POVERTY: SOMALIA: Mortality rates among world's highest in Somaliland

HARGEISA, 2 February 2012 (IRIN) - The self-declared Republic of Somaliland is grappling with high child and maternal mortality rates, malnutrition and inadequate medical personnel, health officials told IRIN.
"Somaliland has one of the worst maternal mortality ratios in the world, estimated to be between 10,443 and 14,004 per 100,000 live births," said Ettie Higgins, head of the UN Children's Fund (UNICEF) field office in Hargeisa, capital of Somaliland.
"The infant mortality rate is 73/1,000 while the under-five mortality [rate] is about 117/1,000. Fully immunized children represent a mere 5 percent. Environmental sanitation is highly challenged," she said.
"There are a little over 100 doctors in the country, both in the public and private sectors, and about the same number of registered midwives," Higgins explained.
"Maternal mortality is the leading cause of death among women of reproductive age; it is caused mainly by haemorrhage, puerperal sepsis, eclampsia and obstructed labour," Higgins said, adding that women in Somaliland had a one in 15 risk of dying of maternal-related causes.

Child mortality
Abdillahi Abdi Yusuf, head of Somaliland's National Health Management and Information System (NHMIS) in the Ministry of Health, said acute respiratory infections accounted for 40 percent of child mortality in Somaliland, while acute watery diarrhoea and malnutrition accounted for another 40 percent.
"Diseases that can be prevented through vaccination, such as polio, diphtheria, tetanus, TB, measles and whooping cough cause 20 percent of children's mortality in Somaliland," Yusuf said.
According to NHMIS statistics, in 2011 "acute respiratory infections [excluding pneumonia] were the highest [cause of] morbidity in Somaliland's public health centres".
Other leading causes included "anaemia, urinary tract infections, watery diarrhoea, pneumonia, skin diseases, eye infections, trauma and burns, sexually transmitted infections and bloody diarrhoea".
According to a UNICEF/Ministry of Health Multi-Indicator Cluster Survey (MICS), diarrhoea is the second-highest cause of morbidity and mortality in Somaliland due to poor sanitation and low rate of access to safe water supplies.
"In Somaliland, only 42 percent of the population have access to latrines and 41 percent have access to safe water supplies," the survey said.
Yasin Nur Tani, a private doctor in Hargeisa, told IRIN: "I used to receive about 20 patients daily, complaining of different ailments; the most common disease is upper respiratory tract infections in all ages while skin disease is second and diarrhoea comes third.
These are then followed by acute gastritis, intestinal parasites, gynaecological and obstetric diseases and other non-communicable diseases including hypertension and diabetes."
Somaliland health authorities, in collaboration with international aid workers, conduct a weekly surveillance of communicable diseases and take action as soon as possible.
"The Ministry's focus on the communicable diseases control programme identifies the control and the prevention of those diseases contributing to the highest burden of disease in the country; these include malaria, tuberculosis, diarrhoeal diseases, HIV/AIDS, meningitis and vaccine preventable diseases," a report [ http://www.emro.who.int/somalia/pdf/Epidemic%20Control-Disease%20tools-EN.pdf ] by the Health Ministry states.
 http://www.irinnews.org/report.aspx?reportID=94782

POVERTY: PAPUA NEW GUINEA: Tackling maternal health "crisis"

GOROKA, 30 November 2011 (IRIN)
 Photo: Marianne Kearney/IRIN
Lisa Micheals, 27, is pictured with two of her five children she started having at age 16. She decided to have a tubal ligation after her most recent one

Decades of neglect, a failing health system and remote mountainous topography have created a "crisis in maternal health", according to a government taskforce in Papua New Guinea.
While progress has been made since the taskforce released its recommendations in 2009, some 250 women are still dying for every 100,000 live births, according to a 2008 inter-agency estimate.
Maternal mortality rates in PNG doubled from 1996-2006, states the government's most recent national health survey, which prompted the government-appointed taskforce to find ways to make pregnancy less deadly.
Inaccessible and ill-equipped health centres, early pregnancies, poor care and ineffective communication are among the reasons health and aid workers cite for the still-high level of maternal deaths.

Access
In PNG, the nearest health clinic might be hours by boat, foot, or in the luckiest of circumstances, local transport, from the village, says Miriam Lovai, former head of the national midwife association.
"On the Sepik River [the country's longest river] and other rivers they [women] are floated down on rafters consisting of tied banana trees or other logs," said Lovai.
At least four out of 10 people in parts of PNG cannot access healthcare due to distance or lack of roads, according to the taskforce.
Even when a woman can access trained medical care, there is still little understanding of when to seek care during childbirth, said Grace Kariwiga from the UN Children's Fund (UNICEF) office in the capital, Port Moresby. "The woman, the family or the husband, often delay seeking care, because they don't recognize the danger signals."
"Most give birth at home, because there is a lack of money, and [transport] infrastructure, so it is difficult for them to come in," said George Manapel from the national Department of Health in Goroka, the capital of East Highlands Province, one of 21 provinces.
Nationwide, 53 percent of women gave birth with a skilled birth attendant in 2006, but access to healthcare in some provinces is worse than others, noted the government taskforce.
To make it easier for pregnant women to seek care, it recommended transport subsidies.
It also suggested expanding local solutions such as a "red card" system in the remote Trobiand Islands of Milne Bay Province where women in labour can display a red card on the side of the road, which obliges any car to take her to the nearest health centre.

Child mortality
In a recent index of health workers' impact by the NGO Save the Children, PNG ranked in the bottom 20 of 161 surveyed countries.
Children in those countries, which all fall below the World Health Organization (WHO) minimum threshold of just over two health workers per 1,000 people, are five times more likely to die, noted the index.
PNG had one health worker (including doctors, midwives, nurses and community health workers) for every 1,000 residents in 2008, according to WHO.



