 25 million in 1950. Saving children's lives will not exacerbate the population problem because, realizing that their children will survive, families will have fewer children. Furthermore, the methods used to reduce mortality, such as breast feeding and empowerment of families to control their lives, are known to reduce fertility.
AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE. 1986 Jan; 35(1):1-2.A paper by Hazlett et al. is of particular importance because it addresses the question of the role of acute respiratory infections (ARI) as a cause of morbidity and especially mortality in 3rd world children. Diarrheal disease and malnutrition are generally thought to be the major killers of these children, and until recently little attention was paid to ARI. Recent data suggest that ARI are more important than realized previously and almost certainly are the leading cause of death in children in developing countries. It is estimated that each year more than 15 million children less than 5 years old die, obviously most in socially and economically deprived countries. Since death usually is due to a combination of social, economic, and medical factors, it is impossible to obtain precise data on the causes of death. It has been estimated that 5 million of the deaths are due to diarrhea, over 3 million due to pneumonia, 2 million to measles, 1.5 million to pertussis, 1 million to tetanus, and the other 2.5 million or less to other causes. Since pertussis is an acute respiratory infection and measles deaths frequently are due to infections of the respiratory tract, it is becoming clear that ARI are associated with more deaths than any other single cause. The significance of this is emphasized when the mortality rates from ARI in developed and underdeveloped nations are compared. Depending on the countries compared, age group, and other factors, increases of 5-10-fold have been reported. These factors raise the question of why respiratory infections are so lethal for 3rd world children. The severity of pneumonia, which is the cause of most ARI deaths, seems to be the big difference. Data are accumulating which show that bacterial infections are associated with the majority of severe infections and "Streptococcus pneumoniae" and "Haemophilus influenzae," infrequent causes of pneumonia in developed world children, are the microorganisms incriminated in a large proportion of cases. The increase in severity of ARI in 3rd world children has been associated, at least in port, with malnutrition, diarrheal diseases, an increased parasite load, and more recently with air pollution. Crowding and other factors associated with poverty doubtless also play a role. How these various factors contribute to increased severity and lethality is not well understood. The increasing recognition of the important role played by ARI as causes of mortality in 3rd world children is encouraging. The UN International Children's Emergency Fund (UNICEF) has joined the World Health Organization in the battle against ARI in developing countries, and the 2 organizations recently issued a joint statement on the subject in which they pledged to collaborate to integrate an ARI component into the primary health care program.
[Vaccination, the right of each child, World Day of Health 1987] Vacunacion: derecho de cada nino, Dia Mundial de la Salud 1987.
BOLETIN DE LA OFICINA SANITARIA PANAMERICANA. 1987 Mar; 102(3):263-80.In the 10 years since the Panamerican Health Organization (PAHO) and the World Health Organization initiated the Extended Immunization Program in the Americas (PAI), coverage has increased from less than 1/3 to over 1/2 of children immunized in their first year against 6 major childhood diseases. Due mainly to the PAI, the incidence of measles, tetanus, and diptheria has been reduced by 1/2, that of whooping cough by 75%, and that of tuberculosis by about 5% annually. About 75% of children are immunized against polio, which has 1/10 as many victims today as 10 years ago. PAHO and several other organizations have targeted 1990 for eradication of polio from the South American continent. Since the PAI was established in 1977, more than 15,000 health workers have been trained, cold chains have been established to preserve vaccines, and more than 250 technicians have been trained to maintain and repair the needed equipment. The cost of the campaign to eradicate polio is estimated at US $ 24 million per year for the entire region--a low total compared to the costs of hospitalization and rehabilitation of the victims in the absence of such a program. The goal of immunizing all the world's children by 1990 proposed by the World Health Assembly in 1977 is achievable, but much remains to be done. The number of children immunized in the largest Third World countries ranges from 20-90% owing in part to national immunization days but also to assumption by local communities of the goal of universal immunization by 1990. All deaths produced by these 6 killer diseases are not registered, but the World Health Organization estimates that measles takes 2.1 million lives annually, neonatal tetanus 800,000, and whooping cough 600,000. Governmental and nongovernmental international organizations have made financial help available to countries needing it for their immunization programs. Most developing countries are expected to achieve the goal of universal immunization by 1990, but the 10 poorst countries of Africa and the Eastern Mediterranean may not be able to do so. At the worldwide level, 41% of the 118 million children who survive their first year have been vaccinated against measles and 46% against tuberculosis. 47% have received the full course of vaccine against diptheria, whooping cough, tetanus, and polio. The cost of these immunization is $5-15 per child and 80% is assumed by local countries. The World Health Organization recommends that all children, even the undernourished or slightly ill, be vaccinated, and that all health services vaccinate. Parents should be urged to return for the 2nd and 3rd doses of polio and DPT vaccines. Vaccination programs should pay more attention to impoverished urban populations. Several countries of the region have added innovations such as vaccination against other illnesses, house to house searches for unvaccinated children, or use of mass media to publicize national vaccination programs.
