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There can be no real growth without healthy populations.
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"21,000 children die every day from preventable causes"  WHO, September 2011

Anup Shah, Today, 21,000 children died around the world - Global Issues, Updated: September 24, 2011

The silent killers are poverty, hunger, easily preventable diseases and illnesses, and other related causes. Despite the scale of this daily/ongoing catastrophe, it rarely manages to achieve, much less sustain, prime-time, headline coverage.



 

 UN Declaration of the ... Rights of the Child
 

The right to affection, love, and understanding. The right to adequate nutrition and medical care. The right to free education. The right to full opportunity for play and recreation. The right to a name and nationality. The right to special care, if handicapped. The right to be among the first to receive relief in times of disaster. The right to learn to be a useful member of society and to develop individual abilities. The right to be brought up in a spirit of peace and universal brotherhood. The right to enjoy these rights, regardless of race, colour, sex, religion, national, or social origin.

 

Health Ecucation To Villages
photo unicef india

 


I told my husband that if Shah Jahan could build the Taj Mahal to honour Mumtaz,
why can’t you build a toilet for me?
Village woman in Maharashtra, India

India, where more than 65 percent of people lack a toilet and 500,000 children die each year from diarrhoeal illnesses.


Fact File on Health Inequities

In developing countries, one child in 10 dies before reaching their fifth birthday, compared with 1 in 143 in high-income countries.

Today, there is a 36-year gap in life expectancy between countries. A child born in Malawi can expect to live for 47 years while a child born in Japan could live for as long as 83 years. (1) In Chad, every fifth child dies before they reach the age of 5, while in the WHO European Region, the under-five mortality rate is 13 out of 1000. (2) There is no biological or genetic reason for these alarming differences in health and life opportunity.
 



Causes of Child Deaths

According to UNICEF, of the 8.1 million child deaths (under-5s) in 2009, most (and 70% in developing countries) result from one the following five causes or a combination thereof: acute respiratory infections, diarrhoea, measles, malaria and malnutrition.

Two-thirds of deaths are preventable. Malnutrition, which weakens the body's resistance to illness, and the lack of safe water and sanitation contribute to half of all these children’s deaths. Millions more survive only to face diminished futures, unable to develop to their full potential. Research and experience show that most of the children who die each year could be saved by low-tech, evidence-based, cost-effective measures such as vaccines, antibiotics, micronutrient supplementation, insecticide-treated bed nets, improved family care and breastfeeding practices, and oral rehydration therapy. In addition to providing vaccines and antibiotics to children, education could also be provided to mothers about how they can make simple changes to living conditions such as improving hygiene in order to increase the health of their children. Mothers who are educated will also have increased confidence in the ability to take care of their children, therefore providing a healthier relationship and environment for them.

An Urgent Need for Health Education
Many of these deaths can be avoided if parents and caregivers understand what to do when illness strikes and how to recognize the danger signs that signal the need for medical help. Facts for Life presents, in simple language, the most authoritative information about practical, effective and low-cost ways to protect children's lives and health. Everyone has the right to know this information.


Focus
The aim of HETV is to establish and promote health educational programs that will provide rapid and long-term capacity-building to improve health and quality of life, and will give mothers and communities more control over their health status. Health gains associated with safe drinking water can be achieved by providing people with simple, affordable technologies, such as chlorination, filtration, solar disinfection and improved storage in their homes. Worldwide, surveys have shown that hand-washing alone reduces the instance of diarrhoea by as much as 43 percent.

Partnered with national and state governments, we work to assist in educating mothers and children, teachers and students, doctors and village health workers, and a variety of community leaders, in the targeted areas of health, water, hygiene, and sanitation.

The Long-Term Effects of Childhood Poverty
Most poor children achieve less, exhibit more problem behaviours, and are less healthy than children raised in more-affluent families. Looking beyond these well-known correlations between poverty and negative outcomes in childhood, recent studies have assessed the effects of childhood poverty on later attainment and health. Experiencing poverty early in childhood may prove harmful later in life, and can be linked to adult outcomes such as earnings and work hours as well as obesity and other health conditions that impair productivity. The evidence suggests that prenatal and early childhood poverty have a substantial negative association with adult earnings, work hours, and certain health conditions, but not with behavioural outcomes such as out-of-wedlock childbearing and arrests.

