MDG 4: REDUCE Child mortality

MDG 4: REDUCE Child mortality

Author(s): Shirley Chen, Lynette Thames, Kathryn Marten, 2010 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike 3.0 License: http://creativecommons.org/licenses/by-sa/3.0/ We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your ability to use, share, and adapt it. The citation key on the following slide provides information about how you may share and adapt this material. Copyright holders of content included in this material should contact [email protected] with any questions, corrections, or clarification regarding the use of content. For more information about how to cite these materials visit http://open.umich.edu/privacy-and-terms-use. Any medical information in this material is intended to inform and educate and is not a tool for self-diagnosis or a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. Please speak to your physician if you have questions about your medical condition. Viewer discretion is advised: Some medical content is graphic and may not be suitable for all viewers. Citation Key for more information see: http://open.umich.edu/wiki/CitationPolicy

Use + Share + Adapt { Content the copyright holder, author, or law permits you to use, share and adapt.} Public Domain Government: Works that are produced by the U.S. Government. (17 USC 105) Public Domain Expired: Works that are no longer protected due to an expired copyright term. Public Domain Self Dedicated: Works that a copyright holder has dedicated to the public domain. Creative Commons Zero Waiver Creative Commons Attribution License Creative Commons Attribution Share Alike License Creative Commons Attribution Noncommercial License Creative Commons Attribution Noncommercial Share Alike License GNU Free Documentation License Make Your Own Assessment { Content Open.Michigan believes can be used, shared, and adapted because it is ineligible for copyright.} Public Domain Ineligible: Works that are ineligible for copyright protection in the U.S. (17 USC 102(b)) *laws in your jurisdiction may differ

{ Content Open.Michigan has used under a Fair Use determination. } Fair Use: Use of works that is determined to be Fair consistent with the U.S. Copyright Act. (17 USC 107) *laws in your jurisdiction may differ Our determination DOES NOT mean that all uses of this 3rd-party content are Fair Uses and we DO NOT guarantee that your use of the content is Fair. To use this content you should do your own independent analysis to determine whether or not your use will be Fair. MDG 4: REDUCE CHILD MORTALITY The Noun Project Shirley Chen, Lynette Thames, Kathryn Marten THE GOAL Target 5: Reduce by two-thirds, between 1990

and 2015, the under-five mortality rate Indicators: 13. Under-five mortality rate 14. Infant mortality rate 15. Proportion of 1 yr-old children immunized against measles WHO via The global health nonprofit PATH, flickr WHAT CAUSES CHILD MORTALITY? In 1993, the number of under-five deaths attributable to malnutrition:

54% United Nations. 2010. The millennium development goals report. New York, NY: Inter-Agency and Expert Group on MDG Monitoring United States Agency for International Development. (2007, June). Diarrheal disease course guide. Retrieved from http://www.globalhealthlearning.org/page.cfm?course=22&topic=1&page=7 SO WHY IS THE MEASLES VACCINE INCLUDED? United Nations. 2010. The millennium development goals report. New York, NY: Inter-Agency and Expert Group on MDG Monitoring United States Agency for International Development. (2007, June). THE MEASLES VACCINE IS INCLUDED BECAUSE 2008: 164,000 measles deaths It costs less than $1 dollar to vaccinate a child against measles

Most common in children in parts of Asia sub-Saharan Africa where child mortality is highest HIV/AIDS, Vit A deficiency, conflict zone co-morbidity WHO Africa region (10% worlds population) accounted for 58% of measles deaths in 2000. Access to measles vaccine varies across socio-economic, education, rural location and birth order demographics Source: World Health Organization. (2009). Measles. Retrieved from http://www.who.int/mediacentre/factsheets/fs286/en/ WHAT ISNT INCLUDED? Advent of medical advances since 1990 Rotavirus vaccine improvement to prevent major cause of diarrheal illness Addressing root causes of childhood illness/death Malnutrition Access to healthcare services Sanitation: ACCESS TO CLEAN DRINKING WATER

Example: Cholera outbreak in Haiti Homelessness led to open defecation No place in temporary camps to purify water ORT WHERE ARE WE NOW? World Development Indicators database, http://data.worldbank.org/data-catalog/world-development-indicators Progress in MDG 4 1990 1995 2000 2005 2008 Mortality rate, under-5 (per 1,000) 92 88 79

