Comments on: How to Reduce Child Mortality Making the Millennium Development Goals Happen Tue, 25 Jan 2011 13:09:41 +0000 hourly 1 By: Carol Jean Gabriel-Domingo Carol Jean Gabriel-Domingo Wed, 08 Dec 2010 03:22:41 +0000 It starts with a genuine commitment of all stakeholders to work hand in hand to attain MDG 4. How I wish all Nutritionist in the public health sector be provided with the training on CMAM. This is a very important knowledge and skill in managing acute malnourished children. I wish to attend a training on this.

By: Sikta Majumdar Sikta Majumdar Fri, 19 Nov 2010 10:10:05 +0000 EKJUT’S INTERVENTION IN INDIA DRAMATICALLY CUTS NEONATAL MORTALITY

Ekjut has achieved dramatic success in reducing neonatal mortality rates in some of the poorest areas of India through a participatory learning and action cycle approach.

Between 2005 and 2008, an evaluation was done to see how women’s groups affected neonatal mortality and maternal depression in intervention areas as compared to areas where no participatory groups were set up. The prestigious medical journal- The Lancet published findings of The Ekjut Trial:
During the trial period, 244 women’s groups met monthly within groups of 15-20 to identify, prioritize and discuss problems related to pregnancy, childbirth, and the post-natal period, and found appropriate strategies to implement to address them. Groups were led by local facilitators trained in participatory communication methods.

The women worked through a ‘community action cycle approach’ involving four stages: identifying the problems associated with pregnancy, childbirth and care of newborns; developing strategies to tackle these problems, such as improving hygiene, raising emergency funds and producing their own birthing kits; working with local community leaders, teachers, politicians and others to implement these strategies, and; evaluating their success.
Participatory groups have the advantage of helping the poorest, being scalable at low cost, and producing potentially wide-ranging and long-lasting effects. By addressing critical consciousness, groups have the potential to create improved capability in communities to deal with the health and development difficulties arising from poverty and social inequalities.

The effects of the interventions were dramatic: by the second and third years of the trial, the neonatal mortality rate in the areas where the participatory women’s groups existed had fallen by 45%. These areas also saw a significant reduction (57%) in moderate depression amongst mothers by the third year of the trial.
Process Evaluation-
Randomised Controlled Trials should also be accompanied by process evaluation that can explain the Context, Methods, how the Intervention was carried out and the Possible mechanisms of change. A paper on Process evaluation of Ekjut initiative was recently published in Biomed central International Health and Human Rights.
It is now recommended that home visits to reduce mortality should be accompanied by community mobilisation in high mortality settings. To have a glimpse of how ekjut (community mobilisation meetings) plays out in the field, please see Ekjut film
To know more about Ekjut, please visit:
Photographs- Sudharak Olwe

Posted by Sikta Majumdar,
Ekjut, INDIA

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By: Nasta Bugonzi Nasta Bugonzi Fri, 12 Nov 2010 10:21:43 +0000 Child mortality and morbidity is a big threat in Africa and Uganda to be precise.As an Information Scientist I have contributed to its fight by participating in researches as a research assistant with different institutions in Uganda the latest being in April and May 2010.In so doing I get in touch with the people in the communities by talking to them in person by doing so,I get to know these peoples problems very well.In these researches we ask people things to do with health issues,feeding habits, level of education and accommodation, to mension but a how they sleep, more so for the pregnant mothers and the children below the age of five because they are the most vulnerable people.These activities help me to find out the problems people in my community face and I advice them with the little knowledge I have acquired even if I am not a health professional.

I normally advise pregnant mothers to go for antinetals,test for HIV when they pregnant, take their children for immunization, sleep under treated mosquito nets, feed their children well so that they are able to fight disease in there bodies, clear all the bushes around their homes,boil drinking water to avoid water born diseases,practice family planning and a above all tell parents to educate their children because if we have an enlightened community then we can fight all these problems easily with out facing many challenges.

As for the children,even if its difficult for some of them,tell them to eat clean foods more so when it comes to fruits,wash their hands after visiting the latrine,always warm food before consuming it it.Study hard a make a difference in the world.

And above all appeal to the government through the research reports to come in help the vulnerable children and their mothers overcome child mortality and morbidity rate.

