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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.
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.
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)
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.
Use of new World Health Organization child growth standards to assess how infant malnutrition relates to breastfeeding and mortality.
Bulletin of the World Health Organization. 2010 Jan; 88(1):39-48.OBJECTIVE: To compare the estimated prevalence of malnutrition using the World Health Organization's (WHO) child growth standards versus the National Center for Health Statistics' (NCHS) growth reference, to examine the relationship between exclusive breastfeeding and malnutrition, and to determine the sensitivity and specificity of nutritional status indicators for predicting death during infancy. METHODS: A secondary analysis of data on 9424 mother-infant pairs in Ghana, India and Peru was conducted. Mothers and infants were enrolled in a trial of vitamin A supplementation during which the infants' weight, length and feeding practices were assessed regularly. Malnutrition indicators were determined using WHO and NCHS growth standards. FINDINGS: The prevalence of stunting, wasting and underweight in infants aged < 6 months was higher with WHO than NCHS standards. However, the prevalence of underweight in infants aged 6-12 months was much lower with WHO standards. The duration of exclusive breastfeeding was not associated with malnutrition in the first 6 months of life. In infants aged < 6 months, severe underweight at the first immunization visit as determined using WHO standards had the highest sensitivity (70.2%) and specificity (85.8%) for predicting mortality in India. No indicator was a good predictor in Ghana or Peru. In infants aged 6-12 months, underweight at 6 months had the highest sensitivity and specificity for predicting mortality in Ghana (37.0% and 82.2%, respectively) and Peru (33.3% and 97.9% respectively), while wasting was the best predictor in India (sensitivity: 54.6%; specificity: 85.5%). CONCLUSION: Malnutrition indicators determined using WHO standards were better predictors of mortality than those determined using NCHS standards. No association was found between breastfeeding duration and malnutrition at 6 months. Use of WHO child growth standards highlighted the importance of malnutrition in the first 6 months of life.
New York, New York, UNICEF, 2010 Sep.  p. (Progress for Children No. 9)‘Achieving the MDGs with Equity’ is the focus of this ninth edition of Progress for Children, UNICEF’s report card series that monitors progress towards the MDGs. This data compendium presents a clear picture of disparities in children’s survival, development and protection among the world’s developing regions and within countries. While gaps remain in the data, this report provides compelling evidence to support a stronger focus on equity for children in the push to achieve the MDGs and beyond. (Excerpt)
Are the goals set by the Millennium Declaration and the Programme of Action of the International Conference on Population and Development within reach by 2015?
Asia Pacific Population Journal. 2008 Aug; 23(2):3-9.This article discusses the likelihood of countries in Asia and the Pacific in reaching their 2015 Millennium Development Goals (MGDs). It touches on malnourishment, the reduction of child mortality, and the improvement of maternal health and stresses that the benefits of development must serve everyone, and not just favor the wealthy.
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)
UN Chronicle. 1987 May; 24: p..While the media focus on Africa from 1984 to 1986 brought extraordinary assistance to that crisis-ridden continent, it may have tended to obscure everyday emergencies wrought by disease and malnutrition elsewhere in the world. Recent events in Africa have alerted United Nations agencies once again that ways must be found to sensitize politicians as well as the press to what the United Nations Children's Fund (UNICEF) Executive Director James P. Grant has called the "silent emergencies'--the less dramatic continuum of death and human suffering imposed by poverty and ignorance. In the UNICEF State of the World's Children Report for 1987, Mr. Grant notes that over the past two years, more children died in India and Pakistan than in most nations of Africa combined. "In 1986, more children died in Bangladesh than in Ethiopia, more in Mexico than in the Sudan, more in Indonesia than in all eight drought stricken countries of the Sahel', he says. (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)
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)
Journal of Biosocial Science. 2003 July; 35(3):335-351.Improved child health and survival are considered universal humanitarian goals. In this respect, understanding the nutritional status of children has far-reaching implications for the better development of future generations. The present study assessed, first, the nutritional status of children below 5 years using the three anthropometric measures weight-forage, height-for-age and weight-for-height in two states of India, Kerala and Goa. Secondly, it examined the confounding factors that influence the nutritional status of children in these states. The NFHS-I data for Kerala and Goa were used. The results showed that the relative prevalence of underweight and wasting was high in Kerala, but the prevalence of stunting was medium. In Goa, on the other hand, the relative prevalence of wasting and underweight was very high, and that of stunting was high. Both socioeconomic and family planning variables were significantly associated with malnutrition in these states, but at varied levels. The study recommends more area-specific policies for the development of nutritional intervention programmes. (author's)
Strengthening maternal and child health programmes through primary health care. Guidelines for countries of the Eastern Mediterranean Region. Based on the deliberations of the Intercountry Meeting on the Integration of MCH into Primary Health Care, Amman, Jordan, 11-15 December 1988.
