mdg progress towards mdg 4 and 5
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7/30/2019 MDG Progress Towards MDG 4 and 5
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Progress towards MDG 4 and 5
MDG4 and Kenyas position,
where are we?-
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Outline
MDG 4
Status of child health
High impact interventions
Progress
Challenges
opportunities
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MDG 4&5
GOAL 4:REDUCE CHILD MORTALITY
Target 4.A:Reduce by two thirds, between 1990 and 2015, theunder-five mortality rate
GOAL 5:IMPROVE MATERNAL HEALTH
Target 5.A:Reduce by three quarters the maternal mortality ratio
Target 5.B:Achieve universal access to reproductive health
http://www.un.org/millenniumgoals/pdf/MDG%20Report%202010%20En%20r15%20-low%20res%2020100615%20-.pdfhttp://www.un.org/millenniumgoals/pdf/MDG%20Report%202010%20En%20r15%20-low%20res%2020100615%20-.pdfhttp://www.un.org/millenniumgoals/pdf/MDG%20Report%202010%20En%20r15%20-low%20res%2020100615%20-.pdfhttp://www.un.org/millenniumgoals/pdf/MDG%20Report%202010%20En%20r15%20-low%20res%2020100615%20-.pdfhttp://www.un.org/millenniumgoals/pdf/MDG%20Report%202010%20En%20r15%20-low%20res%2020100615%20-.pdfhttp://www.un.org/millenniumgoals/pdf/MDG%20Report%202010%20En%20r15%20-low%20res%2020100615%20-.pdfhttp://www.un.org/millenniumgoals/pdf/MDG%20Report%202010%20En%20r15%20-low%20res%2020100615%20-.pdfhttp://www.un.org/millenniumgoals/pdf/MDG%20Report%202010%20En%20r15%20-low%20res%2020100615%20-.pdfhttp://www.un.org/millenniumgoals/pdf/MDG%20Report%202010%20En%20r15%20-low%20res%2020100615%20-.pdfhttp://www.un.org/millenniumgoals/pdf/MDG%20Report%202010%20En%20r15%20-low%20res%2020100615%20-.pdf -
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Global status of child mortality
Globally 8.8 million children under five die
every year.
4.4 million are from the Sub-Saharan Africa
About 96,200 are from Kenya (birth cohort of1.2 million)
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Status in the African Region: Progress towards MDG4 in
Africa 2008
According to the
latest evidence
Kenya is one of the
high burden
disease countrywith high under five
mortality rates that
is not on track to
attain the MDG 4
targets.
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Current Child Health Status in Kenya
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 infants deaths occur during the first month oflife
Prevalence of Low-birth weight:10%
Prevalence of stunting: 35%
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Infant and Under-five Mortality Rates,
Kenya 1990/2009 (KDHS and KIHBS)
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Causes of under-five child deaths in Kenya *
Black RE, Cousens S, Johnson HL, et al. Global, regional, and national causes of child mortality in 2008 :
a systematic analysis. Lancet : 12 May 2010 ; 375 : 1969-87.
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Global Evidence Based Cost Effective Interventions
Table 2a: Cost Effective Preventive Interventions: Lancet 2003
0% 5% 10% 15%
Antimalarial for IPT in pregnancy
Antibiotics for premature rupture of membranes
Nevirapine and replacement feeding
Tetanus Toxoid
New born Temperature Management
Water Sanitation Hygiene
Antenatal steroids
Hib Vaccine
Clean delivery
Zinc
Complementary feeding
ITM
Breastfeeding
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Universal coverage with a few interventions can prevent
over 6 million deaths in a year
Prevention
Intervention
Deaths
Prevented as
proportion of
All child deaths
Treatment
Intervention
Deaths
Prevented as
proportion of
All child deaths
Breastfeeding 13% Oral rehydration 15%
Insecticide-treated materials 7% Antibiotics forpneumonia
6%
Complimentary feeding 6% Antimalarials 5%
Zinc 5% Zinc 4%
Hib vaccine 4% Antibiotics for
dysentery
3%
Water, sanitation, hygiene 3%
Vitamin A 2%
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Sou rce: KDHS 2009, UNGASS 2009
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Priority High Impact Interventions by Level of Care, Cohort and
Intervention Area
Community- L1 Facility level- L2, L3, L4Demand creation for early initiation of
ANCIndividualised birth plan and Emergency
preparedness
Four timely focused ANC visits with a focus on:
Individualised Birth Plan and Emergency PreparednessPrevention and management of pregnancy complications
( IPT, iron and folate, TT, PMTCT, MgSO4, micronutrients
Community actions to promote skilled
care
Emergency Obstetric Care- Administer IV oxytocin, IV antibiotics, Magnesium
sulphate, Manual removal of placenta, removal of retained POCs, Assisted
delivery, Blood transfusion, and caesarean section
Active management of third stage labour
Monitoring labour using partogram
BCC for FP, PNC, Newborn and child care
practicesBCC to promote skilled attendance with
first 24-48 hours after delivery
Hygienic cord care
Skilled attendance within first 24-48 hours after delivery
PNCLong acting and permanent FP methods
Conduct maternal and perinatal death reviews
Newborn temperature management
Hand washing with soap by caregiver
Hand washing with soap by caregiver
Temperature management
Antibiotics for neonatal infections
Newborn resuscitation
ARV prophylaxis
Early initiation and EBFComplementary
fee
ding
Vitamin A
Early initiation and EBF
Complementary feeding
Vitamin A
Immunization
LLITN
ORT and Zinc
Safe drinking water
ACT
Antibiotics for childhood pneumonia
Immunization
LLITN
ORT and Zinc
ACT
Antibiotics for childhood pneumonia
Early Infant Diagnosis of HIV
ART
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Progress has been made..
