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  1. 1
    393224

    Professional care delivery or traditional birth attendants? The impact of the type of care utilized by mothers on under-five mortality of their children.

    Muzyamba C; Groot W; Pavlova M; Rud I; Tomini SM

    Tropical Medicine and Health. 2018; 46(1)

    Background: Because of the high under-five mortality rate, the government in Zambia has adopted the World Health Organization (WHO) policy on child delivery which insists on professional maternal care. However, there are scholars who criticize this policy by arguing that although built on good intentions, the policy to ban traditional birth attendants (TBAs) is out of touch with local reality in Zambia. There is lack of evidence to legitimize either of the two positions, nor how the outcome differs between women with HIV and those without HIV. Thus, the aim of this paper is to investigate the effect of using professional maternal care or TBA care by mothers (during antenatal, delivery, and postnatal) on under-five mortality of their children. We also compare these outcomes between HIV-positive and HIV-negative women. Methods: By relying on data from the 2013-2014 Zambia Demographic Health Survey (ZDHS), we carried out propensity score matching (PSM) to investigate the effect of utilization of professional care or TBA during antenatal, childbirth, and postnatal on under-five mortality. This method allows us to estimate the average treatment effect on the treated (ATT). Results: Our results show that the use of professional care as opposed to TBAs in all three stages of maternal care increases the probability of children surviving beyond 5 years old. Specifically for women with HIV, professional care usage during antenatal, at birth, and during postnatal periods increases probability of survival by 0.07 percentage points (p.p), 0.71 p.p, and 0.87 p.p respectively. Similarly, for HIV-negative women, professional care usage during antenatal, at birth, and during postnatal periods increases probability of survival by 0.71 p.p, 0.52 p.p, and 0.37 p.p respectively. However, although there is a positive impact when mothers choose professional care over TBAs, the differences at all three points of maternal care are small. Conclusion: Given our findings, showing small differences in under-five child's mortality between utilizers of professional care and utilizers of TBAs, it may be questioned whether the government's intention of completely excluding TBAs (who despite being outlawed are still being used) without replacement by good quality professional care is the right decision. © 2018 The Author(s).
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  2. 2
    375813

    State of health inequality, Indonesia.

    World Health Organization [WHO]; Indonesia. Ministry of Health

    Geneva, Switzerland, WHO, 2017. 184 p. (Interactive Visualization of Health Data)

    In order to reduce health inequalities and identify priority areas for action to move towards universal health coverage, governments first need to understand the magnitude and scope of inequality in their countries. From April 2016 to October 2017, the Indonesian Ministry of Health, WHO, and a network of stakeholders assessed country-wide health inequalities in 11 areas, such as maternal and child health, immunization coverage and availability of health facilities. A key output of the monitoring work is a new report called State of health inequality: Indonesia, the first WHO report to provide a comprehensive assessment of health inequalities in a Member State. The report summarizes data from more than 50 health indicators and disaggregates it by dimensions of inequality, such as household economic status, education level, place of residence, age or sex. This report showcases the state of inequality in Indonesia, drawing from the latest available data across 11 health topics (53 health indicators), and eight dimensions of inequality. In addition to quantifying the magnitude of health inequality, the report provides background information for each health topic, and discusses priority areas for action and policy implications of the findings. Indicator profiles illustrate disaggregated data by all applicable dimensions of inequality, and electronic data visuals facilitate interactive exploration of the data. This report was prepared as part of a capacity-building process, which brought together a diverse network of stakeholders committed to strengthening health inequality monitoring in Indonesia. The report aims to raise awareness about health inequalities in Indonesia, and encourage action across sectors. The report finds that the state of health and access to health services varies throughout Indonesia and identifies a number of areas where action needs to be taken. These include, amongst others: improving exclusive breastfeeding and childhood nutrition; increasing equity in antenatal care coverage and births attended by skilled health personnel; reducing high rates of smoking among males; providing mental health treatment and services across income levels; and reducing inequalities in access to improved water and sanitation. In addition, the availability of health personnel, especially dentists and midwives, is insufficient in many of the country’s health centres. Now the country is using these findings to work across sectors to develop specific policy recommendations and programmes, such as the mobile health initiative in Senen, to tackle the inequalities that have been identified.
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  3. 3
    344649

    State of inequality: Reproductive, maternal, newborn and child health.

    World Health Organization [WHO]. Department of Health Statistics and Information Systems

    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.
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  4. 4
    374221

    Inheriting a sustainable world? Atlas on children’s health and the environment.