Alexandria, Egypt, WHO, EMRO, 1991. 75 p. (WHO EMRO Technical Publication No. 18)All countries in the WHO Eastern Mediterranean Region (EMRO) have had maternal and child health (MCH) programs for many years, yet maternal mortality and morbidity and infant mortality remain high. The EMRO office in Jordan, recognizing this dilemma, convened a meeting of national managers from the 22 EMRO member states to discuss how to integrate MCH programs with primary health care (PHC). The meeting resulted in the publication of guidelines and goals to help each country integrate MCH into PHC which would strengthen MCH services and improve MCH status. The managers noted the need to switch from a pregnancy-oriented approach to a holistic approach in which MCH/PHC programs and society consider women as more than childbearers. MCH/PHC programs and society need to be concerned about the well-being of females beginning with infancy and should place considerable health promotion for girls during the pubertal spurt and adolescence. They should also promote prevention of iron deficiency anemia in women. Since maternal mortality is especially high is EMRO, the national managers clearly laid out approaches for health services to reduce maternal mortality caused by obstetrical complications. They also recognized the need for a practical alternative to obstetric care provided by health workers--training traditional birth attendants in each village. They also provided guidance on improving prenatal care to reduce perinatal and neonatal mortality such as vaccination of every pregnant woman with the tetanus toxoid. Since the causes of death in the postneonatal period, MCH/PHC programs need to take action to reduce malnutrition and infection. For example, they must promote breast feeding for at least the first 6 months of life. The managers suggested the implementation of the Child Survival and Development Strategy which includes growth monitoring.
JOURNAL OF TROPICAL PEDIATRICS. 1998 Jun; 44(3):126-7.UNICEF's Child Survival initiative (which disseminated low-cost technologies, such as oral rehydration, immunization, breast feeding, and improvement in weaning practices to reduce child mortality) has led to improvements in survival rates. Improvement in child health lead to improvements in the nutritional status of children since severe infection causes nutritional deterioration. Thus, there is increasing awareness that persistent diarrhea is also a nutritional disease. The promotion of breast feeding has been one of the most cost-effective ways of improving nutrition, and it is important to prevent childhood malnutrition by all available means. Case fatality rates from severe malnutrition remain unchanged, indicating that case management requires reevaluation. It is now known, for example, that clinical recovery during nutritional rehabilitation may precede immunological recovery. The implication that even mild/moderate forms of malnutrition increases the risk of mortality suggests that, while control of some childhood illnesses makes an impact on overall health and nutrition, a resistant core of child mortality is caused by underlying undernutrition. Therefore, interventions are needed to improve the nutrition of children, especially during the weaning period. Child mortality determinants can be classified in three tiers: the proximate tier includes immediate biomedical conditions; the intermediate tier includes factors such as child care that expose children to disease; and the bottom tier is the broader socioeconomic setting that affects distribution of the basic necessities of life.
Geneva, Switzerland, World Health Organization [WHO], Administrative Committee on Coordination, Subcommittee on Nutrition, 1989 Oct. , 136 p. (ACC / SCN State-of-the-Art Series; Nutrition Policy Discussion Paper No. 5)This state-of-the-art UN nutrition policy discussion paper focuses on the interaction of malnutrition and infection in child mortality in developing countries. Given the cyclic nature of the interaction, it is appropriate to define a malnutrition-infection complex. Inadequate dietary intake can cause weight loss or failure of growth in children and lead to low nutritional reserves. This is associated with a lowering of immunity, probably with all nutrient deficiencies. In the case of protein-energy and vitamin A deficiencies, there may be progressive damage to mucosa, lowering resistance to colonization and invasion by pathogens. Under these circumstances, the incidence, severity, and duration of diseases are increased. The disease process itself exacerbates loss of nutrients, inducing malnutrition, which leads, in turn, to further damage to defense mechanisms. The first part of this report reviews present knowledge on malnutrition and infection. The second includes an annotated bibliography of research on the following topics: infection as a risk factor for poor growth, poor growth as a risk factor for infection, vitamin a deficiency as a risk factor for infection, iron deficiency as a risk factor for infection, zinc deficiency as a risk factor for infection, and other vitamins and minerals.