 Photo: Arthur Chapman
Mountainous terrain stands between health centres and women in some parts of the country

Even when health workers are available to serve a population growing at 2.7 percent annually, according to the most recent census in 2000, local health centres lack resources, said Lovai.
In one case Lovai tried to travel by boat to a woman five hours away who was bleeding excessively following a home birth. But the clinic did not have enough fuel, and by the time Lovai purchased some, the woman had died.

Health system
Decentralization of the health system in the 1980s, which put regional governments in charge of health budgets, has worsened access for women seeking maternal healthcare, noted the taskforce.
"The vast majority of women live in rural areas, but the rural health service is not there and is not functioning for various reasons," said Caroline Ninnes from local NGO Susu Mamas, which means Breastfeeding Mums in Pidgin, one of PNG's official languages.
"There is no support and no equipment... and supporting rural health services when access is by boat, foot, road, or even inaccessible is difficult."
Almost nine out of 10 people nationwide lived in rural areas at the time of the 2000 census, but the number of health staff in rural facilities declined by 25 percent between 1987 and 2000.

Communication
Ninnes said illiteracy made it difficult to educate women about the importance of giving birth with the assistance of a trained health worker - or waiting longer to have children.
With 800 different languages across PNG, outreach is not easy. "Languages even vary a lot between villages," said Ninnes.
Susu Mamas is calling on provincial health departments to recruit nurses from underserved communities who speak local languages in addition to the official national languages of Pidgin, Motu and English.
Almost 7 percent of women had given birth before the age of 20 in 2006, which can elevate the risk of pregnancy-related complications, according to the UN Population Fund (UNFPA).
After 27-year-old Lisa Micheals had given birth to her fifth child, she needed little persuasion to end her child-bearing days, which began at 16.
"I saw so many women die in the village, giving birth. So I got them [fallopian tubes] tied," she said.

Initiatives
The Health Ministry and regional health offices are trying to implement the taskforce's recommendations with support from Susu Mamas, as well as UNFPA, WHO and UNICEF, said Ninnes.
For example, the Health Ministry is trying to educate Papuans that husbands and communities should ensure safe pregnancies and deliveries.
Traditionally, pregnancy and birth have been considered a woman's domain in most of Papua's tribal societies where men and women live in separate houses. This has led to many men not understanding the dangers women face giving birth, said Lahui Geita, a government maternal health adviser.
"Pregnancy is everyone's business. It is not an issue that the mother should have to deal with alone," he said.
http://www.irinnews.org/report.aspx?reportid=94352

POVERTY: Community Transportation System to Save Maternal Lives

Bill Brieger : 27 Jun 2011

Guest contribution from: Ahmed Mohammed Ahmed, Community Mobilization Specialist, Targeted States High Impact Project (TSHIP), Bauchi State, Nigeria

TSHIP aims to improve maternal and child health in Nigeria by strengthening health services and enhancing community participation. An example of the latter follows.

Five Ward Development Committees [WDCs] in Pali and Kungibar Districts of Alkaleri Local Government Area in Bauchi State have initiated a community approach to emergency transportation for pregnant women and children. This is at the background to recent 2OO8 NDHS survey which showed high rates of maternal and child mortalities in the North-East part of Nigeria.



The initiative which saw a strong commitment on the parts of different community and ward structures like the National Union of Road Transport Workers [NURTW], Okada Riders Association (motorcycle taxi drivers), Health Providers, Traditional and Religious leaders, was witnessed by other stakeholders such as Alkaleri LGA whose Chairman was represented at the occasion by the Director PHC.

The event was marked with a short drama presentation highlighting the objective of the Emergency Transport Team [ETT], which is to provide free transport service to pregnant women and children under 5 from all the communities within the five wards. Mobile phone numbers of the executive committee members and that of other drivers and motorcycle drivers in the scheme were provided at the inauguration for ease of contact. (see transportation committee members at left)

In his brief speech at the occasion, the visiting Chairman of Bara WDC in Kirfi, Malam Haruna Katukan Bara, says ‘I am here to learn about this unique experience and also help my ward in replicating it.’ He also urge community members to support the good works of the WDCs towards the development of humanity.

Finally, one of the community’s traditional birth attendants (right) thanked the committee for taking action to save the lives of pregnant women in the wards.

http://www.malariafreefuture.org/blog/?p=1228

POVERTY: Stillbirths could be halved

DAKAR, 27 April 2011 (IRIN)

 Photo: MSF
A midwife listens to the foetal heartbeat of an expectant mother in Afghanistan (file photo)

 Preventing stillbirths can cost just US$2.32 per mother if governments, the private sector and international institutions adopt a package of 10 health interventions, rather than allowing stillbirths to be an almost invisible problem.
If ten recommended interventions were 99 percent implemented in 68 priority [low and middle-income] countries, the number of stillbirths could be halved, said Professor Zulfiqar Ahmed Bhutta of the Aga Khan University Medical Centre in Karachi, Pakistan, author of one of a series of papers on stillbirth published in The Lancet medical journal papers.
Even if the interventions were 60% covered, stillbirths could be reduced by one-quarter. Some 2.64 million foetuses die after the 28th week of pregnancy, mostly in low- and middle-income countries.
Interventions include: basic and comprehensive emergency obstetric care; skilled care at birth; detection and management of foetal growth restriction; detection and management of hypertension in pregnancy; elective induction in post-term pregnancies; insecticide-treated bed nets and intermittent prophylaxis to prevent malaria; detection and treatment of syphilis; folic acid supplementation; and management of diabetes in pregnancy.

