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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.
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)
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.
Baltimore, Maryland, Johns Hopkins University, School of Hygiene and Public Health, Dept. of Population Dynamics, 1992. v, 60 p.During most of the 1980s, Iraq was at war with Iran. Despite the war, Iraq, with the help of UNICEF, was able to improve health services that impact on child health so that child survival also improved. They were able to do so because, in 1983, UNICEF, social organizations, the community, and the health sector joined forces to improve the health of the nation's children. They set up a district based primary health care system which saved the lives of 1000s of children annually. Their efforts concentrated on immunization, oral rehydration, unsafe birth practices, and increasing mothers' knowledge of childbearing and child health practices. Some achievements in child survival in Iraq during was included a sharp rise in neonatal tetanus immunizations from 8-72.5% (1985-1989) and a fall in neonatal tetanus deaths between 1983-1989 from 0.7-<.1, a rise in full immunization coverage from 13-85.5% and a fall in all vaccine preventable deaths (e.g., 58 pertussis deaths in 1980 to 0 deaths beginning in 1986), and a rise is use of oral rehydration therapy from 9-76% and a subsequent fall in diarrhea related deaths from 600-<100 (1980-1988). This monograph examined the factors responsible for the evolution of development trends, behavioral patterns, and program management style in Iraq. These factors centered around geopolitical and economic forces. Chapter 3 explains how child survival became a national priority and what strategies were undertaken to achieve child survival goals. Program implementation and the basis of program sustainability are laid out in chapters 4-5. Program achievements are presented in chapter 6. The last chapter discusses lessons learned and assesses child survival in wartime and continuing obstacles. This monograph points out that achieving child survival under adverse circumstances is possible when political will and commitment stands behind child survival efforts.
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)
BACKGROUND NOTES. 1988 Mar; 1-6.Uganda occupies 94,354 square miles in central Africa, bounded by Kenya, Tanzania, Rwanda, Zaire, and Sudan. It includes part of Lake Victoria, and the Ruwenzori mountains are on its border with Zaire. The country is largely on a plateau and thus has a pleasant climate. 12% of the land is devoted to national parks and game preserves. The northeast is semiarid; the southwest and west are rainy. The population of 15,900,896, growing at 3.7% a year, is mostly rural and is composed of 3 ethnic groups: The Bantu, including the Buganda, the Banyankole and the Basoga; the Nilo-Hamitic Iteso; and the Nilots. There are also some Asians and Arabs. The official language is English, but Luganda and Swahili are widely used. The majority of the people are Christian. Literacy is about 52%, and 57% of school-age children attend primary school. Infant mortality rate is 108/1000, and life expectancy is 49 years. The 1st Englishman to see Uganda was Captain John Speke in 1862. The Kingdom of Buganda became a British protectorate in 1894, and the protectorate was extended to the rest of the country in 1896. In the 1950s the British began an africanization of the government prior to formal independence, but the 1st general elections in 1961 were boycotted by the Bugandans, who wanted autonomy. In the 2nd election, in March, 1962, the Democratic Party, led by Benedicto Kiwanuka, defeated the Uganda People's Congress (UPC), led by Apollo Milton Obote; however, a month later, the UPC allied with the Buganda traditionalists, the Kabaka Yekka, and formed a collision government under Obote. Uganda became independent in 1962 with the King of Buganda, Sir Edward Frederick Mutesa II as president. Political rivalries continued, and in 1966 Prime Minister Obote suspended the constitution, and the Buganda government lost its semiautonomy. Obote's government was overthrown in 1971 by Idi Amin Dada, under whose 8-year reign of terror 100,000 Ugandans were murdered. Amin was ousted by an invading Tanzanian army, and various governments succeeded one another in Uganda, including one headed by Obote from 1980-85, which laid waste a large section of the country in an attempt to stamp out an insurgency led by the National Resistance Army (NRA). Obote was overthrown by an army brigade, but the insurgency continued until, in 1986, the NRA seized power and established a transitional government with Yoweri Museveni as president. The transitional government has established a human rights commission and has instituted wide-ranging economic reforms with the help of the International Monetary Fund (IMF) to rehabilitate the economy, restore the infrastructure of destroyed transportation and communications facilities, and bring the annual inflation rate of 250% under control. Uganda has ample fertile land and rich deposits of copper and cobalt, but, due to economic mismanagement and political instability, is one of the world's poorest countries. The gross domestic product in 1983 was $5.9 billion. Exports totalled $380 million, 90% of which was accounted for by coffee. Most industry is devoted to the processing of agricultural produce and the manufacture of agricultural tools, but production of construction materials is resuming. Uganda has 800 miles of railroad, linking Mombasa on the Indian Ocean with the interior, and 20,000 miles of roads, radiating from Kampala, the capital. There is an international airport at Entebbe, built with Yugoslav assistance. The army, i.e., the National Resistance Army, receives military aid from Libya and the Soviet Union. The United States broke off diplomatic relations with Uganda during the Amin regime, but has provided roughly $43 million of aid and development assistance during the 1980s.
