GIVS and UNICEF: Strategic Priorities For Immunization and Child Survival Dr. Peter Salama, Chief...
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- GIVS and UNICEF: Strategic Priorities For Immunization and
Child Survival Dr. Peter Salama, Chief Child Survival and
Immunization Unit Health Section, Programme Division UNICEF GIM,
March 28th 2006
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- Outline UNICEF context UNICEF and GIVS Progress in 60 countries
Programme models CS indicators- some examples Next steps
- Slide 3
- New UNICEF Context UN reform Paris Principles Child survival
and MDG 4 New partnerships GIVS and strategic frameworks New
Executive Director
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- Health and Nutrition Strategy: Conceptual implementation
framework All MDGs MDG 4MDGs 1, 4, 5 & 6 Policies, plans &
budgets Knowledge & Evidence Large scale action Impact
Translating policies, plans and budgets into large scale action
Leveraging policies, plans and budgets through enhanced Knowledge
& evidence Learning by doing, and doing better by learning
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- Global Causes of Under 5 Mortality* * Source: Lancet Child
Survival Series, (measles data revised). Total 10.8 million deaths
per year Malnutrition Contributes to about 50% of this
mortality
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- Global Causes of Under 5 Mortality By Vaccine-Preventable
Status* *Source: WHO/UNICEF Total 10.8 million deaths per year
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- GIVS and UNICEF 1) Reaching the unreached Complete ADC agenda
Large countries, marginalized pops, complex emergencies 2) New
vaccines 3) Linking child survival interventions 4) Global
interdependence Forecasting, supply and procurement Financing
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- Criteria: Either total number of under-five deaths 50,000 Or
under-five mortality rate 90 per thousand Child Survival Countdown
- 60 priority countries Priority Countries
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- 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 Where we are.
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- Progress for 60 Countdown priority countries in
- MeaslesDPT3 CAR, Cote dIvoire, Liberia, Nigeria, PNG, Somalia
CAR, Chad, Cote dIvoire, Eq. Guinea, Gabon, Haiti, Liberia,
Nigeria, PNG, Somalia >90% 90% 60 Countdown priority countries
10 countries with 90% or more coverage Most countries still below
target and need intensified efforts Measles and DTP3
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- Insecticide-treated NetsVitamin A Supplementation
Prevention
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- 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 Developing World 61% Vitamin A
Supplementation
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- Abuja target 2005 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) Sub- Saharan Africa 3% ITNs
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- 80% (1 dose) Case Management
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- 80% (1 dose) 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 is
estimated to cause 26% of all neonatal deaths. Pneumonia 19%
Neonatal causes 27% Pneumonia Case Management
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- 80% (1 dose) 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 Pneumonia Case Management
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- Nutrition
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- +450% +41% 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 +21% +9% Developing World 36% Exclusive Breastfeeding
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- Rapid progress Rates still low Rapid progress Higher rates
achieved Rapid progress is possible Exclusive Breastfeeding
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- 60 Countdown priority countries 23 countries with unacceptably
low rates Exclusive Breastfeeding
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- 80% (1 dose) Newborn Health
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- Coverage levels remain too low for most indicators Rapid
progress is possible A nalysis needed of why rapid progress occurs
in some countries, and for some interventions, but not others
Summary of Findings
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- Coverage too low for most causes of child death Cause of
deathIntervention coverage Malaria Pneumonia Diarrhea
Undernutrition Neonatal Measles ORT ITN use Skilled attendant at
birth Exclusive Breastfeeding Vitamin A supplementation (> 1
dose) Measles vaccine Antibiotics Exclusive breastfeeding
ORT/continued feeding Summary of Findings
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- national household survey activity 2005-2006 MICS DHS Other
surveys Surveys for 2005-6
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- GIVS Strategy 3 Integrating immunization, other linked
interventions and surveillance in the health systems context UNICEF
Approach: Using immunization to deliver evidence-based packages of
child survival interventions at country level
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- Evidence-Based Selection will Lead to a Mix of Interventions
and Operational Strategies
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- SELECTION OF EVIDENCE BASED HIGH IMPACT INTERVENTION PACKAGES
EPI+ Strengthening routine EPI Vitamin A supplementation ITNs*
Cotrimoxazole prophylaxis* IPTi* Antenatal care+: Refocused ANC
Tetanus immunization Intermittent presumptive treatment (IPT)
against malaria Vitamin A (post partum) PMTCT* IMCI + Exclusive
Breastfeeding ORT ITNs (pregnant and under 5 children) Community
management of Malaria and ARI
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- Systematic Scaling Up of Proven Interventions and Appropriate,
Situation-Specific Strategies that Benefit Children and Womens
Health and Nutrition Under 5 Mortality Rate
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- Impact of ACSD package on DPT3 coverage in selected districts
of 3 West African Countries 2001 Baseline 2003 Survey
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- ACSD and Malaria
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- Using immunization as a platform for delivery of package of
child survival interventions Help countries to tailor integrated
packages of interventions at immunization contacts with priority on
outreach and strategies for hard to reach Ensure selected
additional interventions are included in the multi-year plan Assist
in effective implementation and monitoring of the joint
interventions Continue to learn and adapt packages and
implementation
- Slide 35
- Years from randomisation Why is T/S Prophylaxis Important for
HIV-Infected Children in Resource-Poor Settings? CHAP Study: 43%
Decrease Death with T/S Proportion Alive CotrimoxazolePlacebo 0.40
0.60 0.80 1.00 0.511.52 *Source: Chintu C et al. Lancet
2004;364:1865-71
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- Afghanistan; under five child survival indicators as of 2004
U5MR 257 per 1000 live births- Ranked 4 Source: SOWC 2006
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- DR Congo; under five child survival indicators as of 2004 U5MR
205 per 1000 live births- Ranked 8 Source: SOWC 2006
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- Rwanda; under five child survival indicators as of 2004 U5MR
203 per 1000 live births- Ranked 10 Source: SOWC 2006
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- Ethiopia; under five child survival indicators as of 2004 U5MR
166 per 1000 live births Source: SOWC 2006
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- Nigeria; under five child survival indicators as of 2004 U5MR
197 per 1000 live births- Ranked 13 Source: SOWC 2006
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- 0 40 80 120 160 200 199019931996199920022005200820112014 MDG 4
target Current trend ACSD Booster Phase I Phase II Phase III ACSD
Booster Initiative Sub Saharan Africa