The Drum Beat 301: MDG #4 - Reducing Child Mortality

Millennium Development Goal (MDG) #4 seeks to reduce by two-thirds (66%), between 1990 and 2015, the probability of children dying between birth and 5 years of age. This issue of The Drum Beat highlights just a few of the ways in which communication strategies are being implemented - with direct impact on child survival rates - in communities around the world.

To view previously published Drum Beats on related themes, please see issues 264, 251, 224, 180, 156, and 66 - click here for the archived issues.

Next month we will focus on MDG #5: Improving Maternal Health. Please send your projects, articles, events, etc. to Deborah Heimann dheimann@comminit.com

CONTEXT

1.The United Nations' Dept. of Economic and Social Affairs anticipates that MDG #4 will be met in Northern Africa, Latin America and the Caribbean, and South Eastern Asia. Progress has been less significant in Southern Asia and negligible in Western Asia, Oceania, and sub-Saharan Africa. The latter continues to have the highest level of under-5 mortality, with a rate over 20 times that of developed countries. Further, "Despite the availability of a safe, effective and relatively inexpensive vaccine for over 40 years, measles remains a major cause of childhood mortality affecting nearly 30 million children and killing an estimated 610,000....[S]ub-Saharan Africa, the region with the lowest coverage in 1990, has experienced the smallest progress - with immunization coverage improving only from 57 to 61 per cent."

Source: "Progress towards the Millennium Development Goals, 1990-2004" [PDF]

2. Child Mortality

99% of the 10.9 million children under age 5 who died in 2000 were from developing countries; 36% died in Asia and 33% in Africa. More than 50% of all child deaths are due to 5 preventable and treatable communicable diseases: pneumonia, diarrhoea, measles, malaria, and HIV/AIDS. Malnutrition is associated with half of all under-5 deaths.

3. Goals for Children not Being Met

UNICEF projects that by 2015 the under-5 mortality rate will have only dropped by 23%. About 90 countries are on track to achieve the MDG goal, while 98 are stagnating or going backwards. The single most prominent cause of child deaths is poor neonatal conditions.

4. Women's Reproductive Health & Armed Conflict

During the siege of Sarajevo, perinatal mortality increased from 15 deaths per 1,000 live births before the war to 39 deaths per 1,000 afterward. More than 20% of births at a Burundi refugee camp in Tanzania in 1998 were below average weight, and infant deaths rose sharply from prewar levels.

5. India & Hunger

In India, nearly 9 out of 10 pregnant women suffer from malnutrition and anaemia; the latter condition causes 20% of infant mortality. More than 50% of children under 5 are moderately or severely malnourished, or suffer from stunting.

6. Distribution of Inappropriate Malaria Drugs Increasing Child Mortality

"[A] new, highly effective treatment known as artemisinin-class combination therapy (ACT) offers more hope for treating malaria in countries where drug resistance to conventional drugs has become widespread." But, "despite a policy that names ACT as the gold standard of treatment, WHO signs its approval when GFATM [Global Fund for AIDS Tuberculosis and Malaria] funds cheap but ineffective chloroquine or sulfadoxine-pyrimethamine to treat P falciparum malaria." The authors claim that this unwillingness to fund ACT results in the deaths of "tens of thousands of children".

STRATEGIES: ADDRESSING VACCINE-PREVENTABLE DISEASES

7.Africa's 2005 Polio Eradication Strategy

In 2004, the number of African children who contracted polio doubled to 1037 (85% of the global total); the Sudan went from 0 to 112 cases in a 9-month period. Worried by these trends, health ministers gathered in January 2005 to embark on a "massive series of immunization campaigns across 25 countries". The meeting signaled a recognition of the importance of using community mobilisation to motivate behaviour change in the area of polio vaccination. Following resumption of synchronised social mobilisation activities, 80 million children were reached and the epidemic was reined in.