Identifying solutions
Stillbirths have largely been neglected in policy prioritizing for a variety of reasons. “There was little in terms of verified data for stillbirths and even less for its categories - whether intrapartum [during childbirth] or antepartum [before childbirth] - and risk factors, and little confidence that interventions could make a difference,” said Bhutta.
The Lancet series hopes to change this perception by re-framing stillbirths so that they are not seen as an unexplained event that occurs in the womb, but as something that is potentially preventable if appropriate care is given during pregnancy and birth.
Bhutta suggested in his paper that cheaper solutions, such as improving antenatal care, preventing malaria, detecting and treating syphilis, be adopted immediately, while more expensive interventions, such as training health workers, and procuring equipment for emergency births, could be built up gradually.
Other interventions would require improved long-term funding allocations, including addressing hypertension, diabetes, post-term pregnancy (which lasts longer than usual) and monitoring foetal growth problems.
Providing skilled attendants at birth would reduce intrapartum stillbirths by about 23 percent, said Dr Joy Lawn, of NGO Save the Children, making it the most effective single intervention. Almost half the women in low- and middle-income countries give birth at home, without any skilled assistance.
Voucher schemes or conditional cash transfers could be used to encourage women to have their babies in a facility, since in settings where the highest infant mortality occurs, only half of all births take place in facilities.

Maternal mortality
In high-income countries, where most women receive fairly good quality care while giving birth, the proportion of stillbirths is less than 10 percent of all births.
Sub-Saharan Africa, which has a scarcity of skilled birth attendants, has been making swifter progress than Asia in encouraging women to give birth in a facility. “One year ago, the international community became acutely nervous about the lack of progress on reducing maternal mortality,” Lawn said.
A year later, maternal mortality in sub-Saharan Africa had fallen by 2.6 percent. “This marks significant progress… For stillbirths, a lot of the focus in high-income countries has been because parents have called for it. Setting a global policy goal is one good way of getting it on the agenda.”
One-third of African countries could meet the Millennium Development Goal to reduce childhood mortality (Goal Four) and to improve maternal health (Goal Five), which would also reduce stillbirths.
Some investments in reducing maternal mortality are already having a positive effect on the number of stillbirths, but these results are not given due significance. “Governments could argue for more investment if they counted stillbirths in the work they’re already doing,” Lawn told IRIN.
Saving mothers’ lives costs $23,000 per death averted, but if stillbirths and neonatal deaths are included, the figure drops to $2,700 per life saved. “Our single message is, ‘Care at birth may be more expensive, but it gives you the biggest bang for your same buck if you count it properly’
http://www.irinnews.org/report.aspx?reportid=92590

POVERTY: MDG poverty goals may be achieved, but child mortality is not improving

Claire Provost guardian.co.uk, 18 April 2011


IMF and World Bank advocate 'performance-related' pay for medics to improve maternal and child mortality, but the greatest threat to MDGs remains the 'cycles of violence' in fragile states

 
Children in Delhi, next to a billboard for a comic book fair in February. Child mortality targets for the millennium development goals are unlikely to be met and, despite India's economic progress, there remain deep-rooted wealth disparities and enduring social exclusion. Photograph: Manish Swarup/AP

Two-thirds of developing countries are on track or close to meeting the millennium development goal (MDG) targets for extreme poverty and hunger, say the World Bank and the IMF.
According to the Global Monitoring Report, released on Friday in Washington during the Bretton Woods spring meetings, the number of people living in extreme poverty – on less than $1.25 per day – will drop to 883 million by 2015, from 1.4 billion in 2005 and 1.8 billion in 1990.
The joint IMF-World Bank report explores current successes and shortfalls on achieving the MDGs, attempting to project future progress while also offering policy prescriptions – with an emphasis on sustained economic growth.
Much of world's recent progress on the first goal – to halve between 1990 and 2015 the proportion of people in extreme poverty and those suffering from hunger – reflects rapid growth in China and India; the report projects that, by 2015, only 4.8% of China's population will be in extreme poverty compared with 36% in sub-Saharan Africa. While the world is set to halve extreme poverty by 2015, 17 African countries are still off-track.
Progress on reducing poverty at national levels often obscures deep-rooted disparities, says the analysis, adding that enduring issues of social exclusion could lead to uneven improvements that would put at risk aggregate success.
At a press conference on Thursday, Robert Zoellick, the World Bank president, warned that high and volatile food prices could prevent success on poverty and hunger targets. Forty-four million people have "fallen into poverty" since June 2010, said Zoellick.
"If the food price index rises by just another 10% … another 10 million people will fall into extreme poverty where people live on less than $1.25 a day. And a 30% increase would add 34 million more people to the world's poor."
Zoellick's proposed steps to reduce the impact, and likelihood, of future food crises include a new code of conduct on export bans, improved information on the quality and quantity of food stocks, and preparing small stocks of humanitarian food in places like the Horn of Africa.
"The World Bank and the regional development banks can help countries with quick support for the most vulnerable through effective, targeted nutrition and safety-net programmes rather than mistaken price controls or broad-based increases in wages," he added.
Many developing countries are close to meeting targets on primary education completion and eliminating the gender disparity in education, as well as access to safe drinking water. However, no low-income country has reduced mortality for under-fives sufficiently and they are unlikely to meet that MDG target.
Maternal and child mortality targets remain among the most intractable of the goals: 40% of developing countries are far from meeting health MDGs, despite unprecedented amounts of aid funnelled into the health sector in the past 10 years.
Delfin Go, the World Bank's lead economist and the report's lead author, said: "Certain health and education outcomes are disappointing, in part because spending has focused largely on increasing the quantity of services, while not paying enough attention to quality." Go suggests improving incentives for health workers by, for example, paying on the basis of their performance, as well as "strengthening institutions".
The report points to Rwanda's experience, where the government supplemented primary healthcare with a "cash for performance" programme – paying clinics on the basis of, for example, the number of children vaccinated, the number of women who start to use contraceptives, the number of mothers who give birth in the presence of skilled midwives, or the number of malnourished children referred for treatment.
But 45% of developing countries are far from meeting the notoriously neglected international targets on sanitation.
And lagging furthest behind on MDG targets are the so-called "fragile states". These countries "require additional support, to help in building institutions and moving towards a virtuous circle of development, peace, and security", says the report.
The World Bank also urges a stronger focus on development in fragile states in its 2011 development report (WDR), released on Monday last week, in advance of the meetings. But, warns the WDR, the greatest blocks to reaching international development goals are the chronic cycles of criminal and political violence.
http://www.guardian.co.uk/global-development/poverty-matters/2011/apr/18/millennium-development-goals-world-bank-imf-report

