Countdown to 2015- Maternal, Newborn and Child Survival

Publication date: 2008

TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT � TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL The 2008 Report TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �� TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT ��� Tracking Progress in Maternal, Newborn & Child Survival The 2008 Report ISBN: 978-92-806-4284-1 © The United Nations Children’s Fund (UNICEF), 2008 Cover photo © UNICEF/HQ07-1153/Shehzad Noorani This is a working document. It has been prepared to facilitate the exchange of knowledge and to stimulate discussion. Participating agencies and institutions accept no responsibility for errors. The designations in this publication do not imply an opinion on legal status of any country or territory, or of its authorities, or the delimitation of frontiers. The views expressed in this document are solely the responsibility of the contributors. The document may be freely reviewed, abstracted, or translated in part or whole, but not for sale nor use in conjunction with commercial purposes. All reasonable precautions have been taken by UNICEF and the Countdown Partners to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall UNICEF be liable for damages arising from its use. For more information contact UNICEF 3 United Nations Plaza New York, NY 10017 USA www.countdown2015mnch.org TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL The 2008 Report TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �v TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT v Contributors Lead Authors Jennifer Bryce (Johns Hopkins University, USA) and Jennifer Harris Requejo (PMNCH, Switzerland) Special Recognition Tessa Wardlaw, Archana Dwivedi, Holly Newby of UNICEF, for technical support and substantial contribution to all phases of report preparation and production 2008 Countdown Working Group Jasmina Acimovic, UNICEF, USA Priscilla Akwara, UNICEF, USA Henrik Axelson, PMNCH, Switzerland Stan Bernstein, UNFPA, USA Zulfiqar Bhutta, Aga Khan University, Pakistan Robert Black, Johns Hopkins University, USA Ties Boerma, WHO, Switzerland Josephine Borghi, LSHTM, UK Jennifer Bryce, Johns Hopkins University, USA Flavia Bustreo, PMNCH, Switzerland Dennis Caillaux, Global Movement for Children, Switzerland Naomi Cassirer, ILO, Switzerland Eleanora Cavagnero, WHO, Switzerland David Clark, UNICEF, USA Giorgio Cometto, Save the Children, UK Bernadette Daelmans, WHO, Switzerland Nita Dalmiya, UNICEF, USA Maria Dal Poz, WHO, Switzerland Archana Dwivedi, UNICEF, USA Leslie Elder, Saving Newborn Lives / Save the Children, USA David Evans, WHO, Switzerland Vincent Fauveau, UNFPA, Switzerland Helga Fogstad, NORAD, Norway Anastasia J. Gage Tulane University, USA Youssouph Gaye, Ministry of Health, Senegal Wendy Graham, University of Aberdeen, UK Giulia Greco, LSHTM, UK Neeru Gupta, WHO, Switzerland Richard Horton, The Lancet, UK Julia Hussein, University of Aberdeen, UK Monir Islam, WHO, Switzerland Kareen Jabre, Inter-Parliamentary Union, Switzerland Kate Kerber, Saving Newborn Lives / Save the Children, USA Betty Kirkwood, LSHTM, UK Joy Lawn, Saving Newborn Lives / Save the Children, USA Samantha Lobis, Columbia University, USA Viviana Mangiaterra, WHO, Switzerland Elizabeth Mason, WHO, Switzerland Jeffrey Mecaskey, Save the Children, UK Anne Mills, LSHTM, UK Holly Newby, UNICEF, USA Maryanne Neill, UNICEF, USA Arletty Pinel, UNFPA, USA Tim Powell-Jackson, LSHTM, UK Sonya Rabeneck, PMNCH, Switzerland Jennifer Harris Requejo, PMNCH, Switzerland Carine Ronsmans, LSHTM, UK Peter Salama, UNICEF, USA David Sanders, University of Western Cape, South Africa Harshad Sanghvi, JHPIEGO, USA Lale Say, WHO, Switzerland Werner Schultink, UNICEF, USA Anuraj Shankar, WHO, Switzerland Meera Shekar, World Bank, USA Robert Scherpbier, WHO, Switzerland Francisco Songane, PMNCH, Switzerland Marcus Stahlhofer, WHO, Switzerland Ann Starrs, Family Care International, USA Sissel Hodne Steen, NORAD, Norway Nancy Terreri, UNICEF, USA Anne Tinker, Save the Children, USA Jim Tulloch, AusAid, Australia Stewart Tyson, DFID, UK Patrick Unterlerchner, PMNCH, Switzerland Costanza Vallenas, WHO, Switzerland Cesar Victora, Universidade Federal de Pelotas, Brazil Tessa Wardlaw, UNICEF, USA Acknowledgements The Countdown Group would like to thank the following: UNICEF/Strategic Information Section for use of global databases, preparation of country profiles, and review of report text. Particular recognition goes to Xiaodong Cai, Khin Wityee Oo, and Me Me Khine for their input and review of country profiles. Irene Deineko for administrative support and convening of review meetings. WHO regional offices and headquarters staff who contributed to data collection: Christopher Drasbek, Susan Farhoud, Olivier Fontaine, Phanuel Habimana, Ardi Kaptinisingh, Aigul Kuttumaratova, Ramez Mahaini, Sudhansh Malhotra, Shameen Qazi and Mariana Trias. The Countdown communications team for their inputs in shaping the key messages, media strategy and Countdown Executive Summary: Genine Babakian, Flavia Bustreo, Marie Agnes Heine, Olivia Lawe- Davies, Kate Kerber, Ruth Landy, Jessica Malter, Tunga Namjilsuren, George Ngwa, Jennifer Requejo, Jacqueline Toupin, Michelle Zelsman. Christa Fischer-Walker and Jeremy Schiefen of Johns Hopkins University, USA for preparing maps. The DevInfo initiative for the development of the database and the production of the Country Profiles. UN Country Team in South Africa, particularly the UNICEF Sub-Office in Cape Town for administrative and logistics support. The PMNCH Secretariat for convening meetings for Countdown Core Groups and PMNCH colleague Tigest Yilma Desta for providing administrative support. Working Groups Coverage Indicators: Fred Arnold, Linda Bartlett, Stan Bernstein, Zilfiqar Bhutta, Robert Black, Ties Boerma, Jennifer Bryce, Flavia Bustreo, Simon Cousens, Trevor Croft, Bernadette Daelmans, Leslie Elder, Anastasia Gage, Wendy Graham, Kate Kerber, Stein-Erik Kruse, Joy Lawn, Elizabeth Mason, Jeffrey Mecaskey, Carine Ronsmans, Peter Salama, Harshad Sanghvi, Lale Say, Werner Schultink, Anuraj Shankar, Nancy Terreri, Anne Tinker, Vincent Fauveau, Cesar Victora, Tessa Wardlaw Equity: Henrik Axelson, Stan Bernstein, Ties Boerma, Wendy Graham, Kate Kerber, Betty Kirkwood, Jeffrey Mecaskey, Carine Ronsmans, Cesar Victora Financial Flows: Henrik Axelson, Zulfiqar Bhutta, Josephine Borghi, Flavia Bustreo, Guilia Greco, Anne Mills, Tim Powell-Jackson Policy Review: Bernadette Daelmans, Vincent Faveau, Andy Haines, Monir Islam, Stein-Erik Kruse, Viviana Mangiaterra, Jeffrey Mecaskey, Ann Starrs, Nancy Terreri, Stewart Tyson, Patrick Unterlerchner Abbreviations AARP ARV CHERG DHS GAVI GFATM Hib ILO IMCI ISCO ITNs LSHTM JMP WHO/UNICEF MDGs MERG MICS NMR OECD PMNCH SWAps U5MR UNGASS UNICEF WFFC WHO Average annual rate of reduction Anti-retroviral treatment Child Health Epidemiology Reference Group Demographic and Health Surveys Global Alliance for Vaccines Initiative Global Fund for AIDS, TB and Malaria Haemophilus influenzae type B International Labour Organization Integrated management of childhood illness International Standard Classification of Occupations Insecticide-treated nets London School of Hygiene and Tropical Medicine Joint Monitoring Programme on Water Supply and Sanitation Millennium Development Goals Roll Back Malaria Monitoring and Evaluation Reference Group Multiple Indicator Cluster Surveys Neonatal Mortality Rate Organisation for Economic Co-operation and Development Partnership for Maternal, Newborn and Child Health Sector-Wide Approaches Under-five mortality rate United Nations General Assembly Special Session United Nations Children’s Fund World Fit for Children World Health Organization �� ��� © U N IC EF /H Q 05 -2 15 9/ G ia co m o Pi ro zz i TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT � TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT � Summary The last few years have seen enormous and welcome developments in global public health and nutrition. There is growing recognition – increasingly backed by resources – that achieving the Millennium Development Goals (box 1) will demand radical changes to the scale and scope of effective strategies. The Countdown to 2015 responds to these calls for change. The Millennium Development Goals Goal 1: Eradicate extreme poverty and hunger. Goal 2: Achieve universal primary education. Goal 3: Promote gender equality and empower women. Goal 4: Reduce child mortality. Goal 5: Improve maternal health. Goal 6: Combat HIV/AIDS, malaria and other diseases. Goal 7: Ensure environmental sustainability. Goal 8: Develop a global partnership for development. Box 1: The Millennium Development Goals Countdown Principles Focus on coverage Focus on effective interventions Maintain a country orientation Build on existing goals and monitoring efforts Box 2: Countdown principles A collaboration among individuals and institutions established in 2005, the Countdown aims to stimulate country action by tracking coverage for interventions needed to attain Millennium Development Goals 4 and 5 – and, in addition, parts of Millennium Development Goals 1, 6 and 7. Through this unified effort national and international policy makers, programme implementers, development and media partners and researchers are working together to: Summarise, synthesise and disseminate the best and most recent information on country-level progress towards high, sustained and equitable coverage with health interventions to save women and children. Take stock of progress in maternal, newborn and child survival. Call on governments, development partners and the broader community to be accountable if rates of progress are not satisfactory. Identify knowledge gaps that are hindering progress. Propose new actions to achieve the health-related Millennium Development Goals, in particular Millennium Development Goals 4 and 5. • • • • • The Countdown pursues these objectives through conferences, publications and follow-up regional and country activities, focusing attention on progress towards national-level coverage of proven interventions in countries with the highest maternal and child mortality rates. The activities of the Countdown are guided by four principles (box 2). Countdown priority countries The 68 priority countries for the Countdown to 2015 bear the world’s highest burdens of maternal and child mortality (figure 1). Together these countries account for 97 per cent of maternal and child deaths. Included among the priority countries are 34 of the 36 countries in the world with the highest prevalence of child undernutrition. Interventions and indicators All interventions tracked through the Countdown are empirically proven to reduce mortality among mothers, newborns or children. Coverage with broader approaches, such as antenatal and postnatal care, delivery and reproductive health services also need to be tracked, as they provide the basic platform for delivery of multiple effective interventions to reduce maternal and newborn mortality. The Countdown tracks only interventions and approaches that are feasible for universal implementation in poor countries. In addition, to be tracked, an intervention or approach must be associated with a valid coverage indicator that is reliable and comparable across countries and time. The Countdown recognizes the limitations of some coverage indicators now used and is doing technical work to improve them. Finally, the 68 Countdown country profiles present other information helpful for interpreting coverage levels, including: Country-specific estimates of maternal and child mortality and child nutritional status, The status of policies related to maternal, newborn and child health, Indicators of health system strength, Measures of equity in coverage, Estimates of financial flows to maternal, newborn and child health and nutrition. • • • • • DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Benin 1999 2000 2001 2002 2003 2004 2005 23 42 1996 DHS 2001 DHS At least one dose Two doses Source: WHO, 2006 Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Source: UNICEF Underweight prevalence Percent children < 5 years underweight for age* 44 9 *Based on 2006 WHO reference population 20 2001 DHS 22 2006 DHS 2001 DHS 38 70 2006 DHS 56 100 96 8595 98 95 89 92 94 94 Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 1990 1995 2000 20052006 93 93 89 0 20 40 60 80 100 1996 DHS 2001 DHS 32 35 8,760 1,488 358 70 148 88 38 53 840 20 2,900 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2006) (2006) 50 16 (2006) (2001) P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 1996 DHS 10 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 27 62 3 3, 6, 2 49 --- (2001) (2001) (2006) (2001) (2001) Coverage along the continuum of care Source: DHS, MICS, Other NS *See Annex for indicator definition Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 17 88 78 70 89 WATER AND SANITATION EQUITY SYSTEMSPOLICIES Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities Financial Flows and Human Resources Coverage gap by wealth quintile Benin 1990 2004 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 Skilled attendant at delivery Percent live births attended by skilled health personnel Neonatal tetanus protection Percent of newborns protected against tetanus 1996 DHS 2001 DHS 2006 DHS P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1986 1991 20011996 2006 57 73 57 78 67 63 1990 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 2 32 11 59 33 12 Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Yes Yes Partial Yes Yes Partial No Yes Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 40 10 49 0.9 7 4 66 (2007) (2007) (2007) (2004) (2005) (2005) (2002) Coverage gap (%) 1996 DHS 2001 DHS 48 1.9 29 41 1.7 22 Ratio poorest/wealthiest Difference poorest-wealthiest (%) Diarrhoea 2% Tetanus 4% Other 5% Congenital 8% Asphyxia 19% Infection 34% Preterm 28% Pneumonia 21% Diarrhoea 17% Measles 5% HIV/AIDS 2% Injuries 2% Other 0% Malaria 27% Neonatal 25% Causes of neonatal deaths Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care 1990 1995 2000 2005 2010 2015 40 0 80 120 160 200 62 148 185 Source: UNICEF, 2006 MDG Target Under-five mortality rate Deaths per 1000 live births Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 66 Malaria prevention Percent children < 5 years sleeping under ITNs 2001 DHS 2006 MICS 20 7 P er ce nt 20 0 40 60 80 100 Malaria treatment Percent febrile children < 5 years using antimalarials 2006 DHS 2001 DHS 54 60 P er ce nt 20 0 40 60 80 100 1996 DHS 2001 DHS 2006 DHS 2005 Other NS 27 2006 Other NS 53 80 81 88 60 66 78 94 0 000 Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% Country Profiles Figure 2. Country profile example of Benin Key findings of the 2008 Countdown The report contains profiles for each of the 68 Countdown priority countries. Benin is shown as an example in figure 2. Benin was selected because it is the first country profile (in alphabetical order) where data were available for all major indicator categories. Figure 3 presents median national level coverage for The 68 Countdown Priority Countries Figure 1: The 60 priority countries in 2005 (red). The 8 priority countries added in 2008 (yellow): Bolivia, Eritrea, Guatemala, Democratic People’s Republic of Korea, Lao People’s Democratic Republic, Lesotho, Morocco, Peru. Coverage Levels Figure 3. Median coverage levels for selected Countdown interventions and approaches Source: Authors’ compilation based on information supplied in text v�v 7 7 28 32 38 40 43 43 48 49 53 62 69 78 80 81 81 85 0 20 40 60 80 100 IPTp for malaria Children sleeping under ITNs Exclusive breastfeeding Antibiotics for pneumonia Diarrhoea treatment Malaria treatment Early initiation of breastfeeding Improved sanitation facilities Careseeking for pneumonia 4+ antenatal care visits Skilled attendant at delivery Complementary feeding (6-9 months) Improved drinking water Vitamin A supple- mentation (2 doses) Measles immunization DPT3 immunization Neonatal tetanus protection Hib3 immunization Median level of national coverage C ou nt do w n in te rv en tio ns an d ap pr oa ch es Source: UNICEF 2007c TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT � TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT � The Countdown Call to Action All institutions and individuals involved in the Countdown should use the information it provides – in combination with their diverse skills and resources – to promote the following immediate actions: Sustain and expand successful efforts to achieve high and equitable coverage for priority interventions. Recent areas of progress – especially immunizations, vitamin A supplementation and insecticide-treated bed nets – represent a major success for governments and their development partners. Such efforts should continue. But comparable efforts and investments are required for the case management of childhood illnesses, family planning services, and antenatal, childbirth, and postnatal care. Focus on the priority period within the continuum of care, from pre-pregnancy through 24 months – especially around the time of birth. To reduce mortality during childbirth and in the immediate days afterwards, programming efforts must focus on the effective and integrated delivery of interventions and approaches associated with this crucial period (e.g., antenatal, delivery, and postnatal care). Contraceptive services and efforts to improve infant feeding practices also need to be given high priority. Within increased efforts to achieve the health-related Millennium Development Goals, make improving maternal and child nutrition a priority. Nutrition must be central to both national and subnational development strategies. Strengthen health systems, focusing on measurable results. Health systems need to deliver on demand, creating a functional continuum of care over time and across places of service delivery. All new initiatives must focus on outcomes that measurably advance this aim. Set geographic and population priorities, and stick to them. The health-related Millennium Development Goals cannot be met globally without faster progress in sub- Saharan Africa and South Asia. Development efforts and official development assistance must increasingly target countries in these regions with large populations and poor performance. Prioritize a programme for equity. Describing inequities, though an important first step, is not enough. Programmatic efforts to address inequities must be supported by strong monitoring and evaluation activities. Do even more to ensure predictable long-term aid flows for maternal, newborn and child health. Governments and their development partners cannot meet the health- related Millennium Development Goals unless assistance is adequate, predictable and targeted to those goals. Monitor. Evaluate. Conduct locally driven implementation research. And act on the results. The ‘community of practice’ for maternal, newborn and child health must lead the change by improving monitoring and evaluation activities, and supporting efforts to rapidly disseminate and build-on important findings. Lead the change for maternal, newborn and child survival. It is time for all to work together as partners to improve the lives of women, newborns and children. • • • • • • • • • selected Countdown interventions and approaches based on the most recent data available. Seven key conclusions Seven key conclusions emerge from an analysis of the profile data: Countries, while rapidly increasing coverage for some interventions, are making little or no progress with others. Most Countdown countries have high or increasing coverage for preventive interventions such as vaccinations, vitamin A supplementation and insecticide-treated bed nets to prevent malaria (figure 3). But very few are making progress reaching women and children with clinical care services, such as skilled attendants at delivery or treatment for pneumonia, diarrhoea and malaria. Postnatal care is an especially important gap in the first week of life when mothers and newborns are at the highest risk. Prevalence rates for the nutritional indicators that require social and behavioural changes in order to improve, such as early initiation of breastfeeding, exclusive breastfeeding, and complementary feeding, are also low. The continuum of care for maternal, newborn and child health requires multiple delivery approaches. Progress towards the Millennium Development