Kenya’s Progress towards Attainment of Millennium Development Goal number 4 Presentation By Dr. Annah Wamae, OGW Head Department Of Family Health, Ministry Of Public Health and Sanitation 10th January 2013 KNH and UON Symposium on Innovations for Attainment of Millennium Development Goals Number 4 and 5

PRESENTATION 1. Background 2. Child Health Situation 3. Causes of Child Mortality 4. Child Survival Interventions 5. Challenges 6. Opportunities 7. Way Forward 19 April 2017

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) 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) The Child Survival Call to Action; A Promise Renewed 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. 19 April 2017

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

2. Child Health Situation - Global 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 19 April 2017

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 North Eastern 80 Rift Valley 59 Western 121 Kenya 74 Central 51 Nyanza 149 Coast 87 Deaths per 1,000 live births for the 10-year period before the survey Nairobi 64 Kenya National Bureau of Statistics & ICF Macro

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 Malaria , diarrhoea, pneumonia and HIV contribute significantly to under five mortality in African Region as compared with other regions. This 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 Deaths Total Deaths 188,928 Diarrhoea 38,802 Pneumonia 30,406 Malaria 20,666 Neonatal causes = 31% of under 5 mortality Diarrhoea Malaria 19 April 2017 Source: World Health Statistics 2011, WHO

19 April 2017 Source: World Health Statistics 2011, WHO

4. Child Survival Interventions 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 Prevention Intervention Deaths Prevented as proportion of All child deaths Treatment Breastfeeding 13% Oral rehydration 15% Insecticide-treated materials 7% Antibiotics for pneumonia 6% Complimentary feeding Antimalarials 5% Zinc 4% Hib vaccine Antibiotics for dysentery 3% Water, sanitation, hygiene Vitamin A 2% 4/19/2017 Lancet Child Survival series

Child deaths averted (% ) 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) Concerted efforts must be made to improve the quality and expand the coverage of health interventions that have been proven to deliver results. Packages of these proven health intervention have been listed on this slide. We estimate that a large percentage of child deaths can be prevented by their application. This is particularly so, in settings with high child mortality. Source: WHO 2004

4. Child Survival Interventions (Contd) Source: KDHS 2009, UNGASS 2009

Percentage among observed children (N=2,016) 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

Percentage among observed deliveries (N=548) 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

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

7. Way forward Scale up interventions across the continuum of care – 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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