child health in angola luis bernardino march 2013

CHILD HEALTH IN ANGOLALuis Bernardino

March2013

CHILD HEALTHTHE SITUATION IN LESS DEVELOPED VERSUS

DEVELOPED COUNTRIES

• 1. Higher morbility/mortality (Quantity) Perinatal mortality (nº dead 1st week/1000 NB alive or dead) Neonatal mortality (nº dead 1st month /1000 NB) –( M < 1M)

Infant mortality (nº dead 1st year /1000 NB) (M < 1 Y) Mortality >5 (nº dead first five years/ 1000 NB) (M < 5 Y)

2. Different causes of death (Quality)

MORTALITY, QUANTITY *

Levesl & Trends in Child Mortality, 2011 ReportUNICEf, WHO, WORLD BANK, UN.NATIONS,DESA/ Pop. Div.

Best figures among more developed countries

The more unfavourable figures

Country Mort.<1M Mort.<1A Mort.<5A Country Mort.<1M Mort.<1A Mort.<5A

Japan 1 2 3 Burkina Faso

28 93 176

Luxembourg 1 2 3 Chad 41 99 173

Finland 2 2 3 Rep.DemCongo

46 112 170

Sweden 2 3 3 Haiti 20 70 165

Norway 2 3 3 Angola 45 98 161

MORTALITY (Quality)10 more frequent causes of child death in Sweeden na Nigeria( 1990)

SWEDEN NIGERIA

1.Delivery trauma;asphyxia 1. Pneumonia

2. Other neonatal conditions 2. Other neonatal conditions

3. Congenital malformations 3. Malaria

4. Accidents (no trafic) 4. Diarrhoea

5. Trafic accidents 5. Other ilness

6. Other ilness 6. Cause not known

7. Neoplasia 7. Measles

8. Pneumonia 8. Other infectious and parasitic infections

9. Influenza 9. Delivery trauma; asphyxia

10. Diarrhoea 10. Anemia

Environment

GenomaGenoma

Environment

CAUSES OF ILNESS

LESS DEVELOPED COUNTRIES DEVELOPED COUNTRIES

THE UNDERDEVELOPMENT CYCLE

POVERTY

FOOD INSECURITY

POOR EDUCATION

UNHEATHY HABITAT

INFECTIONHIGH

MORTALITY < 5 YEARS

HIGH NATALITY

MALNUTRITION

POPULATION/ RESOURCES GAP

http://www.infoescola.com/geografia/paises-mais-pobres-do-mundo/

Fonte : Wilkipedia.org

HOUSE : AVERAGE NUMBER OF PEOPLE PER SLEEPING ROOM

National 2.9Urban 2.7Rural 3.0

Source : IBEP, 2011

Houses with sanitary facilities

Urban 74.5 10.3 evacuate out

doors

Rural 28.4 63.5 evacuate out

doors

Source : IBEP, 2011

ACCESS TO CLEAN WATER

National 42%Urban 57.9%Rural 22.8%

National 65.9Urbano 46.4

Rural 89.5

From appropriate sources

No treatment of inappropiate sources

Source : IBEP, 2011

VacinationOfficial figures, 2010 * Measles 93%

DPT 3 91%Hib B 3 91%

National survey 2008- 2009 **

Children immunized with BCG,DPT,Polio, MeaslesWith vaccination card 21.1%Information from mother 7.9%

* WHO Report 2012** Population Welfare Survey (IBEP), 2011

5%

20%

19%

14%

11%1%

2%

5%

6%

1%

8%

3% 7% Anemia Aguda

DRA

Malária Complicada

Malnutrição Grave

Sepis Neonatal

Tuberculose

Drepanocitose

Diarreia Aguda

Hipóxia Perinat

Celulite

Prematuridade

Cardiopatias

Meningite

CAUSES OF DEATH IN 1992 CHILDREN IN THE PEDIATRIC HOSPITAL OF LUANDA IN 2012

Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000

The Lancet, Volume 329, nº 2161, Pages 2151 - 2161, 9 June 2012

CAUSES OF DEATH INCHILDREN IN THE WORLD IN 2010. (The Lancet, 2012, 379: 2155)