Goals will require a range of interventions to be delivered in different points during the life-cycle. Services that contribute to the achievement of one Millennium Development Goal will not necessarily advance progress towards another. Of particular concern today is a serious breakdown in the continuum of care at several points in the pre-pregnancy to two-year postnatal period when opportunities to deliver essential services are being lost. Undernutrition is an area of little or no progress. More than one-third of deaths in children under age five are attributable to undernutrition – the underlying cause of 3.5 million child deaths annually. Maternal undernutrition increases the mother’s risk of death at delivery, accounting for at least 20 per cent of such deaths. In 33 of the 68 priority countries, at least 20 percent of children are moderately or severely underweight, and 62 countries have stunting prevalence rates exceeding 20 per cent. Weak health systems and broader contextual factors obstruct progress. Health systems in many countries cannot now deliver essential interventions and approaches widely or well enough to reduce mortality nationwide. Indicators of health financing and health worker density are useful markers of health system strength. Of the 68 Countdown priority countries, 54 – or 80 percent – have workforce densities below the critical threshold for improved prospects for achieving the health-related Millennium Development Goals. It has been estimated that annual per capita total health expenditures of less than $45 are insufficient to ensure access to a very basic set of needed services. Of the 68 priority countries, 21 had annual per capita health expenditures below this amount. Many Countdown priority countries face additional challenges to progress. For example, in the 26 countries with no or reversed progress towards Millennium Development Goal 4, contextual challenges, such as armed conflict, natural disasters, high HIV burdens and low adult female literacy rates, contribute to stagnating or deteriorating coverage. Aid needs to increase and become more predictable. Official development assistance to child, newborn and maternal health increased by 28 percent from 2004 to 2005, including increases of 49 per cent to child health and 21 per cent to maternal and newborn health. Such aid for maternal, newborn and child health and nutrition has increased in most Countdown priority countries, but has decreased in others. Of the 68 countries, 38 received more per capita official development assistance to child health in 2005 than in 2004, while 39 received more to maternal and newborn health per live birth in 2005 than in 2004. Although maternal, newborn, and child health programmes within the priority countries have benefited from these increases in official development assistance, such programmes are still grossly underfunded and much more needs to be done. Countries need more and better coverage estimates and research on programme implementation. Since the first Countdown report in 2005, an unprecedented amount of household surveys have been conducted and include new MICS data from 54 countries and new DHS data for 35 countries. However, many countries are still determining coverage levels for essential interventions using data that is 5, 10 or even 15 years old. In consequence, the knowledge gained through current and ongoing efforts to promote maternal, newborn and child health and nutrition has not been adequately disseminated. Data collection and dissemination processes need improvement to make timely data more readily available, which is crucial for planning and implementation purposes. Inequities obstruct progress. Mortality in children under age five is now concentrated in sub-Saharan Africa (almost 50 per cent) and South Asia (30 per cent). Maternal and newborn mortality are similarly concentrated in those regions. Meanwhile, within countries, the richest quintile is gaining access to key interventions more quickly than the poorest. Reducing both types of inequity – between regions and within countries – is crucial for achieving the health-related Millennium Development Goals. Over one-third of the priority Countdown countries were affected by violent, high-intensity conflict between 2002 and 2006. Challenges to Progress Box 3: Many Countdown priority countries face additional challenges to progress Box 4: The Countdown Call to Action© U N IC EF /H Q 07 -1 30 9/ A ni ta K he m ka v��v� TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT � TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT � Contents Chapter 1: Tracking intervention coverage for maternal, newborn and child survival Countdown principles Links to other monitoring efforts Overview of this report Notes Chapter 2: Tracking indicators and methods Selecting the Countdown priority countries Priority interventions and coverage indicators Indicators for factors that contribute to coverage Tracking improvements in equity Data sources and methods Coverage Policies, health systems and financial flows Equity Notes Chapter 3: The 2008 Countdown findings - and a call to action The bottom line: mortality Nutritional status Coverage in 2008 Recent coverage trends Coverage levels and trends for selected programmatic areas Equity in coverage levels Health policies and health systems Human resources and financing Financial flows to maternal, newborn and child health Conclusions and recommendations The Countdown call to action Notes Chapter 4: The country profiles References Annexes Annex A: Initiatives, resources and databases for monitoring progress towards the health-related Millennium Development Goals, with a special focus on maternal,newborn and child survival Annex B: Indicators and data sources Annex C: Defining current Countdown indicators Annex D: Definitions of policy and health systems indicators Annex E: Countdown to 2015 measuring equity in maternal, newborn and child health through the coverage gap index: technical notesz Annex F: Countdown priority countries considered to be malaria endemic © U N IC EF /H Q 05 -2 13 1/ G ia co m o Pi ro zz i 1 2 4 4 5 7 7 9 10 11 11 12 13 14 15 17 17 21 22 23 24 40 41 44 44 46 48 49 51 188 TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT v��� TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT � 1Tracking intervention coverage for maternal, newborn and child survival The last few years have seen enormous and welcome developments in global public health and nutrition. There is growing recognition, increasingly backed by resources, that achieving the health-related Millennium Development Goals will demand radical changes to the scale and scope of effective strategies. The Countdown to 2015, a movement of governments, individuals and institutions, is responding to these calls for change. In 2003 the Bellagio Lancet Child Survival Series helped raise global awareness of more than 10 million deaths occurring each year in children under age five, mainly from preventable conditions that rarely affect children in wealthy countries.1 In 2005 a second Lancet series focused on the approximately 4 million annual deaths among newborns.2 Later series focused on maternal survival3 and broader issues of child development in developing countries,4 sexual and reproductive health,5 maternal and child health and nutrition6 and health systems.7 Finally, a special issue of the Lancet on “Women Deliver” highlighted the importance of the continuum of care for maternal, newborn and child health.8 A common theme in these Lancet series was the call for a systematic mechanism to track progress in achieving high, sustainable and equitable coverage with interventions proven to reduce maternal, newborn and child mortality – ‘coverage’ being defined as the proportion of those needing an intervention who receive it.9 The response to this call is reflected broadly in global efforts to track progress towards the Millennium Development Goals (box 1.1), and is the specific focus of the Countdown to 2015. Supported through contributions of time and money and governed by a Core Group, the Countdown aims to stimulate country action by tracking coverage for interventions needed to attain Millennium Development Goals 4 and 5, together with parts of Millennium Development Goals 1, 6 and 7. The Countdown tracks coverage within populations targeted by specific interventions and usually measures coverage at the population level (rather than in health facilities, for example). Through the Countdown, national and international policy makers, programme implementers, development and media partners and researchers are working together to: Summarise, synthesise and disseminate the best and most recent information on country-level progress towards high, sustained and equitable coverage with health interventions to save women and children. Take stock of progress in maternal, newborn and child survival. Call on governments, development partners and the broader community to be accountable if rates of progress are not satisfactory. Identify knowledge gaps that are hindering progress. Propose new actions to achieve the health-related Millennium Development Goals, in particular Millennium Development Goals 4 and 5. The Countdown has planned a series of conferences to be held every two to three years until 2015. Focusing attention on national coverage levels for high-impact interventions in countries with the highest burden of • • • • • © U N IC EF /H Q 06 -1 39 1/ G ia co m o Pi ro zz i The Millennium Development Goals Goal 1: Eradicate extreme poverty and hunger. Goal 2: Achieve universal primary education. Goal 3: Promote gender equality and empower women. Goal 4: Reduce child mortality. Goal 5: Improve maternal health. Goal 6: Combat HIV/AIDS, malaria and other diseases. Goal 7: Ensure environmental sustainability. Goal 8: Develop a global partnership for development. Box 1.1. The Millennium Development Goals TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT � TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT � maternal and child mortality rates, the Countdown conferences will catalyse greater action and increase accountability for country and partner commitment to the Millennium Development Goals – in particular, to rapid reductions in maternal and child mortality.10 In addition, Countdown publications report on major determinants of coverage, including policies, health system performance measures and financial flows to maternal, newborn and child health. The first international Countdown conference, focusing on child survival, was hosted in London in December 2005 by 12 organisations.11 Coverage reports were available for 60 countries, accounting for 94 per cent of child deaths worldwide.12 More information on the conference can be found online (http://www. countdown2015mnch.org/). Success for the Countdown, however, will be measured by country-level results. In 2006 Senegal was the first country to hold a national Countdown conference, bringing together government leaders, private and public partners and the research community to review progress in child survival. The second international Countdown conference is scheduled for 17–19 April 2008 in Cape Town, South Africa. Covering maternal, newborn and child survival, it will be held in tandem with an Inter-Parliamentary Union meeting, providing government leaders with opportunities for greater involvement in efforts to save women’s and children’s lives. Participants in the 2005 international Countdown conference had already recognized the importance of working within a broader continuum of care – one that “promotes care for mothers and children from pre-pregnancy to delivery, the immediate postnatal period, and early childhood, recognising that safe childbirth is critical to the health of both the woman and the newborn child.”13 Such a continuum should also link service provision across various settings, from households to community-based care to primary care services to hospitals. The Countdown has explicitly adopted a continuum of care approach. In this report it tracks coverage across the continuum for the first time. The Countdown has always made nutrition central to its efforts. Improving coverage for proven maternal and child nutrition interventions will contribute to Millennium Development Goal 1.14 At this time, however, only child nutritional status and nutrition interventions are tracked through the Countdown. The Countdown also recognises the importance of reproductive health services. The target added to Millennium Development Goal 5 to achieve universal access to reproductive health is an indication of its importance to maternal and newborn survival. Contraceptive prevalence and unmet need are tracked in the present Countdown cycle, and in the next cycle of technical work the Core Group will thoroughly review this area. The 2008 report is complimented by a corresponding Lancet special series on the major findings of the Countdown. 2. Build on existing goals and monitoring efforts The Countdown aims to sharpen and reinforce efforts already under way to support countries in meeting their commitments to global goals, and to further the effective use of information collected through existing monitoring mechanisms. Countdown indicators and measurement approaches build on efforts started in the 1990s to monitor progress towards the World Summit for Children goals, which evolved into monitoring strategies for the Millennium Development Goals.15 Emphasis on measuring progress towards international goals and targets has rapidly increased the availability of intervention coverage data. Today’s maternal and child survival indicators reflect a united effort to define and measure indicators consistently, permitting the assessment of trends over time. In some cases, however – notably the definition and measurement of indicators for oral rehydration therapy to prevent diarrhoea dehydration16 – changing public health recommendations made changes in definition and measurement unavoidable. Tracking through the Countdown complements and promotes country-level monitoring of maternal, newborn and child health programmes. Country-level monitoring focuses on ensuring that policies, plans and resources are in place and that programmes and strategies are implemented fully and adequately; key outcomes for assessing programme implementation include access, quality, coverage and equity. Methods and indicators for monitoring purposes must provide timely information and must reflect country-level needs and decisions. The Countdown aims to build on country-level data, attracting attention and resources for addressing service delivery barriers and to further speed up progress towards the health-related Millennium Development Goals. The Countdown complements country-level monitoring efforts by focusing on indicators that are closer to impact and that can be measured in ways that permit cross-country comparisons and the estimation of global trends. Coverage indicators meet these criteria, as do many indicators of the impact of programme activities on the nutrition and health status of women, newborns and children. Efforts to identify and define indicators of policies, financial flows and human resources that are sufficiently valid and reliable for global monitoring began in 2005 and are continuing. The coverage information presented by the Countdown in this report required no new data collection. But the information on policies, health systems and financial flows – here and in future Countdown reports – combines existing data with those collected specifically for the Countdown. The primary purpose of this report is to bring available data on the priority countries together in one place to facilitate evidence-based review and planning efforts designed to accelerate country-level actions in maternal, newborn and child health. 3. Promote effective interventions The Countdown monitors coverage for interventions and approaches feasible for universal implementation in poor countries and with proven effectiveness in improving maternal and child survival and nutrition. (The next chapter describes how the Countdown selects these interventions and approaches and explains the coverage indicators used.) 4. Maintain a country orientation The Countdown aims to help countries and their development partners achieve the Millennium Development Goals and the World Fit for Children goals and targets.17 While the Countdown will not and should not supplant governments and their partners in their roles as policy makers and service providers, its role extends beyond monitoring – making public health science a basis for public health action. By bringing together diverse individuals with complementary experience, Countdown participants hope to spark and support new insights and concrete directions for improving the health and survival of women and children. So far the Countdown has not taken strong follow-up action in countries, but is a central element of the work scheduled to begin immediately after the April Conference. Countdown Principles The activities of the Countdown are guided by four principles: 1. Focus on coverage 2. Build on existing goals and monitoring efforts 3. Promote effective interventions 4. Maintain a country orientation Box 1.2. The Countdown principles © U N IC EF /H Q 02 -0 57 1/ G ia co m o Pi ro zz i Countdown principles 1. Focus on coverage Timely data on intervention coverage are essential for good programme management. Governments and their partners need up-to-date information on whether their programmes are reaching targeted groups. Such coverage information must be supplemented, of course, with measures of intervention quality and effectiveness. For interventions proven to reduce mortality, coverage is a useful indicator of progress. Increases in coverage show that policies and delivery strategies are reaching women and children. Failures to increase coverage – assuming that resources have been adequate and that planning has been good – are a cause for urgent concern. District, regional and national managers and their partners should address low coverage rates by examining how interventions are delivered and removing bottlenecks or revising service delivery plans. This report, which provides the best and most recent information on country-level progress in achieving intervention coverage, is a central part of the Countdown effort. It offers a basis for documenting accomplishments and revitalising efforts where needed. TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT � TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT � Links to other monitoring efforts As part of a much larger effort to track progress towards the Millennium Development Goals, the Countdown aims to complement the work of others – not replace it. Annex A lists resources and initiatives related to Millennium Development Goal monitoring for mothers, newborns and children at the international level. Box 1.3 highlights the Countdown’s added value compared with other international monitoring efforts. By maintaining a country focus. Individual country profiles offer selected information about demographic and epidemiological contexts and key coverage determinants. By tracking progress in 68 priority countries. Sharing the highest burden of maternal and child mortality, these countries represented more than 97 per cent of all such deaths (deaths in children under 5 in 2006, and maternal deaths in 2005). By maintaining continuity through 2015. The Countdown will continue reporting on progress through 2015, the target date for achieving the Millennium Development Goals. A supra-institutional effort, the Countdown brings together representatives from United Nations agencies, civil society, governments, and the donor and development communities. By promoting country-level action. The Countdown presents information needed to assess progress and to speed up country-level actions in pursuit of Millennium Development Goals 4 and 5, together with parts of Millennium Development Goals 1, 6 and 7. • • • • • action can be improved. Comments, critiques and suggestions can be proposed through communication with any of the many Countdown co-sponsors, or sent directly to www.countdown2015mnch.org. Notes 1 Black, Morris and Bryce 2003; Jones, Steketee, Black and others 2003; Bryce, Arifeen, Pariyo, and others 2003; Victora, Wagstaff, Armstrong-Schellenberg and others 2003; The Bellagio Study Group on Child Survival 2003. 