8.Social Mobilisation/Communication Polio Eradication Partnership - Pakistan

Prior to the National Immunisation Days (NIDs) and Sub-National Immunisation Days (SNIDs), a variety of communication tools were used to encourage Pakistanis to participate by getting their children vaccinated. Television (national, regional and cable) is commonly cited as the most effective medium in Pakistan for delivery of these messages. The popular singer Jawad collaborated in promoting the campaign and in the production of a broadcast song. Information, education, and communication (IEC) materials were designed for selected social groups such as Nazims and teachers. Posters provided basic vaccination pictures and dates, while brochures gave more detailed campaign information.

Contact Sebastian Taylor saep53@hotmail.com

9.Vaccination Week in the Americas (VWA) - The Americas

Headed by the Pan American Health Organization (PAHO), VWA highlights the need for routine childhood vaccinations, especially in rural and border areas. Each year, a week of intensive mobilisation efforts constitutes part of a broader, year-long awareness raising effort. Organisers conclude that, among the keys to the 2003 week's successes were communication campaigns set up in each of the countries. PAHO sent out radio and television spots, posters, and news releases to promote the week, whose theme was "Vaccination: An Act of Love". In the Caribbean, radio spots were produced in indigenous languages and dialects for several countries. On-site evaluations indicated that most parents heard about the week on radio or TV.

Contact Daniel Epstein epsteind@paho.org OR Piedad Huerta huertapi@fep.paho.org OR
Bryna Brennan brennanb@paho.org

10.Measles Initiative - Global

This collaborative global effort uses mass media, community mobilisation, and other communication strategies to control measles. Weeks prior to any vaccination weekend, trained local volunteers go door-to-door and distribute banners, brochures, and posters to encourage participation. They put on plays in the centre of the village that emulate the vaccination process, the harm of not vaccinating the child, and the folly of believing that "witch doctors" have the cure. "It is important for people to hear these messages from their friends. They internalize the information and are convinced. They figure 'how can a friend do anything bad to us?'. We partner with the leaders in a certain village who have the ear of the people - religious leaders, tribal chief, teachers, drummers, clan leaders. It is important to speak their language." WHO and UNICEF claim that, since 2001, the Initiative has vaccinated more than 150 million children against measles. Deaths fell globally by 39% between 1999 and 2003 from 873,000 to 530,000; Africa experienced a 46% reduction in deaths.

Contact Julie Irby irbyj@usa.redcross.org OR Jessica Sapalio sapalioj@usa.redcross.org OR Amy Weiss aweiss@unfoundation.org OR Steven Stewart znc4@cdc.gov OR Erica Kochi ekochi@unicef.org OR Hayatee Hasan hasanh@who.int

11.Marklate ('Vaccinate') - Sierra Leone

From 1988 to 1990, religious leaders, alongside the UNICEF national social mobilisation team and the Ministry of Health, worked to educate and motivate Sierra Leone's people to immunise their children. Developed through partnership and participation, Marklate's strategies included training health workers, expanding the number of vaccination sites, and encouraging outreach services. When UNICEF met resistance among those who considered vaccination anti-Islamic or suspected a secret family planning agenda, the social mobilisation team organised a series of national and district-level workshops. In 1990, Marklate reached its goal, moving from 6% to 75% coverage of Sierra Leone's 135,000 children under age one.

Contact Mohammad Jalloh mjalloh@unicef.org OR Judith Graeff jgraeff@unicef.org OR Salieu Jalloh sjalloh@unicef.org

STRATEGIES: ADDRESSING OTHER CAUSES OF DEATH

12.Millions Saved - Case 7: Preventing Diarrhoeal Deaths in Egypt

by Ruth Levine et al.

In 1977, diarrhoeal diseases were identified as a major cause of infant deaths in Egypt. This finding led to the creation of a national project to promote the use of locally manufactured oral rehydration salts (ORS). More than 63 television spots were aired between 1984 and 1990; billboards, magazine ads, and posters were also used. The language was simple, employing expressions commonly used by mothers, with a theme of maternal love. By 1985 and 1986, ORS distribution was 4 times the level at the start of the programme. By 1986, nearly 99% of mothers were aware of ORS, use of the solution was common, and a majority of women could correctly mix the solution. The number of children with diarrhoea attending a public clinic rose from 630,000 in 1983 to 1.4 million in 1985, indicating increased parental awareness. The campaign helped avert about 300,000 childhood deaths between 1982 and 1989.