 

Taking care of a baby at home after birth: What families need to doTaking care of a baby at home after birth: What families need to do  Download pdf

This flipbook, released in Nov. 2011, contains key messages that pregnant women and their families need in order to plan care of an infant at home right after birth. It focuses on essential actions families can take both to prevent newborn death and illness and to promote healthy newborn development.

This material encourages use, whenever possible, of skilled birth attendants and clinical services and, where that is not realistic, provides some information on what families can do for pregnant women and care of the baby at birth.

Even where mothers deliver with a skilled birth attendant in a health facility, they are often sent home within 6-12 hours of delivery. This material can also be used with women going home soon after delivery in a health facility. It highlights danger signs in the infant that require immediate attention and referral.

This tool was developed by CORE Group, in collaboration with Save the Children, the American College of Nurse-Midwives, and MCHIP.

This material is meant for outreach to pregnant women and their families with poor access to health services. These communities may also have low-literacy levels and/or poor access to health information. It is important to test the material with outreach workers and community members to be sure the messages are understood and acceptable. For guidance on adapting or testing this material, please email contact@coregroupdc.org.


 

Why is breastfeeding so important?Why Is Breastfeeding So Important?
Why Is Breastfeeding So Important?Download .pdf 17.5 mb.

Breastfeeding provides the perfect nutrition for your baby and provides many health benefits for both mother and baby.
- Initiating breast feeding within the first hour and exclusive breastfeeding can prevent under two mortality.
- Breastfeeding: Exclusive breastfeeding
- Colostrum - Gift of a protective cover from the mother
- We believe all mothers know how to feed their child. But do they?
- Myths and facts about breast milk
- Complimentary feeding
- Role of media in promoting proper young child feeding: Media should focus on and promote measures that are required to be taken urgently to ensure the survival of children


 

Respectful Maternity Care: Every Childbearing Woman's Right  Download Poster pdf

In every country and community worldwide, pregnancy and childbirth are momentous events in the lives of women and families and represent a time of intense vulnerability. Imagine the personal treatment you would expect from a maternity care provider entrusted to help you or a woman you love give birth. Naturally, we envision a relationship characterized by caring, empathy, support, trust, confidence, and empowerment, as well as gentle, respectful, and effective communication to enable informed decision making.

Unfortunately, too many women experience care that does not match this image. Pregnant women seeking maternity care instead too often receive ill treatment that ranges from relatively subtle disrespect of their autonomy and dignity to outright abuse: physical assault, verbal insults, discrimination, abandonment, or detention in facilities for failure to pay. Disrespect and abuse of women during maternity care is a problem that has been obscured by a "veil of silence".

NO MORE.

Through the USAID Health Policy Project, partners from the research, educational, clinical, human rights, and global and national advocacy communities are working collaboratively to establish a growing community of concern determined to address the issue of disrespect and abuse during maternity care. This month we are pleased to launch the RESPECTFUL MATERNITY CARE CHARTER: THE UNIVERSAL RIGHTS OF CHILDBEARING WOMEN and new advocacy materials, based on this rights framework, that convey the message RESPECTFUL MATERNITY CARE is every woman's right.

Now we are calling on you to join us by learning more and engaging your communities to speak out and break the silence.


Useful links:
Respectful Maternity Care
Respectful Maternity Care Charter: the Universal Rights of Childbearing Women
Companion brochure  and Poster based on this rights framework.


 

Eliminating health inequities - Every woman and every child counts  Download pdf
The International Federation of Red Cross and Red Crescent Societies (IFRC), in partnership with the Partnership for Maternal, Newborn and Child Health

Health inequities are affecting the life and future of all vulnerable groups of society across the world, creating systems of social injustice. By dismantling the barriers to health services and resources, we reduce the burden of disease that affects the future of children, impoverishes entire families and passes social injustice on through the generations. In this report, we focus on women and children not only because many of them suffer undue hardship, but also because women are instrumental in improving the health of their children, families and communities.