2 Lawn, Cousens and Zupan 2005; Darmstadt, Bhutto, Cousens and others 2005; Knippenberg, Lawn, Darmstadt and others 2005; Martines, Paul, Bhutta and others 2005. 3 Ronsmans and Graham 2006; Campbell and Graham 2006. 4 Grantham-McGregor, Cheung, Cueto and others 2007; Walker, Wachs, Gardner and others 2007; Engle, Black, Behrman and others 2007. 5 Glasier, Gülmezoglu, Schmid and others 2006; Wellings, Collumbien, Slaymaker and others 2006; Cleland, Bernstein, Ezeh and others 2006; Cleland, Bernstein, Ezeh and others 2006; Grimes, Benson, Singh and others 2006; Low, Broutet, Adu-Sarkodie and others 2006. 6 Black, Allen, Bhutta and others 2008; Victora, Adair, Fall and others 2008; Bhutta, Ahmed, Black and others 2008; Bryce, Coitinho, Darnton-Hill and others 2008; Morris, Cogill and Uauy 2008. 7 Haines and Victora 2004; Gwatkin, Bhuiya and Victora 2004; Palmer, Mueller, Gilson and others 2004; Hongoro and McPake 2004; Victora, Hanson, Bryce and others 2004; Lavis, Posada, Haines and others 2004. 8 Starrs 2007; Kerber, de Graft-Johnson, Bhutta and others 2007; Freedman, Graham, Brazier and others 2007. 9 Bryce, Arifeen, Pariyo and others 2003, p. 1068. 10 Bryce, Terreri, Victora and others 2006. 11 The hosting organisations were the London School of Hygiene & Tropical Medicine, the Bellagio Child Survival Group, UNICEF, World Health Organization, Lancet, Save the Children, United States Agency for International Development (USAID), USAID’s Basic Support for Institutionalizing Child Survival (BASICS), the UK’s Department for International Development (DFID), the World Bank, the International Paediatric Association and the Partnership for Maternal, Newborn and Child Health. 12 Bryce, Terreri, Victora and others 2006. 13 Tinker, ten Hoope-Bender, Azfar and others 2005, p. 823. 14 World Bank 2006. 15 The World Summit for Children goals can be found at UNICEF’s website (http://www.unicef.org/wsc/). Committed to by heads of state and government in 2002, they cover vital areas of children’s well- being and development and serve as stepping stones towards the Millennium Development Goals (UNICEF 2007b). 16 Victora, Bryce, Fontaine and others 2000. 17 The World Fit for Children goals and targets can be found at UNICEF’s website (http://www.unicef.org/specialsession/wffc/). How the Countdown Adds Value Box 1.3. How the Countdown adds value compared with other Millennium Development Goal Monitoring efforts Country-level program monitoring Country-level programme monitoring is the most important part of monitoring progress towards the Millennium Development Goals. The Countdown seeks to enhance such monitoring whenever possible. Yet countries bear the main responsibility for interpreting the Countdown results and using them to improve programming. (Quality monitoring and service provision monitoring are the responsibility of governments and their partners and are not addressed here.) The Countdown as an evolving effort .The Countdown is a process, and will continue to expand and improve over time to address additional elements of the continuum of care. For example, although family planning is included as an essential intervention in the 2008 report, special health risks, vulnerabilities and barriers to access for adolescents are not addressed explicitly, nor is the full range of potential interventions to address undernutrition. We present this report recognising its limitations, and accept the need to expand the range of interventions that can be tracked effectively in each Countdown cycle while preserving the quality of the effort, especially as new evidence about the impact of interventions becomes available Overview of this report This report is intended to help policy makers and their partners assess progress and prioritise actions to reduce maternal, newborn and child mortality. Almost all the data presented here can be found elsewhere. The Countdown adds value by collecting in one place the basic information needed to decide whether maternal and child mortality reductions can be expected in countries with the highest rates or numbers of such deaths. It adds further value by creating a context – the Countdown conferences – that can make policy makers, development agencies and donors more likely to notice challenges to progress and to respond to them with sound decisions. Chapter 2 explains how and why the Countdown priority countries were selected, and summarises the selection of Countdown indicators and the data sources and methods used to track progress. Chapter 3 summarises the findings of the 2008 Report. Specific note is taken of countries with demonstrated progress in raising coverage levels, and areas where intensified effort is needed within and across the priority countries. This preliminary discussion provides a starting point for more in-depth review, discussion and action planning that will take place at the Countdown conference scheduled for April 2008 in Cape Town, South Africa and subsequent regional- and country-level Countdown conferences. Chapter 4 introduces the individual country profiles. These profiles represent the basic information to be analysed at Countdown conferences, and evidence for assessing progress since the first Countdown Report in 2005. Each profile presents the most recent available information on selected demographic measures of maternal, newborn and child survival and nutritional status, coverage rates for priority interventions, and selected indicators of equity, policy support, human resources and financial flows. Because the Countdown is an ongoing process that represents an informal affiliation of individuals and agencies committed to accelerating progress toward the health MDGs, we encourage readers to engage with this material critically and to make suggestions about how its utility in promoting and guiding © U N IC EF /H Q 07 -1 50 6/ A ni ta K he m ka TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT � TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT � 2Tracking indicators and methods This chapter begins with an overview of how the priority Countdown countries were selected. In the second section we introduce the interventions and approaches within the continuum of care for maternal, newborn and child health that are tracked through the Countdown and the coverage indicators associated with each. The third section discusses determinants of coverage at the country level, such as policies, health system strength and financial flows, followed by a description of how equity is tracked through the Countdown. In the final section of the chapter we describe the data sources and methods used for the Countdown tracking effort. Selecting the Countdown priority countries The Countdown tracks coverage for the 68 countries with the highest burden of maternal and child mortality, shown in figure 2.1. Country selection took place in two phases – the first in 2004, when the Countdown Core Group defined countries with the highest numbers or rates of under-five mortality, and the second in 2007, when the list was expanded to include those with the highest numbers of maternal deaths or maternal mortality ratios. Each phase is described below. Phase 1: Selecting priority countries based on deaths among children under age five In 2005 the Countdown did not yet address maternal survival. It therefore drew its priority countries from two lists of all developing countries. The first list rank-ordered countries by the total number of child deaths in 2004, the most recent year for which data were available.1 All countries with at least 50,000 child deaths were selected from this list for inclusion in the Countdown. The second list rank-ordered countries by under-five mortality rate. Any country that had a rate of at least 90 under-five deaths per 1,000 live births – and that had not already been selected from the first list – was selected from the second list for inclusion in the Countdown. The addition of the second list ensured that countries with small populations but high mortality rates, most of them in sub-Saharan Africa, were included. Together, the 60 Countdown priority countries selected in 2005 represented almost 500 million children under age five – over 75 per cent of all such children then living. They also represented 94 per cent of all deaths among children under age five in 2004.2 Phase 2: Expanding the priority countries based on maternal deaths For this report the Countdown expanded to include maternal deaths. We relied on procedures like those used for the first Countdown report to determine whether additional priority countries should be included. We again developed two lists of all developing countries. The first list rank-ordered countries by the maternal mortality ratio estimates from the year 2005, the most recent year for which this information was available.3 All countries with a maternal mortality ratio greater than 550 were retained at this stage. The second list rank-ordered countries by the total number of maternal deaths in 2005. Using both lists, we selected for inclusion in the Countdown – if they had not already been included for having a high burden of under-five mortality – all countries with a maternal mortality ratio greater than 550 and all countries with both a maternal morality ratio greater © U N IC EF /H Q 06 -2 69 3/ S H EH ZA D N O O R A N I The 68 Countdown Priority Countries Figure 2.1. The 60 priority countries in 2005 (red). The 8 priority countries added in 2008 (yellow): Bolivia, Eritrea, Guatemala, Democratic People’s Republic of Korea, Lao People’s Democratic Republic, Lesotho, Morocco, Peru. Source: Authors’ compilation based on information supplied in text TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT � TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT � than 200 and at least 750 maternal deaths in 2005. Countries with high under-five mortality overlapped significantly with those that had high maternal mortality. This exercise led to the inclusion of just eight additional Countdown priority countries: Bolivia, the Democratic Republic of Korea, Eritrea, Guatemala, Lao People’s Democratic Republic, Lesotho, Morocco and Peru. Table 2.1 shows the proportion of Countdown priority countries in each region and their share of each region’s population. Priority countries account for a vast majority of people in sub-Saharan Africa and South Asia, and smaller but still substantial proportions of those in the East Asia and the Pacific, Latin America and the Caribbean, and Middle East and North Africa regions. The 68 priority countries represent 97 per cent of maternal and child deaths worldwide and in developing countries. Therefore, the Countdown’s findings are indicative of global progress towards the Millennium Development Goals – although countries with small populations may be underrepresented, and care must be taken when generalizing the results to those settings. Numerous factors not directly related to health service coverage can have an important impact on health outcomes. Though beyond the scope of the Countdown, such factors should be kept in mind when using the findings. For example, important intermediate determinants of health outcomes include women’s education and nutritional status, household wealth and cultural factors that affect health seeking behaviours.4 In addition, the root causes of poor health include disruptions in a country’s social fabric and economic infrastructure. This is evident in conflict and post-conflict situations5 and in countries characterised by severe governance problems. Finally, natural and environmental disasters also contribute to the death toll and strain the capacity of already weak public health systems.6 Many Countdown priority countries are affected by these and other important contextual factors. For example: In 32 per cent (17 of 53) of priority countries with data on adult female literacy, the rate is 50 per cent or less.7 In 93 per cent (62 of 67) of priority countries with data on stunting prevalence among children under five years of age, the rate is at least 20 per cent.8 In 23 per cent (15 of 64) of priority countries with data on HIV prevalence among adults age 15–49, the rate is estimated at 5 per cent or greater. 9 In 98 per cent (49 of 50) of priority countries with data on the World Bank’s international poverty indicators, there are populations living on less than $1 USD per day (range 3 to 85 per cent).10 In 2006, 68 per cent of all Countdown priority countries (46 of 68) were low-income countries – defined as countries with less than $905 of gross national income per capita per year.11 Between 2002 and 2006, 35 per cent of all Countdown priority countries (24 of 68) were affected by violent, high-intensity conflict.12 Between 2000 and 2007, 88 per cent of all Countdown priority countries (60 of 68) were struck by a natural disaster killing at least 100 people or affecting more than 10,000 people.13 Achieving the health-related Millennium Development Goals in the 68 Countdown priority countries will require extraordinary investments and efforts on many fronts. Given the magnitude of the challenge, a special effort is needed to enlist parliamentary champions and harness national commitments at the highest levels of government. Achieving the goals for mothers, newborns and children is a shared responsibility of national governments and their United Nations and non-governmental partners at both international and national levels, together with academic and research institutions, religious and community groups and dedicated individuals. • • • • • • • Priority interventions and coverage indicators Chapter 1 described the principles that guide the Countdown, including its focus on tracking population coverage for effective interventions and approaches that are feasible for universal implementation in poor countries. In this section we describe how the Countdown interventions and approaches were chosen, how indicators of coverage were selected for each and how we arrived at the coverage estimates in this report. Inclusion criteria for interventions and approaches The Countdown’s most important criterion for including an intervention is the availability of internationally accepted (peer-reviewed) evidence demonstrating that it can reduce mortality among mothers, newborns or children under age five. The first Countdown, in 2005, was able to draw on the 2003 and 2005 Lancet series on child and neonatal survival, respectively, which used systematic literature reviews to identify such interventions.14 As the Countdown expanded to include maternal survival, and in light of new thinking about the continuum of care,15 the Core Group recognized that the focus on single interventions was too narrow. Coverage with broader approaches such as antenatal and postnatal care, delivery care and reproductive health services – as basic platforms for delivering multiple interventions proven to reduce maternal and newborn mortality – also needed to be tracked. Beginning with this report, the Countdown will track both interventions and approaches, provided that at least one effective intervention is supported by each approach. For this report a Countdown Working Group on Indicators and Coverage Data was convened and charged with reviewing new evidence on interventions included in the 2005 Countdown, as well as determining whether additional interventions or delivery platforms should be included in 2008. A full report of the Working Group’s deliberations and decisions is at the Countdown website (www. countdown2015mnch.org). Among proven interventions, the Countdown includes only those judged feasible for delivery with universal coverage in low-income countries. Because intervention costs and delivery strategies can change, this criterion must be reassessed in each Countdown cycle. The Countdown does not aim to be comprehensive and does not necessarily include all interventions and approaches meeting the criteria described above. For example, as explained below, interventions have been excluded if no appropriate coverage indicator is available. In addition, the Countdown strives to limit the total number of interventions and indicators to keep the effort manageable and focused. The criteria used to assess potential coverage indicators were based on the normative principle that a ‘good’ coverage indicator should provide a valid measure of whether the target population for a given intervention receives it when it is needed and when it is clinically effective. In addition, though, indicators used for the Countdown must produce results that are: Nationally representative. Reliable and comparable across countries and time Clear and easily interpreted by policy makers and program managers. Available regularly in most of the Countdown priority countries. None of the 68 priority countries has a health information system that can now produce coverage estimates meeting the standards described above for all indicators.11 Fortunately, most of the Countdown coverage indicators used in 2005 have since been included in the protocols for the major population- based surveys used in the 68 priority countries – usually either the UNICEF-supported Multiple Indicator Cluster Surveys16 or the Demographic and Health Surveys supported by the United States Agency for International Development.17 Exceptions include interventions for which data collection and the analysis of coverage indicators are not yet routine or harmonised, such as unmet need for family planning or a postnatal visit for the newborn within two days of birth. In addition, coverage estimates for vaccinations, vitamin A supplementation and the prevention of mother-to-child transmission of HIV/AIDS reflect the synthesis of routine program data and data from household surveys. Annex B lists the data sources for all indicators included in the 2008 Countdown cycle. The 2008 Countdown coverage indicators The Countdown builds on the work of others. Coverage estimates and trends for HIV-related interventions, immunisation, vitamin A supplementation and water and sanitation reflect the work of various interagency working groups described more fully below. For other indicators the Countdown reports available estimates but recognizes the need for improvement in data availability and estimation methods. (Annex C defines the Countdown 2008 coverage indicators.) • • • • Table 2.1. Countdown priority countries compared with the number of countries in each region and as a percentage of each region’s population, 2006, by region Countdown Countries Compared by Region Source: UNICEF 2007c Region Countdown priority countries (n=68) Compared with number of countries in region Percentage of region’s population (2006) Number of Countdown countries Number of countries in region South Asia 5 8 99 Eastern and Southern Africa 18 22 99 West and Central Africa 22 24 100 Middle East and North Africa 6 20 51 East Asia and Pacific 8 29 88 Latin America and Caribbean 6 33 63 Central and Eastern Europe and the Commonwealth of Independent States 3 21 5 Industrialized countries 0 39 0 TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �0 TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �� Through its efforts the Countdown has acquired a clear view of the limitations of available coverage indicators, the data that support them and the process through which country-specific estimates are updated. A part of the Countdown work plan is addressing these issues. Coverage indicators are summarized only for countries to which they are relevant. For example, only 45 of the 68 countries have endemic malaria, defined here as documented risk of Plasmodium falciparum transmission nationwide and throughout the year.18 The country profiles estimate coverage for countries with limited geographic areas of malaria risk, but such countries are not included in the results summarized in this chapter. All Countdown priority countries are considered to need antiretroviral treatment for pregnant women with HIV/AIDS to prevent mother-to- child transmission.19 Indicators for factors that contribute to coverage The Countdown Core Group identified two prerequisites for success in attaining high, sustained and equitable levels of coverage for interventions and approaches proven to improve maternal and child survival: a supportive policy environment with adequate health systems support (including human resources) and predictable, longer term financial support. For the 2008 Countdown, technical groups were convened in each area and charged