A2000 A2001 A2002 A2003 A2004 A2005 A2006 A2007 A2008 A2009 A20100

10

20

30

40

50

60

70

80

90

100

Inte

rnad

os

PEDIATRIC HOSPITALDaily Emergencies admitted, 2000-2010

MONTHLY ADMISSIONS FOR MALARIA2010Malaria 2010

0

100

200

300

400

500

600

700

800

900

1000

Meses

Freq

uênc

ia

Casos 283 267 364 490 941 747 455 230 201 218 330 420

Obitos 27 31 27 27 76 56 32 18 18 12 28 26

1º 2º 3º 4º 5º 6º 7º 8º 9º 10º 11º 12º

SEVERE ANEMIA = TRANFUSIONSNumber of cases Pediatric Hospital, 2010

Anemia severa 2010

0

200

400

600

800

1000

1200

1400

Meses

Freq

uênc

ia

Casos 558 539 728 693 1169 986 718 499 471 568 645 780

Obitos 6 8 9 17 23 15 21 8 5 6 7 20

1º 2º 3º 4º 5º 6º 7º 8º 9º 10º 11º 12º

ADMISSION EMERGENCY WARD PEDIATRIC HOSPITALMay, 2011

A2000 A2001 A2002 A2003 A2004 A2005 A2006 A2007 A2008 A2009 A20100

2

4

6

8

10

12

14

16

Hospital Pediátrico David BernardinoDaily deaths,2000 - 2010

Óbi

tos

ANGOLA : HOW NEAR THE 4TH MILENIUM DEVELOPMENT GOAL?What sould be done?

THE ATTEMPTS: 1978 :ALMA ATA AND HEALTH FOR ALL IN 2000 – THE STRATEGY OF PRIMARY CARE

2000 : THE MILENIUM OBJECTIVES GOALS

THE UNDERDEVELOPMENT CYCLE

POVERTY

FOOD INSECURITY

POOR EDUCATION

UNHEATHY HABITAT

INFECTIONHIGH

MORTALITY < 5 YEARS

HIGH NATALITY

MALNUTRITION

OVERPOPULATION/ RESOURCES GAP

INTEGRATED APPROACH TO REVERT THE POVERTY CYCLEEstrategy defined in 1978 in Alma Ata

The Problem The ReactionPoverty DevelopmentUnhealty environmente SanitationFood insecurityMalnutrition

Nutritional surveillanceEducation

Ignorance Education – general, healthEmphasis on mothers

Infection ImmunizationEducation (hygine)

High natality Family planningAccess to healthcare Heath Centers

Community agents

INSTRUMENTS TO DELIVER HEALTH- ITS COMPONENTS

NUTRITIONAL REHABILITATION

EPI

HEALTH EDUCATIONCOMUNITY HEALTH

WORKERS

PROGRAMSIMCI

MALARIATUBERCULOSIS

SIDA

MILENIUM DEVELOPMENT GOALS (New York, 2000)4 th OBJECTIVE

REDUCE BY 2/3 FROM 1990 TO 2015 THE MORTALITY OF CHILDREN AGED 0 TO 5 YEARS

Indicators• Mortality rate up to 5 yeard (M < 5)• Infantil mortalily (M < 1)• Percentage of children less than one year immunized against

measles

The milestones of Mortality < 5 in Angola, 1990 – 2012WHO Data

A 1990 A 2000 A 2010 A 20150

50

100

150

200

250

300

243

200

161

81

?

EDUCATION HEALTH NATIONAL BUDGET Higher expenceUnversity Terciary Care

Technical Provincial & Municipal traning Hospitals

Primary & Health Centers Secondary Community care Lower expense

BUT HEALTH STRATEGY IN ANGOLA DOES NOT PRIORATIZE PRIMARY CARE

1. The budget of health is below the level advised2. The expenses are at the top levels of Education and Health, rather than on basic services

ANGOLA STRONG AND WEAK POINTS TO REACH THE 4TH MILENIUM GOALS STRENTGHTS RICHESS IM MINERAL, AGRICULTURE WATER AND SEA RESOURCES

POPULATION RELATIVELY SMALL, PER CAPITA PRODUCT INCREASING IN THE LAST YEARS

ANGOLA 6.ooo

Congo Brazaville 4.600

Cabo Verde 4.000

Guiné Bissau 1.200

Moçambique 1.100

NATIONAL GDPWorld Bank

PERCAPITA INCOMECIA World Facts Book 2012

PEACE SINCE 2001

ANGOLA STRONG AND WEAK POINTS TO REACH THE 4TH MILENIUM GOALS

WEAKNESSES

UNEQUAL INCOME DISTRIBUTION

STATE BUDGET FAVOURING THE HIGHER QUINTILE OF THE POPULATION

HEALTH STRATEGY SUFERING FROM SAME APPROACH IN INVESTMENT, NOTWITHSTANDING THE RECENT POLICY OF “MUNICIPALIZATION” (BIG HOSPITALS VERSUS HEALTH CENTERS; SUPRESSION OF BASIC CATEGORIES ON NURSING, TRAINING DOCTORS VS. NURSES , ETC.)

1ST ED. 1973

The basic unity to execute primary child/maternal care

Components• IMCI• Prenatal care• Vaccines • Nutrition surveillance• Handing TB & ARV

drugs

• RESOURCES• Local actors• Basic training• Low costs• Quick implementation• Sustainability

CAN THE POLITICIANS STRAIGHTEN THAT QUICKLY FOR US?