M illennium Development Goals and Child Health: where do we stand? - - PowerPoint PPT Presentation
M illennium Development Goals and Child Health: where do we stand? Zulfiqar A. Bhutta Noordin Noormahomed Endowed Professor & Founding Chair Division of Women & Child Health The Aga Khan University Karachi, Pakistan Outline M DGs
Noordin Noormahomed Endowed Professor & Founding Chair Division of Women & Child Health The Aga Khan University Karachi, Pakistan
Albert Einstein
Goal 1:
Eradicate Extreme Hunger and Poverty
Goal 2:
Achieve Universal Primary Education
Goal 3:
Promote Gender Equality and Empower Women
Goal 4:
Reduce Child Mortality
Goal 5:
Improve Maternal Health
Goal 6:
Combat HIV/AIDS, Malaria and other diseases
Goal 7:
Ensure Environmental Sustainability
Goal 8:
Develop a Global Partnership for Development
Source: http:/ / www.un.org/millenniumgoals/childhealth.shtml
Childhood Newborn/ postnatal Pre-pregnancy Pregnancy
Birth
M aternal deaths Stillbirths Newborn deaths Child Deaths
Ranking for neonatal deaths Ranking for maternal deaths Ranking for stillbirths India 1 1 1 Nigeria 2 2 3 Pakistan 3 8 2 China 4 13 8 DR Congo 5 3 6 Ethiopia 6 5 5 Bangladesh 7 6 4 Indonesia 8 7 7 Afghanistan 9 4 12 Tanzania 10 9 11
2.4 million neonatal deaths Approx 67%
total 340,000 maternal deaths Approx 65%
total
Ref: Lawn JE et al BJOG sept 2009. Data sources: Estimates of maternal (2005) and neonatal (2008) deaths from WHO. Stillbirths from Cousens et al 2010 Updated Aug 2010
1.77 million stillbirths Approx 63%
total
358,000 per year
2.65 million per year
Intrapartum-related maternal deaths (2008)
Death during labour, birth and first 24 hrs
Intrapartum stillbirths (2009)
Fetal death during labour (fresh stillbirths)
814,000
261,000 1,200,000
3.6 million per year
Intrapartum-related neonatal deaths (2009)
Previously called “birth asphyxia”
Daily risk of death (per 1,000 survivors)
Lawn et al. Lancet 2005; 365: 891–900.
Day of life 10 20 30 10 8 6 4 2 75% of neonatal deaths (nearly 3 million)
Up to 50% of neonatal deaths are in the first 24 hours
On track: U5MR is less than 40, or U5MR is 40 or more and the average annual rate of reduction (AARR) in the under-five mortality rate observed for 1990-2007 is 4.0 percent or more Insufficient progress: U5MR is 40 or more and AARR is between 1.0 per cent and 3.9 per cent No progress: U5MR is 40 or more and AARR is less than 1.0 per cent Data not available Progress towards MDG 4, with countries classified according to the following thresholds:
Bhutta et al Lancet 2010
M DG 4 target (32)
Ref: Lawn, Kerber et al BJOG 2009 updated with data for 2008 from UN Child Mortality Group, WHO//CHERG and IHME (Rajaratnam J eta l 2010)
Source: Black RE, et al. Lancet 2010
deaths are in only 5 countries of Asia & Africa
diarrhea deaths appears to have slowed
1975 1980 1985 1990 1995 2000 2005 2010
Snyder & M erson 1982 GBD 1990 EIP 2000 Bern et al, 1992
Source: Boschi-Pinto C, T
CHERG 2010
These 35 Countries Account for 90% of Worldwide Burden
50 100 150 200 250 300 350 400 450 500
Estimated Annual Deaths Due to Diarrhea (thousands)
Notes: For subsequent analyses in this presentation, FSG selected top 35 highest mortality burden, plus highest burden countriesfrom Latin America (Haiti, Mexico and Peru). Of the top 35,
Sources: WHO Global Burden of Disease Estimates 2004; Lopez et al, Global and regional burden of disease, Lancet (367) May 27, 2006: FSG Analysis
50% Deaths
India Nigeria Pakistan DR Congo China Bangladesh Ethiopia Angola Afghanistan Indonesia U Rep, Tanzania Uganda Mozambique Niger Myanmar Kenya Mali Burkina Faso Malawi Sudan Yemen Madagascar Brazil Nepal Côte d'Ivoire Somalia Zambia Cameroon Iraq South Africa Rwanda Egypt Sierra Leone Philippines Cambodia Bold = DHS data available