[Children in poor countries also have a right to good health care. A new health care program will reduce child mortality] Aven barn v fattiga lander har ratt till god vard. Nytt omvardnadsprogram skall minska barnadodligheten.
LAKARTIDNINGEN. 1997 Oct 8; 94(41):3637-41.This article discusses the integrated management of childhood illness (IMCI) approach, developed by WHO and UNICEF based on international experience, which allows the care and treatment of sick children in countries with limited resources. It is estimated that every year 12 million children die in low-income countries before age 5. 70% of these deaths are related to common diseases: respiratory infections, diarrhea, measles, malaria, and malnutrition. The guidelines were developed for local health workers. Two flowcharts were designed for presenting the guidelines: one for children aged 1 week to 2 months and one for children aged 2 months to 5 years. For infants, the treatment of bacterial infections, diarrhea and feeding, and low weight are paramount. Fever and breathing difficulty may be the expression of severe general infection. The care of children aged 2 months to 5 years should consider four general warning symptoms: cramps, loss of consciousness, inability to drink or suckle, and constant vomiting. The presence of one of these symptoms indicates serious illness and the need for immediate care. Coughing and breathing difficulties are signs of severe pneumonia or serious respiratory illness, which requires transfer to a hospital after administering a dose of antibiotics. The use of trimethoprim-cotrimoxazole is recommended for treatment of pneumonia, while trimethoprim-sulfamethoxazole is indicated for malaria. The diagnosis, classification, and treatment of diarrhea is performed according to earlier WHO guidelines. General erythema and either coughing, a cold, or red eyes are the signs of measles.
SYNOPSIS. 1998 Jan; (2):1-8.The World Health Organization (WHO)/UN Children's Fund (UNICEF) Integrated Management of Childhood Illness (IMCI) guidelines were designed to maximize detection and appropriate treatment of illnesses due to the most common causes of child mortality and morbidity in developing countries: pneumonia, diarrhea, malaria, measles, bacterial infections in young infants, malnutrition, anemia, and ear problems. The health worker first examines the child and checks immunization status, then classifies the child's illness and identifies the appropriate treatment based on a color-coded triage system. By May 1997, 17 countries had introduced IMCI and 16 others were in the process of introduction. This issue reports on field tests of the guidelines conducted in Kenya, the Gambia, Uganda, Bangladesh, and Tanzania. Health workers who used the guidelines performed well when compared to physicians who had access to laboratory and radiographic findings as well as health workers trained in full case management. Of concern, however, are research findings suggesting the potential for overdiagnosis in some disease classifications. Current IMCI research priorities include the following: 1) determining health workers' ability to learn to detect lower chest wall indrawing; 2) identifying clinical signs to increase the specificity of referral for severe pneumonia; 3) identifying other clinical signs to increase the specificity of hospital referrals, thereby reducing unnecessary referrals; 4) investigating how clinical care for severely ill children could be expanded in areas where referral is not feasible; 5) finding ways to increase the specificity of the diagnosis of malaria; and 6) recognizing clinical signs to increase the specificity of the diagnosis of severe anemia and the specificity of the diagnosis of moderate or mild anemia, with the possible goal of regional adaptation of the anemia guidelines.
New York, New York, UNICEF, 1992 Jun.  p.This compendium provides statistical profiles for 136 UNICEF countries on the status of children. Statistics pertain to basic population, infant and child mortality, and gross national product data; child survival and development; nutrition; health; education; demography; and economics. Official government sources are used whenever possible. The nine major sources include the UN Statistical Office, UNICEF, the UN Population Division, the Organization for Economic Cooperation and Development, the World Health Organization, the Food and Agriculture Organization of the UN, the World Bank, Demographic and Health Surveys, and UNESCO. Statistics rely on internationally standardized estimates, and whenever standardized estimates were unavailable, UNICEF field office data were used. Some statistics may be more reliable than others. Countries are divided into four groups for under-five mortality: very high (140 deaths per 1000 live births); high (71-140/1000); middle (21-70/1000); and low (20/1000 and under). The median value is the preferred figure, but the mean is used if the range in data is not extensive. Data are footnoted by definitions, sources, explanations of signs, and individual notation where figures are different from the general definition being used. Comprehensive and representative data are used where possible. Data should not be used to delineate small differences. Countries with very high child mortality include Afghanistan, Angola, Bangladesh, Benin, Bhutan, Bolivia, Burkina Faso, Burundi, Cambodia, Cameroon, Central African Republic, Chad, Comoros, Djibouti, Equatorial Guinea, Ethiopia, Gabon, Guinea, Guinea-Bissau, India, Laos, Liberia, Madagascar, Malawi, Mali, Mauritania, Mozambique, Namibia, Nepal, Niger, Nigeria, Pakistan, Rwanda, Senegal, Sierra Leone, Somalia, Sudan, Swaziland, Tanzania, Togo, Uganda, and Yemen.