with reviewing the 2005 Countdown experience and improving on the tracking procedures. The Working Group on health policies and health systems searched for relevant indicators, prioritising those with international benchmarks for health systems strengthening and with data either available in the public domain or objectively assessable within the timeframe of the 2008 Countdown cycle. Box 2.1 shows the list of indicators finally selected through a consultative process involving the Countdown Core Group, health systems experts and experts in maternal, newborn and child health. Each technical or intersectoral policy identified as critical to maternal, newborn and child health was coded as being either fully adopted at country level (‘Yes’), partially adopted (‘Partial’) or not adopted (‘No’; see annex table D1). The inclusion of a policy or plan does not necessarily reflect the extent or quality of implementation, but can often be a prerequisite for effective programme action. (Annexes B and D present further information on data sources, definitions and coding criteria for each indicator.) The Countdown has worked to develop methods for tracking domestic and external financial investments in child health. Efforts through the 2005 Countdown to track official development assistance indicated that overall funding for child survival in the priority countries was insufficient and not well targeted to countries with the greatest needs.20 The present Countdown cycle’s official development assistance tracking effort has expanded to include support for maternal and newborn activities in the priority countries. The country profiles include estimates of official development assistance to child health per child and official development assistance to maternal and neonatal health per live birth. Work on tracking domestic investments in maternal, newborn and child health has also progressed. The most promising method identified by the Working Group was to build on the National Health Accounts approach21 and develop specific procedures for a sub analysis of resources directed to maternal, newborn and child health, including reproductive health. Results on a greater number of countries are expected in the next Countdown cycle. Tracking improvements in equity Efforts to monitor coverage for interventions proven to reduce maternal and child mortality are incomplete without measures of equity, defined here as the extent to which mothers and children in different socioeconomic or ethnic groups or children of different sexes are equally likely to receive services. Each 2005 Countdown country profile included a graph showing the proportion of children under age five in two population quintiles – the poorest and the least poor – who were receiving six or more preventive child survival interventions.22 In the 2008 Countdown cycle we focus on socioeconomic inequities across a broader set of interventions. Because curative services are needed only by particular subpopulations in response to particular health events, we developed a new measure reflecting the gap between universal coverage for an intervention (100 per cent of the population in need) and current coverage for each country. This ‘coverage gap’ measure includes eight interventions grouped into four areas: Family planning (need met or modern contraceptive use). Maternal and newborn care (antenatal care and skilled birth attendance). Immunisation (measles vaccine, Bacille Calmette- Guerin vaccine against tuberculosis and third dose of diphtheria and tetanus with pertussis vaccine). Treatment of child illness (medical care sought for acute respiratory infection and oral rehydration therapy with continued feeding for diarrhoea). Larger coverage gaps indicate poorer coverage for these interventions; smaller coverage gaps indicate better coverage. Thus, while the coverage gap across wealth quintiles represents coverage inequities within a country, it can also be compared with other countries’ coverage gaps to suggest intracountry coverage inequities. (Annex E offers further details about the construction of the coverage gap measure and guidance on its interpretation.) 1. 2. 3. 4. Data sources and methods The Countdown aims to bring together data on coverage for interventions and approaches with proven effectiveness in reducing maternal, newborn and child survival, making this information readily accessible and spurring donors and policy makers to action. The Countdown does not normally collect new coverage data. This section describes the sources of Countdown data (listed for each indicator in annex B) and the quality control mechanisms that are already in place to assess and ensure their validity. Any secondary analysis carried out solely for the Countdown’s use is described in detail. The section follows the order in which indicators are presented on the country profiles available in chapter 4. Child and maternal mortality Country-specific estimates of mortality in children under age five were abstracted from tables in The State of the World’s Children 2008.23 The methods and limitations associated with these estimates are available elsewhere.24 Country-specific cause-of- death profiles were abstracted from World Health Organization statistical databases,25 based on work by the Child Health Epidemiology Reference Group.26 Progress towards Millennium Development Goal 4 was assessed by determining whether the average annual rate of reduction in mortality in children under age five from 1990–2006 matched or exceeded the rate needed from 2007–2015 if the goal is to be met. If a country’s mortality rate in children under age five is less than 40 per 1,000 live births, or greater than or equal to 40 with an average annual reduction rate of at least 4 per cent for 1990–2006, it is considered on track’. If the country’s mortality rate in children under age five is greater than or equal to 40 and the average annual reduction rate for 1990–2006 was between 1.0 per cent and 3.9 per cent, the country is considered to be making ‘insufficient progress’. If the mortality rate in children under age five is greater than or equal to 40 and the average annual reduction rate for 1990–2006 was less than 1.0 per cent, the country is considered to be making ‘no progress’. Country-specific maternal mortality ratios per 100,000 live births reflect 2005 data,27 drawing on estimates developed by the Maternal Mortality Working Group. Because large uncertainty margins surround these estimates, progress towards Millennium Development Goal 5 – improving maternal health – was assessed using four broad categories for maternal mortality: low (maternal mortality ratio of less than 100), moderate (maternal mortality ratio of 100–299), high (maternal mortality ratio of 300–549) and very high (maternal mortality ratio of 550 or greater).28 Box 2.1. Health policies and health systems indicators tracked in the 2008 Countdown Countries with adopted national policies indicating: International Code of Marketing of Breastmilk Substitutes adopted. International Labour Organization Convention 183 on Maternity Protection ratified. Notification of maternal deaths. Midwives authorized to administer a core set of life-saving interventions. Integrated management of childhood illness guidelines adapted to cover newborns 0–1 week of age. Low osmolarity oral rehydration salts and zinc supplements for the management of diarrhoea. Community management of pneumonia with antibiotics. Costed implementation plan or plans for maternal, newborn and child health available. National indicators of health system preparedness to improve maternal, newborn and child health Per capita total expenditure on health (at international US dollar rate). Government expenditure on health as a percentage of total government expenditure. Out-of-pocket expenditure as a percentage of total expenditure on health. Density of physicians, nurses and midwives per 1,000 people. Availability of emergency obstetric care services as a percentage of recommended minimum. • • • • • • • • • • • • • Health Policies and Health Systems Indicators TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �� TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �� Nutritional status The Countdown country profiles include nutritional status indicators (such as underweight prevalence, stunting prevalence, wasting prevalence and incidence of low birthweight) as an important reference point for interpreting coverage. Country-specific estimates for nutritional status indicators29 were adjusted to reflect new World Health Organization growth standards.30 An exception is estimates of low birthweight, which are not dependent on the growth standards and have been adjusted here for high underreporting (especially in sub-Saharan Africa).31 Coverage Data sources and quality. Household surveys are the primary data source for tracking progress in coverage for maternal, newborn and child survival. The main sources of coverage data for the Countdown are UNICEF’s global databases and the coverage estimates in its annual The State of the World’s Children reports. The two most important sources of household survey data are the Multiple Indicator Cluster Surveys (MICS) and the Demographic and Health Surveys (DHS). The latest protocols for these two surveys permit collecting harmonised information on most of the Countdown coverage indicators. The remaining coverage estimates come from several sources. The latest available coverage data and methods of estimating coverage for antiretroviral treatment to prevent mother-to-child HIV transmission reflect harmonised estimates developed by the Joint United Nations Programme on HIV/AIDS (UNAIDS), UNICEF and the World Health Organization. Based on denominators derived from unpublished HIV estimates for 2007 by the Joint United Nations Programme on HIV/AIDS and the World Health Organization, these harmonised estimates are more recent than those published in UNICEF’s The State of the World’s Children 2008. Data on Caesarean section prevalence are drawn from the Demographic and Health Surveys. Many groups share responsibility for the quality control of the coverage estimates for interventions and approaches effective in reducing maternal, newborn, and child mortality. Table 2.2 summarizes quality review and improvement mechanisms for the maternal, newborn and child health coverage indicators, together with selected mortality measures. A number of methodological challenges in coverage measurement have been known for some time. The Countdown throws these challenges into relief. They will be prioritized as part of the Countdown technical work plan in the next reporting cycle. One area that these data points being at least three years apart. We calculated the difference in the coverage estimates and divided it by the number of years between the two point estimates. This product was then multiplied by three to produce a three-year estimate, resulting in a continuous variable across the 68 countries. Coverage patterns for the interventions and approaches presented in the country profiles were also analyzed for the continuum of care. This was done by counting the number of countries that had coverage levels for four of the component indicators of at least 10 per cent, at least 20 per cent, at least 30 per cent and so on. The Countdown countries that were included in the summary estimates for each coverage indicator met the following criteria, consistent with those used in global reporting: Only data from countries with available coverage estimates for 2000–2006 were used. Countries with summary measures from years or • • time periods other than 2000–2006, or with data that differ from the standard definition or refer only to part of a country, were excluded from the analysis. Exceptions to this rule are coverage estimates for vitamin A supplementation, which refer only to 2005 data, and coverage estimates for measles immunisation, neonatal tetanus protection, the third dose of diphtheria and tetanus with pertussis vaccine (DPT3) and the third dose of haemophilus influenzae type B vaccine (Hib3), which refer only to 2006 data. Policies, health systems and financial flows Information on country-specific policies related to maternal, newborn and child health was obtained from staff of the UNICEF and World Health Organization offices in the 68 priority countries in November 2007. These reports were then reviewed and confirmed with technical staff in the relevant programme area at UNICEF’s New York headquarters and the World Health Organization headquarters in Geneva. The information on emergency obstetric care was derived Review Group Coverage or mortality indicators Membership Interagency Child Mortality Estimation Group None at present (Develop joint estimates for under-five, infant and neonatal mortality) International organizations (UNICEF, WHO, The World Bank, UN Population Division) Academia and institutions (Harvard and others) Malaria Monitoring and Evaluation Reference Group (MERG) Use of insecticide-treated nets by children under five Treatment of fever among children under five Intermittent preventative treatment for prgnant women (malaria; IPTp) International organizations (UNICEF, MACEPA, WHO, USAID, The World Bank, The Global Fund) Academia and institutions (Macro International, CDC, LSHTM, others) Joint Monitoring Program (JMP) for Water Supply and Sanitation and Technical Advisory Group Use of improved drinking water sources Use of improved sanitation facilities International organizations (UNICEF, WHO, The World Bank, USAID) Academia and institutions (LSHTM, Macro International and others) HIV/AIDS Monitoring and Evaluation Reference Group (MERG) HIV+ pregnant women receiving ARVs for PMTCT International organizations (UNAIDS, UNICEF, WHO, UNFPA and others) Academia and institutions (various) WHO UNICEF Joint Working Group on Immunizations Measles vaccination DPT vaccination Hib vaccination International organizations (UNICEF, WHO) Child Health Epidemiology Reference Group (CHERG) None at present (Conduct systematic reviews on cause-specific mortality, morbidity and risk factors, including nutrition) International organizations (UNICEF, WHO, UNFPA, CDC, Save the Children US and others) Academia and institutions (Johns Hopkins, LSHTM, others) Interagency group for maternal mortality estimation and trend analysis None at present (Develop joint maternal mortality estimates and new methodology for trend analysis; Prepare regional workshops to explain methodology and promote data analysis and use) International organizations (UNICEF, WHO, UNFPA, World Bank, UN Population Division) Academia and institutions (Harvard and others) needs urgent attention is the development of standard procedures for estimating uncertainty. The 2008 report presents point estimates and makes no attempt to estimate precision or provide uncertainty ranges. Data summary and analysis. The Countdown focuses on accelerating coverage improvements at the country level. Therefore, in summarizing the results this report uses the country as its unit of analysis, consistent with the need for in-depth country-by-country analysis and action. The most appropriate summary measures for this purpose are the median, which gives each of the 68 countries an equal weight, and the range, which illustrates the extent of the variation among countries. All Countdown Core Group members were invited to participate in a consultative process to agree on the most important aspects of the country-specific findings and their implications for achieving Millennium Development Goals 4 and 5. Meetings were held in Addis Ababa (2 December 2007), Geneva (10 December 2007) and New York (12 January 2008). At each meeting participants examined preliminary results and agreed on the most important findings and their implications for continued implementation efforts. These findings were then shared with the broader Countdown Core Group through a draft report, resulting in extensive further discussion and agreement on the conclusions presented here. In 2005, summaries of performance across the priority countries for each indicator were categorized in three ways – on track’, ‘watch and act’ or ‘high alert’ – based on international targets. For indicators without targets, categorizations across the priority countries were based on arbitrary thresholds for high, middle and low performance. In 2008 the challenge was to compare progress over time as well as across countries. Countries were first grouped into the 2005 categories for each indicator. But since the number of countries had increased from 60 in 2005 to 68 in 2008 – resulting in a lack of data for one of the two years in some countries – summaries like those presented in 2005 proved difficult to produce, and an alternative approach to summary analysis was devised. For the 2008 Countdown, then, progress is measured by the average annual percentage point change in coverage for each indicator, standardized to a three- year reference period to conform to the Countdown reporting cycle. Using the databases containing the trend information presented in the 2008 country profiles, we identified the subset of countries that had two data points for each indicator since 1998 with Table 2.2. Quality review and improvement mechanisms for country-specific estimates of coverage and mortality Quality Review and Improvement Mechanisms Source: Author’s compilation based on data as described in the report TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �� TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �� from a joint Averting Maternal Death and Disability– UNICEF database. Averting Maternal Death and Disability and UNICEF headquarters staff reviewed initial country assessments and consulted country staff, United Nations Population Fund colleagues and other experts to determine the reliability of the data. The Countdown Working Group on Financial Flows analysed and coded the complete aid activities database for 2005, using the methodology for the 2005 Countdown cycle.32 The analysis included all 22 donor countries and the European Union, represented in the Development Assistance Committee of the Organisation for Economic Co-operation and Development. The World Bank, UNICEF, the Joint United Nations Programme on HIV/AIDS, the Global Alliance for Vaccines Initiative and the Global Fund to Fight AIDS, Tuberculosis and Malaria were included as multilateral development organisations and global health initiatives. Consistent with earlier analyses, the United Nations Population Fund was treated as a delivery channel and does not appear in the donor list. Because it is a significant supporter of maternal and reproductive health efforts, this approach will be reviewed in future work. For all but one of the donors the analysis used data from the Creditor Reporting System database, which is maintained and administered by the Organisation for Economic Co-Operation and Development.33 The analysis also includes disbursement data provided by the Global Alliance for Vaccines Initiative. Disbursements by the Global Fund to fight AIDS, Tuberculosis and Malaria were already included in the Creditor Reporting System database; the Working Group triangulated the information with the data that the Global Fund to Fight AIDS, Tuberculosis and Malaria provided on its website. The Creditor Reporting System database shows no reported disbursements for Norway, only commitments. Results are reported for two groups: first, children under five years of age; second, mothers and newborns. Both categories include financial flows for nutrition, so far as these could be identified – although nutrition is not defined as a separate category. Equity The 2008 Countdown country profiles present the coverage gap by wealth quintiles, drawing on Multiple Indicator Cluster Surveys and Demographic and Health Surveys conducted since 1990. In particular, the profiles show: The absolute size of the coverage gap (the difference between universal coverage for these eight interventions and actual coverage as measured in each survey). The ratio between the gap in the poorest and the least poor (‘best-off’) quintile of the population. The absolute difference between the two quintiles. Larger gaps reflect poorer coverage; smaller gaps reflect better coverage. The coverage data used to construct the coverage gap index for each country, as well as its wealth quintiles, are based on national Demographic and Health Surveys34 and Multiple Indicator Cluster Surveys. Where multiple surveys were available for a Countdown country, all data were used to assess current levels and trends in the coverage gap measure by wealth quintile. Data on coverage for key interventions by wealth quintile were available from surveys conducted since 1990 for 53 of the 68 Countdown priority countries. Forty countries had more than one survey, 22 more than two surveys. The coverage gap was analyzed by wealth quintiles using a standard methodology.35 (Further details about the analysis methods are in annex E.) • • • 1 UNICEF 2005. 