The Drum Beat 349: MDG #4 - Reducing Child Mortality

Millennium Development Goal (MDG) #4 is a global effort 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 a few of the communication-focused initiatives and strategies that have been implemented all over the world in order to reduce the mortality rate of infants and children under the age of 5 years, as well as to increase the proportion of 1-year old children who have been immunised against measles.

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.Department for International Development (DFID) Factsheet - September 2005 [PDF]

Almost 11 million children under age 5 die each year; 2.2 million of those deaths could have been prevented through routine immunisation. Around 7 out of every 10 deaths among under-5s in developing countries are due to acute respiratory infections, diarrhoea, measles or malaria. While child deaths have been decreasing in the past 2 decades, progress on key indicators is slowing, and in parts of sub-Saharan Africa child mortality is rising: Of the 1 million malaria deaths per year, 90% occur in sub-Saharan Africa, and 90% of those are children under the age of 5. One in 6 babies born in least developed countries will die before the age of 5, compared with 1 in 167 born in rich countries.

2. Repositioning Nutrition as Central to Development

About 30% of children are undernourished, and 60% of children who die of common diseases like malaria and diarrhoea die because they are malnourished. Contrary to popular belief, rates of malnutrition in South Asia are double (50% of children) those in Sub-Saharan Africa (25% of children). Poor nutrition affects more than the economically poor - 26% of children in the highest income bracket in India are underweight and 65% are anaemic.

3. Inequality and Health in the United States - Part 1 of 2

After 50 years of decline, the infant mortality rate in the USA began to rise in 2000 and is now higher than in many industrial countries. In addition, Malaysia - where average incomes are 25% as high - has the same infant mortality rate as the US. The Indian state of Kerala has an urban infant death rate lower than that of African Americans in Washington, DC. Persistent racial and ethnic health disparities are partly a result of differences in insurance coverage, income, language and education.

4. Spending $1 Billion Extra Each Year Could Save 10 Million Lives

A study by the WHO and UNICEF suggests that 10 million additional lives can be saved through child and maternal immunisation between 2006 and 2015 at an annual average cost of US$1 billion. If immunisation coverage were raised 90% and vaccine-preventable illness were reduced by 66% over the next 10 years, 70 million children in the world's economically poorest countries would be protected against 14 major childhood diseases.

5.Progress for Children: Report Card on Immunization Number 3, September 2005

This UNICEF report indicates that "substantial progress is being made in many countries" to meet the goal of 90% coverage against measles; it credits immunisation programmes with preventing over 2 million deaths a year. In addition, immunisation "provides a network and a mechanism by which health services can make contact with the children and women whom they need to reach with other interventions, such as vitamin A supplementation, the delivery of insecticide-treated bednets to combat malaria, and deworming medicine." The authors note, however, that much remains to be done...

AWARENESS CAMPAIGNS TO SPUR ACTION

6.National Immunisation Campaign: Measles, Polio and Vitamin A - Mozambique

From August-October 2005, Mozambique's Ministry of Health, supported by UNICEF and WHO, conducted communication and social mobilisation activities as part of a national effort to wipe out measles and polio, as well as to provide vitamin A supplementation. Children's right to be immunised was a key focus of this campaign, which was interlinked with the right to play and the right to health - communicated in part through the visible involvement of prominent athletes and political/government figures. A key strategy shaping the national advocacy component, grassroots activities, and other campaign components was building the feeling that everyone should participate; for example, TV spots featured authorities and recognisable personalities talking face-to-face with the population and inviting them to go to the vaccination sites.

Contact Patrícia Portela de Souza ppsouza@unicef.org

7.Impact Data - Blue Star Campaign - Nicaragua

In the aftermath of Hurricane Mitch, which struck Central American in October 1998, this campaign sought to reduce the risk of acute diarrhoeal diseases and respiratory illnesses among Nicaraguan children under age 5 through use of an educational mass media campaign based on entertainment-education strategies, as well as community mobilisation, advocacy and training. Of 1,268 people interviewed: the percentage who knew that diarrhoea is avoided by using a potty seat increased from 5% to 11%; the percentage who knew that one should not touch dirty water increased from 17% to 29%; the percentage who knew that diarrhoea is avoided by washing hands increased from 79% to 82%; and the percentage who knew that one should wash hands before preparing food increased from 45% to 62%.

