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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)
Beyond pediatrics: the health and survival of disadvantaged children. E.H. Christopherson Lectureship on International Child Health.
PEDIATRICS. 1993 Apr; 91(4):703-5.The limited success of UNICEF's massive Child Survival campaign reflects a failure to move beyond the practice of medicine and address issues such as social equity, demilitarization, and accountability. Oral rehydration and immunization--the "twin engines" of the child survival effort--are crucial health measures. Their effectiveness has been compromised, however, by 2 factors: 2)a top-down, vertical model of planning and implementation, in which no input has been sought from the disadvantaged families who are the target population, and 2) a narrow, technological approach to medical problems whose root causes are largely social and political. The promotion of oral rehydration, for example, tends to obscure the web of physical, cultural, economic and political causes underlying the malnutrition that produces diarrhea mortality. Expenditures by poor families on harmful products exported from developed countries (e.g., infant formula, useless medications for diarrhea, and cigarettes) contribute to this undernutrition, yet the profit needs of multinational corporations are supported over the human needs of poor Third World families. Also devastating have been unnecessarily high military expenditures, promoted by arms merchants and developed country governments. Numerous studies have shown that home- mix rehydration drinks are as effective as commercial packets, more quickly and easily available, and likely to enhance mothers' confidence in their ability to confront health problems. Despite this evidence, peasant families are encouraged by health officials to purchase rehydration packets--another example of a prioritization of the needs of the commercial sector. US pediatricians are urged to follow the example of Dr. Benjamin Spock and his opposition to militarism, the arms race, environmental destruction, and social injustice.
[Unpublished] 1991. Presented at the Demographic and Health Surveys World Conference, Washington, D.C., August 5-7, 1991. 8 p.The maternal and child health/family planning (MCH/FP) program at WHO specifies the priorities for MCH/FP in the 1990s. Results of the Demographic and Health Surveys (DHS) in many, but not all, developing countries have shown overall improvement in fertility and maternal and child health, especially in the family planning and child survival movements. Maternal mortality did not change, however. Moreover, maternal mortality in some countries exceeded natural maternal mortality. These elevations sparked a 3rd movement in the late 1980s, safe motherhood. These results confirm that the public health community cannot become complacent. Indeed it must strengthen the infrastructure, management, and performance of the health system to maintain gains. This involves identifying a novel strategy to priority setting and program development which are adapted to the changing needs and circumstances of each country, and even within each country. In fact, firm program strategies and policies need to concentrate on maternal health and morbidity, newborn care, breast feeding, perinatal infections, and HIV/AIDS. Based on DHS data and on evaluations of MCH/FP programs, WHO lists crucial principles for successful programs. The 1st principle includes equity in access and use of social resources which includes disaggregating data according to geographic and population subgroups to find appropriate strategies to close the widening gap within and between countries. The next principle is community and health care provider participation and ownership. Indeed successful MCH/FP programs are those where the community identifies problems and needs and evaluates the program. The 3rd principle encompasses quality data collection to assess quality of care and program effectiveness. WHO has proposed 5 priorities for organization and management of MCH/FP programs. 1 priority which WHO suspects will generate the most debate is integration of family planning, child survival, and safe motherhood programs.
In: Issues in contemporary international health, edited by Thomas A. Lambo and Stacey B. Day. New York, New York, Plenum Medical Book Company, 1990. 113-33.The causes of mortality and disability in the world are reviewed, and the 4 most important mechanisms for promoting maternal and child health are proposed: female literacy, family planning, community-based efforts and global strategies for international cooperation. The health needs of women, children and adolescents, who make up the majority and the most vulnerable segment of the population, must be met. Malnutrition is the single most important cause of health problems through adult life, and affects 20 million children in Africa alone. Statistics are cited for infant mortality, vaccine-preventable diseases, diarrheal diseases and respiratory infections, infant mortality and maternal mortality. The key determinant of infant survival is female literacy. Existing scientific cooperation is the closet thing we have to a global international community. An example of applied scientific solutions to health care is the risk approach in maternal health care. 2 strategies of scientific cooperation have emerged: the international center model in a country or region to address a specific problem, and the task force model, as used effectively by WHO, UNICEF, and the Task Force for Child Survival. Research topics on health in developing countries are listed that could be tackled by universities and scientific networks, e.g. scientific research is lacking on how to make household hygiene effective in poor countries. A concerted global research effort and surveillance effort is needed for AIDS.