2 UNICEF 2004. 3 WHO, UNICEF, UNFPA and World Bank 2007; UNICEF 2007c; Hill, Thomas, AbouZahr and others 2007. 4 Glewwe, 1999; Schell, Reilly, Rosling and others 2007. 5 Pedersen 2002; Al Gasseer, Dresden, Keeney and others 2004. 6 Noji 2000. 7 UNICEF 2006b. 8 UNICEF 2007c. 9 UNICEF 2007a; UNAIDS and WHO 2007; UNAIDS 2007. 10 UNICEF 2007c. 11 World Bank n.d. 12 Personal communication from Edilberto Loaiza, DPP/SIS UNICEF, 25 January 2008, based on a recent analysis by UNICEF of the Uppsala conflict database, the Conflict Barometer of the Heidelberg Institute for International Conflict Research, and Project Ploughshares 2007.the Project Ploughshares’ Armed Conflicts Report 2007. 13 Emergency Events Database n.d. 14 Jones, Steketee, Black and others 2003; Darmstadt, Bhutto, Cousens and others 2005. 15 Tinker, ten Hoope-Bender, Azfar and others 2005; Kerber, de Graft- Johnson, Bhutta and others 2007. 16 UNICEF n.d. 17 Measure DHS, MACRO International, Inc. n.d. 18 WHO 2007a. 19 UNICEF 2007c; UNICEF 2007a; UNAIDS and WHO 2007; UNAIDS 2007. 20 Powell-Jackson, Borghi, Mueller and others 2006. 21 World Bank, WHO and USAID 2003. 22 Bryce, Terreri, Victora and others 2006. 23 UNICEF 2007c. 24 UNICEF, WHO, World Bank and UNPD 2007. 25 WHO 2007b. 26 Bryce, Boschi-Pinto, Shibuya and others 2005. 27 UNICEF 2007b, p. 27. 28 Hill, Thomas, AbouZahr and others 2007. 29 UNICEF 2007c, pp. 118–21. 30 WHO 2006a. 31 Blanc and Wardlaw 2005. 32 Powell-Jackson, Borshi, Mueller and others 2006. 33 IDS n.d. 34 Gwatkin, Rutstein, Johnson and others 2007. 35 Filmer and Pritchett 2001. Notes © U N IC EF /H Q 04 -1 22 0/ A m i V ita le TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �� TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �� 3The 2008 Countdown findings – and a call to action The Countdown’s most important findings appear in the individual country profiles, which answer basic questions about maternal, newborn and child survival. For example: What proportion of women, newborns and children have benefited from life-saving interventions? Are there coverage gaps? Are supportive policies in place? Are adequate resources directed to maternal, newborn and child health? How equitable is existing coverage? Aggregated statistics often mask the answers to such questions, making it difficult to see where the problems are and the steps needed to address them. This chapter summarises information from the 68 country profiles in simple ways that can be useful for planning country programmes and future analyses, and the text follows the layout of the country profiles. We begin with a summary of the epidemiological context in the 68 countries, continue by examining coverage levels and equity in coverage, and end with information about health system policies and financial flows. Where the data are sufficient we highlight trends, and especially progress or its absence, since about 2000. Finally, this chapter presents the core group’s preliminary conclusions capped by a Countdown call to action The bottom line: mortality Coverage indicators for effective interventions and approaches are linked to mortality reduction. The correlation between coverage indicators and mortality in children under age five is very strong.1 The correlation is less strong for maternal mortality2 – suggesting that coverage, though a necessary condition for impact, may not be sufficient when care is substandard. • • • • • Table 3.1 shows progress towards Millennium Development Goal 4 – reducing child mortality – in the 68 Countdown priority countries. Most have under- five mortality rates greater than 40. Such countries are considered ‘on track’ if their under-five mortality rates from 1990–2006 showed an average annual reduction rate of at least 4.0 per cent, roughly the improvement needed for all developing countries to achieve Millennium Development Goal 4. All countries with under-five mortality rates of less than 40 are considered ‘on track.’ For the 2008 Countdown cycle, 16 of 68 countries (24 per cent) were judged ‘on track,’ compared with 7 of 60 (12 per cent) in 2005. Seven countries which had been ‘on track’ in reducing child mortality in 2005 retained that status in 2008 (Bangladesh, Brazil, Egypt, Indonesia, Mexico, Nepal and the Philippines). Among the remaining nine ‘on track’ countries in 2008, three had been included in the Countdown in 2005 and made demonstrable progress in reducing child mortality since then (China, Haiti and Turkmenistan). The six remaining ‘on track’ countries participated in the Countdown for the first time in 2008 (Bolivia, Eritrea, Guatemala, Lao People’s Democratic Republic, Morocco and Peru). Twenty-six of the 68 priority countries (38 per cent) were judged to have made insufficient progress in reducing child mortality in 2008, and 26 (38 per cent) no progress at all.3 In twelve countries the average annual rates of reduction in under-five mortality since 1990 were negative (Botswana, Cameroon, Central African Republic, Chad, Congo, Equatorial Guinea, Kenya, Lesotho, South Africa, Swaziland, Zambia and Zimbabwe), indicating that child mortality has increased. © U N IC EF /H Q 06 -2 76 5/ B ru no B rio ni TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �� TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �� Neonatal deaths – deaths in the first month of life – account for 40 per cent of deaths in children under age five, or four million worldwide deaths each year.4 As countries reduce deaths of children under age five, the proportion of children dying in the neonatal period typically increases. Reaching Millennium Development Goal 4 will require specific attention to achieving good coverage for interventions to reduce neonatal mortality. Latin America and South-East Asia have made substantial progress in reducing neonatal mortality rates. Africa has made no measurable progress. In South Asia progress has been minimal, though a few countries such as Bangladesh and Nepal have achieved substantial reductions.5 Annual country-level data or estimates for neonatal mortality are an important adjunct to tracking for Millennium Development Goal 4. Although Demographic and Health Surveys produce neonatal mortality rates, Multiple Indicator Cluster Surveys currently do not. Careful assessment of data reliability and a transparent methodology for developing estimates, where data on neonatal mortality rates are not available, are urgently needed for tracking progress towards Millennium Development Goal 4. Reducing stillbirths also requires more attention and depends on improved data collection and monitoring. Up to 3.2 million babies are dying each year during the last 12 weeks of pregnancy.6 In addition to under-five mortality rates, table 3.1 presents the best available estimates of maternal mortality ratios for the 68 Countdown priority countries. Country-specific maternal mortality ratios are the basis for judging progress towards Millennium Development Goal 5 – improving maternal survival. Because large uncertainty margins surround these estimates, progress towards Millennium Development Goal 5 was assessed using four broad categories for maternal mortality: low (maternal mortality ratio of less than Progress Towards Millennium Development Goals 4 and 5 Country or territory Millennium Development Goal 4 (reduce by two-thirds, between 1990 and 2015, the mortality rate in children under age five) Millennium Development Goal 5 (reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio)a Under-five mortality rate Millennium Development Goal target 2015 Average annual rate of reduction (%) Progress towards the Millennium Development Goal target Maternal mortality ratio (2005, adjusted) Lifetime risk of maternal death (2005) 1 in: Level of maternal mortality1990 2006 Observed 1990–2006 Required 2007–2015 Afghanistan 260 257 87 0.1 12.1 No progress 1,800 8 Very high Angola 260 260 87 0.0 12.2 No progress 1,400 12 Very high Azerbaijan 105 88 35 1.1 10.2 Insufficient 82 670 Low Bangladesh 149 69 50 4.8 3.6 On track 570 51 Very high Benin 185 148 62 1.4 9.7 Insufficient 840 20 Very high Bolivia 125 61 42 4.5 4.2 On track 290 89 Moderate Botswana 58 124 19 –4.7 20.7 No progress 380 130 High Brazil 57 20 19 6.5 0.6 On track 110 370 Moderate Burkina Faso 206 204 69 0.1 12.1 No progress 700 22 Very high Burundi 190 181 63 0.3 11.7 No progress 1,100 16 Very high Cambodia 116 82 39 2.2 8.3 Insufficient 540 48 High Cameroon 139 149 46 –0.4 13.0 No progress 1,000 24 Very high Central African Republic 173 175 58 –0.1 12.3 No progress 980 25 Very high Chad 201 209 67 –0.2 12.6 No progress 1,500 11 Very high China 45 24 15 3.9 5.2 On track 45 1300 Low Congo 103 126 34 –1.3 14.5 No progress 740 22 Very high Congo, Democratic Republic of the 205 205 68 0.0 12.2 No progress 1,100 13 Very high Côte d’Ivoire 153 127 51 1.2 10.1 Insufficient 810 27 Very high Djibouti 175 130 58 1.9 8.9 Insufficient 650 35 Very high Egypt 91 35 30 6.0 1.6 On track 130 230 Moderate Equatorial Guinea 170 206 57 –1.2 14.3 No progress 680 28 Very high Eritrea 147 74 49 4.3 4.6 On track 450 44 High Ethiopia 204 123 68 3.2 6.6 Insufficient 720 27 Very high Gabon 92 91 31 0.1 12.1 No progress 520 53 High Gambia 153 113 51 1.9 8.8 Insufficient 690 32 Very high Ghana 120 120 40 0.0 12.2 No progress 560 45 Very high Guatemala 82 41 27 4.3 4.5 On track 290 71 Moderate Guinea 235 161 78 2.4 8.0 Insufficient 910 19 Very high Guinea-Bissau 240 200 80 1.1 10.2 Insufficient 1,100 13 Very high Haiti 152 80 51 4.0 5.1 On track 670 44 Very high India 115 76 38 2.6 7.6 Insufficient 450 70 High Indonesia 91 34 30 6.2 1.3 On track 420 97 High Iraq 53 46 18 0.9 10.6 No progress 300 2 High Kenya 97 121 32 –1.4 14.7 No progress 560 39 Very high Korea, Democratic People’s Rep 55 55 18 0.0 12.2 No progress 370 140 High Lao People’s Democratic Republic 163 75 54 4.9 3.6 On track 660 33 Very high Lesotho 101 132 34 –1.7 15.2 No progress 960 45 Very high Liberia 235 235 78 0.0 12.2 No progress 1,200 12 Very high Madagascar 168 115 56 2.4 8.0 Insufficient 510 38 High Malawi 221 120 74 3.8 5.4 Insufficient 1,100 18 Very high Mali 250 217 83 0.9 10.6 No progress 970 15 Very high Mauritania 133 125 44 0.4 11.5 No progress 820 22 Very high Mexico 53 35 18 2.6 7.6 On track 60 670 Low Morocco 89 37 30 5.5 2.4 On track 240 150 Moderate Mozambique 235 138 78 3.3 6.3 Insufficient 520 45 High Myanmar 130 104 43 1.4 9.7 Insufficient 380 110 High Nepal 142 59 47 5.5 2.5 On track 830 31 Very high Niger 320 253 107 1.5 9.6 Insufficient 1,800 7 Very high Nigeria 230 191 77 1.2 10.1 Insufficient 1,100 18 Very high Pakistan 130 97 43 1.8 9.0 Insufficient 320 74 High Papua New Guinea 94 73 31 1.6 9.4 Insufficient 470 55 High Peru 78 25 26 7.1 –0.4 On track 240 140 Moderate Philippines 62 32 21 4.1 4.8 On track 230 140 Moderate Rwanda 176 160 59 0.6 11.1 No progress 1,300 16 Very high Senegal 149 116 50 1.6 9.4 Insufficient 980 21 Very high Sierra Leone 290 270 97 0.4 11.4 No progress 2,100 8 Very high Somalia 203 145 68 2.1 8.5 Insufficient 1,400 12 Very high South Africa 60 69 20 –0.9 13.8 No progress 400 110 High Sudan 120 89 40 1.9 8.9 Insufficient 450 53 High Swaziland 110 164 37 –2.5 16.6 No progress 390 120 High Tajikistan 115 68 38 3.3 6.4 Insufficient 170 160 Moderate Tanzania, United Republic of 161 118 54 1.9 8.7 Insufficient 950 24 Very high Togo 149 108 50 2.0 8.6 Insufficient 510 38 High Turkmenistan 99 51 33 4.1 4.8 On track 130 290 Moderate Uganda 160 134 53 1.1 10.2 Insufficient 550 25 Very high Yemen 139 100 46 2.1 8.6 Insufficient 430 39 High Zambia 180 182 60 –0.1 12.3 No progress 830 27 Very high Zimbabwe 76 105 25 –2.0 15.8 No progress 880 43 Very high a. Due to the large margins of uncertainty around these estimates, country-level trend analysis is problematic. Progress towards this Millennium Development Goal is therefore assessed based on the latest available estimates and is classified according to the following thresholds: Very high: maternal mortality ratio of 550 or more; High: maternal mortality ratio of 300–549; Moderate: maternal mortality ratio of 100–299; Low: maternal mortality ratio below 100. Source: UNICEF 2007a Table 3.1. Progress towards Millennium Development Goals 4 and 5. TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �0 TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �� 100), moderate (maternal mortality ratio of 100–299), high (maternal mortality ratio of 300–549) and very high (maternal mortality ratio of 550 or greater). Of the 68 priority countries, 56 (82 per cent) have either high or very high maternal mortality ratios. Only three have low maternal mortality ratios (Azerbaijan, China and Mexico). In table 3.1, the column for lifetime risk of maternal death reflects the combined input of risks associated with each birth (the maternal mortality ratio) and the total exposure to risk represented by the total number of births (the total fertility rate). Lifetime risk of maternal death varies widely across the priority countries, from 1 in 7 (Niger) to 1 in 1,300 (China). As explained in chapter 2, reproductive health will receive special attention in the next cycle of the Countdown. Comparisons of country-specific progress towards Millennium Development Goal 4 and Millennium Development Goal 5 show that the great majority of the priority countries (50 of 68) are judged to be doing poorly in both areas, with either ‘no progress’ or ‘insufficient progress’ towards Millennium Development Goal 4 and either ‘high’ or ‘very high’ maternal mortality ratios. The remaining 18 countries, however, are making good progress towards Millennium Development Goal 4, Millennium Development Goal 5 or both (table 3.2). A closer look at the country profiles for the 10 countries making good progress towards both Millennium Development Goal 4 and Millennium Development Goal 5 is encouraging, since several are among the priority countries with the largest populations. Summary of Progress Good progress towards Millennium Development Goal 4 and Millennium Development Goal 5 Good progress towards Millennium Development Goal 4 but not Millennium Development Goal 5 Good progress towards Millennium Development Goal 5 but not Millennium Development Goal Number of countries 10 6 2 Countries Bolivia, Brazil, China, Egypt, Guatemala, Mexico, Morocco, Peru, the Philippines, Turkmenistan Bangladesh, Eritrea, Haiti, Indonesia, Lao People’s Democratic Republic, Nepal Azerbaijan, Tajikistan Nutritional status Undernutrition is the underlying cause of over one- third of deaths among children under age five. And it is the underlying cause of one-fifth of maternal deaths in childbirth.7 The aim of Millennium Development Goal 1 – eradicating extreme poverty and hunger – is inextricably linked to achieving Millennium Development Goals 4 and 5.8 One target for Millennium Development Goal 1, “to halve, between 1990 and 2015, the proportion of people who suffer from hunger,”9 is now monitored through an indicator of underweight prevalence among children under age five. Underweight can reflect either wasting (low weight-for-height, indicating acute weight loss), or much more commonly, stunting (low height-for-age, indicating chronic restriction of a child’s potential growth).10 Table 3.3 shows the Countdown priority countries that are ‘on track’ for the underweight target of Millennium Development Goal 1, based on their average annual rate of reduction in underweight prevalence. Table 3.3. Countdown countries making ‘no progress’ or ‘on track’ towards achieving the underweight target of Millennium Development Goal 1 (2008) Progress Towards Underweight Targets Source: UNICEF 2007b No progress (n=15) On track (n=16) Burkina Faso Afghanistan Burundi Bangladesh Cameroon Bolivia Central African Rep. Botswana Djibouti Brazil Lesotho Cambodia Madagascar China Niger Congo Sierra Leone Ghana Somalia Guatemala South Africa Guinea-Bissau Sudan Indonesia Togo Malawi Yemen Mauritania Zimbabwe Mexico Peru Many countries with a high burden of maternal and child undernutrition also show high maternal mortality rates and high mortality rates in children under age five. Of the 36 countries that account for 90 per cent of the world’s estimated 178 million stunted children,11 34 are among the 68 Countdown priority countries (the exceptions are Viet Nam and Turkey). The Countdown country profiles include data on underweight, wasting, stunting and low birthweight as contextual information important to interpreting coverage levels for interventions to reduce maternal, newborn and child mortality. Underweight, wasting and stunting estimates (table 3.4) have been adjusted using the new World Health Organization Child Growth Standards.12 In 33 of the 68 priority countries, at least 20 per cent of children are either moderately or severely underweight. Among the 67 countries with stunting prevalence data, 62 have stunting prevalence of at least 20 per cent and 12 have stunting prevalence of more than 50 per cent. A recent analysis showed that stunting rates could be reduced by at least 36 per cent in countries with rates of 20 per cent or more by achieving high coverage for interventions that are already available and affordable in developing countries.13 Results from the 2008 Countdown show that progress in coverage for such interventions remains unacceptably low. Table 3.4. Nutritional status indicators in the Countdown priority countries (n=68) Nutritional Status Source: UNICEF 2007c, adapted based on new World Health Organization growth standards Number of countries Number of Countdown priority countries with prevalence among under-fives < 5% 5–19% 20–30% 31–50% >50% Underweight moderate or severe 68 1 34 16 17 0 Stunting moderate or severe 67 0 5 11 39 12 Wasting moderate or severe 66 11 51 4 0 0 Babies who are born at term (after 37 weeks of gestation) but with low birthweight (less than 2,500 grams) are likely to have experienced intrauterine growth restriction, which is rarely a direct cause of neonatal death but is an indirect contributor to neonatal mortality.14 Monitoring low birthweight is difficult in developing countries, where fewer than 6 in 10 newborns are weighed at birth. A procedure to adjust for the missing data, and for the bias introduced when mothers report birthweight inaccurately, was developed in 200415 and has since been applied to estimates of low birthweight prevalence.16 Estimates are available for 65 of the 68 priority countries.17 The median low birthweight prevalence in these 65 countries is 13, with a range from 2 per cent (China) to 32 per cent (Yemen). Maternal and child nutrition need to be improved more vigorously and rapidly in most of the 68 Countdown priority countries. Nutrition during the period from pre-pregnancy through 24 months is associated with adult health and productivity.18 And weighing newborns, though not a lifesaving measure, should be a part of packaged maternal, newborn and child health interventions because it yields critical monitoring information. © U N IC EF /H Q 05 -1 87 0/ D on na D eC es ar e Source: Abstracted from UNICEF 2007b Table 3.2. Summary of progress towards Millennium Development Goals 4 and 5 TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �� TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �� Table 3.5 highlights three points with important programming implications: Overall coverage levels remain too low. Figure 3.2 shows the distribution of median coverage across 18 interventions and approaches tracked through the Countdown. Of these 18, only the 4 vaccination interventions are reaching 80 per cent of the children who could benefit from them. The empty space in the chart represents millions of • deaths each year that could be prevented if all interventions were universally available. Median coverage estimates vary widely across different interventions. Such variations can reflect the different characteristics of interventions, such as how each is delivered, how long it has been available, if it is accessible and affordable