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Effects of the World Bank's maternal and child health intervention on Indonesia's poor: evaluating the safe motherhood project.
Social Science and Medicine. 2011 Jun; 72(12):1948-55.This article examines the impact of the World Bank's Safe Motherhood Project (SMP) on health outcomes for Indonesia's poor. Provincial data from 1990 to 2005 was analyzed combining a difference-in-differences approach in multivariate regression analysis with matching of intervention (SMP) and control group provinces and adjusting for possible confounders. Our results indicated that, after taking into account the impact of two other concurrent development projects, SMP was statistically significantly associated with a net beneficial change in under-five mortality, but not with infant mortality, total fertility rate, teenage pregnancy, unmet contraceptive need or percentage of deliveries overseen by trained health personnel. Unemployment and the pupil-teacher ratio were statistically significantly associated with infant mortality and percentage deliveries overseen by trained personnel, while pupil-teacher ratio and female education level were statistically significantly associated with under-five mortality. Clinically relevant changes (52-68% increase in the percentage of deliveries overseen by trained personnel, 25-33% decrease in infant mortality rate, and 8-14% decrease in under-five mortality rate) were found in both the intervention (SMP) and control groups. Copyright (c) 2010 Elsevier Ltd. All rights reserved.
Reproductive health emergency assistance - United Nations Population Fund airlift to Eritrea - Brief article.
UN Chronicle. 2000 Summer; 37(2): p..The United Nations Population Fund (UNFPA) on 22 June began airlifting life-saving motherhood and reproductive health supplies to help Eritreans displaced by the recent fighting with Ethiopia. UNFPA's emergency assistance, including home delivery kits and tools for blood transfusions, will help reduce maternal and child deaths and unwanted pregnancies for some 450,000 displaced persons for about three months. The reproductive health kit was first used in the Great Lakes region of Africa in 1996. Since then, UNFPA has responded to emergencies in 33 countries and territories. (excerpt)
UN Chronicle. 1991 Jun; 28(2): p..The United Nations Children's Fund (UNICEF) has made a "promise to children"--to try to end child deaths and child malnutrition on today's scale by the year 2000. The Fund estimates that a quarter of a million children die every week from common illnesses and one in three in the world are stunted by malnutrition. That broad goal, declared on 30 September 1990 by 71 Presidents and Prime Ministers attending the first World Summit for Children, includes 20 specific targets detailed in the Plan of Action for implementing the World Declaration on the Survival, Protection and Development of Children in the 1990s, adopted at the Summit. Among them are: one-third reduction in under-five death rates; halving maternal mortality rates; halving of severe and moderate malnutrition among the world's under-fives; safe water and sanitation for all families; and measures covering protection for women and girls, nutrition, child health and education. Other goals include making family planning available to all couples and cutting deaths from diarrhoeal diseases--which kill approximately 4 million young children annually--by one half, and pneumonia--which kills another 4 million a year--by one third. (excerpt)
RNIS. Report on the Nutrition Situation of Refugees and Displaced Populations. 2003 Nov; 18-24.There was an upsurge in violence in August and September 2003, which, among other things, has led to the displacement of about 53,000 people in Bujumbura rural Province and 21,000 people in Bubanza Province (OCHA, 29/08/03; WFP, 26/09/03). After the signature of a peace agreement between the Burundian President and the country's largest Hutu rebel group, the Forces for the Defence of Democracy (FDD), in early October, the situation has calmed down but has remained volatile (AFP, 07/10/03; UNICEF, 06/11/03). An enlarged government with members of the FDD, should be formed by the end of November 2003 (AFP, 7/11/03). However, the other Hutu rebel group, the National Liberation Force (FNL) was not part of the cease-fire negotiations (AFP, 08/10/03). The deployment of about 3,000 peacekeepers from Ethiopia, Mozambique, and South Africa, to help in the demobilisation, disarmament, demobilisation and reintegration of rebel troops and to monitor the transition to democracy, has been completed (OCHA, 02/11/03). As of end October 2003, UNHCR reported 26,690 facilitated returns of Burundian refugees and 42,103 spontaneous returns in 2003 (OCHA, 02/11/03). (excerpt)
Lancet. 2003 Dec 13; 362(9400):1986.The Millennium Development Goals of eradicating extreme poverty and hunger, reducing child mortality, improving maternal health, and combating diseases such as HIV/AIDS and malaria by 2015 are looking increasingly unrealistic because the war against terror is diverting resources away from development, according to the UN Children’s Fund. In its annual report State of the world’s children, issued on Dec 11, UNICEF said that one of the most crucial goals—to achieve gender equality in education by 2005—was slipping away. (excerpt)
Achieving the millennium development goals. Population and reproductive health as critical determinants.