8.Let's Work Together to Beat Measles - Australia

In 1998, the Commonwealth of Australia launched a 4-month national campaign focused on primary schools, which became sites of mass Measles, Mumps, Rubella (MMR) vaccination. Research was conducted and workshops were organised with parents, teachers, and school principals from various communities to help develop and evaluate materials such as a consent form and information booklets. Mass media advertising included direct marketing to parents and principals, as well as advertising on TV and in women's and parents' magazines. A multicultural marketing strategy addressed 12 language groups; one community health centre developed a video that was narrated by an Aboriginal health worker in the local language. In total, 1.7 million primary school children were vaccinated, preventing an estimated 17,500 children from contracting measles.

Contact Lisa Brett - Tel: 8223 1130 or 0411 261 336

9.Juanita Campaign - Colombia

This UNICEF-led campaign sought to meet child survival goals by integrating the mayoral contest in a politically competitive way through direct challenges from and for children. Juanita, the character who symbolically represents children in the campaign, writes a letter to the future mayor of her village on a page torn from her school notebook to communicate the shortages and needs facing her peers, such as immunisation. This letter was sent to each of the 3,500 mayoral candidates as part of a leaflet featuring a photograph of Juanita and the campaign slogan on one side, and information/messages on the other, such as "In Colombia, 60,000 children under-five die each year from preventable causes. 34,000 of the 700,000 children born each year die before their first birthday. How many children die in your community?....What can you do, as Mayor?....What will be the impact in your community?" The media were used not only to reinforce the message sent to each candidate, but also to create public awareness and pressure at the community level. A few days after receiving the Juanita material, the Caracol radio network organised a roundtable discussion with 6 candidates for the post of Mayor of Bogotá...

Contact Sonia Restrepo Estrada colinsonia@compuserve.com

10.Month of Prayer for Child Survival - Global

In October 2005, the Rx for Child Survival campaign collaborated with religious groups of all faiths and denominations to observe a global Month of Prayer for Child Survival. The event drew on community-based interpersonal interaction to raise awareness (such as by asking individuals to watch the primetime PBS television series "Rx for Survival - A Global Health Challenge" and discuss it with others) and to stimulate advocacy (such as by encouraging letter-writing to congressional representatives). An accompanying web page provides access to sermons, websites with reflections on child survival, and other resources.

Contact Tiffany M. Foster tfoster@globalhealth.org

11.National Infant Immunization Week (NIIW)/Vaccination Week in the Americas (VWA) - Mexico & the United States

Held each year in the last week of April, the NIIW-VWA programme draws on collaboration with immunisation partners in both Mexico and the USA to stimulate local, bi-national awareness and education events in sister city sites along the border. Radio and television spots and posters - in both English and Spanish - are among the tools used to promote the effort. For example, the Mexican radio programme "A Los Niños: Quierelos, Protegelos...Vacunalos" featured information about immunisations. Following a kickoff event in Shreveport, Louisiana, the Willis Knighton Health System Shots for Tots advertised NIIW with billboards throughout the metropolitan area, and a food service company planned to advertise the event on pizza boxes (with coupons for a free food item for all children receiving immunisations).

Contact Janis Elaine Borton j.e.borton@att.net OR Dr. Elisa Aguilar eaguilar@borderhealth.org OR NIPINFO@cdc.gov

MEDIA & MARKETING TO EDUCATE, ENTERTAIN & MOBILISE

12.He Ha Ho - Ghana

About three-quarters of malaria cases in Ghana are treated at home or in the community, yet only 22% of current home-based treatments are correct and complete. In this context, the radio drama He Ha Ho aims to educate, motivate, and demonstrate to mothers and caretakers the means to correctly and completely treat malaria and other childhood illnesses. The drama is a component of a multi-channel edutainment approach that also includes a magazine show; organisers hope that, by developing synergy among various Roll Back Malaria (RBM) interventions, the ability of caregivers to recognise and respond appropriately to malaria will be strengthened.