in developing countries, and the training required to deliver it adequately and with effective management and monitoring. Other reasons for coverage variations include differences between services that can be scheduled in advance (for example, through campaigns that reach children of a particular age during recommended immunisation periods) and services that must be more regularly available (such as delivery, postnatal care, family planning services or nutritional counselling). The characteristics of interventions, and their relationship to achieving high and sustained coverage, are priority areas for the Countdown’s continuing technical work. Coverage levels for all interventions show large intercountry differences. The ‘Range’ columns in table 3.5 show wide variations in coverage for each intervention across the 68 priority countries. Though a full explanation of these gaps is beyond the scope of this report, it should be a priority research topic for Countdown conference participants. Recent coverage trends This section presents results on progress by the priority countries in increasing coverage for the interventions and approaches proven effective in reducing mortality among mothers and children. As was explained in chapter 2, trend assessment is limited to those countries with coverage data for at least two points in time: one around 2000 and one around 2005. An exception is neonatal tetanus protection, for which annual coverage estimates are available; here data from 2003 and 2006 are used. (The four missing countries have no data for any year since 1980. No matter what years were used, they could not have been included in the trend analysis for neonatal tetanus protection coverage.) The inter-survey periods vary considerably; most, however, span five years. Progress is measured by calculating the average annual percentage-point change between the data point collected within two years of 2000 and the most recent data point, then standardising to a three-year period for consistency with the Countdown reporting cycle. • • Coverage in 2008 Unprecedented amounts of household survey activity in 2005–2006 have yielded new coverage estimates for most of the 68 Countdown priority countries. Figure 3.1 shows the year in which the most recent Multiple Indicator Cluster Survey19 or Demographic and Health Survey20 was conducted for each country. The years for the specific estimates presented in the country profiles deserve special attention. First, the Figure 3.1. Most recent MICS or DHS coverage data available in the 68 Countdown priority countries Most Recent MICS or DHS Coverage Data Source: Compiled by UNICEF based on MICS and DHS surveys conducted through to 2006 mortality estimates in table 3.1 may refer to periods before increases in intervention coverage reflected in the 2008 Countdown coverage estimates could have affected mortality. Second, coverage data for some countries are from around 2000. Even 2006 coverage survey results might not fully reflect recent global scaled-up efforts to meet the health-related Millennium Development Goals. The next round of Countdown reporting is expected to register such recently intensified efforts. Table 3.5 shows the latest available medians and ranges across the priority countries for the subset of coverage indicators for which: Data from at least 19 countries are available. An exception is antiretroviral prophylaxis to prevent mother-to-child transmission of HIV, which is reported separately to maintain consistency with other global reports. Postnatal care coverage, for which few countries have data, is also presented separately. • Medians and Ranges of Coverage Indicators Table 3.5. Coverage estimates for selected Countdown interventions and approaches, 68 priority countries, latest available data (2000–2006) Range Coverage indicator Number of countries Median Low High Nutrition Exclusive breastfeeding (less than six months) 63 28 1 88 Breastfeeding and complementary feeding (6–9 months) 63 62 10 91 Vitamin A supplementation: two doses 55 78 0 99 Vitamin A supplementation: at least one dose 55 90 9 100 Child health Measles immunisation 68 80 23 99 Third dose of diphtheria and tetanus with pertussis vaccine (DPT3) immunisation 68 81 20 99 Third dose of haemophilus influenzae type B vaccine (Hib3) immunisation 20 85 10 99 Oral rehydration therapy or increased fluids, with continued feeding 57 38 7 76 Children sleeping under insecticide-treated netsa 35 7 0 49 Antimalarial treatment for fevera 34 40 0 63 Careseeking for pneumonia 60 48 12 93 Antibiotic use for pneumonia 19 32 3 82 Maternal and newborn health Contraceptive prevalence rate 64 29 3 87 Unmet need for family planning 40 23 9 41 Antenatal care coverage: four or more visits 39 49 12 87 Antenatal care coverage: at least one visit 65 82 16 99 Neonatal tetanus protection 64 81 31 94 Intermittent preventive treatment for pregnant women (IPTp) for malariaa 22 7 0 61 Skilled attendant at delivery 66 53 6 100 Early initiation of breastfeeding (within one hour of birth) 47 43 23 78 Water and sanitation Use of improved drinking water sources (total) 68 69 22 100 Urban 68 87 32 100 Rural 68 56 11 100 Use of improved sanitation facilities ( total) 68 43 9 86 Urban 68 59 24 95 Rural 68 32 3 82 Coverage Levels Figure 3.2. Median national coverage levels for selected Countdown indicators and approaches across the 68 priority countries, most recent estimate Source: UNICEF 2007c a. Intervention applies only to the 45 malaria endemic priority countries. Source: Author’s analysis based on data from UNICEF global databases with contributions from WHO databases abd United Nations Population Fund databases 7 7 28 32 38 40 43 43 48 49 53 62 69 78 80 81 81 85 0 20 40 60 80 100 IPTp for malaria Children sleeping under ITNs Exclusive breastfeeding Antibiotics for pneumonia Diarrhoea treatment Malaria treatment Early initiation of breastfeeding Improved sanitation facilities Careseeking for pneumonia 4+ antenatal care visits Skilled attendant at delivery Complementary feeding (6-9 months) Improved drinking water Vitamin A supple- mentation (2 doses) Measles immunization DPT3 immunization Neonatal tetanus protection Hib3 immunization Median level of national coverage C ou nt do w n in te rv en tio ns an d ap pr oa ch es TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �� TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �� Table 3.6 summarises the trend data reported in the 2008 Countdown country profiles for select coverage indicators. The greatest reported increase is in the proportion of children sleeping under insecticide- treated nets (median: 7; range: 2 to 18), followed by neonatal tetanus protection (median: 5, range –11 to 31). Delivery care, contraceptive prevalence and diarrhoea treatment have median three-year increases of 2 percentage points. Careseeking for pneumonia has increased by a median of 1 percentage point over three years. The table shows that interventions showing steadier progress are generally preventive and deliverable on a planned schedule – unlike other interventions that must be available on demand in response to health events. Coverage levels and trends for selected programmatic areas This section summarises the most recent coverage levels, and trends in coverage levels since 2000, as presented in the 2008 Countdown country profiles. Current coverage levels and three-year progress estimates for specific subsets of interventions are described. In addition, an analysis of four component indicators associated with continuum of care for maternal, newborn and child survival. (Descriptive statistics for each coverage indicator were shown in table 3.5; trends were summarised in table 3.6. Later analyses will bring together the coverage results and measures of policy, health system strength and equity.) The Countdown is an evolving effort. Further input on methodological and programmatic issues is expected from discussions planned for the 2008 Countdown conference. Readers are cautioned that this section presents simple summary measures and that more meaningful programmatic information can be found in the profiles of coverage for the individual countries. Figure 3.3 shows the estimated percentage point change in exclusive breastfeeding in countries with adequate data to support trend analysis (n=36). Five countries have reported increases in the prevalence of exclusive breastfeeding of at least 10 percentage points over a three-year period since about 2000. But drops in coverage of similar magnitude occurred in three countries. Readers can refer to the individual country profiles to better understand these changes. Changes in Coverage Table 3.6. Summary of estimated coverage changes for selected interventions for the most recent three-year period since 2000 (for Countdown priority countries with at least two measurements since about 2000) Source: Author’s analysis based on data from UNICEF global database Average three-year change in percentage points Coverage indicator Number of countries Median Range Low High Nutrition Exclusive breastfeeding (0–5 months) 36 3 –11 29 Maternal and newborn health Antenatal care coverage (at least one visit to skilled provider) 42 4 –21 19 Births attended by skilled health personnel 45 2 –5 12 Neonatal tetanus protection 64 5 –11 31 Contraceptive prevalence rate 39 2 –7 10 Child health Careseeking for pneumonia 33 1 –10 18 Oral rehydration therapy (oral rehydration salts or recommended home fluids) or increased fluids, with continued feeding 31 2 –17 23 Children sleeping under insecticide-treated nets 19 7 2 18 Nutrition Infant and young child feeding. The recent Lancet series on maternal and child undernutrition reinforces this area’s importance and offers guidance about effective country interventions and strategies.21 Its recommendations are consistent with the Global Strategy for Infant and Young Child Feeding.22 Most of the interventions identified as effective23 are being tracked through the Countdown. The Lancet series emphasised the importance of exclusive breastfeeding in the first six months of life24 and highlighted individual and group counselling as effective ways to increase exclusive breastfeeding rates in countries with high stunting rates.25 In 2008, in the 66 priority countries with available data, the median prevalence of exclusive breastfeeding for infants less than six months old was 28 per cent (table 3.5), with a range from 1 per cent (Djibouti) to 88 per cent (Rwanda). Changes in Exclusive Breastfeeding Source: Authors’ compilation based on data from UNICEF global database (household survey data 2000–2006) Figure 3.3. Estimated percentage point change in exclusive breastfeeding over a three-year period, by country, 2000-2006 Country Change over 3 years Cambodia 29 Madagascar 20 Benin 19 Lesotho 16 Bolivia 15 Ghana 9 Haiti 8 Guinea 8 Gambia 7 Tajikistan 7 Iraq 6 Niger 6 Malawi 6 Tanzania 6 India 5 Togo 5 Rwanda 4 Cameroon 3 Central African Rep. 3 Sierra Leone 2 Country Change over 3 years Turkmenistan -1 Uganda -2 Peru -2 Cote d'Ivoire -3 Ethiopia -3 Bangladesh -4 Zimbabwe -5 Chad -6 Nepal -9 Burundi -10 Guinea Bissau -10 Egypt -11 Country Change over 3 years Burkina Faso 0 Kenya 0 Nigeria 0 Somalia 0 Percentage point change over 3-year period C ou nt do w n co un tr ie s w ith 2 c ov er ag e es tim at es (n = 35 ) 2008 Median: 29 Range: 1 - 88 -40 -20 0 20 40 TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �� TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �� Breastfeeding plus complementary foods between six and nine months is a Countdown coverage indicator reflecting the importance of ensuring that children receive adequate quantities and quality of complementary foods after six months and up to 24 months of age. This is an essential intervention to prevent stunting.26 An evidence base pointing to specific effective interventions is described in detail elsewhere.27 Two methodological problems continue to constrain coverage monitoring for complementary feeding: the lack of a consensus about a valid and measurable indicator of complementary feeding behaviour and the use of a behavioural outcome (feeding behaviour) as a proxy for the intervention or interventions that could affect that outcome. The Steering Team of the Interagency Working Group on Infant and Young Child Feeding is addressing the first issue, having recently completed a five-year programme of research to develop new and more valid indicators.28 There has also been some progress in defining effective interventions and approaches.29 This Countdown cycle relies on the existing indicator, which is not adequate to support the estimation of trends. As shown in table 3.5, among the 63 countries with coverage data available for this report, the median prevalence of complementary feeding from six to nine months was 62 per cent, with a range from 10 to 91 per cent. Ten countries reported rates of 80 per cent or more (Tanzania 91, Malawi 89, Burundi 88, Haiti and Zambia 87, Kenya 84, Cambodia 82, Peru 81, Mozambique and Uganda 80). Three countries reported prevalence rates of less than 20 per cent (Somalia 15, Tajikistan 15, Lao People’s Democratic Republic 10). Vitamin A supplementation. Of the 68 Countdown priority countries, 66 are also priority countries for vitamin A supplementation, underscoring the importance of national-level programmes to ensure high two-dose coverage in almost all the Countdown countries.30 Table 3.7 shows fairly high coverage rates for 2005, when 55 of 68 priority countries (81 per cent) reported estimates. The median for two-dose coverage of children 6–59 months of age is 78 per cent, with a range from 0 per cent (Djibouti, Papua New Guinea) to 99 per cent (Rwanda). And the median coverage for at least one dose is 90 per cent, with a range from 9 per cent (Lesotho) to 100 per cent (Rwanda). Table 3.7 shows the remarkable progress many priority countries have made in achieving gains in vitamin A coverage. From 2003–2005 the number of countries with 80 per cent two-dose coverage nearly doubled (from 12 to 22), 13 countries increased two-dose coverage by more than 20 percentage points, and 8 others sustained a rate of greater than 80 per cent (Cameroon, Malawi, Niger, Nigeria, Rwanda, Sudan, Togo, Zimbabwe). Much of this progress is attributable to including vitamin A and other low-cost, high-impact preventive child survival interventions (measles immunisation, insecticide-treated bed nets) as part of integrated child health events. However, 11 countries with available trend data still report two-dose vitamin A coverage rates of less than 80 per cent, and in two of these countries coverage has remained at 0 per cent (Djibouti, Papua New Guinea). The lack of sufficient progress in achieving high two-dose coverage rates in some priority countries is a reminder that increased efforts to institutionalise support for semi-annual delivery strategies, such as child health days, are needed to ensure that more at-risk children are fully protected from vitamin A deficiency. Also needed are outreach strategies that target areas of poor coverage within countries. Child health Immunisation. Measles immunisation is an indicator for Millennium Development Goal 4. Nearly all deaths attributable to measles in 2006 occurred in the 68 Countdown priority countries.31 In 2006, for the first time, global routine coverage rates for measles vaccination reached 80 per cent (up from 72 per cent in 1990).32 Across the Countdown priority countries, estimates based on 2006 data show median measles coverage at 80 per cent, with a range from 23 per cent (Chad) to 99 per cent (Brazil, Peru, Turkmenistan). Similarly, the estimated median coverage rate for three doses of diphtheria and tetanus with pertussis vaccine (DPT3) is 81 per cent for the 68 priority countries, with a range from 20 per cent (Chad) to 99 per cent (Brazil, Malawi, Rwanda, South Africa). A recent analysis estimated that in 2007 there were 26 million children not immunised with DPT3 and that 20 million of those children lived in just 10 countries – all of them Countdown priority countries.33 Haemophilus Influenzae Type B (Hib) vaccine is a fairly new intervention, recently recommended for delivery with DPT3 in all low-income country immunisation schedules.34 In 2005 the Countdown reported on the number of priority countries that had included haemophilus influenzae type B vaccine in their child immunisation schedules as an indicator of country responsiveness to new interventions. This report presents coverage rates for the third dose of haemophilus influenzae type B vaccine (Hib3) for the first time. Among the 68 Countdown countries, 20 had data on Hib3 coverage for 2006. The median was 85 per cent, with a range from 10 per cent (Morocco) to 99 per cent (Brazil, Malawi, Rwanda, South Africa). These results demonstrate that rapid increases in immunisation coverage are possible where a strong delivery platform already exists. © U N IC EF /H Q 04 -0 17 4/ R og er L eM oy ne H A IT I © U N IC EF /H Q 04 -1 20 2/ A m i V ita le Changes in Vitamin A Coverage Table 3.7. Trends in two-dose vitamin A coverage in Countdown priority countries, 2003–2005 Source: UNICEF Vitamin A global database 2008 Country 2003 (%) 2005 (%) Change (percentage points) Rwanda 8 99 91 Sudan 0 90 90 Zimbabwe 0 81 81 Cameroon 21 95 74 Nigeria 0 73 73 Malawi 14 86 72 Kenya 0 69 69 Eritrea 0 50 50 Haiti 0 42 42 Swaziland 0 40 40 Ethiopia 22 59 37 Niger 68 94 26 Togo 72 92 20 India 45 64 19 Cambodia 47 65 18 Burundi 0 17 17 Ghana 78 95 17 Mozambique 0 16 16 Yemen 0 15 15 Congo, The Democratic Republic of 72 87 15 Burkina Faso 80 95 15 Indonesia 62 76 14 Madagascar 84 95 11 Sierra Leone 84 95 11 Congo 0 9 9 Philippines 76 85 9 Myanmar 87 95 8 Afghanistan 85 91 6 Mali 61 66 5 Tanzania, United republic of 91 95 4 Guinea 93 95 2 Bolivia 38 39 1 Djibouti 0 0 0 Papua New Guinea 0 0 0 Korea, Democratic People’s Republic of 95 95 0 Pakistan 95 95 0 Nepal 96 96 0 Lao People’s Democratic Republic 64 62 –2 Angola 68 65 –3 Benin 95 92 –3 Bangladesh 87 82 –5 Zambia 73 66 –7 Gambia 52 16 –36 Lesotho 75 2 –73 TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �� TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �� Insecticide-treated bed nets. Another fairly new intervention, insecticide-treated bed nets have received much attention and resources at both national and international levels, with international funding for malaria control increasing dramatically over the past decade.35 Of the 68 Countdown priority countries, 45 have endemic malaria – defined here as nationwide risk of Plasmodium falciparum throughout the year.36 Figure 3.4 shows median coverage and ranges for children Changes in ITN Coverage Source: UNICEF and Roll Back Malaria, 2007 Kenya (2000, 2003) S ierra Leone (2000,2005) Cote d'Ivoire (2000,2006) S enegal (2000, 2005) Niger (2000, 2006) Burundi (2000, 2005) Burkina Fas o (2003, 2006) Uganda (2000, 2001, 2006) Rwanda (2000, 2005) Cameroon (2000, 2006) Central African Republic (2000, 2006) Tanzania, United Rep. of (1999, 2004-5) Benin (2001, 2006) Ghana (2003, 2006) Zambia (1999, 2006) Malawi (2000, 2006) Togo (2000, 2006) Guinea-Bis s au (2000, 2006) Gambia (2000, 2006) Per cent coverage 3 5 2 1 2 1 1 2 5 6 7 7 8 10 0 5 10 13 1 2 2 7 4 13 15 16 20 22 1 3 2 7 15 23 23 38 39 49 6040200 80 100 Roll Back Malaria target for 2010 Roll Back Malaria target for 2005 (Abuja) Around 2005 Around 2000 Figure 3.5. Children sleeping under ITN’s in Countdown priority countries with two coverage surveys since about 2000 ITN Coverage Source: Author’s analysis based on data from UNICEF global database (household survey data from 2000–2006) Figure 3.4. Insecticide-treated net coverage for children in the 45 countries with endemic malaria, most recent estimate, 2008. (Endemic countries defined here as countries with nationwide risk of p. falciparum throughout the year.) C ou nt do w n pr io rit y co un tr ie s (n = 45 ) Per cent coverage 0 20 40 60 80 100 Guinea, Madagascar and Sudan had “0%” coverage (see country profiles) 10 countries had no data for this indicator Median 7 Range 0 - 49 sleeping under insecticide-treated nets in those 45 countries. The median coverage is 7 per cent, with a range from 0 per cent (Guinea, Madagascar, Sudan) to 49 per cent (The Gambia). For each of the 19 priority countries with available trend data, figure 3.5 presents two successive recent estimates for insecticide-treated net coverage. While showing dramatic increases for most countries, the