1. 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

2. 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

3. 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
Alma Ata Declaration on PHC – PHC as a means of achieving health for all by 2000
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)

4. 1. Background - International Declarations (contd)
1979 –Launch of the Global Strategy for Health for all in resolution WHA which endorsed the Report and Declaration of Alma Ata
UN endorsement of the Declaration in resolution 34/58.
September 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

5. 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

6. 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

7. 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

8. 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%

9. 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

10. 2. Child Health Situation- Kenya(Contd) Progress in Infant and Under-five Mortality Rates, Kenya 1990/2009 (KDHS)

11. 3. Causes of Child Mortality –
Major causes of death in neonates and
children under-five in the world
35% of global under-five deaths are
associated with nutrition-related factors*
Sources: (1) WHO. Global Health Observatory (
(2) *For undernutrition: Black et al. Lancet, 2008

12. 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 (

13. 3. Causes of Child Mortality (Contd)
Major causes of death in neonates and children under-five in the European Region
Source: WHO. Global Health Observatory (

14. 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

15. 19 April 2017
Source: World Health Statistics 2011, WHO

16. 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)

17. 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

18. 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

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

20. 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

21. 4. Child Survival Interventions (Contd) Training of Providers
Source: KSPA 2009

22. Percentage among observed deliveries (N=548)
4. Child Survival Interventions (Contd Essential Newborn Care Practices - Kenya
Percentage among observed deliveries (N=548)

23. 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

24. 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

25. 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

26. Child Health is Everybody’s Business
THANK YOU