MALNUTRITION: India: Madhya Pradesh tops child mortality, malnutrition rates

2010-12-24

Bhopal, Dec 24 (IANS) Madhya Pradesh tops the child mortality and malnutrition rates among children in the country, a central health ministry report has said.
The latest report of the National Rural Health Mission (NRHM) says that Madhya Pradesh has also fared poor in the mother mortality rate, remaining behind three states.
According to the NRHM, which works under the central ministry of health and family welfare, malnutrition among children is most prevalent in Madhya Pradesh. Here 60 out of 100 children suffer from malnutrition while the national average is a mere 42.
At the other end of the spectrum are Sikkim and Mizoram witb a mere 19 percent. While they remain at the bottom of the chart, Kerala and Manipur at 22 percent jointly hold the second position from the bottom.
The 2010 report also says that child mortality rate in Madhya Pradesh is 70 out of 1,000 children born while the national average is 53. Kerala (12) has the most healthy record in this area. Tamil Nadu (31) and Maharastra (33) are second and third respectively from the bottom.
Again, Madhya Pradesh is only behind Bihar, Utter Pradesh and Rajisthan in mother mortality, the NRHM report says. While 100,000 children were born, 335 mothers lost their lives in the state. The national average is 254.
However, S.R. Mohanty, the state health department secretary, feels that Madhya Pradesh is doing fine. 'The state has tried hard to reduce the mother and child mortality rates. Earlier, 73 percent of women used to give birth at home. Now its only 19 percent,' he says.
Recently, the Asian Human Rights Commission also voiced concern over increasing cases of malnutrition in the state.
http://www.sify.com/news/madhya-pradesh-tops-child-mortality-malnutrition-rates-news-health-kmyqEkdbedi.html

MALNUTRITION: India: PM-led nutrition panel to meet for first time in 2 years

Aradhana Sharma,  Nov 13, 2010,

NEW DELHI: The Prime Minister may have called malnutrition a "national shame", but it has taken him more than two years to focus his attention on it and finally conevene a meeting of the National Council on India's Nutritional Challenges. Though the PM-headed Council was formed in October 2008, it will hold its first meeting later this month.
Despite impressive economic growth, India has one of the poorest records in the world when it comes to malnutrition, particularly among children. At 43%, malnutrition among under-five children is worse than Sub-Saharan Africa. Around 28% infants in India are born underweight as opposed to just 4% in China. Under-five mortality rate in India stands at 69 as compared to 21 in China. Similarly, other wider indicators also paint a grim picture.
According to the global hunger index, India scores 24 on a scale of 100 as compared to China's 6 (The higher a country scores on the index, the worse is its standing).
The terms of reference of the Council were to give a direction to overcome the nation's nutritional challenges through coordinated inter-sectoral action.
Also, the Council was to review nutrition programmes every quarter. But, several quarters have been lost, thanks to the delay in holding the first meeting.
Experts maintain that an over-reliance on the Integrated Child Development Scheme (ICDS) to tackle the nutritional issue has backfired. The focus on anganwadis and mid-day meal schemes has narrowed the focus on the target group -- between three and six years.
However, recent studies have shown that maximum damage is done from the time a child is conceived till the time the baby is two years old -- a crucial phase when intervention is required. There is near unanimity that impact could be felt only if the scope of the programme is widened.
Most of the young children die, or are undernourished due to recurring infection and illness, making it imperative to address sanitation, potable water and sundry health issues simultaneously. A mother's health and education are also major contributing factor.
Dr Rajiv Tandon, a nutrition expert, falls back on "guarded optimism" to convey his sense of hope.
The PM's scathing remark has certainly pitchforked it in the national consciousness. Be that as it may, multi-pronged approach, integrated mechanism and, significantly, appropriate oversight is the need of the hour to translate it into actions on the ground.
As the recent UN's Human Development Report has shown, GDP growth does not automatically lead to better development indicators. According to the latest report, though India figured among the top 10 nations in terms of income growth, it fared rather poorly on the human development index.
http://timesofindia.indiatimes.com/articleshow/6915211.cms?prtpage=1