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.
[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.
[Unpublished] 1986. Presented at the All-Africa Parliamentary Conference on Population and Development, Harare, Zimbabwe, May 12-16, 1986. 7 p.The Second African Conference on Population and Development, held early in 1984, marked a decisive stage in African thinking about population. During the 12 years between the 1972 and 1984 conferences, African nations learned in detail about their demographic situation and confronted the ever-increasing costs of development and their lack of physical and administrative infrastructure. In the midst of these and other concerns came the drought, which for over a decade in some parts of the continent has reduced rainfall, dried up rivers, lakes, and wells, and forced millions into flight. It is in this context that population became an African issue. African countries on the whole are not densely populated nor do they yet have very large concentrations in cities. Yet, population emerges as more than a matter of numbers, and there are features which give governments cause for concern. First, the population of most African countries, and of the continent as a whole, is growing rapidly and could double itself in under 25 years. Second, mortality among mothers and children is very high. Third, life expectancy generally is lower in African than in other developing countries. Fourth, urbanization is sufficiently rapid to put more than half of Africa in cities by 2020 and 1/3 of the urban population in giant cities of over 4 million people. The 1984 conference recognized these and other uncomfortable facts and their implications for the future, and agreed that attention to population was an essential part of African development strategy. Strategy is considered in terms of the 4 issues mentioned. First, high rates of growth are not in themselves a problem, but they mean a very high proportion of dependent children in the population. About 45% of Africa's population is under age 14 and will remain at this level until the early years of the 21st century. Meeting the needs of so many children and young adults taxes the ability of every African nation, regardless of how rapidly its economy may expand. Understanding this, a growing number of African leaders call for slower growth in order to achieve a balance in the future between population and the resources available for development. Reducing mortality requires innovation. Among the new approaches to health care are the use of traditional medicine and practitioners in conjunction with modern science and the mobilization of community groups for preventive care and self-help. Health care and better nutrition also are keys to improvement in life expectancy and call for ingenuity and innovation on the part of African governments and communities. Part of the solution to the impending urban crisis must be attention to the viability of the rural sector. The role of the UN Fund for Population Activities in addressing the identified issues is reviewed.
