Subject: FCM III

Topic: Regional Child

Survival Strategy
WHO/UNICEF
Shifting /Date: August 1, 2008
Trans group: Paolo Paraiso

Learning Objectives Immediate Causes of Deaths Among Underfive

By the end of this session, the students will be able Children In High and Middle Mortality Areas
to: (WPRO:2000-2003)
(1) describe the overall health status of children
in
the Western Pacific Region;
(2) explain the underlying causes and other
related factors against child survival; and
(3) enumerate the essential package of
interventions applicable for counties of
varying levels of child health status

Trend in Infant Mortality Reduction Towards

Target 2015 MDG, WPR

Immediate Causes of Death in Underfive

Children, WPR

Under-five Mortality Rates of Countries in the

Western Pacific Region, 2004 WHO

Immediate Causes
 deaths in perinatal and neonatal periods
dominate the U5MR; the perinatal period is
also associated with the highest number of
disabilities; highest risk is in the first day of
birth;
 40 - 80% of neonatal deaths are associated
with low birth weight;

MARY YVETTE ALLAIN TINA RALPH SHERYL BART HEINRICH PIPOY TLE JAM CECILLE DENESSE VINCE HOOPS CES XTIAN LAINEY RIZ KIX EZRA GOLDIE BUFF MONA AM MAAN ADI KC
PENG KARLA ALPHE AARON KYTH ANNE EISA KRING CANDY ISAY MARCO JOSHUA FARS RAIN JASSIE MIKA SHAR ERIKA MACKY VIKI JOAN PREI KATE BAM AMS HANNAH MEMAY PAU
RACHE ESTHER JOEL GLENN TONI

Survival Strategy
 malnutrition remains the highest attributable
causal factor of all childhood deaths in
children under 5;
 most important immediate causes of death
from communicable diseases remain
diarrhoea and ARI
Predisposing Factors
 Inadequate Care for Women:
-currently, most women seek antenatal care
(ANC) in the 2nd or 3rd trimester
 High fertility, poor birth spacing:
- 2.5 times chance of surviving infancy if >3
years interval;
 Community and environment:
-indoor, outdoor and personal hygiene are
major contributors to ARI/CDD;
parentless/orphans are 6-7 times greater
chance of dying in infancy
 Improper infant and young child feeding:
- the transition between intrauterine and
extrauterine life; infants not breastfed have 6-
fold increased chance of dying in first two
months; protection against infections
 Lack of access to safe water, sanitation:
- WPRO/ EAPRO has 3 of the 10 countries
‘worst off’ for water safety (Cambodia, PNG,
Laos); Cambodia worst off in toilet sanitation;
1 billion people in the region live without
adequate sanitation = 305,000 metric tons of
fresh excreta deposited outside each day
 Lack of access to basic social services:
- pockets of poor immunization rates, poor
access to appropriate management of diarrhea
and pneumonia
Underlying Causes:
A. Undernutrition
 conditions interfering with nutrient absorption
that lead to deficiencies prior to and
throughout pregnancy (e.g., malaria,
hookworm, Tb, UTIs, HIV/AIDS, etc.)
 Low Birth Weight:
Subject: FCM III
Topic: Regional Child
Page 2 of 6
 significantly increased mortality risk
in the neonatal and early infancy
period;
 cognitive function impairment;
 predicts underweight later in life;
 risk for adult diseases.
B. Poor Intrauterine Nutrition
 Stunting:
• persists into adulthood;
• intergenerational effect: associated
with an increase in surgically assisted
births, and birth of LBW babies;
• associated with poor cognitive and
motor development
C. Others
 Increasing inequity:
- the poor being marginalized in the delivery
of health care;
 Policy Environment:
- lack of supportive laws or poor
implementation of the laws;
 Constraints Financing for Child Survival.
- public spending in health is only 1.9 % of
GDP in comparison to global average of 3.2
%; policies not driven by concepts of public
goods, or of human rights based approaches;
 Human resource constraints:
-underpaid, demotivated health workers;
inequitably distributed;
 Social norms and Gender issues:
-women are underfed, poorly educated,
overworked.
 Subject: FCM III
Topic: Regional Child
Survival Strategy
Page 3 of 6

• Case management of pneumonia and

neonatal sepsis would prevent an estimated
12% of child deaths
• Use of insecticide treated bed nets and
prompt treatment of malaria would reduce
child mortality by approximately 13%

Essential Package of Child Survival Interventions

Child Survival Actions by Country Group
Group 1 • Essential package for
child survival
• Deworming of children 6-
59 mos. and pregnant
women