[Interview of M. Stanislas Adotevi: "...children first..."] Interview de M. Stanislas Adotevi: "...l'enfant d'abord..."
VIE ET SANTE. 1990 Apr; (3):3-7.10 years following the International Year of the Child (1979) Africa is facing a severe economic crisis worsened by the structural adjustment programs (SAP's) that have reduced government's social budgets affecting the most vulnerable populations, women and children. Each week more than 250,000 children are dying from malnutrition and preventable diseases. Since 1980 the revenues of some African countries decreased by 25%; minimum salaries decreased by 50% in some urban area; educational expenditures declined by 25% and by 1988 Africa's debt crisis represented 47% of its export revenues. UNICEF interventions such as vaccination have saved the lives of 3000 children of the 11,000 that die each day. But besides providing immediate solutions UNICEF has trained vaccination committees from the communities to maintain the health status of children and created alliances with all sectors of the population to protect and defend the rights of children as described in the UN Convention on the Rights of the Child adopted November 20, 1989.
JOURNAL OF TROPICAL PEDIATRICS. 1989 Aug; 35(4):197-8.The 'Child Survival Revolution' (CSR) which emphasizes the technological approaches of Primary Health Care (PHC) as defined in Alma Ata, disregards the structural conditions and processes that lead to seldom diminishing morbidity and mortality rates among the poor in the Third World. The CSR may save some lives, but will not attack the underlying and basic causes of child mortality in developing countries. We must not rely on GOBI as a technical solution to what is essentially a socioeconomic and political problem. Choices to seek or not to seek better health for family members are all intimately linked to the state of poverty of most potential beneficiaries of GOBI-FF. Some additional empowerment of the people is needed for meaningful choices to become realistic options. GOBI-FF and the CSR are a combination of new technologies communicated by social marketing with mostly a top-down implementation, taking for granted the existing social and political institutions. Although the messages of the program call for political will, for social mobilization, for involvement of the population, and for changes in the health infrastructure, these concepts are used in a very inconsistent, demagogic, fuzzy and empty way. GOBI is too strongly supply oriented and ignores the social constraints behind a weak demand for the effective utilization of existing or new health services. Third World countries often end up following rules dictated from or set-up outside the country. Social marketing too, makes people mostly consumers, not protagonists and promoters. People need access to significant remedial interventions; knowledge is not enough. Evidence shows that people are 'patterning' their behavior to what the provider wants from them just to receive the program's benefits. Health professionals must help create the necessary support systems to empower the poor. (author's modified)
World Health. 1985 Nov; 13-15.In November 1980, Dr. Halfdan Mahler, Director-General of the World Health Organization (WHO), and James Grant, head of the UN Children's Fund (UNICEF), drafted a joint program to improve the nutritional status of children and women through developmental measures based on primary health care. The government of Italy agreed to fund in full the estimated cost of US$85.3 million. When a tripartite agreement was signed in Rome in April 1982, the WHO/UNICEF Joint Nutrition Support Program (JNSP) came into being. It was agreed that resources would be concentrated in a number of countries to develop both demonstrable and replicable ways to improve nutrition. Thus far, projects are underway or are just starting in 17 countries in Africa, Asia, Latin America, and the Caribbean. In most of these countries, infant and toddler mortality rates are considerably higher than the 3rd world averages. Program objectives include reducing infant and young child diseases and deaths and at the same time improving child health, growth, and development as well as maternal nutrition. These objectives require attention to be directed to the other causes of malnutrition as well as diet and food. JNSP includes nutrition and many other activities, such as control of diarrhea. The aim of all activities is better nutritional status leading to better health and growth and lower mortality. Feeding habits and family patterns differ from 1 country to another as do the JNSP country projects. Most JNSP projects adopt a multisectoral approach, incorporating varied activities that directly improve nutritional status. Activities involve agriculture and education as well as health but are only included if they can be expected to lead directly to improved nutrition. A multisectoral program calls for multisectoral management and involves coordination at all levels -- district, provincial, and national. This has been one of the most difficult things to get moving in many JNSP projects, yet it is one of the most important. Community participation is vital to all projects. Its success can only be judged as the projects unfold, but early experiences from several countries are encouraging.