MALNUTRITION: WHO commends Peru on fight against child malnutrition

Photo: ANDINA/Jorge Paz
Lima, Sep. 28 (ANDINA). The World Health Organization has praised Peru for making significant progress in reducing malnutrition and mortality rates among children under 5 years of age, one of the eight Millenium Development Goals (MDGs).
During the opening session of the 50th meeting of the PAHO Directing Council, WHO’s Director-General Margaret Chan said the adjustment of social determinants and the interventions through primary health care can reduce the preeminence of chronic malnutrition quite quickly.
She explained that the junction of the programs of water and rural sewerage, food, health care, housing, among others, have allowed Peru to reduce child mortality rate from 81 per 1,000 born alive in 1990 to 26 per 1,000 born alive, while the goal for 2015 was of 27 per 1,000 born alive.
For his part, Peruvian Health Minister Oscar Ugarte said that “the best of the day was the message of the WHO Director-General and her praiseworthy mention about Peru’s progress on health.”
On the other hand, Peru and Santa Lucia were elected to hold the two vice-presidencies of the Council. Canada is to perform as rapporteur, while Mexico was elected to chair the PAHO Directing Council in 2011.
http://www.andina.com.pe/Ingles/Noticia.aspx?id=HO488Lhm+3Q=

POVERTY: Aid and fairer trade crucial to boost Africa's poverty reduction efforts

4 September 2010 – Africans need both foreign aid and fairer trading terms with other regions to achieve the poverty reduction and social development targets known as the Millennium Development Goals (MDGs) by their 2015 deadline, Secretary-General Ban Ki-moon stressed today.
“Far more than that, they need the tools with which they themselves will create jobs, generate income and unleash the continent's own potential,” Mr. Ban said in a message to the two-day Africa Consultative Forum on the MDGs in the Rwandan capital, Kigali.
Mr. Ban said Africa had seen remarkable success in combating hunger, reducing child malnutrition and mortality, improving school enrolment, expanding access to clean water and HIV/AIDS treatment, as well as controlling tuberculosis, malaria and other neglected tropical diseases.
He gave the example of the forum's host, Rwanda, which he said had made impressive efforts in achieving almost universal primary enrolment, including gender parity at the primary school level.
With nearly 60 per cent of children sleeping under insecticide-treated bed nets aimed at keeping out malaria-spreading mosquitoes, the country has registered the largest increase in the use of the nets in Africa, Mr. Ban said in his message, delivered by Jeffrey Sachs, his Senior Adviser on MDGs.
Rwanda also made history in 2008 when the representation of women in parliament reached the highest level in the world, Mr. Ban noted.
Progress has, however, been uneven across the goals, as well as from country to country and within nations, the Secretary-General noted. Moreover, Africa remains the continent facing the most severe challenges in achieving the MDGs, and progress has been especially slow in improving maternal health and reducing maternal mortality, he pointed out.
The MDGs provide concrete benchmarks for tackling extreme poverty and include goals and targets on income poverty, hunger, maternal and child mortality, disease, inadequate shelter, gender inequality and environmental degradation.
Overall, and despite the recent food security crisis and global economic upheaval, the developing world remains on track to halve extreme poverty from 1990 levels by 2015, Mr. Ban said.
“Encouraging progress has also been made in a significant number of least developed countries. This is no small feat; it shows that the MDGs are achievable,” he said.
The high-level summit on the MDGs bringing together nearly 150 world leaders later this month will provide the strong political impetus needed to address the remaining gaps and accelerate progress, the Secretary-General noted.
“For my part, I will continue to press hard for a successful summit. We need the strongest possible outcome document – a results-oriented action plan, with concrete steps and timelines, and with mechanisms for holding all partners accountable.
“The summit will also showcase success stories, with the hope of scaling them up and creating partnerships that will allow us to do even more in Africa and around the world. I will continue to be your close partner in this effort,” Mr. Ban said.
http://www.un.org/apps/news/story.asp?NewsID=35831&Cr=MDG&Cr1=

MALARIA: LiST as a catalyst in program planning

Background
African countries are working to achieve rapid reductions in maternal and child mortality and meet their targets for the Millennium Development Goals (MDGs). Partners in the Catalytic Initiative to Save One Million Lives (CI) are assisting them by providing funding and technical assistance to increase and accelerate coverage for proven interventions. Here we describe how the Lives Saved Tool (LiST) was used as part of an early assessment of the expected impact of CI plans in Malawi, Burkina Faso and Ghana.
Methods LiST builds on country-specific demographic and cause-of-death profiles, and models the effect of changes in coverage for proven interventions on future levels of mortality among children less than 5 years of age. We worked with representatives of Ministries of Health and their development partners to apply LiST to assess the potential impact of CI plans and coverage targets, generating a short list of the highest-priority interventions for additional scale-up to achieve rapid reductions in under-5 mortality.
Results
The results show that in each country, achieving national coverage targets for just four or five high-impact interventions could reduce under-5 mortality by at least 20% by 2011, relative to 2006 levels. Even greater gains could be obtained in Burkina Faso and Ghana by scaling up these high-impact interventions to 80%. Discussion
LiST can contribute to the development of stronger programmes by identifying the highest-impact interventions in a given epidemiological setting. The quality of LiST estimates is dependent on the available data on coverage levels and causes of death, and assumes that the target levels of coverage are feasible in a given context while maintaining service quality. Further experience is needed in the feasibility and usefulness of LiST as part of the program planning process at district and subdistrict levels.
http://ije.oxfordjournals.org/cgi/content/abstract/39/suppl_1/i40?ijkey=837e394a3a48ea97e028691e249adb9038c9f32c&keytype2=tf_ipsecsha