    Drisse MN; Goldizen F

    Geneva, Switzerland, WHO, 2017. 164 p.

    In 2015, 26% of the deaths of 5.9 million children who died before reaching their fifth birthday could have been prevented through addressing environmental risks – a shocking missed opportunity. The prenatal and early childhood period represents a window of particular vulnerability, where environmental hazards can lead to premature birth and other complications, and increase lifelong disease risk including for respiratory disorders, cardiovascular disease and cancers. The environment thus represents a major factor in children’s health, as well as a major opportunity for improvement, with effects seen in every region of the world. Children are at the heart of the Sustainable Development Goals, because it is children who will inherit the legacy of policies and actions taken, and not taken, by leaders today. The third SDG, to “ensure healthy lives and promote well-being for all at all ages,” has its foundation in children’s environmental health, and it is incumbent on us to provide a healthy start to our children’s lives. This cannot be achieved, however, without multisectoral cooperation, as seen in the linkages between environmental health risks to children and the other SDGs. This publication is divided by target: SDGs 1, 2 and 10 address equity and nutrition; SDG 6 focuses on water, sanitation and hygiene (WASH); SDGs 7 and 13 call attention to energy, air pollution and climate change; SDGs 3, 6 and 12 look at chemical exposures; and SDGs 8, 9 and 11 study infrastructure and settings.
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  5. 5
    376642

    Addressing the Child and Maternal Mortality Crisis in Haiti through a Central Referral Hospital Providing Countrywide Care.

    Jacobs LD; Judd TM; Bhutta ZA

    Permanente Journal. 2016 spring; 20(2):59-70.

    The neonatal, infant, child, and maternal mortality rates in Haiti are the highest in the Western Hemisphere, with rates similar to those found in Afghanistan and several African countries. We identify several factors that have perpetuated this health care crisis and summarize the literature highlighting the most cost-effective, evidence-based interventions proved to decrease these mortality rates in low- and middle-income countries.To create a major change in Haiti's health care infrastructure, we are implementing two strategies that are unique for low-income countries: development of a countrywide network of geographic "community care grids" to facilitate implementation of frontline interventions, and the construction of a centrally located referral and teaching hospital to provide specialty care for communities throughout the country. This hospital strategy will leverage the proximity of Haiti to North America by mobilizing large numbers of North American medical volunteers to provide one-on-one mentoring for the Haitian medical staff. The first phase of this strategy will address the child and maternal health crisis.We have begun implementation of these evidence-based strategies that we believe will fast-track improvement in the child and maternal mortality rates throughout the country. We anticipate that, as we partner with private and public groups already working in Haiti, one day Haiti's health care system will be among the leaders in that region.
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  6. 6
    337129

    Monitoring health inequality: an essential step for achieving health equity. Illustrations of fundamental concepts.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, 2014. [16] 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.
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  7. 7
    359923

    Progress in introduction of pneumococcal conjugate vaccine worldwide, 2000-2012.

    Releve Epidemiologique Hebdomadaire. 2013 Apr 26; 88(17):173-80.

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  8. 8
    353226

    Progress in the introduction of rotavirus vaccine--Latin America and the Caribbean, 2006-2010.

    Centers for Disease Control and Prevention (CDC)

    MMWR. Morbidity and Mortality Weekly Report. 2011 Dec 2; 60:1611-4.

    Rotavirus disease is the leading cause of childhood morbidity and mortality related to diarrhea in Latin America and the Caribbean (LAC), where an estimated 8,000 deaths related to rotavirus diarrhea occur annually among children aged <5 years. After two safe and effective rotavirus vaccines became available, the World Health Organization (WHO) in 2007 recommended inclusion of rotavirus vaccine in the immunization programs of Europe and the Americas, and in 2009 expanded the recommendation to all infants aged <32 weeks worldwide. This report describes progress in the introduction of rotavirus vaccine in LAC, where it was first introduced in 2006 in Brazil, El Salvador, Mexico, Nicaragua, Panama, and Venezuela; by January 2011, it was included in the national immunization schedules of 14 countries in LAC. Estimated national rotavirus vaccine coverage (2 doses of the monovalent vaccine or 3 doses of the pentavalent vaccine) among children aged <1 year in 2010 ranged from 49% to 98% (median: 89%) in the 11 LAC countries with vaccine introduction before 2010. Of the 14 countries that had introduced rotavirus vaccine into their national immunization programs, 13 participate in a hospital-based rotavirus surveillance network. Data from some countries in this network and from other monitoring efforts in LAC countries have shown declines in hospitalizations and deaths related to severe diarrhea after rotavirus vaccine introduction. The rapid introduction of rotavirus vaccine in LAC demonstrates the benefits of the early commitment of national decision makers to introduce these vaccines in low-income and middle-income countries at the same time as in high-income countries.
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  9. 9
    351815
    Peer Reviewed

