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The Millennium Development Goals Linkages with Child Health Dr. KANUPRIYA CHATURVEDI Dr.S.K CHATURVEDI The Challenge in India Slide 2 Millennium Development Goals In the United Nations Millennium Summit in 2000, 147 countries adopted MDGs Eradicate extreme poverty and hunger by half relative to 1990 Achieve universal primary education Promote gender equality and empower women Ensure environmental sustainability Reduce child mortality by two thirds relative to 1990 Improve maternal health, including reducing maternal mortality by three quarters relative to 1990 Prevent the spread of HIV/ AIDS, malaria and other diseases Develop a global partnership for development Slide 3 The Global Challenge Nearly half the MDGs relate to health & nutrition The targets cover a large share of the burden of disease & deaths among poor people Child mortality: 10.4 million/y Maternal deaths: 0.5 million/y AIDS: 2.9 million/y TB: 1.6 million/y Malaria 1.1 million/y Illness, death, malnutrition impede economic growth & contribute to income poverty Slide 4 Goal 4: reduce child mortality Reduce by two thirds, between 1990 and 2015, the under-five mortality rate. Close to 11 million children die every year before reaching the age of five, or 20 per minute,30,000 per day. Nearly 4 million of these die in the first 28 days of life. Most of the deaths are due to a handful of causes (pneumonia, diarrhoea, measles, malaria, and neonatal causes). Malnutrition is associated with 54% of the deaths. 99% of the deaths are in low and middle-income countries, mostly in sub-Saharan Africa and South Asia. Measles deaths world-wide dropped by nearly 40% between 1999 and 2003, with the largest reduction in Africa. Slide 5 Slide 6 Countries with most under-5 deaths, 2000 Slide 7 Goal 5: Improve maternal health Every year, at least 529,000 women die in pregnancy or childbirth. 99% of these occur in the developing world. For every woman who dies in childbirth, around 20 more suffer injury, infection or disease - touching approximately 10 million women each year. Complications resulting from unsafe abortions account for 13% of all maternal deaths. Slide 8 Avoidable maternal deaths each year Slide 9 Goal 6: Combat HIV/AIDS, malaria and other diseases Every day, 8000 people die of AIDS-related conditions or some 3 million deaths per year. Only 400 000 of the five to six million people in the advanced stage of the disease had access to the anti- retroviral therapy in developing countries at the end of 2003. There are 8.8 million new cases of tuberculosis (TB) a year. There are 5500 deaths a day, or million deaths worldwide each year from TB. Some 80% of this morbidity and mortality from TB falls on 22 high-burden countries. There are almost 300 million cases of acute cases of malaria each year. More than a million cases of malaria are fatal each year. Some 90% of the burden falls on tropical Africa, where malaria is a major cause of mortality and morbidity in children under five years of age. Slide 10 Challenges in India Slide 11 MDG4- Reduce child mortality Infant and Young Child mortality remains unacceptably high. About 2.4 million deaths occur annually in under-5 year-old children in India. Seven out of every 10 of these are due to diarrhea, pneumonia, measles, or malnutrition and often a combination of these conditions. In India abut 30% of children born with LBW. Slide 12 Goal 4. Reduce child mortality: Infant Mortality Rate Slide 13 Slide 14 Slide 15 Slide 16 MDG5- Improve maternal health 130000 deaths an year Equivalent to maternal Deaths in a year in India Every day in the year Every six minute in India For every Maternal Death 20 mothers start leading a life in the morbid conditions. Every here 1- 1.25 lakh children get MDS (Maternal Deprivation Syndrome) Slide 17 Direct causes of Maternal Deaths Haemorrhage (Antepartum & Postpartum). Pregnancy Induced Hypertension & Eclampsia. Sepsis & Septicaemia. Obstructed Labour & Ruptured Uterus. Septic Abortion. Other Causes. Slide 18 MDG6- Combat HIV/AIDS, malaria and other diseases Halt and begin to reverse the spread of HIV/ AIDS Sentinel surveillance optimal way of measuring infection among high and low risk groups Number of sentinel sites and their location an indicator of adequacy of coverage Slide 19 Slide 20 People living with HIV Slide 21 Target: Halt by 2015 and begin reversal of incidence of malaria and other major diseases Combat malaria and other diseases Slide 22 Why a special effort now? political and financial commitmentsNew political and financial commitments sustainable health systems and financingRenewed focus on building sustainable health systems and financing Successful implementationSuccessful implementation builds confidence that scaling up of known interventions can accelerate progress on MDGs donor harmonization and aid effectivenessProcesses and mechanisms emerging to improve donor harmonization and aid effectiveness Slide 23 But rapid gains are possible through Practical approaches to achieve the MDGs- key interventions and policies Changes in national policies & strategic directions, capacity building, and financial support Stronger health systems Complementary actions across sectors (education, water, energy, transport) Donor mobilization and harmonization We can learn from success stories Slide 24 Evidence based interventions Estimated U5 Deaths Prevented With Universal Coverage Preventive interventions Proportion of all deaths (%) Breastfeeding 13 Insecticide treated materials 7 Complementary feeding 6 Zinc 5 Clean delivery 4 Water, sanitation, hygiene 3 Newborn temperature management 2 Tetanus toxoid 2 Vitamin A 2 Measles vaccine 1 Slide 25 Evidence based interventions Estimated U5 Deaths Prevented With Universal Coverage Treatment interventions Proportion of all deaths (%) Oral rehydration therapy15 Antibiotics for sepsis 6 Antibiotics for pneumonia 6 Antimalarials 5 Zinc 4 Newborn resuscitation 4 Antibiotics for dysentery 3 Vitamin A