50% of 1.34M Diarrheal Disease Deaths Occur in Only 5 Countries 50% of 1.34M Diarrheal Disease Deaths Occur in Only 5 Countries
1.8M Deaths Total
Rank M ortality Adjusted for Population Size Nepal India Bangladesh
Niger Burka Fasino
Source: World Health Report 2006
Referral Hospital
Tertiary
University Hospital
Secondary
District General Hospital Sub-district Hospitals
Primary
Rural Health Center Village Health Units
Lawn UNAPSA SAP A 2008
M aternal Series 2006 Repro- ductive Health Series 2006
Child develop ment series 2007 Newborn 2005
Child 2003
Under Nutrition series 2008 Alma Ata series 2008 Stillbirth series 2011
Preventive Intervention
deaths prevented
(‘000s)
Deaths prevented as proportion of all child deaths Breastfeeding 1301 13% Insecticide
691 7% Complementary feeding 587 6% Zinc 459 5% Hib vaccine 403 4% Antiseptic delivery 411 4% Water, sanitation, hygiene 326 3%
Source: Jones G, Steketee R, Bhutta Z, Morris S. and the Bellagio Child Survival Study Group. How many child deaths can we prevent this year? Lancet 2003.
Oral rehydration therapy 1477 15% Antibiotics for neonatal sepsis 583 6% Antibiotics for pneumonia 577 6% Antimalarials 467 5% Zinc for diarrhea 394 4% Newborn resuscitation 467 5% Antibiotics for dysentery 310 3%
Source: Jones G, Steketee R, Bhutta Z, Morris S. and the Bellagio Child Survival Study Group. How many child deaths can we prevent this year? Lancet 2003.
Treatment Intervention
deaths prevented
(‘000s)
Deaths prevented as proportion of all child deaths
Bhutta et al (Lancet 2010)
Pre-pregnancy Pregnancy Birth Postnatal Neonatal Infancy Childhood
M edian national coverage levels for 19 Countdown interventions and approaches, most recent estimates since 2000.
Bhutta et al, Lancet 2010
0% 20% 40% 60% 80% 100%
Family planning needs satisfied Antenatal care (4+ visits) Skilled attendant at delivery Postnatal visit Insecticide-treated net use (child) DPT3 vaccine M easles vaccine BCG vaccine Vitamin A administration (child) Care seeking for pneumonia ORT and continued feeding Coverage
Poorest Richest
Source: Institute for Health Metrics and Evaluation (2010) Financing Global Health 2010
26 33 37 42 31 2012
4 12 15 12
2011
4 10 20
2014
15 6 13 18
Direct costs for programs targeting women and children
7
2015 Health systems costs of programs targeting women and children Other costs for scaling up to meet the health MDGs 2013
5 12 16 Billions (2005 US$)
Funding Gap is significant
Gap for health MDGs in 49 lowest- income countries:
–
US$26 billion (US$19 per capita) additional in 2011.
–
US$42 billion (US$27 per capita) additional in 2015 Almost half of these costs are related to women and children
Across three distinct categories
Low income countries must spend more and prioritise reaching the poor as per Abuja target of 15% of government spending on health
Tanzania Zambia Ethiopia
Donor countries must meet their commitment of 0.7% of GDP
At MDG Summit in 2010, $40 billion USD committed as policy, service delivery and financial commitments
3,215 4,694 1,038
378 2,000 4,000 6,000 8,000 10,000 Prevention Treatment Type of intervention Millions of 2004 US$
Additional ("new") Current
. Estimated annual running costs of delivering child survival interventions at current
(2000) coverage levels and at universal coverage, in millions of 2004 US dollars.
Annual running costs:
Bryce et al (Lancet 2005)
347 3236 409 536 90 1283 500 1000 1500 2000 2500 3000 3500 WW1 WW2 Korea Vietnam Gulf War 1 Iraq & Afghanistan
Faille M & Congressional Research Service (2011)
President Dwight D. Eisenhower April 16, 1953
M DG targets for M aternal & Child survival
across the continuum of care
through community engagement, outreach, promoting women empowerment and gender equity
development priority, a moral imperative and collective responsibility
equity gap in child survival