    Global cost of child survival: estimates from country-level validation.

    van Ekdom L; Stenberg K; Scherpbier RW; Niessen LW

    Bulletin of the World Health Organization. 2011 Apr 1; 89(4):267-77.

    OBJECTIVE: To cross-validate the global cost of scaling up child survival interventions to achieve the fourth Millennium Development Goal (MDG4) as estimated by the World Health Organization (WHO) in 2007 by using the latest country-provided data and new assumptions. METHODS: After the main cost categories for each country were identified, validation questionnaires were sent to 32 countries with high child mortality. Publicly available estimates for disease incidence, intervention coverage, prices and resources for individual-level and programme-level activities were validated against local data. Nine updates to the 2007 WHO model were generated using revised assumptions. Finally, estimates were extrapolated to 75 countries and combined with cost estimates for immunization and malaria programmes and for programmes for the prevention of mother-to-child transmission of the human immunodeficiency virus (HIV). FINDINGS: Twenty-six countries responded. Adjustments were largest for system- and programme-level data and smallest for patient data. Country-level validation caused a 53% increase in original cost estimates (i.e. 9 billion 2004 United States dollars [US$]) for 26 countries owing to revised system and programme assumptions, especially surrounding community health worker costs. The additional effect of updated population figures was small; updated epidemiologic figures increased costs by US$ 4 billion (+15%). New unit prices in the 26 countries that provided data increased estimates by US$ 4.3 billion (+16%). Extrapolation to 75 countries increased the original price estimate by US$ 33 billion (+80%) for 2010-2015. CONCLUSION: Country-level validation had a significant effect on the cost estimate. Price adaptations and programme-related assumptions contributed substantially. An additional 74 billion US$ 2005 (representing a 12% increase in total health expenditure) would be needed between 2010 and 2015. Given resource constraints, countries will need to prioritize health activities within their national resource envelope.
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  10. 10
    345609
    Peer Reviewed

    Use of new World Health Organization child growth standards to assess how infant malnutrition relates to breastfeeding and mortality.

    Vesel L; Bahl R; Martines J; Penny M; Bhandari N; Kirkwood BR

    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.
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  11. 11
    331941

    Diarrhoea: Why children are still dying and what can be done.

    Johansson EW; Wardlaw T; Binkin N; Brocklehurst C; Dooley T

    New York, New York, UNICEF, 2009. [65] p.

    This report sets out a 7-point strategy for comprehensive diarrhoea control that includes a treatment package to reduce child deaths, and a prevention package to reduce the number of diarrhoea cases for years to come. The report looks at treatment options such as low-osmolarity ORS and zinc tablets, as well as prevention measures such as the promotion of breastfeeding, vitamin A supplementation, immunization against rotavirus -- a leading cause of diarrhoea -- and proven methods of improving water, sanitation and hygiene practices. Diarrhoea's status as the second leading killer of children under five is an alarming reminder of the exceptional vulnerability of children in developing countries. Saving the lives of millions of children at risk of death from diarrhoea is possible with a comprehensive strategy that ensures all children in need receive critical prevention and treatment measures. (Excerpt)
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  12. 12
    326748

    Child and Adolescent Health and Development progress report 2006-2007. Highlights.

    World Health Organization [WHO]. Department of Child and Adolescent Health and Development

    Geneva, Switzerland, WHO, Department of Child and Adolescent Health and Development, 2008. 20 p.

    The first few days and weeks of life are among the most critical for child survival. Every year, an estimated 4 million children die during the first month of life. Almost all of these deaths (98%) occur in developing countries. Most neonatal deaths are due to ore-term birth, asphyxia and infections such as sepsis, tetanus and pneumonia. In 2006-2007, to support efforts by countries and regions to reduce newborn deaths, we worked to build capacity for the planning and delivery of improved newborn care services in health facilities and communities, to provide tools and guidance for extending population coverage, and to evaluate the impact of all those actions. (excerpt)
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  13. 13
    321141

    Adolescent pregnancy -- unmet needs and undone deeds. A review of the literature and programmes.