MALNUTRITION: the key to maternal and child health

A medical aid group says if G8 leaders want to improve mother and child health, they must first solve the malnutrition problem.
Doctors Without Borders, also known as MSF, is calling for “fundamental changes” in addressing malnutrition, as well as “new sustainable funding resources.” The group says malnutrition affects 195 million people worldwide – most in sub-Saharan Africa - and is the “underlying cause of at least one-third of the 8 million annual deaths of children under age 5.”
Marilyn McHarg, General Director of MSF Canada, says, “There’s a real risk that the maternal-child health agenda will not move forward. We will not be able to improve the situation worldwide if we are not looking (at) and addressing malnutrition.”
She says it’s not necessarily the amount of food aid being provided that’s at issue, but rather the quality.
“We are very concerned about the fact that a lot of G8 countries are providing food that is sub-standard from the perspective that it is not addressing the nutritional needs of children worldwide…. It’s not enough to provide corn-soy blend or wheat. Foods that get used as porridge,” she says.
The MSF official says more “higher quality” foods are needed to ensure children’s survival, what she calls “comprehensive nutritional activities.”
She adds, “We see a very strong need for micro-nutrient supplements, for ready-to-use therapeutic foods like the peanut-paste mixtures that can exist. And this needs to be in combination with the other types of foods that are already accessible.”
MSF says it agrees with a World Bank estimate that it would cost (US) $12 billion per year to address malnutrition in the most affected countries. It calls donor funding during the global economic slowdown “insufficient, volatile and unpredictable.”
McHarg says, “It’s a matter of making sure there are sufficient funds for intervention over time.”
Sharply reducing hunger is one the Millennium Development Goals that come due in 2015. G8 and G20 leaders are expected to discuss the issue at their summits in Canada.
http://www1.voanews.com/english/news/asia/decapua-g8-msf-22jun10-96902634.html

POVERTY: Child mortality rates up in Africa despite UN push

Jun 22, 2010 NAIROBI, Kenya — Ten African countries have halved their poverty rates over the last two decades, but child mortality rates have increased in six sub-Saharan nations, a report on the U.N.'s Millennium Development Goals released Tuesday found.
The countries that halved their poverty rates since 1990 include relatively populous countries such as Ethiopia and Egypt and post-conflict countries such as Angola, the report said. However, in Nigeria and Zimbabwe, the proportion of the population living in extreme poverty has risen.
Sub-Saharan Africa is the only region in the world registering an increase in the under age 5 mortality rate, which has risen in Cameroon, Central African Republic, Chad, Congo, Kenya and Zambia. Thirty-four of the world's 36 countries with child mortality rates above 100 per 1,000 births are in sub-Saharan Africa. The others are Afghanistan and Myanmar.
The Millennium Development Goals Report Card, which was sponsored in part by the Bill and Melinda Gates Foundation, was released Tuesday to coincide with meetings of G-8 and G-20 countries in Canada beginning Friday.
The report said that the key message concerning the millennium goals is that progress is possible.
The conditions that help a country make progress include open trade policies, an openness to technology, consistent leadership committed to reducing poverty, and reform aimed at making the public sector accountable, the report said.
The Millennium Development Goals, adopted by 189 world leaders in 2000, include cutting extreme poverty by half, ensuring universal primary school education for all children, reducing child and maternal deaths, halting and reversing the HIV/AIDS pandemic, and cutting in half the proportion of people without access to safe water and basic sanitation, all by 2015.
Tuesday's report said that progress was mixed on the goal of halving the number of people who suffer from hunger. Just over half of countries have made progress in reducing undernourishment. Progress has varied greatly. In Ghana, hunger levels were cut 75 percent between 1990 and 2004. But in the Democratic Republic of Congo, hunger levels more than doubled to 76 percent during the same period.
Ahead of the World Cup earlier this month, the U.N. tried to underscore some of the vast differences between countries by noting that life expectancy in Nigeria is 48 years compared with 75 years in Argentina, and that women in Ivory Coast are eight times more likely to die in child birth than women in Brazil.
http://www.google.com/hostednews/ap/article/ALeqM5jAuroldiX21Lo3CTmbUjAr3Ix0oQD9GGBF2O0

MALNUTRITION: NIGER: Acute child malnutrition increases by 42%

DAKAR, 28 June 2010 (IRIN) - Nearly 17 percent of Niger's children younger than five suffer acute malnutrition, a 42 percent increase over the same period last year, according to a national survey released by the government. More than 15 percent acute malnutrition is classified as a critical emergency by the UN World Health Organization (WHO). The report links this increase to the poor 2008-2009 harvests. [http://www.irinnews.org/Report.aspx?ReportId=86689]. The government, with UN agency and NGO support, surveyed 8,000 under-fives nationwide from late-May to mid-June. In Agadez region, only urban centres were surveyed due to insecurity. Without immediate intervention, the situation is likely to further deteriorate before the September harvests, according to the government. Below are some of the report's most important findings: . Nationwide acute malnutrition: Nearly half a million children are acutely malnourished, including some 87,000 severely malnourished. The most affected regions are Diffa [http://www.irinnews.org/Report.aspx?ReportId=88425], Maradi [http://www.irinnews.org/Report.aspx?ReportId=89393], Zinder [http://www.irinnews.org/Report.aspx?ReportId=88541] and Tahoua [http://www.irinnews.org/report.aspx?ReportId=89499], where acute malnutrition falls into WHO's critical threshold. Acute severe malnutrition has increased to 3.2 percent from 2.1 percent a year ago. According to WHO, the median fatality rate for severe acute malnutrition ranges from 30 to 50 percent, but can be reduced substantially when properly treated. . Age and gender: Throughout the country, with the exception of Diffa region, children younger than three are twice as affected by acute malnutrition than older children (21.7 percent compared with 9.5 percent). More boys than girls are malnourished. . Mortality: The rate is higher than one death per 10,000 children a day but remains below the humanitarian community's emergency threshold of two deaths per 10,000 children a day, except in Zinder region. The relatively low death rate may not reflect the gravity of the nutritional crisis due to the ongoing depletion of food stocks. . Chronic under-nutrition: Similar to 2009, nearly half of Niger's children are chronically undernourished and lacking life-sustaining nutrients. In Zinder region, six children in 10 do not eat enough on a daily basis to maintain natural physical activity. In Niamey, 17 percent of children suffer from under-nutrition. A fifth of the surveyed children nationwide are severely chronically undernourished.