This report provides evidence that health inequities can and need to be addressed through a holistic approach. Health inequities, and the resulting social injustice are closely linked with other issues such as poverty, gender inequality and human rights violations which in turn, have an impact on education, transport, health, agriculture, and overall well-being. Our interventions should therefore be multi-sectoral, going beyond health to address social and economic determinants - malnutrition, alcohol abuse, poor housing, indoor air pollution and poverty, among others.


 

Featured Resources: WHO Reproductive Health Publications

Sexual and reproductive health - Maternal and perinatal health - Publications

 

Managing newborn problems - a guide for doctors, nurses and midwives Managing newborn problems: A guide for doctors, nurses and midwives

This guide, based on the latest available evidence, provides up-to-date, authoritative clinical guidelines that are relevant to a facility with basic laboratory facilities, selected essential drugs and supplies, and the capability to provide safe blood transfusion. In some settings, the guide will be relevant to large health centres that provide childbirth care and have the capacity to care for sick or small newborn babies.

More information/full text

 

Pregnancy, childbirth, postpartum and newborn care - a guide for essential practice

Pregnancy, childbirth, postpartum and newborn care - a guide for essential practice

Aimed at skilled attendants working at the primary health care level in settings with limited resources, this book provide guidance on how to deliver essential care to women (and their newborn) during pregnancy, childbirth and postnatal period (up to six weeks after delivery)

More information/full text
Français

 

Managing complications in pregnancy and childbirth: A guide for midwives and doctors

Managing complications in pregnancy and childbirth

A must for midwives and doctors at the district hospital who are responsible for the care of women with complications of pregnancy, childbirth or the immediate postpartum period, including immediate problems of the newborn. Both physicians and midwives will find this manual essential for promoting and assessing the quality of health services, in the training of providers and in supporting quality services through supervision and performance feed-back.

More information/full text
Español - Français

 

Sexually transmitted and other reproductive tract infections - A guide to essential practice

Sexually transmitted and other reproductive tract infections - A guide to essential practice

This publication is intended to assist health care managers and practitioners in resource-limited reproductive health care settings around the world to meet the needs of individuals who may be at risk of reproductive tract infections (RTIs).

It is assumed that readers are familiar with certain clinical knowledge, such as drugs and their dosages, although they may not have experience with management of sexually transmitted infections (STIs) and RTIs.

More information/full text
Español - Français

 

Guidelines for the management of sexually transmitted infections

Guidelines for the management of sexually transmitted infections

Sexually transmitted infections (STIs) remain a public health problem of major signifi cance in most parts of the world. The incidence of acute STIs is believed to be high in many countries. Failure to diagnose and treat STIs at an early stage may result in serious complications and sequelae, including infertility, fetal wastage, ectopic pregnancy, anogental cancer and premature death, as well as neonatal and infant infections. The individual and national expenditure on STI care can be substantial.

More information/full text
Español - Français - Portuguese


 

Institute for Reproductive Health at Georgetown UniversityInstitute for Reproductive Health at Georgetown University


Since its founding in 1985, IRH has been recognized as a leader in the effort to improve reproductive health worldwide. The Institute’s strengths are its quantitative and qualitative research skills, its focus on critical needs in reproductive health, and its research-to-practice strategy that includes working with partners to build capacity for sustainable services. The Institute collaborates with a wide variety of organizations from central to community levels to implement evidence-based service delivery programs in countries worldwide.


 

Health Workers Count: The World Needs More Health Workers, Better SupportedHealth Workers Count: The World Needs More Health Workers, Better Supported

No Child Out of Reach: Time to end the health worker crisis - Download pdf
 

The current shortage of over 3.5 million doctors, nurses, midwives and community health workers means that millions of children do not receive the health care they need, and risk an early death from preventable causes. We cannot achieve the goal of saving 15 million children’s lives by 2015 unless a health worker – with the right skills, equipment and support – is within reach of every child.

The new report sets out the scale and the causes of the crisis, and recommendations for how it can be overcome. Progress will require political action at the global level, backed by strong national efforts in every country with a critical shortage of health workers.