68 63 Mortality rate, infant (per 1,000 live births) 64 61 55 48 44 Immunization, measles (% of children ages 12-23

months) 73 74 73 78 83 The average rate of decline from 2000 to 2008 is 2.3%, compared to a 1.4% average decline from 1990 to 2000. Source: United Nations Childrens Fund. (2009, September 10). Global child mortality continues to drop. Retrieved from http://www.unicef.org/media/media_51087.html WHERE ARE WE NOW? Under-5 mortality rate, 2008

Value Rank Afghanistan Angola Chad Somalia Dem. Republic of the Congo Guinea-Bissau Mali Sierra Leone Nigeria Central African Republic Montenegro Slovakia United Arab Emirates United States Finland Iceland

Luxembourg Singapore Sweden Liechtenstein San Marino Source: UNICEF State of the Worlds Children 2010 257 220 209 200 199 195 194 194 186 173

8 8 8 8 3 3 3 3 3 2 2 1 2 3 4 5 6

7 7 9 10 149 149 149 149 188 188 188 188 188 193 193 U.S. is lagging in child mortality reduction

Ranked 42nd (6.7 deaths/1,000 children) compared to 29th in 1990 7.7 million child deaths in 2010, down from 11.9 million deaths in 1990 Across 21 regions of the world, rates of neonatal, postneonatal, and childhood mortality are declining Source: Rajaratnam JK, Marcus JR, Flaxman AD, et al. Neonatal, postneonatal, childhood, and under-5 mortality for 187 countries, 19702010. Lancet 2010; 375: 1988-2008 OVERALL PROGRESS BUT Globally, child mortality has only fallen by 28% since 1990 Not yet 1/3 of the way to meeting our target in 2015

Out of the 64 countries with highest child mortality rates, only 9 are on track to meet MDG 4. 99% of child deaths take place in developing countries The highest rates of child mortality rates are found in subSaharan Africa, which accounts for half all deaths Increased mortality in Chad, Congo, Kenya, South Africa Source: Save the Children. (2010). A Fair Chance at Life: Why Equity Matters for Child Mortality. Report for the 2010 Summit on the Millennium Development Goals. Retrieved from http://www.savethechildren.net/alliance/media/newsdesk/2010-09-07.html http://www.un.org/millenniumgoals/2008highlevel/pdf/newsroom/Goal%204%20FINAL.pdf WHO and UNICEF Countdown to 2015 Decade Report (20002010): Taking stock of maternal, newborn and child survival, 2010 DISPARITIES BETWEEN COUNTRIES Gap mirrors economic development between countries but there is

no obvious correlation between changes in GDP and child mortality South Africa Egypt Policy choices Distribution of wealth and health resources Save the Children. (2010). A Fair Chance at Life: Why Equity Matters for Child Mortality. DISPARITIES WITHIN COUNTRIES Victoria, et al. Applying an equity lens to child health and mortality: more of the same is not enough. Lancet. 2003;362(9379):233-41. GROWING RICH-POOR GAP Save the Children Analysis using data from Demographic and Health Surveys

ADDRESSING INEQUITIES Human rights framework for child health UN Convention on the Rights of the Child (1989) Egalitarian approach Rate of reduction in each quintile matches that in the fastest improving quintile Equitable approach? Universal access/delivery of essential services Comprehensive strategies to tackle wider determinants of child survival Links to other MDGs The Noun Project The Noun Project The Noun Project

The Noun Project The Noun Project WHY ARENT WE THERE? Lack of progress in maternal health (MDG 5) 41% of under-five deaths are due to neonatal causes Preventable Antenatal care Skilled birth attendants Emergency obstetric care Continuum of care Harbor Life, flickr Source: Kiros, G., & Hogan, D. (2000). War, famine and excess child mortality in Africa: the role of parental education. International Journal of Epidemiology., 30 (3), 447-455.