Contact Ian Tweedie itweedie@jhuccp.org OR Marc Boulay, PhD mboulay@jhuccp.org

13.Children's Safe Drinking Water - Dominican Republic

According to Population Services International (PSI), diarrhoea is an underlying cause of childhood malnutrition and the world's second leading killer of children under 5 - every day 5,000 children die from it. To address the problem of contaminated water, PSI and Procter & Gamble are developing approaches to bring the PUR Purifier of Water® to the Dominican Republic. PSI will market the PUR sachets through activities including traditional social marketing with a multi-media brand awareness campaign, complementary public awareness campaigns, and a network of community groups and educators to provide training. PSI claims that the combination of home water treatment, hand-washing and proper hygiene contributes to a substantial reduction in the number of diarrhoea episodes - dramatically reducing the child fatality rate.

Contact info@psi.org

14.Early Childhood Development Programme - Republic of Georgia

Resource centres, television programmes, and printed materials are among the channels being used to communicate about early childhood development (ECD) as part of this UNICEF/Ministry of Labour, Health, and Social Welfare initiative. For example, weekly 50-minute ECD programmes aired on one of the popular TV channels from September 2004 through April 2005. Topics explored included nutrition (and breastfeeding), hygiene, immunisation, and other child rearing issues. Video materials, either in the form of a film or questions from the public, were designed to stimulate participants (especially those from outside the capital) to engage in active discussion.

Contact Maya Kurtsikidze mkurtsikidze@unicef.org

15.Insecticide-Treated Nets - Kenya

Launched by Population Services International (PSI), Kenya, with funding from the Department for International Development (DFID), this project is designed to prevent malaria by increasing awareness about and use of insecticide-treated mosquito nets (ITNs). As part of a 3-pronged strategy, PSI is working to create informed demand for ITNs through branded and generic communication campaigns; these messages are delivered through the mass media and interpersonal communicators. The campaign also works to educate community members and change behaviour through what are intended to be innovative and entertaining programmes, such as a daylong festival to engage the public in learning about malaria and ITNs via drama, discussions, and games.

Contact info@psi.org

16.Understanding and Addressing Childhood Immunization Coverage in Urban Slums

This paper, from USAID-Environmental Health Project (EHP), examines issues and suggestions for improving immunisation coverage in urban slums. One process involves developing mass media immunisation drives, combined with community counseling and peer contact to enhance service utilisation.

LOCAL PARTICIPATION FOR CHILD SURVIVAL

17.Female Community Health Volunteers (FCHVs)

by Keshab Poudel

This article details the experience of the Female Community Health Volunteers (FCHVs) Programme in Nepal, which prepares local women to cover difficult mountainous terrain to reach rural households in the hope of helping to reduce the nation's high infant mortality rate. The FCHVs are selected by local mothers' groups and then participate in 18 days of basic training to deliver such interventions as Oral Rehydration Solution (ORS) and to treat children with pneumonia. According to the author, in a country with a virtually nonexistent modern communication network, 48,307 FCHVs have developed their own way to communicate with the public, mobilising to administer Vitamin A capsules to 3.5 million children and polio drops to 4.2 million children twice every year.

18.Bringing Down Mosquito Fever: How NGOs Promote Home-Based Treatment of Malarial Fever in Uganda

"Training mothers to treat childhood fevers with antimalarial medications reduced under-five mortality by 40% in Ethiopia. In Burkina Faso, early home treatment of malaria with pre-packaged drugs decreased severe malaria morbidity in children by 53%."