Some of these interventions are already at
over 50% coverage and this needs to be
sustained and increased.
Coverage of LLITNs,
Water and sanitation and hygiene
Hib and measles immunization
New vaccines: Pneumococcal vaccine this year
and Rotavirus in 2013
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What can be done to Accelerate child
Survival
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Focus on:
Commonest Killers
HIIs to address these killers
Urgency to scale up these interventions
Continuum of care and responsibility from
family, community level to HF level
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Status of Maternal Health
Population: Estimated at 40m
Women of childbearing age: 9.6m
MMR: 488/100,000 live births (2008-09)
Skilled birth attendance: 44%
? Quality
ANC 92%- once, 47%- 4 times
Unmet need for FP: 26%
Adolescents and youth: 30%
18% of young women age 15-19 have begun childbearing
21% of women have suffered sexual violence
Provision of youth-friendly services still a great challenge
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With less than 5 years to 2015, Kenya is
far from achieving MDG 5 targets:
Indicator KDHS 08 MDG 15
MMR 488 147
SBA 44% 90%
BEOC 15% 100%
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Trends in Maternal care indicators in Kenya (KDHS
2008-09)
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Family PlanningTrends
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Availability of Delivery Services:All Health Care Facilities
(Table 6.5)
Percent of all facilities (N=690)
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Safe Motherhood Ideal vs Real
17 Jan 2011 20
Ideal World
All deliveries have a skilledattendant.
Increasing the access of womento EmOC Facilities. Hospital basedEmOC is the foundation of theSMI.
Mortality rates will be decreasedby reducing the 3 delays.
Reality in Kenya
53% delivers at home (decline by 2%in five years).
Non-skilled attendants at thecommunity level.
Institutions with maternity do notmeet standards for safe delivery andnewborn care (KSPA).
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EAvailability of Services in Facilities
Offering Deliveries ncyEquipment and
Services
(Table A-6.36)
Percentage of facilities offering delivery services where specific services, equipment,and supplies
are available (N=207)
Assistlabour
Remove retainedproducts
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Challenges in Scaling up Health Systems Challenges
Human resources- numbers, skills, attitude,
Health Financing(current expenditure/woman is 2USD, recommended is
40USD)
Reliable Data
Referrals
Commodity security
Governance
Policy gaps at community level service delivery
Access
Geographic, Financial, socio-cultural
Multi-sectoral challenges
Infrastructure, safe water, status of women, education
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Opportunities
Current Constitution Devolution of resources & health Rights Increased GOK budget allocation to FP and Output Based
Approach (OBA)
Community Strategy
Economic stimulus program: More HWs and health facilities Increased Global interest in Maternal Health - Global Health
Initiative
Other funding modalities (HSSF,CDF)
Free Primary & Highly subsidized Secondary Education Increasing public private partnerships
Mobile Technology
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Conclusion
17 Jan 2011 24
No/Slow progress in indicators related to maternal and
newborn health in Kenya
We continue to work on improving institutional
deliveries and care at health facilities. In the meantime, we need to focus on
The major killers of mothers, newborns and children
HIIs to address these killers
Identify the barriers in scaling up these interventions
Address these barriers incl. mobilize sectors outside health
to address these
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Goal: Ensuring, availability accessibility and
acceptability of services even for this woman and
her baby
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