Transcript POLICY GUIDELINES FOR DIARRHOEA MANAGEMENT FOR …

Kenya’s Progress towards Attainment of
Millennium Development
Goal number 4
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Presentation By
Dr. Annah Wamae, OGW
Head Department Of Family Health, Ministry
Of Public Health and Sanitation
1 0 th J a n u a r y 2 0 1 3
KNH and UON Symposium on Innovations for
Attainment of Millennium Development Goals Number 4
and 5
PRESENTATION
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1. Background
2. Child Health Situation
3. Causes of Child Mortality
4. Child Survival Interventions
5. Challenges
6. Opportunities
7. Way Forward
17 July 2015
1. Background - International Declarations
 1977 – Health for all by 2000 i.e Health to a level that will
permit all people to lead a socially and economically
productive life – WHA resolution WHA 30.43
 1978 - Alma Ata Declaration on PHC – PHC as a means of
achieving health for all by 2000
 1979 - Bellagio Conference – Selective Primary Health Care
 to complement Primary Health Care
 more economical feasible,
 targeting specific areas of health i.e Growth monitoring, Oral
Rehydration Treatment, Breastfeeding, Immunization –later- FP,
Female Literacy, and Food supplementation e.g iron and folic acid
to pregnant women (GOBI-FFF)
1. Background - International Declarations
(contd)
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 1979 –Launch of the Global Strategy for Health for
all in resolution WHA 32.30 which endorsed the
Report and Declaration of Alma Ata
 1979 - UN endorsement of the Declaration in
resolution 34/58.
 September 2000 - Millennium Declaration – 8
goals with 21 targets, and a series of measurable
indicators for each target.
 In 2010, UN secretary General launched the Global
strategy on women's and children's health
1. Background - International Declarations
(Contd)
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 The Child Survival Call to Action; A Promise
Renewed
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Held from June 14–15, 2012 in Washington, DC.
Convened by Govts of United States, India, and Ethiopia, in
close collaboration with UNICEF
high-level forum: public and private constituencies
Aim: to identify the smart investments that can be dedicated to
one ambitious, yet simple, goal – to end preventable child
deaths.
challenges the world to make specific plans to reduce child
mortality to below 20 child deaths per 1,000 live
births in every country by 2035.
17 July 2015
1. Background - International Declarations
(Contd)
 MDG 4: Reduce child mortality rates
 Target 4A: Reduce by two-thirds, between 1990 and 2015,
the under-five mortality rate
Under-five mortality rate
 Infant (under 1) mortality rate
 Proportion 1-year-old children of immunized against measles
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2. Child Health Situation - Global
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 75 countries identified as contributing to more
than 90% of deaths of mothers and children.
 Out of the 75 countries, 47 are from sub-Saharan
Africa and Kenya is one of these countries.
 Worldwide, under-5 mortality has declined from
more than 12 million deaths in 1990 to 7.6 million
in 2010 yet thousands of children still die every day
from preventable diseases.
Division of Child and Adolescent Health
17 July 2015
Child Health Situation- Kenya (KDHS
2008/09)
 Under 5 mortality rate: 74/1000 live births
 Under 1 mortality rate: 52/1000 live births
 Newborn mortality rate: 31/1000 live births
(60% of infant deaths in Kenya occur in the
neonatal period)
 Stunting is - 35%
 Underweight is - 16%
2. Child Health Situation- Kenya (Contd)
Under-five Mortality by Province
Eastern
52
Western
121
Rift
Valley
59
North
Eastern
80
Kenya 74
Central
51
Nyanza
149
Nairobi
64
Kenya National Bureau of Statistics & ICF Macro
Coast
87
Deaths per 1,000 live births
for the 10-year period
before the survey
2. Child Health Situation- Kenya(Contd)
Progress in Infant and Under-five Mortality Rates, Kenya
1990/2009 (KDHS)
3. Causes of Child Mortality –
Major causes of death in neonates and
children under-five in the world - 2010
35% of global under-five deaths are
associated with nutrition-related factors*
Sources:
(1) WHO. Global Health Observatory (http://www.who.int/gho/child_health/en/index.html)
(2) *For undernutrition: Black et al. Lancet, 2008
3. Causes of Child Mortality (Contd)
Major causes of death in neonates and children
under-five in the African Region- 2010
Deaths among children under-five