19.Reaching Every Child for Primary Immunization: An Experience from Parsa District, Nepal

by Hari Krishna Shah & Mizan Siddiqi

This document describes an approach used in the Parsa District of Nepal to involve community leaders and local health workers, volunteers, and organisations in tracking children who had dropped out or not started their basic immunisations, and motivating their caregivers. The strategy included training and ongoing communication within the community, as well as the implementation of a "drop-out slip" system which reminded parents to continue with immunisation programmes. From July-September 2003, 89% of the drop-out children received slips; 42% of them came back and were vaccinated. During the initial phase in 4 Village Development Committees (VDCs), drop-out was reduced from 40% to 10%. The approach was then introduced in the entire district and a gradual number of VDCs.

20.Community-based Strategies for Breastfeeding Promotion and Support in Developing Countries

This paper examines the contribution that community-based interventions can make to improving infant and young child feeding, and identifies factors that may affect success and sustainability. The findings show that families and communities are not just beneficiaries of interventions; they are resources for shaping the interventions and extending coverage: "Well-designed behaviour change communication, training of healthcare workers and lay counsellors to provide accessible and appropriate counselling support to mothers, and active involvement of women's groups are important elements of effective breastfeeding behaviour change strategies..."

21.Behavior Change Communication for Improved Infant Feeding: Training of Trainers for Negotiating Sustainable Behavior Change

This module is designed to prepare community health workers and trainers of community health workers to offer training on behaviour change communication related to infant feeding.

RESEARCH & INFORMATION CHANNELS

22.Turning Health Research Into Action

by Debra Anthony

According to this report, among the critical issues surrounding child mortality is the need for research to focus on "how to get appropriate interventions to the people who need them." Knowing how health systems function is key to understanding how to reform them by integrating low-cost interventions such as vaccines, vitamin supplements, and insecticide-treated bednets. For example, informed by research that stressed the importance of focusing on local diseases, Tanzania's Essential Health Interventions Project (TEHIP) led to a 54% reduction in infant deaths in the 2 districts and a 47% drop in under-5 mortality after 5 years.

23.Pésinet and Saint Louis Net - Senegal

Pésinet and Saint Louis Net are social-development-focused organisations operating in Senegal which share an intranet site as well as related infrastructure. In an effort to provide preventative healthcare to low-income children (birth to 5 years), Pésinet launched a telemedicine project in which trained community members weigh children in their homes twice per week, and then track and monitor changes in the children's weight - sending the information to a hospital database via the internet. Pésinet's weighing agents also work to educate families on the benefits of prevention and to motivate mothers to seek medical care when a child looks ill (they arrange for follow-up care by doctors when necessary).

Contact François Jay fjay@afrique-initiatives.com

24.Global Immunization Vision and Strategy (GIVS)

This WHO/UNICEF endeavour aims to expand the reach of immunisation and to develop new vaccines between 2006 and 2015. The GIVS strategic framework on immunisation presents a range of strategies (24 in total; divided into 4 thematic areas) from which countries are invited to select those most suited to their needs. Key themes are global partnership and the power of information and communication technologies (ICTs) and the mass media to spread vaccine-related information and to correct misconceptions.

25. Immunization Surveillance, Assessment and Monitoring

This website offers various tools for evaluating the impact of strategies and activities that aim to reduce morbidity and mortality associated with vaccine-preventable diseases.

26.Benchmarking Immunisation Program Performance in the Africa Region

by Joseph F. Naimoli, Shilpa Challa, Miriam Schneidman, Kees Kostermans & Rashmi Sharma

As part of a study to demonstrate the application of the benchmarking concept to childhood immunisation in Africa, the World Bank found that almost two-thirds of the countries surveyed demonstrated some degree of progress; however, there was no single specific route or combination of activities that led to success. In light of these findings, the report suggests that the immunisation community create more opportunities for countries to meet and share their experiences. In addition, this global community might revisit previous efforts to develop a set of indicators of immunisation programme performance to monitor progress over time. A toolkit could also be developed to help countries assess, explain, and act on differences in performance at national, regional and/or district levels.

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.


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