POVERTY: MDG stats

Ten African countries have halved their poverty rates over the last two decades, but child mortality rates have increased in six sub-Saharan nations, a report on the U.N.'s Millennium Development Goals released Tuesday found.The countries that halved their poverty rates since 1990 include relatively populous countries such as Ethiopia and Egypt and post-conflict countries such as Angola, the report said. However, in Nigeria and Zimbabwe, the proportion of the population living in extreme poverty has risen.Sub-Saharan Africa is the only region in the world registering an increase in the under age 5 mortality rate, which has risen in Cameroon, Central African Republic, Chad, Congo, Kenya and Zambia. Thirty-four of the world's 36 countries with child mortality rates above 100 per 1,000 births are in sub-Saharan Africa. The others are Afghanistan and Myanmar.The Millennium Development Goals Report Card, which was sponsored in part by the Bill and Melinda Gates Foundation, was released Tuesday to coincide with meetings of G-8 and G-20 countries in Canada beginning Friday.The report said that the key message concerning the millennium goals is that progress is possible.The conditions that help a country make progress include open trade policies, an openness to technology, consistent leadership committed to reducing poverty, and reform aimed at making the public sector accountable, the report said.The Millennium Development Goals, adopted by 189 world leaders in 2000, include cutting extreme poverty by half, ensuring universal primary school education for all children, reducing child and maternal deaths, halting and reversing the HIV/AIDS pandemic, and cutting in half the proportion of people without access to safe water and basic sanitation, all by 2015.Tuesday's report said that progress was mixed on the goal of halving the number of people who suffer from hunger. Just over half of countries have made progress in reducing undernourishment. Progress has varied greatly. In Ghana, hunger levels were cut 75 percent between 1990 and 2004. But in the Democratic Republic of Congo, hunger levels more than doubled to 76 percent during the same period.Ahead of the World Cup earlier this month, the U.N. tried to underscore some of the vast differences between countries by noting that life expectancy in Nigeria is 48 years compared with 75 years in Argentina, and that women in Ivory Coast are eight times more likely to die in child birth than women in Brazil.
http://www.nola38.com/health/sns-ap-af-africa-development-goals,0,1569823.story

MALARIA: Health metrics assessment

It is clear that most countries will not reach the Millennium Development Goal targets by 2015. Yet there can still be dramatic improvements over the next five years – and beyond – if we take the opportunity to learn from the successes and find ways to replicate them.
In an era where demonstrating the effectiveness of development assistance for health is becoming increasingly important, following up this study with careful country case studies will be vital. Bursts of rapid improvement are possible, with countries such as Egypt and Tunisia achieving remarkable declines in both maternal and child mortality rates.
Country-specific research that focuses on the steps taken to achieve these rapid reductions could reveal the necessary formula for countries that are falling behind. We also need to know more about how interventions targeted at child and maternal health are working. To better understand child mortality reductions, we must examine how policy initiatives such as vaccine programs, insecticide-treated bed net distribution, or the scale-up of antiretroviral treatment
are contributing to accelerated mortality declines.
Next steps could include exploring how levels and trends in child mortality are related to changes in the key drivers of child mortality, including income per capita, levels of maternal education, the HIV epidemic, and malaria. Studying these indicators will help us understand where country performance has been better than expected.
With hindsight, we can ask whether the targets set for MDG4 and MDG5 were realistic or overly ambitious. Looking past 2015, when a new round of health targets may be formulated, it will be important to ground the choice of targets in an informed discussion of the distribution of progress across nations.
http://www.healthmetricsandevaluation.org/print/reports/2010/building/building_momentum_conclusion_IHME_0610.pdf

Global, regional, and national causes of child mortality in 2008: a systematic analysis.

BACKGROUND:
Up-to-date information on the causes of child deaths is crucial to guide global efforts to improve child survival. We report new estimates for 2008 of the major causes of death in children younger than 5 years.
METHODS:
We used multicause proportionate mortality models to estimate deaths in neonates aged 0-27 days and children aged 1-59 months, and selected single-cause disease models and analysis of vital registration data when available to estimate causes of child deaths. New data from China and India permitted national data to be used for these countries instead of predictions based on global statistical models, as was done previously. We estimated proportional causes of death for 193 countries, and by application of these proportions to the country-specific mortality rates in children younger than 5 years and birth rates, the numbers of deaths by cause were calculated for countries, regions, and the world.
FINDINGS:
Of the estimated 8.795 million deaths in children younger than 5 years worldwide in 2008, infectious diseases caused 68% (5.970 million), with the largest percentages due to pneumonia (18%, 1.575 million, uncertainty range [UR] 1.046 million-1.874 million), diarrhoea (15%, 1.336 million, 0.822 million-2.004 million), and malaria (8%, 0.732 million, 0.601 million-0.851 million). 41% (3.575 million) of deaths occurred in neonates, and the most important single causes were preterm birth complications (12%, 1.033 million, UR 0.717 million-1.216 million), birth asphyxia (9%, 0.814 million, 0.563 million-0.997 million), sepsis (6%, 0.521 million, 0.356 million-0.735 million), and pneumonia (4%, 0.386 million, 0.264 million-0.545 million). 49% (4.294 million) of child deaths occurred in five countries: India, Nigeria, Democratic Republic of the Congo, Pakistan, and China.
INTERPRETATION:
These country-specific estimates of the major causes of child deaths should help to focus national programmes and donor assistance. Achievement of Millennium Development Goal 4, to reduce child mortality by two-thirds, is only possible if the high numbers of deaths are addressed by maternal, newborn, and child health interventions.
FUNDING:
WHO, UNICEF, and Bill & Melinda Gates Foundation.
Lancet. 2010 May 11.