results also show that additional rapid improvement is needed to achieve global targets. Some programme efforts may not yet be captured in these estimates. For example, both Ethiopia and Kenya are reported to have distributed millions of nets since coverage data were last collected in 2005 (for Ethiopia) and 2003 (for Kenya).37 Future surveys are expected to document coverage rates that reflect these accelerated efforts. Antiretroviral prophylaxis to prevent mother-to- child HIV transmission. Over 90 per cent of infant and child HIV infections are passed on by mothers during pregnancy, labour, delivery or breastfeeding.38 Effective, feasible and well-known interventions to reduce such transmission could save thousands annually. Many low- and middle-income countries are scaling up national programmes to approach the global target – set by the United Nations General Assembly Special Session on HIV/AIDS in 2001 – of reaching at least 80 per cent of pregnant women with services to prevent mother-to-child HIV transmission by 2010. In a number of Countdown priority countries increased amounts of effort, resources and political commitment have significantly boosted coverage for antiretrovirals to prevent mother-to-child HIV transmission. The Countdown country profiles present trend data on HIV- infected pregnant women receiving this intervention for 2004–2006.39 Coverage increased in each of the 51 countries that reported data during that period. Progress is especially evident in Eastern and Southern African Countdown countries, where the majority of new child HIV infections occur (for example, coverage in South Africa tripled from 15 per cent in 2004 to 50 per cent in 2006). Despite the increasing trends in coverage for antiretrovirals to prevent mother-to-child transmission, progress towards meeting the United Nations General Assembly Special Session goal remains insufficient in most Countdown countries. Using an average annual 8 per cent target increase in antiretroviral coverage for each year since 2001, countries are defined as ‘on track’ if at least 48 per cent of all HIV-positive pregnant women received the intervention in 2006. Of the 51 Countdown countries that reported data, only 8 achieved that coverage rate and are considered ‘on track’ to meet the global goal of 80 percent coverage for prevention of mother-to-child transmission (Botswana, Brazil, Swaziland, Rwanda, Burkina Faso, Benin, South Africa, Kenya). Coverage rates remain low in some Countdown priority countries, particularly in sub-Saharan Africa where the greatest country HIV prevalence rates occur. All 15 Countdown countries with adult HIV prevalence of at least 5 per cent are in sub-Saharan Africa, yet in 11 of those countries coverage rates for antiretrovirals to prevent mother-to-child HIV transmission remain less than 40 per cent (table 3.8). Preventing mother-to-child HIV transmission requires giving pregnant women access to testing, safe delivery practices, antiretroviral therapy where needed and guidance for selecting safe and optimal infant-feeding options. Complementary efforts to prevent HIV transmission include providing family planning services to all women – with and without HIV infection – to increase the proportion of births that are intended. Treatment of child pneumonia, diarrhoea and malaria. Pneumonia remains the biggest killer of children40 and, together with diarrhoea and malaria, constitutes the cause of over 50 per cent of child deaths in most sub-Saharan African countries.41 Prompt and effective treatment of these three infectious diseases is essential for newborn and child survival. Prevention of Mother-to-Child HIV Transmission Table 3.8. Percentage of HIV-infected pregnant women receiving antiretrovirals to prevent mother-to-child HIV transmission in Countdown priority countries with estimated adult (age 15–49) HIV prevalence of at least 5 per cent, 2004–2006 Note: Numbers in parentheses, representing the range in coverage estimates, are based on plausibility (uncertainty) bounds in the denominator (low and high estimated numbers of HIV-infected pregnant women). — is not available. Source: For the latest available coverage data and methods of estimating coverage, UNICEF and WHO, Report Card on the Prevention of Mother-to-Child Transmission of HIV and Paediatric Care (2007); for denominators, unpublished 2007 HIV estimates by the Joint United Nations Programme on HIV/AIDS and the World Health Organization Country 2004 2005 2006 Botswana 87 (81-94) 64 (60-69) >95 --- Cameroon 11 (10–13) 10 (9–12) 22 (18–30) Central African Republic 2 (2–3) 7 (7–8) 18 (16–20) Congo 7 (6–8) 23 (20–28) 7 (6–9) Gabon — — 4 (3–5) 4 (3–5) Kenya 25 (22–29) 24 (21–28) 48 (42–59) Lesotho 7 (6–7) 15 (14–16) 17 (15–18) Malawi 4 (4–5) 8 (7–9) 14 (12–16) Mozambique 3 (3–4) 9 (8–11) 13 (11–15) South Africa 15 (13–17) 34 (29–40) 50 (43–60) Swaziland 5 (4–5) 36 (33–40) 62 (57–69) Tanzania, United Rep. of 2 (1.7–2) 6 (6–7) 15 (14–16) Uganda 9 (8–11) 15 (13–17) 25 (22–28) Zambia 18 (16–20) 19 (17–22) 35 (31–39) Zimbabwe 8 (7–8) 13 (12–14) 17 (16–19) TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �0 TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �� Coverage of antibiotic use for pneumonia in children under age five in the priority countries is low. Of all children under age five with suspected pneumonia, a median of 32 per cent receive antibiotics. Country coverage rates range from 3 per cent (Haiti) to 82 per cent (Iraq). Coverage is only slightly better for diarrhoea treatment. Of children under age five with diarrhoea, the median proportion receiving oral rehydration therapy (or increased fluids) with continued feeding is 38 per cent, with a range of 7 per cent (Botswana, Somalia) to 76 per cent (the Philippines). Antimalarial Treatment Coverage Source: Author’s analysis based on data from UNICEF global database (household survey data from 2000–2006) Figure 3.6. Antimalarial treatment coverage in the 45 countries with endemic malaria, most recent estimate, 2008. (Endemic countries defined here as nationwide risk of p. falciparum throughout the year.) C ou nt do w n pr io rit y co un tr ie s (n = 45 ) Per cent coverage 0 20 40 60 80 100 Cambodia had “0%” coverage (see country profile) 11 countries had no data for this indicator Median 40 Range 0 - 63 Figure 3.6 shows coverage for antimalarial treatment among children under age five. The results are similar to those for diarrhoea and pneumonia treatment, with a median of 40 percent across the 34 countries with available data. Changes in Treatment of Diarrhoea Source: Author’s analysis based on data from UNICEF global database (household survey data from 1998–2006) Figure 3.7. Estimated percentage point change in treatment of diarrhoea among children less than five years of age over a three-year period, by country (1998-2006). Trend data are available only for diarrhoea treatment (figure 3.7) and careseeking for pneumonia (figure 3.8). Both show limited progress – if any – over the most recent three-year period for which data are available. Pneumonia, diarrhoea and malaria, together with undernutrition, caused 54 per cent of the 10.6 million annual deaths from 2000–2003, or a total of more than 17 million deaths in newborns and children under age five.42 In the 68 Countdown priority countries, which account for 97 per cent of all child deaths, coverage rates for pneumonia, diarrhoea and malaria treatment are poor and generally not improving. The priority countries can reach more newborns and children with timely identification and treatment by adopting and implementing related policies monitored by the Countdown. The extension of integrated management of childhood illness to cover newborns, the introduction of new low osmolarity oral rehydration salts and zinc supplements for diarrhoea and policies facilitating the treatment of uncomplicated pneumonia in the community, for example, are all measures that the priority countries can introduce to reach more newborns and children with needed care. © U N IC EF /H Q 04 -1 29 2/ G ia co m o Pi ro zz i -20 -15 -10 -5 0 5 10 15 20 25 Percentage point change over three-year period Philippines 23 Kenya 18 Lesotho 18 Myanmar 17 Peru 8 Tanzania 7 Bangladesh 7 Côte d'Ivoire 6 Senegal 5 Iraq 5 Burundi 5 Guinea 5 Rwanda 5 India 4 Turkmenistan 2 Ghana 2 Haiti 2 Madagascar 0 Central African Republic 0 Gambia 0 Egypt -1 Togo -2 Tajikistan -4 Bolivia -5 Cameroon -5 Indonesia -5 Sierra Leone -5 Malawi -13 Ethiopia -14 Chad -17 Country Change over 3 years Country Change over 3 years Country Change over 3 years 2008 Median: 38 Range: 7 - 76 TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �� TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �� Changes in Pneumonia Treatment Source: Author’s analysis based on data from UNICEF global database (household survey data from 1998–2006) Figure 3.8. Estimated percentage point change over three years in the proportion of children less than five years of age with suspected pneumonia taken to an appropriate health provider, by country (1998-2006) Maternal and newborn health Contraceptive prevalence and unmet need for family planning. Every woman has the right to plan her pregnancies and have access to effective family planning methods to space or limit births and to prevent unintended pregnancies benefits both maternal and newborn health. Target coverage rates for this indicator are less than 100 per cent because at any given time a certain proportion of women will want to conceive. The median prevalence of contraceptive use among currently married women or those in union of reproductive age (15–49) is 29 per cent in the 64 priority countries with available data, with a range from 3 per cent per cent (Chad) to 87 per cent (China). Unlike the contraceptive prevalence rate, unmet need for family planning is based on a target coverage rate of 100 per cent; the indicator measures the gap between the proportion of women who desire contraception and those who receive it. The median rate of unmet need is 23, with a range from 41 percent (Uganda) to 9 percent (Indonesia, Peru). But as figure 3.9 shows, data on unmet need are available for only 40 of the 68 Countdown priority countries. Of the countries with estimates for both contraceptive prevalence and unmet need, nearly half have an unmet need rate that exceeds contraceptive prevalence. Overall, the proportion of stated desires to space the next birth by at least two years or avoid pregnancy that are being met by family planning services requires significant improvement through various supply and demand efforts. The Lancet sexual and reproductive health series has addressed this topic.43 Antenatal care can provide a platform for delivering several effective maternal and newborn interventions, including (among others) tetanus toxoid immunisation, intermittent preventive treatment for malaria and preventing mother-to-child transmission for HIV. The Countdown indicator for antenatal care is the percentage of women attending at least four antenatal care sessions during pregnancy, as recommended by the World Health Organization and UNICEF.44 For continuity with past monitoring efforts, the country profiles also include the percentage of women attending at least one antenatal care session under a skilled health provider. Indicators for one and for four visits have recently been added to the list of indicators for Millennium Development Goal 5 (Millennium Development Goal 5B, Target 5.5).45 Readers should note that the survey protocol asks about the type of provider for the one-visit indicator but not for the four- visit indicator. Future analyses will explore the relationship between the two measures. Figure 3.10 summarises the median prevalence of at least four antenatal care visits in the 39 Countdown priority countries for which data were available. In those countries a median of 49 per cent of mothers attended four or more antenatal care sessions, with a range from 12 per cent (Ethiopia) to 87 per cent (Peru). Family Planning Unmet Need Source: Author’s analysis based on data from United Nations Population Fund global database, 2008 C ou nt do w n pr io rit y co un tr ie s (n = 68 ) Per cent unmet need 0 20 40 60 80 100 28 countries with data missing or collected before 2000 Median 23 Range 9 - 41 Maternal & newborn tetanus. Mothers and newborns are considered protected from tetanus if the pregnant woman receives two doses of tetanus toxoid vaccine during an appropriate period before the birth. Those vaccines are often provided at antenatal care visits. But many countries have improved their rates by introducing special maternal and neonatal tetanus campaigns. Some countries have also introduced programmes to cover school-age girls and adolescents. Antenatal Care Coverage Source: Author’s analysis based on data from UNICEF and WHO global databases (household survey data from 2000–2006) Figure 3.10. Median coverage for antenatal care ( four or more visits) 0 20 40 60 80 100 29 countries with data missing or collected before 2000 C ou nt do w n pr io rit y co un tr ie s (n = 68 ) Per cent Median 49 Range 12 - 87 15 10 5 0 5 10 15 20 Country Change over 3 years Myanmar 18 Turkmenistan 16 Ghana 12 Senegal 12 Malawi 12 Nepal 10 Tajikistan 8 Peru 8 Lesotho 7 Burkina Faso 7 Cambodia 7 Cameroon 5 Rwanda 5 Haiti 3 Iraq 3 Ethiopia 2 Guinea 1 India 1 Madagascar 1 Country Change over 3 years Central African Republic Country Change over 3 years Cote d'Ivoire -1 Burundi -1 Sierra Leone -1 Bolivia -2 Egypt -2 Togo -3 Gambia -3 Tanzania -4 Guinea Bissau -4 Bangladesh -5 Kenya -5 Chad -7 Philippines -10 2008 Median: 48 Range: 12 - 93 Percentage point change over three-year period Figure 3.9. Median prevalence of unmet need for family planning in the Countdown countries, 2008 TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �� TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �� In the 64 Countdown priority countries with data for 2006, the median coverage estimates for neonatal tetanus protection is 81 per cent, with a range from 31 per cent (Haiti) to 94 per cent (Benin, The Gambia). Table 3.6 reports a median three-year increase of 5 percentage points in the 64 countries – an impressive trend, given that coverage is already so high. Intermittent preventive treatment for pregnant women (IPTp) for malaria involves the provision of two or more doses of an antimalarial drug to women during pregnancy, protecting both mothers and their children. Figure 3.11 shows coverage for 22 of the 45 priority countries with endemic malaria (annex F);46 the remaining 23 had no coverage data. In most countries with intermittent preventive treatment for pregnant women, the countries have adopted it only recently. Rapid gains are expected in the next round of national surveys. Priority countries that adopted this intervention earlier had achieved fairly high coverage levels by 2006, such as 61 per cent (Zambia) or 45 per cent (Malawi). Intermittent preventive treatment for pregnant women is not recommended for malaria endemic countries where large proportions of the population live in low- intensity malaria transmission areas. For this reason Botswana, Burundi, Eritrea and Ethiopia have not made it a part of their national malaria control strategies. They are not included in the coverage estimates for this indicator.47 Malaria Treatment Source: Author’s analysis based on data from UNICEF global database (household survey data from 2000–2006) Figure 3.11. Coverage for intermittent preventive malaria treatment in pregnancy 45 countries with endemic malaria, most recent estimates, 2008. (Endemic countries defined here as nationwide risk of p. falciparum throughout the year.) 0 20 40 60 80 100 Niger and Rwanda “0%” coverage (see country profile) C ou nt do w n pr io rit y co un tr ie s (n = 45 ) Per cent coverage 23 countries had no data for this indicator Median 7 Range 0 - 61 © U N IC EF /H Q 06 -1 39 1/ G ia co m o Pi ro zz i The presence of a skilled attendant at delivery is associated in observational studies with better delivery outcomes, including reduced maternal deaths.48 This association is plausible, since an attendant who is authorised to perform life-saving functions and supported by a performing health system can provide life-saving interventions in a timely manner. Across the 66 priority countries with available coverage data for this Countdown cycle the median was 53 per cent, with a range from 6 per cent (Ethiopia) to 100 per cent (Azerbaijan, Turkmenistan). That rate may be compared with a recently published estimate of 61 per cent coverage for all developing countries.49 Of the 68 Countdown priority countries, 45 have data for the presence of a skilled attendant at delivery from two coverage surveys conducted at least three years apart between 1998 and 2007. Figure 3.12 shows the average three-year percentage point change for each. The results suggest that while the majority of these priority countries are improving delivery care coverage, some need further improvement and others require efforts to sustain high coverage rates. The effectiveness of this approach depends on the specific interventions provided and on the quality of delivery, making national and subnational monitoring necessary. Caesarean section coverage differs in important ways from the other coverage indicators tracked through the Countdown. First, the target coverage rate is not 100 per cent. Instead, the suggested acceptable rate of caesarean section – based on the estimated frequency of life-threatening obstetric complications – is between 5 and 15 percent of births.50 By general agreement, rates of less than 5 per cent indicate that a substantial proportion of women lack access to caesarean sections and could die as a result. But rates greater than 15 per cent could indicate that the procedure is being over-utilised and performed for other than life-saving reasons, increasing morbidity and possibly mortality from unneeded risks associated with surgery.51 Changes in Births Attended by Skilled Health Personnel Source: Analysis by authors based on UNICEF global database (household survey data from 1998–2006) -6 -4 -2 0 2 4 8 6 10 12 Country Change over 3 years Country Change over 3 years Ethiopia Korea, DPR Country Change over 3 years Three-year percentage point change in coverage Nigeria Senegal Lesotho Côte d'Ivoire Bolivia Kenya Chad Malawi Azerbaijan Peru Burkina Faso Niger Itaq, Egypt Tajikistan, Benin, Cambodia Togo Somalia, Pakistan Burundi, Nepal, Central African Republic, Tanzania, South Africa Rawanda, Bangladesh, Madagascar Indonesia, Zimbabwe India, Guinea Bissau, Ghana, Afghanistan, Uganda, Philippines, Guinea, Cameroon Haiti, Turkmenistan, Gambia, Sierra Leone, China -5 -4 -3 -3 -2 -2 -1 -1 0 0 12 11 10 9 8 7 6 5 4 3 2 1 Figure 3.12. Estimated percentage point change in the percentage of live births attended by skilled health personnel, by country (1998- 2006) TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �� TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �� referral or treatment when required – and for providing counselling on family planning services.53 Compelling evidence shows that the earlier the first postnatal visit, the more effectively it will prevent neonatal mortality and improve healthy behaviours. Home visits by trained community health workers in the first two days of life can significantly reduce neonatal mortality.54 Other studies show that, controlling for other factors, a visit on the first day of life is associated with fewer neonatal deaths compared with a visit on the third day.55 All mothers and babies should receive a first postnatal contact within 24 hours of birth or within 24 hours of discharge after a facility birth. For these reasons the Countdown indicator has been revised to focus on early postnatal care within two days of birth (rather than three days as in the 2005 report). Second, caution is required when interpreting these results at the national level because of the substantial heterogeneity between urban and rural areas, different wealth strata and public and private sectors. If rates for a minority of the country’s population exceed 15 per cent, then a national rate considerably greater than 5 per cent could mask widespread unmet need in a majority of the population. Even if country coverage rates are within the acceptable range, unmet need might vary both within and across countries. Table 3.9 shows the percentage of live births delivered by caesarean section for the 39 