13.Control of Diarrhoeal Diseases (CDD) Programme - Bangladesh

Thanks to door-to-door contact made in the 1980s with over 13 million rural households, today there is a 90% knowledge of oral rehydration therapy (ORT) in Bangladesh. CDD aimed to convert this knowledge into life-saving action by increasing ORT usage from 60% (up from 24% in 1990) to the mid-decade goal of 80%. The campaign addressed ground-level "influencers" or spokespeople who would create an environment of acceptance and support for caretakers, the primary audience being addressed. Specific packages were developed for schoolteachers, development and health workers, maulvis or Islamic religious leaders, urban medical professionals, and rural health functionaries/village doctors. One package featured an inflatable plastic doll. When filled with water, the doll depicts a healthy child; when drained, it becomes shriveled to depict a dehydrated child. Merely replacing the stopper in the outlet doesn't restore the doll; it has to be refilled to look healthy, demonstrating that it is crucial to replenish the body with fluids rather than to merely stop the diarrhoea.

Contact Professor Dr. Md. Shahadat Hossain maliha@bol-online.com OR Shivaji Bhattacharya shivaji.bhattacharya@undp.org

14.Impact Data - Mass Media & Health Practices Project - Honduras & Africa

The programme provided 900 health care workers with 4 to 8 hours of oral rehydration therapy (ORT) training; accompanying print materials and radio ads issued basic messages related to ORT. After one year, 93% of the mothers surveyed in rural Honduras knew that the radio campaign was promoting Litrosol, the brand name of the locally packaged oral rehydration salts (ORS) used to treat diarrhoea; 49% had used Litrosol. Of these women, 94% accurately described the correct mixing volume and 96% knew that the entire package of ORS was to be used in treatment. Between 1981 and 1982 mortality rates for children under 5 decreased from 47.5% to 25%.

15.Impact Data - Back to Sleep Campaign - Canada

This Health Canada project used mass media messaging strategies - e.g., magazines shipped to healthcare professionals, TV public service announcements, and the instructive message "Back to Sleep" printed in English, French, and Spanish on the waistband of Pampers' 2 smallest-sized diapers - to teach parents and other caregivers how to avoid the risk factors associated with Sudden Infant Death Syndrome (SIDS). In 1999, 61% of health professionals claimed to have given advice to place a child on its side to sleep; only 21% advised the placing of the child on its back. In contrast, in 2001, 21% claimed to have advised a side position, while 67% of advised a back position. Among caregivers who have taken action to reduce the risk of SIDS, 69% said they lay their babies on their backs to sleep, up from 41% in 1999.

16.Africa Malaria Day - Burkina Faso

Launched by the Maternal & Neonatal Health (MNH) Program, this one-week programme promoted use of Insecticide-Treated bed Nets (ITNs) and effective antimalarial treatments on the part of women and young children. Among the activities were screenings of an information film in Kouritenga province, followed by sessions in which community members discussed the effects of malaria and learned about the use and benefits of ITNs; more than 3,000 people participated. As part of a contest based on a 10-question survey on key malaria messages, 2000 questionnaires were distributed; 53 contestants achieved a perfect score.

Contact Jeremie Zoungrana jzoungrana@jhpiego.net

MEASURING PROGESS

17. The Child Survival Sustainability Assessment (CSSA): For a Shared Sustainability Evaluation Methodology in Child Survival Interventions

"The CSSA is presented as a tool helping CS [child survival] interventions, notably PVO [private voluntary organisation] CS interventions, better integrate their plans and monitoring and evaluation (M&E) systems under the overarching purpose of achieving sustainable child health gains. It seeks to do so through a realistic and contextually relevant systematic approach, yet expecting to increase the ability of the CS community as a whole to be accountable, to learn about and to communicate our common responsibility to the children today and tomorrow."

