Coverage Presentation for Countdown

1
Working Group on Coverage Monitoring
Tessa Wardlaw
Coverage of Key Child
Survival Interventions
Tessa Wardlaw
2
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
3
Purpose of Presentation

• 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

4
Interventions
Which interventions?
63 of child deaths could be prevented if a
limited set of interventions were universally
implemented

• Nutrition interventions
• Vaccination
• Other prevention interventions
• Newborn health
• Case management of illness

5
Data Sources

• Latest available estimates
• ? National-level household surveys (MICS, DHS
  and others)
• ? UNICEF, The State of the Worlds Children 2006
• Trends
• ? UNICEF and WHO global databases

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Priority Countries
Child Survival Countdown - 60 priority countries
Criteria Either total number of under-five
deaths 50,000 Or under-five mortality rate
90 per thousand
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Selected Findings
Progress for 60 Countdown priority countries
Estimates for all developing countries
Developing World X
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Nutrition
9
Exclusive Breastfeeding
Developing World 36

• 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.

41
9
21
450
10
Exclusive Breastfeeding
Rapid progress is possible
Rapid progress Rates still low
Rapid progress Higher rates achieved
11
Exclusive Breastfeeding
60 Countdown priority countries23 countries with
unacceptably low rates
12
Exclusive Breastfeeding
60 Countdown priority countries24 countries with
low rates
13
Exclusive Breastfeeding
60 Countdown priority countries10 countries with
rates of 50 or more
14
Exclusive Breastfeeding
60 Countdown priority countries
15
Immunization
16
Measles and DPT3Immunization Coverage

• Major progress during the 1980s
• Coverage stagnated since 1990

DPT3
Developing World 76
Target
Measles
Developing World 74
17
Measles and DPT3Immunization Coverage
60 Countdown priority countries
10 countries with 90 or more coverage
Most countries still below target and need
intensified efforts
Measles
DPT3
gt90
lt50
gt90
lt50
18
Measles and DPT3Immunization Coverage
60 Countdown priority countries
10 countries with 90 or more coverage
Most countries still below target and need
intensified efforts
Measles
DPT3
CAR, Chad, Cote dIvoire, Eq. Guinea, Gabon,
Haiti, Liberia, Nigeria, PNG, Somalia
CAR, Cote dIvoire, Liberia, Nigeria, PNG, Somalia
gt90
lt50
gt90
lt50
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Prevention
Insecticide-treated Nets
Vitamin A Supplementation
20
Insecticide-treated nets
Sub-
Saharan Africa
3
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)

Abuja target 2005
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Vitamin A Supplementation

Developing World
61
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
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Newborn Health
?80 (1 dose)
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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)
24
Case Management
?80 (1 dose)
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Pneumonia Case Management
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 10
Neonatal causes 27
Pneumonia 19
?80 (1 dose)
Neonatal pneumonia/sepsis is estimated to cause
26 of all neonatal deaths.
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Pneumonia Case Management
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
?80 (1 dose)
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Summary of Findings
Coverage too low for most causes of child death
Cause of death
Intervention coverage
Malaria Pneumonia Diarrhea Undernutrition
Neonatal Measles
ITN use
ORT
Antibiotics
ORT/continued feeding
Exclusive breastfeeding
Vitamin A supplementation (gt 1 dose)
Exclusive Breastfeeding
Skilled attendant at birth
Measles vaccine
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Summary of Findings
? Coverage levels remain too low for most
indicators ? Rapid progress is possible ?
Analysis needed of why rapid progress occurs in
some countries, and for some interventions, but
not others
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Future Monitoring Plans
? 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 2005-2006 to
inform WFFC monitoring
30
2005-2006 Surveys
national household survey activity
2005-2006
MICS
DHS
Other surveys
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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!