Increased long-term investment is needed to recruit and train more health workers, with a balance across different cadres. At the same time better use of the existing workforce must be made by ensuring they are equitably deployed, receive a fair living wage, and are well supported, trained, equipped and motivated. Tackling the health worker crisis will also require governments and donors to spend more, and spend more smartly, focusing on areas that will have the greatest impact on children’s health.

More Health Workers
The world is suffering from a massive gap of more than 3.5 million health workers. Join with hundreds of organisations who have already signed up to our urgent call for more health workers, better supported. click here

Scaling Up, Saving Lives - download pdf
Task Force for Scaling Up Education and Training for Health Workers, Global Health Workforce Alliance

Health workers are the cornerstone and drivers of health systems. And yet the world is facing a serious shortage of health workers – a shortage that is identified as one of the most critical constraints to the achievement of health and development goals.

This crisis is impairing the provision of essential, life-saving interventions such as childhood immunization, safe pregnancy and delivery services for mothers, and access to treatment for HIV/AIDS, malaria and tuberculosis.

New and innovative initiatives are urgently needed to increase the numbers of trained health workers. This requires scaling up investment in education, skill mix and remuneration of the workforce as laid out in the Kampala Declaration and Agenda for Global Action, endorsed in March 2008 at the First Global Forum on Human Resources for Health.


 

Infographic, World Health, GOOD, Transparency, Women's health, Infants, Babies Health

Infographic: How Community Health Workers Save Lives in the Developing World

Imagine if pregnant women and their kids in developing countries could be given simple, lifesaving health care, even when miles away from a hospital or doctor. Community health workers—trained practitioners who provide health care for pregnant women, assist in childbirth, and treat newborns—provide just that service. Without community health workers, pregnant women and newborn babies in the developing world are at risk for disease. More than 350,000 women die in childbirth and pregnancy each year, and almost 3.6 million babies die before they are a month old. Even small complications can be deadly for people living so far away from hospitals. Community health workers are saving lives by using a very basic—but very important—set of solutions and techniques.


 

Child mortality rate drops by a third since 1990 - UNICEF  •  Levels & Trends in Child Mortality - The Lancet
download report September 2011 download pdf24 pages - 3.6 mb
Report 2011 - Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation

Only four years remain to achieve Millennium Development Goal 4 (MDG 4), which calls for reducing the under-five mortality rate by twothirds between 1990 and 2015. Since 1990 the under-five mortality rate has dropped 35 percent, with every developing region seeing at least a 30 percent reduction. However, at the global level progress is behind schedule, and the target is at risk of being missed by 2015. The global underfive mortality rate needs to be halved from 57 deaths per 1,000 live births to 29—that implies an average rate of reduction of 13.5 percent a year, much higher than the 2.2 percent a year achieved between 1990 and 2010.


 

Global strategy for women's and children's healthGlobal strategy for women's and children's health


Each year, millions of women and children die from preventable causes. These are not mere statistics. They are people with names and faces. Their suffering is unacceptable in the 21st century. We must, therefore, do more for the newborn who succumbs to infection for want of a simple injection, and for the young boy who will never reach his full potential because of malnutrition. We must do more for the teenage girl facing an unwanted pregnancy; for the married woman who has found she is infected with the HIV virus; and for the mother who faces complications in childbirth.  » more

UN launches $40bn woman and child health plan
The UN has launched a $40bn health initiative aimed at saving the lives of 16 million women and children over the next five years. About eight million under-fives die every year and more than a third of a million women lose their lives during pregnancy or childbirth.


 

image: Countries with the greatest number of rotavirus-related deaths

25 October 2011 - 2008 estimate of worldwide rotavirus-associated mortality in children younger than 5 years before the introduction of universal rotavirus vaccination programmes: a systematic review and meta-analysis

The Lancet Infectious Diseases, Early Online Publication - download pdf


Rotavirus remains a major killer of children under five years of age worldwide, taking the lives of 453,000 children in 2008 according to the latest estimates, published today in the Lancet Infectious Diseases journal. This translates into the staggering fact that more than 1,200 young children will die from rotavirus diarrhea each day. Rotavirus-related deaths accounted for 37% of all diarrheal deaths and 5% of all deaths in children under five years of age. One of every 260 children born each year will die from rotavirus diarrhea by their fifth birthday.

