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  1. 1

    Child survival: India and China's challenges [editorial]

    Lancet. 2008 Aug 16; 372(9638):508.

    Last week, UNICEF published The State of Asia-Pacific's Children 2008-its first annual report on maternal, newborn, and child survival in the region. The report has a particular focus on the challenges for India and China, since, with their huge populations, achievements in these countries can make a substantial difference to child survival in the region and worldwide. China has made good investments in health (10% of gross domestic product) and is on track to reach Millennium Development Goal (MDG) 4 on child survival. However, UNICEF notes that the country's progress has slowed down in the past 10 years and the coverage of essential interventions remains low in rural areas. The report singles out India. It states that the global attainment of the health-related MDGs will largely depend on the country's progress in improving health and addressing the social determinants of health. A fifth of all deaths (2.1 million) in children younger than 5 years occurred in India in 2006. Huge disparities in infant mortality rates exist-within cities and between urban and rural areas, and between the sexes, socioeconomic groups, and different castes. The privatisation of health care in India and China is set to widen the gaps between rich and poor people. Without progress on reducing disparities, efforts to provide primary health care to women and children could founder, says UNICEF. But there are reasons for optimism in India. The government launched the National Rural Health Mission in 2005 to tackle deepening disparities in the country, with the reduction of the infant mortality rate as a primary goal. Interventions, such as cash transfers for expectant mothers living below the poverty line, neonatal services, and the Integrated Management of Neonatal and Childhood Illness, are gradually being rolled out. Such initiatives show there is political will in India to address child survival. But this commitment is not backed-up by serious financial investment. The Indian Government spends less on health (3% of gross domestic product) than several other countries in the Asia-Pacific region, despite a gross domestic product growth rate of 9% in 2007. India can, and must, spend more on health if its mothers and children are to prosper. (full text)
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  2. 2

    Situation analysis of maternal and child health in Bangladesh.

    Preble EA

    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.
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