New York, New York, UNFPA, 2003. ix, 24 p. (Population and Development Strategies No. 10)The ICPD goal of universal access to quality reproductive health services by 2015 is not one of the Millennium Development Goals (MDGs). Yet, as this publication demonstrates, the attainment of reproductive health and reproductive rights are fundamental for development, for fighting poverty, and for meeting the MDG targets. Conversely, reproductive ill-health undermines development by, inter alia, diminishing the quality of women’s lives, weakening and, in extreme cases, killing poor women of prime ages, and placing heavy burdens on families and communities. (excerpt)
Lancet. 2003 Sep 13; 362(9387):917.I find reassuring the fact that the Child survival series could constitute a renaissance in child-health matters, as suggested by Boniface Kalanda in the accompanying Debate section online. To remain quiet while 10 million children die every year, mostly in developing countries, is certainly unacceptable. (excerpt)
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.
JOURNAL OF BIOSOCIAL SCIENCE. 1990 Jul; 22(3):365-72.Data from a 1985 survey in 2 urban centers in Sudan, Juba and Wau, were analyzed to assess childhood mortality levels and the effect of UNICEF's health care program. A sample of 5120 mothers (Juba, 3061 and Wau, 2059) with 21,509 children were collected from the towns. Logistic regression analysis was used to delineate determinants of child survival. The child mortality measures denote continued high infant and child mortality levels for Southern Sudan. 3 components of the UNICEF program were significantly associated with child survival: oral rehydration therapy, maternal education and immunization. The study concludes that maternal education is the most important determinant of child survival, affecting both the cure and prevention of child ill- health. (Author's modified).
Report of the Expanded Programme on Immunization Global Advisory Group meeting, 9-13 November 1987, Washington, D.C.
[Unpublished] 1988. (WHO/EPI/GEN/88.1)A review of progress at both the global and regional levels by participants at the 10th meeting of the Expanded Program on Immunization (EPI) Global Advisory Group, held in 1987, indicated that all countries are accelerating their immunization programs in order to meet the goal of universal immunization by 1990. Crucial to this success has been the political commitment of governments and various international agencies; neither technical problems nor different stages of national development have posed major obstacles. For the 1st time, immunization coverage with 3 doses of DPT or polio vaccines in infants are at a 50% level in developing countries. As a result, more than 1 million deaths/year from measles, neonatal tetanus, and pertussis and 188,000 cases of polio are being prevented. On the other hand, each year, 2 million children die as a result of measles, neonatal tetanus kills 800,000 children, pertussis is responsible for 600,000 child deaths, and 250,000 polio cases occur each year. Accelerating and sustaining national immunization efforts represent the EPI's major challenges at present. Obstacles here include inadequate planning, administration of large numbers of immunizations to children too old to benefit, high costs, high drop-out rates, disruption of other ongoing primary health care services, and an inability to sustain coverage at the level achieved during the acceleration. Specific goals for the period ahead are: provide immunization at every contact point; reduce drip-out rates between 1st and last immunizations; improve immunization services to the disadvantaged in urban areas; and increase the priority given the control of measles, polio, and neonatal tetanus.
In: UNICEF Bangladesh. Situation analysis report, prepared for UNICEF Bangladesh country programming. [DACCA] Bangladesh, UNICEF, 1977 Apr. 25-34.The lack of a vital registration system in Bangladesh and the absence of any nationwide health statistics make it impossible to form an accurate impression of the situation of maternal and child health in the country. However, the few statistics gathered from small scale research projects show that infant and child mortality rates in Bangladesh are unacceptably high. The most important children's health problems in the rural areas appear to be diarrheal diseases, dysentery and malnutrition. A number of factors contribute to this low level of health status including poverty, lack of health and nutrition education, lack of health services and poor sanitation. Children's health care needs are usually served by the same facilities as the general public; the existing health services do not address the major health problems of children which could be cured and prevented with rather unsophisticated interventions. Data on maternal health is also insufficient. Crude indicators reveal that women marry young, the mean age at 1st delivery is 18.5 and the average number of pregnancies in a woman's reproductive life is 8. Maternal mortality is high and the largest proportion of these deaths are directly related to obstetrical factors, with eclampsia being the commonest single cause of death. Family planning programs, antenatal and postpartum services could reduce a large proportion of these maternal deaths. Health services for mothers are of poor quality. No information is available on % of deliveries attended by the various providers (physicians, nurses, TBAs, relatives) and about the quality of such deliveries. Recent government health policy focuses on establishing a health infrastructure in the rural areas, which is prevention-oriented. Examination of the government's health budget, however, does not reveal that health is a high priority. An important recent addition to the government's health delivery system specifically for children is the initiation of Under-5 Clinics, held once a month and offering comprehensive services, e.g., immunization, physical exams, stool and blood exams, nutrition and hygiene training and milk supplement provision. In terms of policy, this is the 1st massive effort specially concerned with children; the initial response indicates an important commitment to children by the government. UNICEF's assistance in the past 5 years has consisted primarily of supplies of drugs, medical equipment and vehicles. Future UNICEF aid will be planned with a more Basic Services/Primary Health Care approach which is domiciliary and rural-based. Attached are tables illustrating trends in infant and child mortality and their causes.
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.