Tessa Wardlaw

1. Working Group on Coverage Monitoring Tessa Wardlaw Coverage of Key Child Survival Interventions Tessa Wardlaw

2. Introduction We know: ● How many children are dying ● What they are dying of ● Which interventions can prevent most child deaths Need to know: ● What are current coverage levels of interventions ● Is progress being made ● Where do we need to focus programs

3. • Selected findings from the Countdown 2005 monitoring report • First in a series of Countdown reports to be issued every two years • Identify areas for greater focus • Countdown monitoring plans for the future Purpose of Presentation

4. • Nutrition interventions • Vaccination • Other prevention interventions • Newborn health • Case management of illness Interventions Which interventions? 63% of child deaths could be prevented if a limited set of interventions were universally implemented

5. Latest available estimates ● National-level household surveys (MICS, DHS and others) ● UNICEF, The State of the World’s Children 2006 Trends ● UNICEF and WHO global databases Data Sources

6. Priority Countries Child Survival Countdown - 60 priority countries • Criteria: • Either total number of under-five deaths ≥ 50,000 • Or under-five mortality rate ≥ 90 per thousand

7. Selected Findings Progress for 60 Countdown priority countries Estimates for all developing countries Developing World X%

8. Nutrition

9. Exclusive Breastfeeding Developing World 36% • Significant progress has been made since 1990 • Sub-Saharan Africa, in particular, has made significant • gains during the 1990s. • Rates continue to be low across the developing world. +41% +9% +21% +450%

10. Exclusive Breastfeeding Rapid progress is possible Rapid progress Higher rates achieved Rapid progress Rates still low

11. Exclusive Breastfeeding 60 Countdown priority countries23 countries with unacceptably low rates

12. Exclusive Breastfeeding 60 Countdown priority countries24 countries with low rates

13. Exclusive Breastfeeding 60 Countdown priority countries10 countries with rates of 50% or more

14. Exclusive Breastfeeding 60 Countdown priority countries

15. Immunization

16. Measles and DPT3Immunization Coverage • Major progress during the 1980s • Coverage stagnated since 1990 DPT3 Developing World 76% Target Measles Developing World 74%

17. Measles and DPT3Immunization Coverage 60 Countdown priority countries • 10 countries with 90% or more coverage• Most countries still below target and need intensified efforts Measles DPT3 >90% >90% <50% <50%

18. Measles and DPT3Immunization Coverage 60 Countdown priority countries • 10 countries with 90% or more coverage• Most countries still below target and need intensified efforts Measles DPT3 CAR, Chad, Cote d’Ivoire, Eq. Guinea, Gabon, Haiti, Liberia, Nigeria, PNG, Somalia CAR, Cote d’Ivoire, Liberia, Nigeria, PNG, Somalia >90% >90% <50% <50%

19. Prevention Insecticide-treated Nets Vitamin A Supplementation

20. Insecticide-treated nets Sub- Saharan Africa 3% Sub-Saharan Africa: malaria endemic countries • Low rates of ITN use • Major investments in • recent years • Rapid increases expected soon; 10-fold increase in nets distributed in • Sub-Saharan Africa • (1999-2003) Abuja target 2005

21. Vitamin A Supplementation Developing World 61% • 3-fold increase in % children fully protected by two doses • Greatest gains in least developed countries • Among the 60 priority countries, 26 have 70% or more coverage with at least one dose, and 7 have unacceptably low coverage

22. Newborn Health 80% (1 dose)

23. Low Birth Weight • Low birth weight is a key impact indicator • Serious measurement problems as most births not weighed • Results in biased and underreported estimates • Intensified efforts are needed to weigh infants at birth Percentage of births NOT weighed 80% (1 dose)

24. Case Management 80% (1 dose)

25. Pneumonia Case Management •Pneumonia kills more children than any other illness, accounting for 19% of all under five deaths • Only 1 in 5 caregivers know the ‘danger signs’ of pneumonia – cough and fast or difficult breathing • 54% of children with pneumonia are taken to an appropriate health care provider Neonatal pneumonia/ sepsis 10% Neonatal causes 27% Pneumonia 19% 80% (1 dose) Neonatal pneumonia/sepsis is estimated to cause 26% of all neonatal deaths.

26. Pneumonia Case Management Roughly 20% of children with pneumonia received antibiotics (based on limited data from the early 1990s) ● Current estimates not available ● Questions on antibiotic use for pneumonia included in current round of MICS and DHS ● Rapid progress is possible 80% (1 dose)

27. Summary of Findings Coverage too low for most causes of child death Cause of death Intervention coverage Malaria Pneumonia Diarrhea Undernutrition Neonatal Measles ITN use ORT Antibiotics ORT/continued feeding Exclusive breastfeeding Vitamin A supplementation (> 1 dose) Exclusive Breastfeeding Skilled attendant at birth Measles vaccine

28. Summary of Findings ● Coverage levels remain too low for most indicators ● Rapid progress is possible ● Analysis needed of why rapid progress occurs in some countries, and for some interventions, but not others

29. Future Monitoring Plans • ● Findings are a starting line to monitor progress, which will be tracked closely in the coming years • ● Increased frequency and scope by expanding monitoring at national and sub-national levels to better track program implementation • ● Countdown monitoring to build on other ongoing efforts (MDG and WFFC) • ● MICS, DHS and other surveys in 2005-2006 to inform WFFC monitoring

30. 2005-2006 Surveys national household survey activity 2005-2006 MICS DHS Other surveys

31. Conclusion • Countdown is a renewed opportunity to: • Systematic follow-up and rigorous monitoring • Identify disparities • Better understand implementation challenges With all this information there is no excuse… Numbers must translate into action!