Causes of mortality change: observations based on the experience of selected countries in the ESCAP Region.
In: Mortality and health issues: review of current situation and study guidelines. Bangkok, Thailand, U.N. Economic and Social Commission for Asia and the Pacific, 1985. 93-97. (Asian Population Studies Series No. 63.)In the past 30 years or so, mortality has declined in all countries, and the member countries of Economic and Social Commission for Asia and the Pacific (ESCAP) are no exception to this general trend. Standardization is most often used in a limited fashion to account for the effect on demographic indices of a changing age and sex structure of the population; this chapter uses it to examine the fast decline in mortality. A decline in mortality may be due to any of the following processes: 1) reduction of exposure to risk, or an increased proportion of the population protected from the risk by immunization or other preventive measures; 2) introduction of effective treatment may result in the considerable reduction of case fatality, and hence of mortality from a given disease; and 3) intervention along both lines. Foremost among the studies of variation of mortality levels among the countries at various stages of socioeconomic development are those associating measures of national income and life expectancy at birth. Economic advance appears not to be a major factor in more recent mortality reductions; a large part of the decline has resulted from the application of broad-based public health programs of insect control, environmental sanitation, and immunization. Mother's educational level, family income, family size, and pattern of child spacing have demonstrable effects on the probability of child survival. Further advancement to understand the complex fabric of social and bioligical processes involved in health protection and health impairments that often lead to death requires joint formulation at the planning stage of methodologies and concepts combining suitable factors from different disciplines. The multidisciplinary approach to research in mortality would lend assurance to the results of studies and would provide a firmer basis for the development of relevant policies to reduce morbidity and mortality.
Bangkok, Thailand, World Health Organization, Global Epidemiological Surveillance and Health Assessment, and Mahidol University, Faculty of Public Health, Institute for Population and Social Research, 1986. 546 p. (UNFPA Project No. INT/80/P09)This book on new developments in mortality analysis is a product of a joint WHO/UN research program. Part 1 examines mortality transition in terms of the causes and mechanisms of mortality decline in Europe and North America, reflecting on the study of development processes in countries now undergoing development. Part 2 deals with the use of mortality data in health planning and the use of mortality and other epidemiologic information in the assessment of preventable deaths. Attention is paid to the development of an index of preventable deaths. Part 3, Methodological Developments, examines intersectoral aspects of mortality projections (in terms of health care inputs), the measurement of social inequality and mortality, and maternal death and its impact on the female population. Part 4 deals with cause of death analysis: estimation of global mortality patterns by cause of death, trends and differentials in Thailand, and maternal mortality and differentiation by cause of death. Part 5 discusses nutrition, including a Southern Asia-based study of the relationship between nutritional deficiencies and infant and child mortality, and a study on advances in child nutrition and health that have taken place despite slow economic development. Part 6 discusses mortality change: achievements and failures in South and East Asia, a study on changing health in Japan, mortality decline in Mexico, and socioeconomic correlates of mortality in Pakistan. The section concludes with articles on trends and differentials in mortality in Malaysia and Thailand, and a study of the effects of declining mortality and population aging in rapidly-developing Jamaica.
Washington, D.C., World Bank, 1981. 148 p. (LSMS working paper, no. 16)Add to my documents.