Group 2 • Essential package for

child survival w/
geographic targeting
in underserved areas
• Institutional deliveries w/
comprehensive newborn
care
• Deworming of children 6-
59 months, and pregnant
women
Essential Package of Child Survival Interventions • Promotion of childhood
– WHY? safety
• Skilled attendance. during pregnancy, • Introduction of new or
childbirth and the immediate postpartum underused vaccines (HiB,
would prevent approximately 13% of child rotavirus, conjugate
deaths pneumococcal vaccine)
• Exclusively breastfeeding for six months,
Group 3 • Essential package for
and adequate and safe complementary
child survival with
feeding from six months onwards with targeting of the socio-
continued breastfeeding and micronutrient economically
supplementation would prevent underprivileged and
approximately 20% of child deaths marginalized
• Vaccination against common vaccine • Institutional deliveries
preventable diseases would prevent with newborn care
approximately 3% of child deaths • Promotion of child safety
• Introduction of new or
• Case management of diarrhoea would save
underused vaccines (HiB,
approximately 21% of child lives rotavirus, conjugate
 Subject: FCM III
Topic: Regional Child
Survival Strategy
Page 4 of 6

pneumococcal vaccine)

1. Skilled Attendance During Pregnancy,

Childbirth and the Immediate Postpartum
 Antenatal care
 Skilled attendance at delivery
 Immediate postpartum care

The Philippines fared better than Lao and Cambodia

with regard to early initiation of breastfeeding. It
must be noted though that the current level is still far
below than the 80% set by the DOH for early iniation
of breastfeeding.

Skilled Care Attendance At Birth

3. Breastfeeding and Complementary Feeding
100
Exclusive Breastfeeding
80

60
t
n 100
e
40
c
r
e
20
P
0
50
t
Cambodia China Lao PDR PNG PhilippinesViet Nam n
e
c
r
e
P

In the Philippines, the proportion of deliveries 0

attended by a health professional is about 60%, which Cambodia China Lao PDR PNG PhilippinesViet Nam
is lower that that in China and Vietnam. It is higher
though than Cambodia, Lao and PNG. Comparing the proportion of infants exclusively-
breastfed among the different countries, the
Philippines reported only about a third of infants
2. Care of the Newborn who were breastfed exclusively. It has better
 Early initiation of breastfeeding (within one coverage of exclusively breastfed infants than
hour of birth) Vietnam, PNG and Laos.
 Temperature control
100Low-birth-weight management
100 Timely Complementary Feeding
Early 80
Initiation of Breastfeeding (within one hour 80

60
of birth)
t 60
n t
e
c n
r e
e
40
P rc
40
e
P
20 20

0 0

Cambodia Lao PDR Philippines Cambodia China Lao PDR PNG PhilippinesViet Nam
 Subject: FCM III
Topic: Regional Child
Survival Strategy
Page 5 of 6

Timely provision of complementary feeding means

that the infant has been introduced to semi-solid or
solid food to complement nutrients at age 6 months, WHO recommends immunization of children against
not later or earlier. measles. The Philippines is better off than PNG, LAO
and Cambodia in terms of measles vaccination
coverage. In 2004, the DOH conducted a nationwide
Follow-up Measles Campaign where all children
4. Micronutrient Supplementation were given measles vaccination. That nationwide
 Vitamin A supplementation (6-59 months-old) immunization covered about 95% children.
 Iron supplementation
 Use of iodized salt – iodine supplementation
Vitamin A Supplementation
Tetanus Toxoid Immunization
100

80 100

60 80
t
n
e
c
r
40
e 60
t
P n
e
c
r
20 40
e
P

0 20
Cambodia Lao PDR PNG Philippines Viet Nam
0
Coverage of Vitamin A supplementation in the Cambodia Lao PDR PNG Philippines Viet Nam
Philippines has improved in the past 5 years. This The WHO recommends that women should have at
improvement is attributed to the conduct of least two injections against TT to prevent their babies
Garantisadong Pambata (GP) sponsored by the DOH from being infected with neonatal tetanus. It is
twice a year. The GP allows the 6-71 months old lamentable that the Philippines has the least
children to avail of the Vitamin A supplementation proportion of women with at least TT 2 Plus
twice a year. In 2006, the DOH began to integrate the vaccination.
provision for deworming drugs to the same age group
of children.
6. Integrated Management of Sick Children
100
5. Immunization of Children and Mothers Oral Rehydration Therapy for Diarrhoeal Disease
100 80

Measles Immunization 60
t
n
e
t c
50 r
e
n
e 40
P
c
r
e
P
20
0
0
Cambodia China Lao PDR PNG PhilippinesViet Nam
Cambodia Lao PDR PNG Philippines Viet Nam
 Subject: FCM III
Topic: Regional Child
Survival Strategy
Page 6 of 6

Summary and Conclusion

The indicator refers to the number of diarhea cases
who were given ORT
o seven evidence-based intervention areas have
been linked with 10 indicators;
o countries are implementing many of these
child survival interventions, but coverage is
low
o countries use different indicators for the same
intervention, making data comparison and
tracking progress towards implementation
coverage difficult

Care-seeking for Acute Respiratory Infection

100

50
t
n
e
c
r
e
P

0
Cambodia Lao PDR Philippines Viet Nam

As shown in the slide, there is poor seeking

behaviour among mothers with children suffering
from ARI. Although the coverage is lower than
Vietnam, it is still below the 80% target set by the
DOH.

7. Use of insecticide treated nets (ITN) in

malarious areas
 20 % sleeping under ITN (Cambodia)
 20.6 % sleeping under ITN (Lao PDR)
 35% sleeping under ITN (PNG)