By: Catherine Connor, Director of Public Policy Catherine Connor, Director of Public Policy Thu, 11 Nov 2010 14:41:51 +0000 Scale-Up of PMTCT Critical to Achieving Millennium Development Goal

The mission of the Elizabeth Glaser Pediatric AIDS Foundation – to prevent HIV-positive pregnant women from transmitting HIV to their babies, as well as to identify and treat children living with HIV and AIDS – is a critical component to reducing child mortality worldwide and ultimately reaching Millennium Development Goal 4.

Preventing HIV infection is a critical first step toward ensuring a child’s long-term health and survival, and is a fundamental part of the Foundation’s work around the world. Antiretroviral medicines (ARVs) given to HIV-positive women during pregnancy and to their infants during breastfeeding can significantly reduce the potential of transmission of HIV to their infants. By March 31, 2010, the Foundation had provided close to 10 million women with access to these critical services, preventing millions of new HIV infections in children. Despite our efforts, nearly 1,200 children are still infected with HIV every day (UNAIDS, AIDS Epidemic Update 2009), and yet every one of these infections is preventable.

For those children already infected with HIV, almost half of, all HIV-positive infants will die before their second birthdays without medical treatment (UNAIDS, Towards Universal Access, 2010). ARVs, together with comprehensive care and support, directly improve the health and well-being of children living with HIV and increase their chances of leading longer, healthier lives. The Foundation is a global leader in this work, by providing HIV care and treatment, with particular emphasis on provision of services to children. In fact, as of March 31, 2010, more than 82,000 children had been enrolled in Foundation-supported care and treatment programs, and more than 43,000 children had begun life-prolonging antiretroviral treatment.

Additionally, the Foundation promotes child health programs among new mothers to ensure that their infants receive immunizations and other essential well-child services. These services also provide an important opportunity to identify children whose mothers are living with HIV and provide timely care and treatment to those who need it.

The statistics are staggering. In 2008, for example, nearly 300,000 children under the age of 15 died from AIDS-related causes (UNAIDS, AIDS Epidemic Update 2009). The impact of the HIV/AIDS epidemic on the health of children must be made a greater priority as we work to achieve Millennium Development Goal 4 by 2015.

By: Laura Sider Jost Laura Sider Jost Wed, 10 Nov 2010 00:20:51 +0000 MSH strengthens health systems, making health care more accessible and sustainable, by building local capacity and integrating services. These efforts not only reduce child mortality, they are the foundation upon which all development goals can be achieved. We empower local people, including women, to be leaders in their communities; we fortify civil society, local NGOs, and the private sector to play active roles in development; we strengthen the ability of governments to be efficient and accountable; and we build partnerships among governments, service organizations, and donors that foster local economic growth.

MSH supports the achievement of MDG 4 by working at all levels—from communities to governments—to close gaps in health care for women and children. Working with ministries of health and other partners, such as local governments and NGOs, we establish community-based care, link that care to health facilities, and improve the quality of care along the entire continuum of care, from the community up to hospital referral care, and all services in between. We increase coverage of interventions such as prenatal and postnatal care, skilled attendants during childbirth, treatment of childhood illness, child nutrition, prevention of mother-to-child transmission of HIV, and healthy timing and spacing of pregnancy. We also strengthen supply chains that provide immunizations, contraceptives, and other drugs, and improve service management by implementing performance-based financing and leadership development programs.

The MSH approach has proven effective even in fragile states:

In Afghanistan, MSH and its partners bolster local capacity to expand community-based care in 13 provinces. From 2003 to 2006, the number of Afghans with access to basic health services increased from half a million to 7.5 million, the rate of births attended by skilled providers doubled, the number of children immunized increased from 15 to 37 percent, and the use of modern contraceptives rose from 16 to 26 percent. These achievements were facilitated by the training of 6,300 community health workers (half of whom are women) and an innovative literacy program that reached 8,500 women. Today, as a result of these early efforts, nearly 60 percent of pregnant women receive prenatal care, and deaths of children under the age of five have declined by one-third.

In Haiti, MSH has worked closely with the Ministry of Public Health and local health organizations to train 4,000 community health agents and 4,000 traditional birth attendants (matrones) who provide basic health care for women and children through home visits. When Lina, a mother in the Grand’Anse region, went into labor in her home last year, her mother sent for a local matron. After two days, the matron contacted a local health agent because she knew Lina and the baby were at risk. The agent initiated an emergency evacuation by calling the hospital for an ambulance and organizing community members to carry Lina to the nearest road, five hours away, where the ambulance could meet them. At the hospital, Lina delivered a healthy baby and recovered well. In 2009, nearly half of all pregnant women among the 4.5 million people covered by the work of MSH’s partners received prenatal care, compared to almost none when the program started two years before. Nearly 80 percent of these women made birth plans in case of emergency.