Hunger and malnutrition: the determinant of development: the case for Africa and its food and nutrition workers.
East African Medical Journal. 1992 Aug; 69(8):424-7.Hunger and malnutrition in Africa have been on the increase since the 1960s. During the 1970s, it is estimated that 30 million people were directly affected by famine and malnutrition. About 5 million children died in 1984 alone. In Mozambique during the 1983-84 famine, about 100,000 people perished. In Ethiopia, Sudan, Somalia, Liberia, and Angola armed conflicts compound the problem. Ethiopia alone had 9 million famine victims in 1983. The most common form of malnutrition in Africa is protein energy deficiency affecting over 100 million people, especially 30-50 million children under 5 years of age. Almost another 200 million are at risk. Iron deficiency, commonly called anemia, also affects 150 million people, mostly women and children. Iodine deficiency leads to disorders like mental retardation, cretinism, deafness, abortion, low resistance to disease, and goiter and this affects 60 million with about 150 million more at risk. Vitamin A deficiency causes blindness and low resistance to disease and affects about 10 million. Protein energy deficiency is treated by using donated foods in hospitals, rehabilitation centers, day care centers, and feeding centers. There are no community programs for anemia, or vitamin A or iodine deficiencies. Vaccines for preventing and drugs for treating diseases that cause malnutrition are imported. Therefore, African food and nutrition professionals met in 1988 and created the Africa Council for Food and Nutrition Sciences (AFRONUS) to eliminate famine and malnutrition in Africa. Activities have started in: 1) developing contacts between the workers in food and nutrition; 2) assessing the situation of food and nutrition in Africa; 3) developing an action plan; 4) implementing the plan; and 5) monitoring progress. Food and Nutrition Policy Guidelines have also been prepared by AFRONUS for food and nutrition workers. Africa has enough natural resources to solve the problem of hunger and malnutrition, but these resources have to be harnessed.
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.
Washington, D.C., World Bank, 1992. iii, 23 p.Both current and future returns toward the goal of alleviating poverty and boosting economic growth may be realized from investments in nutrition. While incomes remain low, population well-being and human productivity benefit from such direct investment. Increased productivity among the labor force and students are essential in establishing a solid foundation for social and economic development. Specifically, direct investment in nutrition helps reduce child and maternal mortality faster than as yet unrealized trickle effects from eventual overall economic development. While the World Bank invests to develop food crop production and incomes, its direct nutritional aid is also booked. World Bank direct nutrition operational expenditures grew from US$50 million in total projects costs for fiscal 1987-89 to US$900 million in fiscal 1990092; US$1.2 billion are expected for fiscal 1993-95. Country experiences are reviewed in programs which target food transfer programs, provide essential services to those at risk, supply critical micronutrients, use a multifaceted approach, and build nutrition programming capacity. The World Bank can help by investing in nutrition projects, nutrition components in other sectoral projects, structural and sectoral adjustment operations; providing policy advice and analytic work on country or regional nutrition situations; and collaborating in nutrition operations with other donors and nongovernmental organizations. Overall, experience shows that the provision of nutrition is central to development; resources are available; timely, targeted, low-cost responses are effective; micronutrients can not be ignored; education is recommended to change nutritional behavior over the long term; and programs should be kept focused, simple, and flexible. Strong technical training and frequent supervision along with monitoring and evaluation are also called for.