POVERTY: MADAGASCAR: "May you have seven sons and seven daughters"

ANKILIBORY, 28 May 2010 (IRIN) - In a tiny shack in Ankilibory a village, southern Madagascar, Herintsoa, just 16 years old, recently gave birth to her second child, but it was easy compared to the first one, which she had when she was 14. "That was a lot more painful. I did it at home myself - my husband cut the [umbilical] cord." Unfazed, she said, "We want 10 children."According to government figures, 70 percent of 16-year-old girls in some parts of Madagascar have given birth to their first child, but the fact that early pregnancy is common on the huge Indian Ocean Island does not make it less dangerous. The 2009 national Demographic and Health Survey noted that every day eight women die as a result of complications during pregnancy or delivery, often at a very young age. Jocelyne Rasoanirina, head of the UN Population Fund (UNFPA) in southern Madagascar, pointed out that besides the immediate risks there were also longer-term implications. Large families are an important contributor to household poverty - the average Malagasy family has five children but the number rises dramatically in rural areas, where it is not uncommon for women to have 10 children by their mid-thirties.Too farRasoanirina said the biggest obstacle to reducing maternal and neonatal mortality was access to quality healthcare. "People live very far from health centres and don't have any transport options."Herintsoa has never seen a hospital, a doctor or a nurse - the nearest health centre is 30km from her village, and the only way to get there is an expensive ride in a "chariot" - an ox-drawn cart - or walking through the desert-like terrain. "The death rate is high for mother and child," said Aro Rajoelina, Regional Medical Inspector of Ampanihy district, where Herintsoa's village is located. Although some 70 percent of pregnant women in the south of the island have access to prenatal services, only about 10 percent of births are attended by skilled health personnel. Government figures put maternal mortality at 469 deaths per 100,000 live births."We try to ensure that a health centre can cover several villages, and that the maximum distance to travel is 80 kilometres, but it is still difficult for people to cover such distances," Rajoelina told IRIN.Too lateWomen and girls often seek medical attention very late in the pregnancy, and sometimes only when the situation has reached a critical stage. "It's the culture to stay at home and see a traditional doctor or midwife, but they are not qualified to [handle complications]. When that does not work, they might go to the clinic but it's often too late," Rajoelina said.The poorest Malagasy get free treatment at the health centres, but traditionally the entire family goes along when one of them needs medical attention, making the trip too expensive. "They have to pay for food and accommodation for everyone; it's a financial problem," Rajoelina commented.Sambetire, 16, has come to the Health Centre in Amphany, a town in southwestern Madagascar, because she is four months pregnant but has started bleeding vaginally. Luckily her family owns a chariot and the six of them could all came with her on the 20km journey to the centre. "This is my third child, and I already lost one," she said from her bed. The midwife at the centre, Henriette Baofeno, said there was a real risk that Sambetire could lose the baby. "I get sad when I see cases like that," she said. In her 23 years as a midwife at centre there has been "no big change - I still see young girls like this very often."Too smallPostpartum haemorrhage, or bleeding after delivery, in girls giving birth at home in their communities, far from qualified help, is a major contributor to the maternal death rate.Another serious cause of maternal death - the second most common in Madagascar, according to the demographic survey - is obstetric fistula, or a hole in the birth canal caused by prolonged and obstructed labour. Rajoelina said he had seen girls as young as 10 give birth, and "taking out the baby can damage the organs [of the mother]. They are too small and not developed yet."Obstetric fistula is often the result of early childbirth, when the birth canal is too narrow and there are no qualified medical personnel to perform a caesarean operation. The condition often leaves young women incontinent, causing their husbands, families and communities to shun them. "In those cases you need surgical intervention, but that is impossible here," Rajoelina said.Too manyIn Ankazoabo, a coastal village in the southeast of the island, Avivelo, 34, encourages her 17-year-old daughter, who already has two children, to have as many as possible. "I gave birth to eight children and now it is her turn to do the same, but it is difficult."Southern Madagascar, where aid agencies struggle to feed thousands, is a hostile place even in a good year, and the past four have been particularly harsh, but more mouths to feed has not been a deterrent.The 10 children huddled around Avivelo are a poster for malnutrition in the region: swollen bellies, visible emaciation, and their mouths stained by red raketa - a local cactus fruit used only in desperate times that Rajoelina said was "unfit for human consumption"."Having many children is a blessing for people here, and that's why family planning programmes are so important ... but it's very difficult to change the way people think," UNFPA's Rasoanirina commented."Its part of the culture," she said, referring to the traditional Malagasy wedding blessing, "May you have seven sons and seven daughters".

Malaria annual death rate

Over the past 20 years, the United Nations and its partners have helped to reduce child mortality by more than 50 percent in developing countries, bring us to the brink of polio eradication, and cut measles deaths by 78 percent worldwide. One-third of the 108 malaria-ravaged countries reduced malaria cases by more than half in 2008 compared to 2000, and the malaria rate continues to fall. These are important milestones to help us achieve the United Nations Millennium Development Goals (MDGs).
However, the work is far from finished. Each year, more than 23 million children do not get the vaccines they need, 8 million children die needlessly, over 500,000 women die due to complications from pregnancy, and close to 1 million people die from malaria. These sobering facts point to how much work remains to be done.
http://www.undispatch.com/node/9749