    Neelofur-Khan D

    Geneva, Switzerland, World Health Organization [WHO], 2007. [109] p. (WHO Discussion Papers on Adolescence; Issues in Adolescent Health and Development)

    The World Health Organization (WHO) has been contributing to meeting the Millennium Development Goals (MDGs) by according priority attention to issues pertaining to the management of adolescent pregnancy. Three of the aims of the MDGs - empowerment of women, promotion of maternal health, and reduction of child mortality - embody WHO's key priorities and its policy framework for poverty reduction. The UN Special Session on Children has focused on some of the key issues affecting adolescents' rights, including early marriage, access to sexual and reproductive health services, and care for pregnant adolescents. This review of the literature was conducted to identify (1) the major factors affecting the pregnancy outcome among adolescents, related to their physical immaturity and inappropriate or inadequate healthcare-seeking behaviour, and (2) the socioeconomic and political barriers that influence their access to health-care services and information. The review also presents programmatic evidence of feasible measures that can be taken at the household, community and national levels to improve pregnancy outcomes among adolescents. (excerpt)
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  14. 14
    320507

    Child and adolescent health and development in a European perspective --- a new WHO strategy.

    Ostergren MM; Barnekow V

    Danish Medical Bulletin. 2007 May; 54:150-152.

    In general, children and adolescents in the WHO European Region today have better nutrition, health and development than ever before. There are striking inequalities in health status across the 52 countries in the Region, however, with over ten-fold differences in infant and child mortality rates. Inequalities are also growing within countries, and several health threats are emerging. Against this background, the WHO Regional Office for Europe has developed a European strategy for child and adolescent health and development. The purpose of the Strategy, together with a tool kit for implementation, is to assist member states in formulating their own policies and programmes. (author's)
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  15. 15
    319153

    Focusing on malnutrition management to improve child survival in India [editorial]

    Ashworth A; Jackson A; Uauy R

    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)
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  16. 16
    307068
    Peer Reviewed

    Weaning practices of the Makushi of Guyana and their relationship to infant and child mortality: A preliminary assessment of international recommendations.

    Wilson W; Milner J; Bulkan J; Ehlers P

    American Journal of Human Biology. 2006 May-Jun; 18(3):312-324.

    The World Health Organization (WHO) recommends exclusive breastfeeding (EBF) for the first 6 months of life, primarily because of potential immunological benefits which are deemed to outweigh nutritive costs for infants. This recommendation is controversial, as studies of the relationship between the term of EBF and infant and child health have produced conflicting results. The purpose of this paper is to evaluate the relationship between the term of EBF and infant and child mortality among a group of swidden-horticulturalists in lowland South America. Consistent with the WHO, we hypothesized that EBF < 6 months will compromise the survival of the infant or child. This relationship was assessed via recall data generated in 2001 in structured interviews with 60 Makushi Amerindian women in Guyana's North Rupununi region. The data were analyzed with t-tests, Fisher's exact test, and logistic regression. The results do not support our hypothesis; the term of EBF is not found to be related to infant or child mortality. This is surprising given the potential for contamination in nonbreast-milk foods in this environment. Notably, this is occurring among mothers who are not energetically stressed. We propose that the apparent lack of benefit of EBF = 6 months is due to insufficient energy supply from breast milk alone, which may predispose the child to morbidity when subsequently stressed. This study concurs with others which revealed no significant benefits to the infant of EBF > 6 months, and the recognition that universal recommendations must be situated within local ecological contexts. (author's)
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  17. 17
    297460
    Peer Reviewed

    Malaria deaths are the hardest to count.

    Iley K

    Bulletin of the World Health Organization. 2006 Mar; 84(3):161-256.

    In the early hours of the morning, Aurola Ngueve strapped her feverish daughter to her back and walked almost three kilometres to a tiny Angolan government health post, a white concrete structure sitting incongruously amid the mud huts of the village of Muinha in central Bié province. In the rudimentary examination room, Aurola anxiously tells the Bulletin that 18-month-old Rosalina, who is screaming as a nurse takes a tiny blood sample from her finger, has had chronic diarrhoea for days. Fifteen minutes later, Aurola receives the dreaded, if not unexpected, news. Rosalina has malaria. Malaria is believed to be one of the chief culprits behind Angola's appalling child mortality statistics. UNICEF estimates that one child in four in this south-western African country is unlikely to live beyond his or her fifth birthday. Rosalina is one of the lucky ones. At this health post, run by the Health Ministry and supported by nongovernmental organization Médecins Sans Frontières, she has been accurately diagnosed and prescribed medication. Her personal details, symptoms, diagnose sis and treatment have been entered into a logbook, and the nurse is confident that with the right care she will bounce back to health in a few days. (excerpt)
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  18. 18
    297438
    Peer Reviewed

    Tracking progress towards the Millennium Development Goals: reaching consensus on child mortality levels and trends.