[Unpublished] 1984 Aug 13. 40 p. (E/CONF.76/L.3; M-84-718)This report of the International Conference on Population, held in Mexico City during August 1984, includes: recommendations for action (socioeconomic development and population, the role and status of women, development of population policies, population goals and policies, and promotion of knowledge and policy) and for implementation (role of national governments; role of international cooperation; and monitoring, review, and appraisal). While many of the recommendations are addressed to governments, other efforts or initiatives are encouraged, i.e., those of international organizations, nongovernmental organizations, private institutions or organizations, or families and individuals where their efforts can make an effective contribution to overall population or development goals on the basis of strict respect for sovereignty and national legislation in force. The recommendations reflect the importance attached to an integrated approach toward population and development, both in national policies and at the international level. In view of the slow progress made since 1974 in the achievement of equality for women, the broadening of the role and the improvement of the status of women remain important goals that should be pursued as ends in themselves. The ability of women to control their own fertility forms an important basis for the enjoyment of other rights; likewise, the assurance of socioeconomic opportunities on a equal basis with men and the provision of the necessary services and facilities enable women to take greater responsibility for their reproductive lives. Governments are urged to adopt population policies and social and economic development policies that are mutually reinforcing. Countries which consider that their population growth rates hinder the attainment of national goals are invited to consider pursuing relevant demographic policies, within the framework of socioeconomic development. In planning for economic and social development, governments should give appropriate consideration to shifts in family and household structures and their implications for requirements in different policy fields. The international community should play an important role in the further implementation of the World Population Plan of Action. Organs, organizations, and bodies of the UN system and donor countries which play an important role in supporting population programs, as well as other international, regional, and subregional organizations, are urged to assist governments at their request in implementing the reccomendations.
New York, New York, United Nations, 1984. ix, 476 p. (International Conference on Population, 1984; Statements)The Expert Group on Fertility and Family was one of 4 expert groups assigned the task of examining critical, high priority population issues and, on that basis, making recommendations for action that would enhance the effectiveness of and compliance with the World Population Plan of Action. The report of the Expert Group consisted of 6 topics: 1) fertility response to modernization; 2) family structure and fertility; 3) choice with respect to childbearing, 4) reproductive and economic activity of women, 5) goals, policies and technical cooperation, and 6) recommendations. Contained in this report are also selected background papers with discuss in detail fertility determinants such as modernization, fertility decision processes, socioeconomic determinants, infant and child mortality as a ddeterminant of achieved fertility in some developed countries, the World Fertility Survey's contribution to understanding of fertility levels and trends, fertility in relation to family structure, measurement of the impact of population policies and programs on fertility, and techinical cooperation in the field of fertility and the family.
Planned Parenthood Review. 1984 Spring-Summer; 4(1):9-10.The Planned Parenthood Federation of America supports international family planning efforts through its affiliation with the International Planned Parenthood Federation (IPPF) and the activities of its own International Division, Family Planning International Assistance (FPIA). FPIA is founded on the beliefs that family planning is a basic human right; family planning programs benefit individuals, families, communities, and nations; and family planning along with other needed socieconomic programs can have a major impact on development. Careful timing, spacing, and limiting of births is directly and causally related to improved infant and maternal survival through readily observed and easily explained mechanisms. Mothers in developing countries are anywhere from 10 to 20 or 30 times as likely to die in childbirth as mothers in developed countries. Risks are greatest for mothers under 18 years old, over 30, for those having births within 2 years of a previous birth, and 4th or later deliveries. The differences occur for women at all levels of affluence and access to medical care in all societies, but are particularly sharp in developing countries. Among the poorest countries, 200 or more of every 1000 liveborn infants may die in their 1st year compared to fewer than 10/1000 live births in some wealthy egalitarian countries. The infant mortality rate is so closely related to the overall level of well-being in a country or region that it is regarded as 1 of the most revealing measures of how well a society is meeting the needs of its people. Many of the risk factors for maternal mortality also contribute to infant mortality. Infant mortality in developing countries drops appreciably when women practice family planning and reduce the number of high risk pregnancies. Throughout the developing world, the higher risk infants born to very young or older mothers, mothers with recent previous pregnancies, and mothers with 3 or 4 previous births are 3-10 times more likely to die in their 1st year. Too short birth intervals may threaten the life of the older child through early weaning and resulting increased susceptibility to malnutrition and infection. Careful planning of births through contraception can result in a population better able to contribute economically and less likely to strain the medical resources.