Journal of Tropical Pediatrics. 1983 Aug; 29(4):217-9.The World Health Organization (WHO) launched the Expanded Program of Immunization (EPI) in 1974 based on the belief that most countries already had some elements of national immunization activities which could be successfully expanded if the program became a national priority with a commitment from the government to provide managerial manpower and funds. The federal government of Nigeria quickly adopted the policy of WHO on EPI and urged the state governments to set up administrative arrangements for planning and implementation of EPI. The program started off in Oyo State of Nigeria after a pilot study conducted at Ikire in Irewole Local Government area in 1975. The stated objectives of the programs were: to provide immunization service to at least 85% of the target population e.g. children under 4 years; and to integrate immunization programs into routine activities of all static primary health centers in the state. This study focuses on administration of the immunization program in the Oranmiyan Local Government area of Oyo State, within the structure of the local government health system and the field health administration of the state government. This study shows that the stated objectives of the EPI are not likely to be achieved in the near future because of low coverage of the eligible population, due to inadequate community involvement in the planning and implementation of the program; 2) poor communication between different government departments; and 3) inadequate publicity. The effect of improvement in health status because of immunization programs, has been very difficult to demonstrate in Nigeria because a lack of accurate data on birth, morbidity, and mortality patterns of the population. Other socioeconomic and health factors of significance in the battle against infectious diseases include environmental sanitation, adequate and safe water supply, housing and nutrition. Nevertheless, immunization programs constitute one of the most economical and effective approaches to the prevention of communicable diseases and can produce dramatic effects in the battle to lower infant and childhood mortaltiy rates in the developing countries if they are well implemented.
In: Grant JP. The state of the world's children, 1982-83. New York, Oxford Univ. Press, 1982. 3-42.40 thousand young children died each day from malnutrition and infection in developing countries during 1982. For each child that died, 6 live on in hunger and ill-health. A continuation of present trends would result in an increase in the nubers to some to 650 million seriously undernourished children by the year 2000. This report indicates that organized communities and trained paraprofessional development workers backed by government services and international assistance can bring basic education, primary health care, cleaner water, and safer sanitation to the majority of poor communities in the developing world. Specifically, oral rehydration therapy, universal child immunization, promotion of breast feeding, and the use of growth charts are touted as low-cost, low-risk people's health actions that do not depend on economic and political changes. 1/3 of the families whose children are malnourished are simply too poor to provide enough food for the children to eat. For these people, the long-term solution to eradicate malnutrition lies in having the land to grow food or the jobs and income with which to buy it. Employment and land reform are therefore areas that must eventually be addressed in the quest for reduced child mortality levels.
REVIEWS OF INFECTIOUS DISEASES. 1983 May-Jun; 5(3):452-9.This summary of the worldwide impact of measles discusses epidemiology, reported incidence, clinical severity, community attitudes toward measles, and the impact of immunization programs on measles. Measles, 1 of the most ubiquitous and persistent of human viruses, occurs regularly everywhere in the world except in very remote and isolated areas. Strains of measles virus from different counties are indistinguishable, and serum antibodies from diverse population have identical specificity. Yet, the epidemic pattern, average age at infection, and mortality vary considerably from 1 area to another and provide a contrasting picture between the developing and the developed countries. In the populous areas of the world, measles causes epidemics every 2-5 years, but in the rapidly expanding urban conglomerations in the developing world, the continuous immigration from the rural population provides a constant influx of susceptible individuals and, in turn, a sustained occurrence of measles and unclear epidemic curves. In the economically advanced nations, measles epidemics are closely tied to the school year, building up to a peak in the late spring and ceasing abruptly after the summer recess begins. Maternal antibody usually confers protection against measles to infants during the 1st few months of life. The total number of cases of measles reported to WHO for 1980 is 2.9 million. Considering that in the developing world alone almost 100 million infants are born yearly, that less than 20% of them are immunized against measles, and that various studies indicate that almost all nonimmunized children get measles, less than 3 million cases of measles in 1980 is a gross underestimate. There was adecrease in the global number of reported cases of measles during the 1979-80 period due primarily to the reduction in the number of cases in the African continent and, to a lesser extent, in Europe. It is premature to conclude that such a reported decline is real and that it reflects the beginning of a longterm trend. The contrast between the developed and the developing worlds is most marked in relation to the severity and outcome of measles. Case fatality rates of more than 20% have been reported from West Africa. It has been estimated that 900,000 deaths occur yearly in the developing world because of measles, but data available to WHO indicate that the global case fatality rate in the developing world approaches 2% (in contrast to 2/10,000 cases in the US), and the actal mortality may be greater than 1.5 million deaths per year. The advent of WHO's Expanded Program on Immunization has brought about an awareness of the measles problem. Whenever and wherever measles vaccine has been used effectively on a large scale, a marked reduction in the number of cases has been recorded.