    Child Mortality Coordination Group

    Bulletin of the World Health Organization. 2006 Mar; 84(3):225-232.

    The increased attention to tracking progress towards the Millennium Development Goals (MDG), including Goal 4 of reducing child mortality, has drawn attention to a number of interrelated technical, operational and political challenges and to the underlying weaknesses of country health information systems upon which reliable monitoring depends. Assessments of child mortality published in 2005, for almost all low-income countries, are based on an extrapolation of the trends observed during the 1990s, rather than on the empirical data for more recent years. The validity of the extrapolation depends on the quality and quantity of the data used, and many countries lack suitable data. In the long run, it is hoped that vital registration or sample registration systems will be established to monitor vital events in a sustainable way. However, in the short run, tracking child mortality in high-mortality countries will continue to rely on household surveys and extrapolations of historical trends. This will require more collaborative efforts both to collect data through initiatives to strengthen health information systems at the country level, and to harmonize the estimation process. The latter objective requires the continued activity of a coordinating group of international agencies and academics that aims to produce transparent estimates -- through the consistent application of an agreed-upon methodology -- for monitoring at the international level. (author's)
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  19. 19
    280136
    Peer Reviewed

    Vaccination and child mortality. [Vaccination et mortalité infantile]

    Hall AJ

    Lancet. 2004 Dec 18-25; 364:2156-2157.

    A report in 2000 from Guinea Bissau suggested a worrisome association between diphtheria, pertussis, and tetanus (DPT) vaccination and mortality. In this issue of The Lancet, Robert Breiman and colleagues respond to concerns about DPT with a highly detailed and reassuring study of vaccination and mortality in Bangladesh. At an epidemiology conference in Helsinki in 1989, Peter Aaby and I spent a few days discussing a problem: vaccines are usually introduced into developing countries with no assessment of their potential effect on overall mortality. The key issue is that if trials of vaccines are to show a beneficial effect, or at least that they cause no harm, the trials need to be so large that they are difficult to fund. Another problem is that once a vaccine has been shown to reduce the frequency of the target disease, it becomes ethically questionable to have an unvaccinated group. Aaby tried to address this issue by using observational data from demographic surveillance in Guinea Bissau. He has published papers suggesting unexpected associations between vaccine use and later patterns of mortality. His findings on DPT vaccine prompted WHO to look closely at his data (including a site visit by independent experts), to commission studies around the world where the association could be studied, and then to hold a meeting of experts to review and report all data in WHO’s Weekly Epidemiological Record. (excerpt)
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  20. 20
    275357

    Evidence Base for the Community Management of Pneumonia, June 11-12, 2002, Stockholm, Sweden.

    World Health Organization [WHO]. Department of Child and Adolescent Health and Development

    Geneva, Switzerland, WHO, Department of Child and Adolescent Health and Development, 2002. 28 p. (WHO/FCH/CAH/02.23)

    Although the past 15 years have seen a decline in child mortality due to pneumonia, it remains a very important cause of death in developing countries. In Africa in particular, pneumonia and malaria are by far the most important causes of death for children under 5. The overall aim of this meeting was to help to define practical community approaches which could deliver a rapid reduction in this preventable mortality. WHO has developed and supported the use of case management of pneumonia through the ARI Programme and later as a part of IMCI. The main focus for these initiatives has been the health facility, although much of the demonstration of the efficacy of the clinical interventions was carried out at community level, using community health workers. IMCI uses the same clinical methodology. Although IMCI stresses the promotion of care-seeking by families with sick children, in general, the clinical management of such children is offered at the first level health facility. The importance of providing care without delay for children with malaria has led to the development and introduction, so far on a small scale, of interventions based in the community, either through a community health worker or directly by families, who are provided with packs of antimalarials. These two diseases in childhood, pneumonia and malaria, have major overlaps in terms of clinical presentation, the requirements for their effective management and the feasibility of providing standardised care in the community. Technically sound and operationally manageable community interventions that tackled both conditions would offer a most valuable tool for use in the reduction in child mortality in developing countries. (excerpt)
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  21. 21
    274751

    WHO / UNICEF joint statement: management of pneumonia in community settings.