18.Immunization Promotion Activities: Are They Effective in Encouraging Mothers to Immunize Their Children?

by Ricardo Perez-Cuevas, Hortensia Reyes, Ulises Pego, Patricia Tome, Karla Ceja, Sergio Flores & Gonzalez Gutierrez

This study evaluated the Mexican National Vaccination Council's communication activities for the Second National Health Week in Mexico City. Mass media promotion and popular campaigns were found to be effective: 83% of mothers were aware of the campaign and 63% were impacted by its messages, and the net increase in immunisation between the "aware" and "unaware" groups was 14.8%. The authors stress that the design of health promotion messages must be incorporated into local cultural patterns, and must be based on formative research and focus-group activities. These messages must provide full information, and must also be tailored to continue the trend toward proactive approaches to preventive health care. In short, programmes should create "active demand" for services.

19.Reaching Communities for Child Health & Nutrition: A Framework for Household & Community IMCI

by Peter Winch, Karen LeBan & Barmak Kusha

"While NGOs [non-government organisations] clearly have much to offer in terms of experiences with community approaches to child health and nutrition, the sharing of these experiences with other partners has at times been hampered by uncertainty about what exactly is meant by Household and Community IMCI [Integrated Management of Childhood Illness], and by the tremendous diversity of NGO activities in the field. It is hoped that the framework as it is discussed here can be used as a tool to help NGOs organize and present lessons learned based on their child survival and HH/C IMCI programs, both to each other and to other public health agencies. NGOs have proven experience in reducing mortality and morbidity and in improving child health and nutrition at the community level."

***

RESOURCES FOR AWARENESS, ADVOCACY & ACTION

20.Why Invest in Newborn Health?

by Nancy V. Yinger & Elizabeth I. Ransom

Newborns are "15 times more likely to die during the first month of life than at any other time during their first year." This policy brief (and the series it is a part of) shows how incorporating newborn care into existing safe motherhood and child survival programmes can ensure newborn survival.

21.Neonatal Survival Series

"Eight million children are either stillborn or die each year within the first month of life. This figure never makes news." The Lancet has launched a series of papers in an effort "to erase the excuse of ignorance for public and political inaction once and for all". The special issue provides new epidemiological evidence detailing the time, place, and causes of neonatal deaths worldwide - and the low-tech, low-cost interventions that are available to prevent them.

22.Saving Newborn Lives - Tools for Newborn Health: Qualitative Research to Improve Newborn Care Practices

by Ronald P. Parlato, Gary L. Darmstadt & Anne Tinker

Published by Save the Children as a reference tool for conducting qualitative research, this guide focuses on evidence-based practices, data collection techniques, data analysis, and behaviour change communication (BCC) planning and programming. It highlights evidence-based practices that have been shown to have the most significant and direct implications for newborn health, mortality, and morbidity.

23.Questioning the Solution: The Politics of Primary Health Care & Child Survival

by David Werner & David Sanders

This book explores the problem of primary health care and child survival in underprivileged countries and communities. Examples from all over the world illustrate approaches to health and development that put children's needs before top-heavy economic growth.

24. Shaping Policy for Maternal & Newborn Health: A Compendium of Case Studies

JHPIEGO, Save the Children/Saving Newborn Lives, and Family Care International compiled this collection of case studies highlighting the strategies and processes involved in securing national policy commitments to improve healthcare for mothers and newborns. Together these 12 case studies show how civil society and nongovernmental organisations can contribute to positive change for safe motherhood and newborn health.

This issue was written by Kier Olsen DeVries.

The Drum Beat seeks to cover the full range of communication for development activities. Inclusion of an item does not imply endorsement or support by The Partners.


Please send material for The Drum Beat to the Editor - Deborah Heimann dheimann@comminit.com


To reproduce any portion of The Drum Beat, see our policy.


To subscribe, click here.