Source: WHO. Global Health Observatory (http://www.who.int/gho/child_health/en/index.html)
3. Causes of Child Mortality (Contd)
Major causes of death in neonates and children under-five in
the European Region - 2010
Source: WHO. Global Health Observatory (http://www.who.int/gho/child_health/en/index.html)
3. Causes of Child Mortality (Contd)- Kenya
Cause
Deaths
Total Deaths
188,928
Diarrhoea
38,802
Pneumonia
30,406
Malaria
20,666
19%
Neonatal
causes =
31% of
under 5
mortality
3% 16%
3%
8%
20%
10%
9%
10%
1%
11%
Pneumonia
Diarrhoeal Causes
HIV/AIDS
Malaria
Measles
Prematurity
Birth Asphyxia
Neonatal Sepsis
Congential Anomalies
Other diseases
Injuries
17 July 2015
Source: World Health Statistics 2011, WHO
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Kenya’s Diarrhoea, Pneumonia & Malaria Mortality Rates Global & regional comparison
25%
20%
20%
17%
18%
18%
16%
15%
14%
15%
11%
8%
10%
5%
0%
Diarrhoeal diseases
17 July 2015
Source: World Health Statistics 2011, WHO
Pneumonia
Kenya
Africa
Malaria
Global
4. Child Survival Interventions
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 The major causes of childhood morbidity and
mortality can be mitigated by simple high
impact interventions
 There is need to accelerate these intervention in
order to reduce child mortality by 2/3rds its
level in 1990, by 2015 (MDG 4)
4. Child Survival Interventions (Contd)
Universal coverage with a few interventions can prevent
over 6 million deaths this year
Deaths
Prevented as
proportion of
All child
deaths
Prevention
Intervention
Treatment
Intervention
Deaths
Prevented as
proportion of
All child
deaths
Breastfeeding
13%
Oral rehydration
15%
Insecticide-treated
materials
7%
Antibiotics for
pneumonia
6%
Complimentary feeding
6%
Antimalarials
5%
Zinc
5%
Zinc
4%
Hib vaccine
4%
Antibiotics for
dysentery
3%
Water, sanitation, hygiene
3%
Vitamin A
2%
7/17/2015
Lancet Child Survival series
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4. Child Survival Interventions (Contd)
Child mortality reduction by different intervention
combinations
Core sets of Preventive intervention combinations
Child
deaths
averted (% )
Package 1: appropriate antenatal care, clean delivery
and appropriate newborn care
13%
Package 2: adequate nutrition (incl. exclusive
breastfeeding, appropriate complementary feeding, and
vitamin A supplementation)
20 %
Package 3: immunization
7%
Package 4: case management of diarrhoea (incl zinc
supplementation and antibiotics for dysentery)
21%
Package 5: case management of sepsis and pneumonia
12%
Package 6: prevention and case management of malaria
(incl. insecticide-treated nets and effective anti-malarials)
13%
Source: WHO 2004
4. Child Survival Interventions (Contd)
Source: KDHS 2009, UNGASS 2009
4. Child Survival Interventions (Contd)
Main Symptoms Assessed During Observed Sick Child
Consultations – in Kenya
Percentage among observed children (N=2,016)
Source: KSPA 2009
4. Child Survival Interventions (Contd)
Training of Providers
Source: KSPA 2009
4. Child Survival Interventions (Contd
Essential Newborn Care Practices - Kenya
Percentage among observed deliveries (N=548)
5. Challenges
Inadequate resources /inefficient utilization of
resources – human, commodities, financial etc
 Focus on curative at expense of preventive and
promotive care
 Previous low focus on maternal newborn and
child health
 Health workers/community attitude
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6. Opportunities
 The New Constitution – right to health, devolution
 Global, Regional and Local renewed interest in
MNCH
 Devolved funds including HSSF
 Introduction of New Vaccines
 Renewed focus on Community and Primary Health
Care
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7. Way forward
 Scale up interventions across the continuum of care –
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Pneumonia and diarrhoea plan being implemented through
IMCI
Focus on maternal and newborn care
Strengthen Health Systems and community participation
Continue with efforts on control of malaria and HIV
Address the multi- sectoral challenges - infrastructure,
security, safe water, sanitation etc
Advocacy for increased resource allocation for MNCH
Currently conducting countrywide Rapid Results Initiatives
(RRIs) on (a) increasing capacity to provide all the signal
functions for basic emergency obstetric and newborn care
and (b) on roll out of use of ORS and zinc for diarrhoea
management
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Child Health is Everybody’s Business
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