BMJ. British Medical Journal. 1992 Feb 22; 304(6825):455-6.Iraq is faced with large scale public health problems that have been caused by the destruction to their infrastructure during the Gulf war. Humanitarian aid is needed in order to avoid a large scale human disaster. In 1988 73% of Iraq's population lived in urban areas. The loss of electrical generating capacity has affected hospitals, water purification and sewage treatment. Iraq had made great strides int he health of their people with an infant mortality rate of 42/1000 in 1990 and 52./1000 for children under 5. The international study team's survey of over 9000 households revealed surprising evidence of widespread chronic malnutrition. Based on accepted mortality as a baseline, data suggests that mortality among Iraqi infants and children under 5 doubled in 1991. The current food ration provides only half of the energy requirement and with rapidly accelerating inflation, the cost of food while only make the situation worse. The UN Disaster Relief Office has received $1.059 billion from donor countries; but, only half of the requested $14 million has been funded through Unicef. This money is needed to meet basic requirements for water, sanitation, antibiotics, and vaccines. The UN Security Council approved resolutions 706 and 712 which would have allowed Iraq to sell $1.6 billion for foodstuffs, medicines, and materials and supplies necessary to civilian needs subject to monitoring and supervision to ensure equitable distribution. The Iraqi government has not met the requirements of 706 and 712 because of the monitoring conditions, so no money has been issued. More money is needed if humanitarian organizations are to do their work. Only $29 million of the $145 million needed for the 1st half of this year has been pledged.
INDIAN JOURNAL OF PEDIATRICS. 1990 Jan-Feb; 57(1):7-14.Problems facing the world's children, development goals for children, and strategies for meeting these goals in the 1990s are abstracted from a UNICEF publication "Strategies for Children in the 1990s". Children face poverty (45% of children under 5 outside China), mortality from diarrhea, preventable diseases, malaria, meningitis and others, disabling diseases, being unplanned, low birth weight, malnutrition, lack of sanitation and education, and 20% are in "especially difficult circumstances" i.e. war, disaster, abandonment of refugee status. Children should be the starting point of development strategy since human capital is the basis of national investment. The UN goals are to reduce infant mortality by 50% in all countries or to 50-70/1000; reduce maternal mortality by 50%, provide safe drinking water, sanitation and universal education and eliminate guinea worm by 1995. Specific goals in maternal and child health are listed. Emphasis should be placed on implementation with today's technology, reaching the hard to reach, giving preferential access to women.
[Children's health. 40. Unacceptable that 14 million children die every year] Borns sundhed. 40. Uacceptabelt at 14 millioner born dor hvert ar.
SYGEPLEJERSKEN. 1987 Oct 7; 87(41):30-1.The 40th annual report of the UN Children's Emergency Fund (UNICEF) states that about 7 million of the 14 million children who die throughout the world each year could be saved by modern methods of health care and food supply. UNICEF's executive director James Grant points out that 40 years ago little international attention was given to mass death from starvation, but today any such crisis attracts the mass media, and people and governments act to avoid mass death. Undernourishment and epidemics continue to threaten the world's children and more than 280,000 children die from these causes each week. Even with the crises of the past two years in Africa there have been more deaths among children in India and Pakistan than in all of Africa's 46 countries together. Existing knowledge on cheap methods of improving the health of children in underdeveloped countries is sufficient to save at least 7 million children's lives each year. Many millions more could have a normal growth with better information on replacements on mother's milk, vaccinations and access to supplies of water, sugar, and salt for oral rehydration therapy. Just as important are the new technologies of the communications revolution which is taking place in underdeveloped countries. Most homes have a radio, and televisions are available in most villages and in many small communities there are schools and health workers.
The Population Council's research program on infant and child mortality in Southeast Asia: a case study of the relationship between contamination of infant weaning foods, household food handling practices, morbidity, and growth faltering in a rural Thai population.
Bangkok, Thailand, Population Council, Regional Office for South and East Asia, 1986 Aug. 24 p. (Population Council Regional Research Papers. South and East Asia)This booklet describes the overall plan of the research program on infant and child mortality in Southeast Asia, sponsored by the Population Council, the Ford Foundation, the Australian Development Assistance Bureau, and the Canadian International Development Research Center. The objectives are to gain scientific knowledge about the socioeconomic, behavioral and medical factors in mortality; to increase awareness through networking and publication; and to evaluate the effectiveness of interventions at the household and community levels. It is assumed that a small number of simple techniques will prevent over half of child deaths. Applied social science or operations research will be used primarily, rather than clinical or demographic studies. Statistical sociological correlations between a variety of environmental characteristics and mortality as the dependent variable will point to determinants of mortality. The 5 chief determinants are: maternal factors, environmental contamination, nutrient deficiencies, injury, and personal illness controls. The concerns reflected in the projects funded so far include: to focus on some combination of determinants of child survival; to focus on a specific location; to use multiple approaches to data collection; to produce results that can be applied as interventions. As an example, the study on the relationship of contamination of infant weaning foods to morbidity and infant growth in a rural Thai population is summarized.