Tragically, approximately 95% of rotavirus deaths occurred in countries that are eligible to receive GAVI-support to introduce rotavirus vaccines. Five countries–India, Nigeria, Pakistan, Democratic Republic of Congo, and Ethiopia–all GAVI-eligible, accounted for more than half of all rotavirus deaths globally.

Introduction of effective and available rotavirus vaccines could substantially affect worldwide deaths attributable to diarrhoea. Our new estimates can be used to advocate for rotavirus vaccine introduction and to monitor the effect of vaccination on mortality once introduced.


 

Tanzanian lessons in using non-physician clinicians to scale up comprehensive emergency obstetric care in remote and rural areas
by Angelo S Nyamtema, Senga K Pemba, Godfrey Mbaruku et al.
Human Resources for Health 2011, 9:28 (9 November 2011) 26 pp. 537 kB:
http://www.human-resources-health.com/content/pdf/1478-4491-9-28.pdf

A new study from Tanzania has shown that 'Tanzanian assistant medical officers, clinical officers, and nurse-midwives can be trained as a team, in a three-month course, to provide effective comprehensive emergency obstetrical care and anaesthesia in remote health centres'.

'In Tanzania, 47% of pregnant women deliver in health facilities and only 46% of deliveries are assisted by skilled personnel. The met need for emergency obstetric care, at 15-30%, and the caesarean section rate (CSR) of 3% are still below ideal levels and constitute the lowest rates in the world... Considering that most Sub-Saharan countries are already off-track in their attempts to achieve the MDGs for maternal and perinatal survival, evidence resulting from the current training programmes calls for urgency to scale up the application of the concept of 'task shifting' with the use of NPCs for CEmOC services provision and anaesthesia.'


 

Good health at low cost - 25 years on. What Makes a successful health system?
Editors: Dina Balabanova; Martin McKee; Anne Mills - London School of Hygiene & Tropical Medicine LSHTM - 2011
full book PDFdownload pdf - 399 pages 5.6Mb | mirror copy

'Why do some low and middle income countries manage to achieve good health outcomes while others fail? What factors drive improvements in the health system and in access to primary health care? How can we act on the social determinants of health in cash-strapped economies?

These questions are as relevant today as they were in 1985 when the Rockefeller Foundation published what was to become a seminal report - Good health at low cost. The report explored why some low and middle income countries achieved better health outcomes than others, making Good health at low cost essential reading for health systems decision- and policy-makers alike.

This new edition of Good health at low cost 25 years on draws on a series of new case studies from Bangladesh, Ethiopia, Kyrgyzstan, Tamil Nadu and Thailand providing fresh insights into the role of effective institutions, innovation and country ownership in catalysing improvements in health.

New challenges such as increasing urbanisation, a growing private sector and an upsurge in non-communicable diseases suggest that both learning from the past and new thinking are required to strengthen health systems. This edition provides both and is a vital resource for academics, policy-makers and practitioners grappling with how to improve health in low and middle income countries..'

The authors emphasise the need for a 'systems thinking approach that understands the relationships between different health system components, the context in which the systems exist, and the sequencing of actions'. In their conclusion, the authors say: 'The key message of this book is that success in improving health and delivering health care is facilitated by capacity, both individual and institutional, continuity, or the ability to maintain a course even when all around is changing, catalysts, or the ability to seize windows of opportunity, and sensitivity to context, so that policies that are adopted take account of the circumstances in which they will be implemented'. Their 'Pathways to Improving Health and Access to Care' include 'Political commitment... Collaboration... Flexible use of health workers... Building health system resilience... Economic factors... Social development'.


 

UN reports progress towards poverty alleviation, urges increased support for the poorest - Download pdf
7 July 2011 – Some of the world’s poorest countries have made impressive gains in the fight against poverty, but the least developed countries still lag in efforts to improve living standards, the United Nations said today in a report showing significant overall progress towards achieving the global targets against extreme poverty.

Giving examples of achievements, the Millennium Development Goals (MDGs) Report – prepared by the UN Department of Economic and Social Affairs (DESA) – says that Burundi, Rwanda, Samoa, Sao Tome and Principe, Togo and Tanzania attained or are nearing the goal of universal primary education, one of the targets.