WHO Partnership for Maternal, Newborn, and Child Health. Countdown to 2015: Decade Report (2000-2010). WHY ARENT WE THERE? Womens education 1-3 years of maternal schooling could decrease child mortality by 15% Regional instability Conflict zones make food production difficult 44% of child deaths happen in countries considered fragile Lack of sanitary food and water sources Diarrhea and malnutrition Source: Save The Children. (2010). A Fair Chance at Life,: Why Equity Matters For Child Mortality. Retrieved from: http://www.savethechildren.org.uk/en/54_12454.htm WHY ARENT WE THERE? Lack of funding 1.7 million measles-related deaths are predicted between 2010 and 2013

Sub-standard funding/aid Food aid dalexfilms,, flickr Source: Save The Children. (2010). A Fair Chance at Life,: Why Equity Matters For Child Mortality. Retrieved from: http://www.savethechildren.org.uk/en/54_12454.htm WHAT IS WORKING? Enhancing immunization programs Vietnam Egypt Bangladesh Encouraging breastfeeding in Cambodia Cambodian Ministry of Healths Baby Friendly Community Initiative Offering mosquito nets in: Congo Democratic Republic of Congo

Gabon Mali Source: Unites Nations. (2010). Goal 4 Reduce Child Mortality. Retrieved from: http//www.un.org/millenniumgoals/pdf/MDG_FS_4_EN.pdf WHAT IS WORKING? Open Clip Art Open Clip Art WHO and UNICEF contributions GOBI= Growth monitoring, Oral rehydration therapy, Breastfeeding & Immunization GOBI/FFF: World Bank added Family planning, Food production, and female education Expanded Program on Immunization (EPI) Integrated Management of Childhood Illness (IMCI)

UN Accomplishments Global Strategy for Women and Children's Health Source: Unites Nations. (2010). Goal 4 Reduce Child Mortality. Retrieved from : http//www.un.org/millenniumgoals/pdf/MDG_FS_4_EN.pdf Jacobsen, K.H. Introduction to Global Health. 2008 Please see original image of Jeopardy! at http://www.slotshero.com/slots/jeopardy/jeopardyslots.jpg Additional Source Information for more information see: http://open.umich.edu/wiki/CitationPolicy Slide 3, Image 1: Jack Biesek, Gladys Brenner, Margaret Faye, Healther Merrifield, Kate Keating, Wendy Olmstead, Todd Pierce, "Teddy Bear", The Noun Project, http://thenounproject.com/noun/teddy-bear/, Public Domain. Slide 4 , Image 1: WHO and The global health nonprofit PATH, Child receives MenAfriVac shot in Burkina Faso, flickr, http://www.flickr.com/photos/pathphotos/5225170834/, CC: BY-NC, http://creativecommons.org/licenses/by-nc/2.0/. Slide 15, Image 1: The Noun Project, Salad, The Noun Project, http://thenounproject.com/noun/salad/, CC: BY 3.0, http://creativecommons.org/licenses/by/3.0/. Slide 15, Image 2: The Noun Project, Pencil, The Noun Project, http://thenounproject.com/noun/pencil/, CC: BY 3.0, http://creativecommons.org/licenses/by/3.0/. Slide 15, Image 3: Unknown, Female, The Noun Project, http://thenounproject.com/noun/female/, Public Domain.

Slide 15, Image 4: Jack Biesek, Gladys Brenner, Margaret Faye, Healther Merrifield, Kate Keating, Wendy Olmstead, Todd Pierce, "Baby", The Noun Project, http://thenounproject.com/noun/baby/#icon-No626, Public Domain. Slide 15, Image 5: The Noun Project, "Tree", The Noun Project, http://thenounproject.com/noun/tree/#icon-No479, CC: BY 3.0, http://creativecommons.org/licenses/by/3.0/. Slide 16, Image 1: Harbor Life, Sweet Dreams, flickr, http://www.flickr.com/photos/harborlife/3123845264, CC:BY-NC-SA, http://creativecommons.org/licenses/by-nc-sa/2.0/. Slide 19, Image 1: dalexfilms, Rice Bags, flickr, http://www.flickr.com/photos/dalexfilms/4321055414/, CC:BY-NC-SA, http://creativecommons.org/licenses/by-nc-sa/2.0/. Slide 21, Image 1: Anonymous, Flag of the Unicef, Open Clip Art Gallery, http://www.openclipart.org/detail/23724, CC:zero, http://creativecommons.org/publicdomain/zero/1.0/. Slide 21, Image 2: Anonymous, Flag of the WHO, Open Clip Art Gallery, http://www.openclipart.org/detail/23720, CC:zero, http://creativecommons.org/publicdomain/zero/1.0/. Slide 22, Image 1: Please see original image of Jeopardy! at http://www.slotshero.com/slots/jeopardy/jeopardy-slots.jpg

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