How many child deaths can we prevent this year

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(07)61693-6.pdf

What works? Interventions for maternal and child undernutrition and survival.

It has long been known that malnutrition undermines economic growth and perpetuates poverty. Yet the international community and most governments in developing countries have failed to tackle malnutrition over the past decades even though well-tested approaches for doing so exist. The consequences of this failure to act are now evident in the worlds inadequate progress toward the Millennium Development Goals (MDGs) and toward poverty reduction more generally. Persistent malnutrition is contributing not only to widespread failure to meet the first MDG--to halve poverty and hunger--but to meet other goals in maternal and child health HIV/AIDS education and gender equity. The unequivocal choice now is between continuing to fail as the global community did with HIV/AIDS for more than a decade or to finally make nutrition central to development so that a wide range of economic and social improvements that depend on nutrition can be realized. (excerpt)

Repositioning nutrition as central to development: a strategy for large-scale action.

Background. Infant and under-5 childhood mortality rates in developing countries have declined significantly in the past 2 to 3 decades. However, 2 critical indicators, maternal and newborn mortality, have hardly changed. World leaders at the United Nations Millennium Summit in September 2000 agreed on a critical goal to reduce deaths of children Objective. This review of community-based antenatal, intrapartum, and postnatal intervention trials in developing countries aimed to identify (1) key behaviors and interventions for which the weight of evidence is sufficient to recommend their inclusion in community-based neonatal care programs and (2) key gaps in knowledge and priority areas for future research and program learning. Methods. Available published and unpublished data on the impact of community-based strategies and interventions on perinatal and neonatal health status outcomes were reviewed. Evidence was summarized systematically and categorized into 4 levels of evidence based on study size, location, design, and reported impact, particularly on perinatal or neonatal mortality. The evidence was placed in the context of biological plausibility of the intervention; evidence from relevant developed-country studies; health care program experience in implementation; and recommendations from the World Health Organization and other leading agencies. Results. A paucity of community-based data was found from developing-country studies on health status impact for many interventions currently being considered for inclusion in neonatal health programs. However, review of the evidence and consideration of the broader context of knowledge, experience, and recommendations regarding these interventions enabled us to categorize them according to the strength of the evidence base and confidence regarding their inclusion now in programs. This article identifies a package of priority interventions to include in programs and formulates research priorities for advancing the state of the art in neonatal health care. Conclusions. This review emphasizes some new findings while recommending an integrated approach to safe motherhood and newborn health. The results of this study provide a foundation for policies and programs related to maternal and newborn health and emphasizes the importance of health systems research and evaluation of interventions. The review offers compelling support for using research to identify the most effective measures to save newborn lives. It also may facilitate dialogue with policy makers about the importance of investing in neonatal health.

/pdf/community-based-interventions-for-improving-perinatal-and-17rlant020.pdf

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(08)60835-1.pdf

Effect of community-based newborn-care intervention package implemented through two service-delivery strategies in Sylhet district, Bangladesh: a cluster-randomised controlled trial.

Every year nearly 11 million children die before reaching their fifth birthday and most of them during their first year of life. Most of these deaths (98% in 2002) are in developing countries; more than half are due to acute respiratory infections diarrhoea measles malaria and HIV/AIDS. In addition malnutrition underlies 54% of all child deaths. Projections based on the 1996 analysis The Global Burden of Disease indicate that these conditions will continue to be major contributors to child deaths in 2020 unless significant efforts are made to control them. In response to this challenge the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) developed the Integrated Management of Childhood Illness (IMCI) strategy which focuses on these five conditions and which includes three main components: Improvements in the case management skills of health workers through the provision of locally adapted guidelines on IMCI and through activities to promote their use. Improvements in the health system that are required for the effective management of childhood illness. Improvements in family and community practices. This paper addresses improvements in family and community practices. More specifically it presents the evidence for twelve key practices (see below) identified by UNICEF and WHO to be of key importance in providing good home-care for the child concerning the prevention or treatment of the IMCI conditions in order to ensure survival reduce morbidity and promote healthy growth and development. It does not include the four additional practices added following a meeting of UNICEF the WHO Regional Office for Africa and nongovernmental organizations(NGO) which took place in Durban South Africa in June 2000 as these practices will need additional work to reach a specificity whose impact can be measured. (excerpt)

BR Kirkwood

Papers

Family and community practices that promote child survival growth and development. A review of the evidence.