 

Malnourishment in India

More than 5,000 Indian children below five years die every day due to malnourishment or lack of basic micronutrients like Vitamin A, iron, iodine, zinc or folic acid.

Overall, India hosts 57 million - or more than a third - of the world's 146 million undernourished children. 45.9 per cent of India's under-three kids are underweight, 39 per cent are stunted, 20 per cent severely malnourished, 80 per cent anaemic while infant mortality hovers at 67 per 1,000. 440 million people languish at the bottom of the economic pyramid in India and about 500,000 children are born deformed each year due to vitamin/mineral deficiencies.

National Family Health Survey, India  2005-2006 - NFHS-3

"Malnourishment severely retards a child's cognitive, physical and emotional growth and has a cascading effect on his/her productivity in adult years."  -- Dr Suresh Kasana, New Delhi

"India should be worried." Experts reiterate that child malnutrition is not only responsible for 22 per cent of India's disease burden - and for 50 per cent of the 2.3 million child deaths in India -- but is also a serious economic hazard. Neeta Lal reports.


 

25% of all Global Maternal Deaths are in India.
WHO defines maternal mortality as the death of a woman during pregnancy or in the first 42 days after the birth of the child due to causes directly or indirectly linked with pregnancy.

Globally, every year over 500,000 women die of pregnancy related causes and 99 percent of these occur in developing countries.
  • The Maternal Mortality Ratio (MMR) in India is 254 per 100,000 live births according to Sample Registration System (SRS) Report for 2004-2006. This is a decline from the earlier ratio of 301 during 2001-2003.
     
  • In the region, the MMR in China stands at 45, Sri Lanka at 58, Bangladesh at 570, Nepal at 830 and Pakistan at 320 in 2006.
     
  • Wide disparities exist across states in India. The MMR ranges from 95 in Kerala to 480 in Assam.
     
  • MMR has a direct impact on infant mortality Babies whose mothers die during the first 6 weeks of their lives are far more likely to die in the first two years of life than babies whose mothers survive.
     
  • Only 47 per cent of women likely in India have an institutional delivery and 53 percent had their births assisted by a skilled birth attendant. As many as 49 percent of pregnant women still do not have three antenatal visits during pregnancy. Only 46.6 percent of mothers receive iron and folic acid for at least 100 days during pregnancy.

Key Issues

  • About half of the total maternal deaths occur because of hemorrhage and sepsis. A large number of deaths are preventable through safe deliveries and adequate maternal care.
     
  • More than half of all married women are anaemic and one-third of them are malnourished

Maternal Mortality in India: Using International and Constitutional Law to PromoteMaternal Mortality in India: Using International and Constitutional Law to Promote Accountability and Change
The Center for Reproductive Rights - 2008 pdf

The Government of India has a legal obligation to ensure that women do not die or suffer complications as a result of preventable pregnancy-related causes. The staggering scale and continuing occurrence of maternal deaths and morbidity in India reveals the Government’s failure to protect women’s rights and comply with international law.

As the nation leading the world with respect to the number of maternal deaths, the Indian government has an immediate obligation to take meaningful steps to dramatically reduce maternal mortality by fully implementing national policies on maternal health and holding those responsible for the failure of its policies accountable.

This report is intended to serve as a resource for those interested in using international and constitutional legal norms and mechanisms to establish government accountability for maternal deaths and pregnancy-related morbidity through public interest litigation and human rights advocacy.


India Statistics - Women - UNICEF
Estimates of Maternal Mortality Ratios in India and its States - A Pilot Study pdf
Institute for Research in Medical Statistics, Indian Council of Medical Research - July 2003


 

Is Economic Growth Associated with Reduction in Child Undernutrition in India?
published by PLoS Medicine - 8 March, 2011

No Link Found Between Economic Growth and Child Undernutrition Rates in India
ScienceDaily (Mar. 8, 2011) — Economic growth in India has no automatic connection to reducing undernutrition in Indian children and so further reductions in the prevalence of childhood undernutrition are likely to depend on direct investments in health and health-related programs. These are the conclusions of a large study by researchers at the Schools of Public Health at University of Michigan and Harvard University.
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