Tessa Wardlaw Working Group on Coverage Monitoring Coverage of Key Child Survival Interventions Tessa Wardlaw

Introduction 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

Selected findings from the Countdown 2005 monitoring report First in a series of Countdown reports to be issued every two years Identify areas for greater focus Countdown monitoring plans for the future Purpose of Presentation

Nutrition interventions Vaccination Other prevention interventions Newborn health Case management of illness Which interventions? 63% of child deaths could be prevented if a limited set of interventions were universally implemented Interventions

Latest available estimates ● National-level household surveys (MICS, DHS and others) ● UNICEF, The State of the World’s Children 2006 Trends ● UNICEF and WHO global databases Data Sources

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

Estimates for all developing countries Progress for 60 Countdown priority countries Developing World X% Selected Findings

Nutrition

+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

Rapid progress Rates still low Rapid progress Higher rates achieved Rapid progress is possible Exclusive Breastfeeding

60 Countdown priority countries 23 countries with unacceptably low rates Exclusive Breastfeeding

60 Countdown priority countries 24 countries with low rates Exclusive Breastfeeding

60 Countdown priority countries 10 countries with rates of 50% or more Exclusive Breastfeeding

60 Countdown priority countries Exclusive Breastfeeding

Immunization

DPT3 Measles Major progress during the 1980s Coverage stagnated since 1990 Developing World 76% Developing World 74% Measles and DPT3 Immunization Coverage Target

MeaslesDPT3 >90% <50% >90% 60 Countdown priority countries 10 countries with 90% or more coverage Most countries still below target and need intensified efforts Measles and DPT3 Immunization Coverage

MeaslesDPT3 CAR, Cote d’Ivoire, Liberia, Nigeria, PNG, Somalia CAR, Chad, Cote d’Ivoire, Eq. Guinea, Gabon, Haiti, Liberia, Nigeria, PNG, Somalia >90% <50% >90% 60 Countdown priority countries Measles and DPT3 Immunization Coverage 10 countries with 90% or more coverage Most countries still below target and need intensified efforts

Insecticide-treated NetsVitamin A Supplementation Prevention

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 ( ) Sub- Saharan Africa 3% Insecticide-treated nets

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

80% (1 dose) Newborn Health

80% (1 dose) Low Birth Weight Low birth weight is a key impact indicator Serious measurement problems as most births not weighed Results in biased and underreported estimates Intensified efforts are needed to weigh infants at birth Percentage of births NOT weighed

80% (1 dose) Case Management

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 pneumonia/ sepsis 10% Neonatal causes 27% Pneumonia Case Management

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

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

● 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

● Findings are a starting line to monitor progress, which will be tracked closely in the coming years ● Increased frequency and scope by expanding monitoring at national and sub-national levels to better track program implementation ● Countdown monitoring to build on other ongoing efforts (MDG and WFFC) ● MICS, DHS and other surveys in to inform WFFC monitoring Future Monitoring Plans

national household survey activity MICS DHS Other surveys Surveys

Conclusion Countdown is a renewed opportunity to: Systematic follow-up and rigorous monitoring Identify disparities Better understand implementation challenges With all this information there is no excuse… Numbers must translate into action!