By: Likondwa Phiri Likondwa Phiri Tue, 09 Nov 2010 09:54:18 +0000 Most under five children deaths are preventable indeed only that in most developing countries like mine there is problem poor health information delivery.

Most mothers don’t know whens there is a deviation of a child health status and mostly this is only reported to health facility in the worst condition.

these things puts pressure on health workers making it difficult to save lives of the child.

I think if we would increase the awareness giving capacity it would increase the knowledge at a grassroots level. Problems would be known,prevented and reported in time if arises.


By: Xiangfang Li Xiangfang Li Sun, 07 Nov 2010 20:42:37 +0000 Most neonatal, post neonatal, infant and child deaths are preventable. The majority of their deaths occurred in developing countries because lacking of appropriate delivery attendants and obstetricians, lacking of appropriate skills of birth attendants or midwives, lacking of medical services, lacking of appropriate vaccines, lacking of appropriate food nutrition, even starving, and so on. If we can improve these deficiencies, the mortality can be significantly decreased. As a previous OB/GYN and experienced to work at a developing country to improve maternal and child health at the rural areas, I would love to contribute my knowledge and skill to join the team who works for the Millennium Development Goals for reducing child mortality.

By: Diwakar Sharma Diwakar Sharma Sat, 06 Nov 2010 07:53:02 +0000 A lot of work is needed to be done in Developing countries like India where in spite of various government run programs and schemes the results are not up to the mark. There are a number of states where even the Routine Immunization is a problem. Though the data shows a satisfactory improvement but the ground reality is something different.
Nutritional problems is again a very big issue which leads to anaemia.
The average age of marriage in the state of Jharkhand is 15.8 years. The early Marriage is again related to various reasons like inequality towards the gender and the custom of dowry.
The Nutritional problem combined with early marriage is giving a devastating results in terms of IMR and MMR.
The system of monitoring and evaluation from the government front is needed to be improvised.
Diarreohea and Malaria are also very deadly diseases affecting the child mortality.
A convergent plan from the grass root to apex level is needed with proper monitoring.

By: Sharon McCarty-Painter Sharon McCarty-Painter Thu, 04 Nov 2010 16:19:57 +0000 Child health lies at the core of Project HOPE’s global activities – we strengthen linkage between families, communities, health care facilities, and Ministry of Health – ensuring accessible, sustainable, and institutionalized essential health care services. Programs are designed based on local need and in collaboration with community, district or provincial leadership. Priority interventions include C-IMCI, management of obstetric/newborn complications, maternal/newborn care, exclusive breastfeeding, nutrition, immunization, diarrheal disease control, malaria, and pneumonia case management. Given the local need, additional interventions in program design may include family planning/ reproductive health, HIV/AIDS/STI, PMTCT, breast and cervical cancer prevention.

Infant and child deaths are preventable. The best defense a mother has to prevent childhood disease or death is to ensure that she is educated, empowered, and has access to professionally trained health care workers and essential health care services — not just for her child but for herself as well.

Our approach to reducing child mortality is to leverage public and private resources. Key strategies and activities are applied through training and capacity building for mothers, community health care workers, community volunteers and community leaders; implementation of behavior change and communication outreach; economic strengthening; health systems strengthening and supplementation of product donations.

As an example, Project HOPE has leveraged private funding in the Dominican Republic by working in partnership with the Dominican Association of the Order of Malta (ADOM) to build a high quality, low cost Maternal and Child Health Clinic in Herrera, a poor urban area of Santo Domingo. Currently 96% self-sustaining, the Herrera Clinic serves 70,000 registered patients in an area populated by 300,000 people. Services include gynecology (including cytology and sonograms), pediatric care, psychological counseling, hematology, pharmacology and dentistry. The Herrera Clinic was recognized as a global model by PAHO. Because of the successes of the clinic in Herrera a second clinic was opened in the rural area of Monte Plata, serving 35,000 patients in a region of 175,000 inhabitants. Following the destruction of storms Olga and Noel HOPE leveraged funding from BD, Merck and Sanofi Pasteur to work with local health officials to provide vaccines and medical supplies. Over one million Dominicans, mostly children, were vaccinated against influenza, diphtheria, pneumonia, tetanus and other diseases. In a country where maternal death is high despite a high rate of medically attended births, the Clinics focus on a high quality of care and empowering mothers to become active partners in the care of their families.
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