    World Health Organization [WHO]; UNICEF

    Geneva, Switzerland, WHO, Department of Child and Adolescent Health and Development, 2004. [8] p. (WHO/FCH/CAH/04.06; UNICEF/PD/Pneumonia/01)

    Pneumonia remains a major killer of children under five years of age. The best way to reduce pneumonia-related mortality is to provide effective treatment promptly. A meeting of experts, national and international agencies, a meta-analysis of trials, and a comprehensive review of community treatment programmes all came to the same conclusion: Pneumonia can be effectively treated in the community. UNICEF and WHO therefore recommend that community-level treatment be carried out by well-trained and supervised community health workers. (excerpt)
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  22. 22
    273819

    WHO / UNICEF joint statement: Clinical management of acute diarrhoea.

    World Health Organization [WHO]; UNICEF

    Geneva, Switzerland, WHO, 2004. 7 p. (WHO/FCH/CAH/04.7; UNICEF/PD/Diarrhoea/01)

    Though the mortality rate for children under five suffering from acute diarrhoea has fallen from 4.5 million deaths annually in 1979 to 1.6 million deaths in 2002, acute diarrhoea continues to exact a high toll on children in developing countries. Oral rehydration salts (ORS) and oral rehydration therapy (ORT), adopted by UNICEF and WHO in the late 1970s, have been successful in helping manage diarrhoea among children. It is estimated that in the 1990s, more than 1 million deaths related to diarrhoea may have been prevented each year, largely attributable to the promotion and use of these therapies. Today, however, there are indications that in some countries knowledge and use of appropriate home therapies to successfully manage diarrhoea, including ORT, may be declining. (excerpt)
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  23. 23
    191583

    Global health improvement and WHO [letter]

    Shatenstein S

    Lancet. 2004 Apr 3; 363(9415):1162.

    I commend Lee Jong-Wook for his Public health article, the most shocking statistic of which highlights the fact that almost a fifth of all deaths across the world occur in developing countries in children younger than 5 years. Efforts by WHO to alleviate this terrible burden are to be acclaimed. I find it disheartening, however, that a 5000-word essay on global health improvement makes only a few general references to noncommunicable diseases and fails to mention the Framework Convention on Tobacco Control (FCTC), one of WHO’s signal achievements. In fact, the words smoking and tobacco do not appear anywhere in the article, despite WHO’s acknowledgment that 4·9 million people are dying each year from tobacco use—a figure that will double within a generation. According to WHO’s own statistics, the burden of disease is currently shared evenly by developed and developing countries, but 70% of this risk will be borne by those in developing countries by the 2020s. (excerpt)
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  24. 24
    190493
    Peer Reviewed

    Health-related millennium development goals out of reach for many countries.

    Bulletin of the World Health Organization. 2004 Feb; 82(2):156-157.

    Many developing countries will not be able to reach the health-related Millennium Development Goals (MDGs) unless clear and immediate action is taken combined with a concerted effort over the next 12 years, warned the World Bank and WHO in Geneva at a meeting on 8 and 9 January. The meeting brought together representatives from concerned countries, development agencies and UN organizations to assess progress towards the healthrelated goals and to map out a future strategy for their achievement. The World Bank and WHO noted that the health goals are particularly difficult to meet and that progress towards them is slower than towards some of the other goals. Four of the eight MDGs, set at the United Nations Millennium Summit in September 2000, relate to health: to reduce maternal mortality by threequarters and child mortality by twothirds, halve the proportion of people who suffer from hunger, combat HIV/ AIDS, malaria and other diseases, and improve access to safe drinking-water and essential drugs. (excerpt)
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  25. 25
    189040
    Peer Reviewed

    WHO urges developing countries to invest in health.

    Lancet. 2003 Nov; 362(9395):1557.

    In a follow up to demands by the 2001 Commission on Macroeconomics and Health (CMH) for a massive increase in health investment, ministers in charge of health, finance, and planning from 40 developing countries met on Oct 29–30 to discuss progress and priorities. Aside from lip service paid to recent achievements, the assessment from the WHO-convened conference was bleak. “Two years on, the world still has not shown determination to increase health investment enough to measurably impact major diseases that affect the world’s poor”, said WHO. (excerpt)
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