priority Countdown countries with estimates from 2000 to 2006, stratified by urban or rural residence. Rural rates range from 0 per cent (Burkina Faso, Chad, Ethiopia, Mali, Niger) to 15 per cent (Egypt), with a median of 2 per cent. Urban rates range from 1 to 29 per cent, with a median of 7 per cent. In rural areas all but 8 of the 39 countries have caesarean section rates of less than 5 percent. In urban areas 5 countries have rates greater than the recommended threshold of 15 per cent (Bolivia, Egypt, Guatemala, India, Peru) and 10 have rates less than 5 per cent. These data indicate that, in the 68 priority countries, rates of life-saving caesarean section use are low and require urgent attention. Despite evidence of overuse in some urban settings, large urban-rural differentials suggest inadequate access in most countries. The data for caesarean section rates should spur programme planners at the subnational, national and international levels to take urgent action to achieve appropriate coverage for this life-saving procedure. The limited availability of emergency obstetric care facilities, documented later in this report, is further evidence of the need for greater investments in health care systems so that pregnant women have access to essential care. Early initiation of breastfeeding benefits both mothers and newborns. Immediate breastfeeding, facilitated by placing the newborn skin-to-skin on the mother’s breast, helps prevent hypothermia, promotes bonding, and reduces the mother’s risk of haemorrhage. The mother’s milk during the first post-partum days, colostrum, also provides protective antibodies and essential nutrients. Figure 3.13 shows the prevalence of for the 68 priority countries, which was included as a Countdown intervention for the first time in 2008. Among the 47 priority countries with available data, the median prevalence is 43 per cent with a range of 23 (Guinea-Bissau, Senegal) to 78 (Eritrea), suggesting that the uptake and reinforcement of this behaviour will require special programmatic attention within the continuum of care. Births by Caesarean Section Table 3.9. Percentage of live births delivered by caesarean section in Countdown priority countries with coverage estimates since 2000, by maternal residence (urban or rural) Source: Author’s analysis based on data from UNICEF and WHO global database (household survey data from 2000–2006) Country Urban (%) Rural (%) Total (%) Azerbaijan 4 1 3 Bangladesh 11 2 4 Benin 6 2 3 Bolivia 21 6 15 Burkina Faso 3 0 1 Cambodia 6 1 2 Cameroon 4 1 2 Chad 1 0 0 Cote d’Ivoire 8 6 6 Egypt 29 15 20 Eritrea 7 1 3 Ethiopia 9 0 1 Gabon 6 4 6 Ghana 8 2 4 Guatemala 19 8 11 Guinea 5 1 2 Haiti 6 1 3 India 17 6 9 Indonesia 7 2 4 Kenya 9 3 4 Lesotho 8 5 5 Madagascar 2 1 1 Malawi 4 3 3 Mali 3 0 1 Mauritania 6 1 3 Morocco 9 2 5 Mozambique 5 1 2 Nepal 8 2 3 Niger 5 0 1 Nigeria 4 1 2 Peru 23 6 16 Philippines 10 5 7 Rwanda 8 2 3 Senegal 7 1 3 Tanzania 8 2 3 Turkmenistan 4 2 3 Uganda 9 2 3 Zambia 4 1 2 Zimbabwe 9 3 5 Postnatal care is a Countdown indicator because of the importance of the postnatal period for maternal and newborn survival and health. Three-quarters of newborn deaths occur in the first week of life – up to half (2 million) on the first day.52 The same period poses high risks for maternal death. On the other hand, it is a crucial time for establishing home care practices – especially breastfeeding, warmth for the baby, recognition of illness or danger signs and Postnatal Visits Table 3.10. Percentage of newborns delivered at home whose mothers report receiving a postnatal visit for the newborn within two days of delivery Source: Analysis provided by Saving Newborn Lives (household survey data from 2000–2006) Country Total (%) Bangladesh 22 Egypt 9 Haiti 4 Ethiopia 2 Nepal 2 Early Initiation of Breastfeeding Source: Author’s analysis based on data from UNICEF global database (household survey data from 2000–2006) Figure 3.13. Median prevalence of early initiation of breastfeeding in the Countdown priority countries, 2008 C ou nt do w n pr io rit y co un tr ie s (n = 68 ) Per cent reporting early initiation of breastfeeding 0 20 40 60 80 100 Median 43 R ange 23 - 78 21 countries with no data Effective postnatal care, like antenatal care, requires several contact visits. Visits after the first should occur at around day 3, at 6 to 7 days and six weeks after the birth. Comparable data for postnatal care are lacking. Demographic and Health Surveys provide data on postnatal visits for 12 countries, but the question refers only to the mother, and it is not clear whether care for the baby (such as breastfeeding counselling) is included. Coverage for the 12 countries with such data is very low, with a median of 24 per cent and a range that begins at 2 per cent. Two countries have better coverage – 64 per cent (Cambodia) and 56 per cent (Egypt). Five countries have adapted the standard Demographic and Health Survey questionnaire to ask mothers about whether a postnatal visit for the newborn occurred within two days after the birth. For those five countries, table 3.10 shows the coverage rates for postnatal newborn care. Since this question is addressed only to mothers who delivered at home, the denominator differs from that for the maternal postnatal care question; data from the two questions cannot be compared. Postnatal care is a neglected area in many Countdown priority countries. Without clear policies –especially for early contact, specified programmatic delivery (who, what, where) and consistent data tracking – the lack of postnatal care represents a significant gap in the continuum of care. Important opportunities for the delivery of needed care to mothers and babies are missed, and linkages between care at birth and child health and ongoing reproductive health services remain poor.56 TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �� TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �� Data availability and quality for postnatal care would improve if the standard Demographic and Health Survey questionnaire were to ask about postnatal care for the mother and the baby, detail more visits than just the first and make the questionnaire ask about postnatal care at home after facility births (so that denominators become comparable). Advancing these aims now will create better data for the next Countdown report. In at least 12 countries, large-scale implementation research is evaluating an expansion of locally adapted approaches for visits to mothers and babies, including postnatal care. Coverage across the continuum of care Achieving the health-related Millennium Development Goals must start with an effective response to the needs of women, newborns and children. The continuum of care for maternal, newborn and child health includes integrated health service delivery throughout the lifecycle, including adolescence, pregnancy, childbirth, the postnatal period and childhood. This care is provided by families and communities and through outpatient, outreach and clinical services. To save the most lives, linkages among the time periods and places for caregiving are crucial.57 The graph in each 2008 Countdown country profile (upper right corner) highlights coverage for six interventions and approaches within the continuum of care: contraceptive use, antenatal care, a skilled attendant at delivery, a postnatal care visit for the newborn, exclusive breastfeeding up to six months and measles vaccination. Of these six interventions, four have target coverage levels of 100 per cent and coverage data since 2000 for a majority of the 68 Countdown countries and could therefore be included in a summary coverage measure for the continuum. (Another measure reflecting coverage across multiple interventions is presented and discussed later in the report, in the section on equity.) Figure 3.14 shows the number of the 62 priority countries with coverage data since 2000 that have achieved specific coverage rates for all four of these interventions: at least one antenatal care visit, a skilled attendant at delivery, exclusive breastfeeding up to six months and measles vaccination. Few countries have even moderately good coverage across this grouping of four interventions. Starting with the leftmost bar in figure 14, 52 of the 62 countries with the required data (84 per cent) have at least 10 per cent coverage across the four interventions. Moving towards the right, only 40 countries (65 percent) have at least 20 per cent coverage, and only 26 countries (42 percent) have at least 30 per cent coverage. Just two countries have at least 60 per cent coverage across the four interventions and approaches (Benin, Peru); only one has reached 70 per cent coverage or above (Benin). Focusing on the continuum of care means focusing on the need to strengthen health systems. Health systems need to be shored up so that they can support a continuum of high quality services, one that spans the family and community and that includes both local providers and providers who can deliver emergency obstetrical care (contacted through operative referral mechanisms). Renewed efforts must focus on clarifying the root causes of health system underperformance and on effective approaches for strengthening health systems.58 Water and sanitation The seventh Millennium Development Goal includes a target of halving, from 1990–2015, the proportion of people without sustainable access to safe drinking water. Improving water and sanitation are important to preventing infectious diseases and thereby to achieving the health-related Millennium Development Goals. Table 3.11 shows the Countdown priority countries that were ‘on track’ to achieve the targets for water (n=36) and sanitation (n=14), based on data from 1990 and 2004.59 Countries not listed had shown either insufficient or no progress. Water and Sanitation Table 3.11. Countries ‘on track’ to achieve the Millennium Development Goal targets for water and sanitation Source: UNICEF 2007b Use of improved drinking water sources (n=36) Use of improved sanitation facilities (n=14) Afghanistan Afghanistan India China Angola Djibouti Indonesia Egypt Azerbaijan Guatemala Kenya Malawi Bolivia Mexico Korea, DPR Morocco Botswana Myanmar Malawi Nepal Brazil Pakistan Mali Peru Burkina Faso Philippines Mauritania Senegal Burundi Mexico Cambodia Morocco Cameroon Myanmar Central African Republic Nepal Chad Pakistan China Peru Côte d’Ivoire Rwanda Egypt Senegal Eritrea South Africa Ghana Uganda Guatemala Zimbabwe Continuum of Care Coverage Source: Adapted from UNICEF 2007c Figure 3.14. Number of countdown priority countries achieving coverage for interventions/aproaches within the continuum of care (n=62 countries with coverage data for all four interventions/aproaches) 52 40 26 15 7 2 1 0 10 20 30 40 50 60 10% 20% 30% 40% 50% 60% 70% N um be r of C ou nt do w n pr io rit y co un tr ie s (n = 62 ) * Intervention or approach Antenatal care (at least 1 visit) Skilled attendent at delivery Exclusive breastfeeding (<6 months) Measles Immunization Minimum coverage achieved for 4 interventions/approaches* within the continuum of care TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �0 TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �� Equity in coverage levels The 2008 Countdown country profiles present findings about equity in coverage using a new measure, the ‘coverage gap’, which includes eight interventions grouped into four areas across the continuum of care: Family planning (need satisfied or contraceptive use). Maternal and newborn care (antenatal care and skilled birth attendance). Immunisation (measles vaccine, Bacille Calmette-Guerin vaccine against tuberculosis [BCG] and third dose of diphtheria and tetanus with pertussis vaccine [DPT3]. Treatment of child illness (medical care sought for acute respiratory infection and oral rehydration therapy with continued feeding for diarrhoea). Annex E gives further details on the data sources and methods of analysis. (Some inconsistencies in definitions between the component indicators of the coverage gap measure and Countdown indicators should not affect the validity of results as a measure of coverage equity.) Comparing the absolute size of coverage gaps across the Countdown priority countries suggests intercountry inequities. The coverage gaps for 54 countries ranged from less than 20 per cent, indicating about 80 per cent coverage for the eight interventions (Turkmenistan, Peru), to over 70 per cent, indicating about 30 per cent coverage for the eight interventions (Chad, Ethiopia). In the 40 Countdown countries with at least two surveys since 1990, coverage gaps decreased by about 1 percentage point per year, indicating improved coverage across the eight interventions or approaches. Coverage gap decreases, measured in percentage points, were faster for countries with gaps over 40 per cent than for countries with smaller gaps – suggesting that improvements in coverage can occur more rapidly where initial coverage levels are low. The ‘coverage gap’ provides information on equity in coverage within countries, as reflected in the country profiles. The profiles show large intracountry differences between the poorest quintile of the population and the least poor quintile. In India (2006), Philippines (2003) and Peru (2000), for example, the coverage gap was at least three times as large in the poorest as in the least poor quintile. Measured by absolute differences in coverage, the largest inequity for maternal, newborn and child health interventions and approaches is in Nigeria (2003), where the difference between universal and current coverage for the eight interventions is 45 percentage points greater for the poorest than for the least poor quintile. • • • • Coverage Gaps by Wealth Quintile Source: Analysis provided by WHO, 2008 Figure 3.15. Coverage gaps by wealth quintile (countries grouped by overall coverage gap size) < 30% 30-40% 40-50% 50-60% >60% 0 10 20 30 40 50 60 70 80 90 P oores t 20% M iddle 20% B est-off 20% G ap (% ) To examine trends, associations between patterns of inequity and coverage gap size were first examined; intracountry trends were then assessed. The surveys were classified into five groups based on coverage gap size. Figure 3.15 summarises the size of the coverage gap in each of the five groups across the five wealth categories. Although the coverage gap is consistently higher among the poorer and lower among the less poor, there are important differences in the patterns of inequity (the shape of the curve) that have implications for how programmes should be designed and targeted to reduce inequities. In countries where the coverage gap is the highest – indicating low coverage (the upper red line in figure 3.15) – there is an almost linear relationship between increasing wealth and decreases in the coverage gap except among the least poor, for whom coverage is much greater and the coverage gap much smaller. This pattern has been termed ‘top inequity’, its unusual feature being the striking comparative superiority in coverage for the least poor. To address such coverage inequities, efforts can decrease the coverage gap for all but the least poor. The pattern is different in countries with the lowest coverage gap, indicating relatively high coverage levels across the eight interventions (the lower light orange line in figure 3.15). Though in these findings the effect is relatively small, there is a linear improvement from the second poorest quintile to the least poor quintile, with a noticeable change in the slope of the line representing the poorest quintile. Referred to as ‘bottom’ inequity, this can often be addressed through effective targeting of services to the poor. The country profiles provide a wide array of examples of these patterns, with notable exceptions. Some countries (such as Turkmenistan and Azerbaijan) show only small differences by wealth quintile. Others have dramatic ‘top inequity’ (for example, Burkina Faso) or ‘bottom inequity’ (such as Brazil). Countries with multiple surveys provide examples of changes over time. The analyses show that the overall annual rate of coverage gap change is just less than 1 percentage point on average and rarely exceeds 2 percentage points. Patterns of inequity by wealth quintile normally change only gradually – but there are several examples of rapid change. For example, in Cambodia a substantial reduction of the coverage gap from 2000–2005 changed the pattern from ‘top inequity’ to a linear pattern. In Egypt and Peru progress was marked by reduced ‘bottom inequity.’ Yet in several countries, such as India, a marked overall reduction in the coverage gap did not change the inequity pattern and was not associated with greater progress for the poorest quintile. In most sub-Saharan African countries, likewise, coverage gaps decreased, but ‘top inequity’ remained. Health policies and health systems Figure 3.16 shows the frequency distribution of responses from 68 countries on adopting specific health policies affecting the continuum of care for maternal, newborn and child health. The remainder of this section summarises findings for each individual policy. The International Code of Marketing of Breastmilk Substitutes In 1981, as a minimum requirement to protect and promote breastfeeding, the World Health Organization member states almost unanimously adopted the International Code of Marketing of Breastmilk Substitutes. As urged in the Global Strategy for Infant and Young Child Feeding, governments should act Adoption Status of Key Health Policies Source: Compiled by WHO and UNICEF Figure 3.16. Adoption status of key maternal, newborn and child health policies in the 68 Countdown priority countries 0 10 20 30 40 50 International Code of Marketing of Breastmilk ILO Convention 183 on Maternity Protection Notification of maternal deaths Midwives authorised to administer core set of interventions IMCI guidelines adopted to cover newborns Low osmolarity ORS and zinc supplement Community management of pneumonia with antibiotics Costed implementation plan(s) Yes Partial No No data TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �� TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �� on the Code and on later World Health Assembly resolutions.60 By the end of 2007, 25 of the 68 Countdown priority countries had reported adopting legislation covering all provisions of the International Code while 28 reported having legislation or voluntary agreements covering some Code provisions. Another 13 countries had taken no action to adopt the Code and no information was available for 2 countries. These data reflect marked improvement since 2005, when the Countdown reported that 15 of 60 countries had fully adopted the Code and 39 had adopted parts of it (figure 3.17).61 The ILO Convention 183 on Maternity Protection International labour standards on maternity protection are important to protect the maternal health of women at work and to protect the employment of women during maternity.62 Over the history of the International Labour Organization, member states have adopted three Conventions on maternity protection (No. 3, 1919; No. 103, 1952; No. 183, 2000), progressively expanding the scope and entitlements of maternity protection at work. Convention No. 183 provides for health protection at work, 14 weeks of maternity leave, cash and medical benefits, employment security the seven signal functions (administer perenteral antibiotics, perenteral oxytocics and perenteral anticonvulsants, manually remove the placenta, remove retained products of conception, assist with vaginal delivery and resuscitate newborns) and, if needed, a comprehensive emergency obstetric care facility that can also perform caesarean section and blood transfusion. The availability of emergency obstetric care services provides one measurement of a health system’s capacity to prevent both maternal and newborn deaths. For every 500,000 people it is recommended to provide at least five basic emergency obstetric care facilities, of which at least one should also offer comprehensive emergency obstetric care.65 The geographic distribution of such facilities should ensure access for all women, not only those living in a few regions or urban centers. The emergency obstetric care availability data in this report come from government surveys conducted with support from agencies and organisations such as UNICEF, the United Nations Population Fund, the World Health Organization and the Averting Maternal Death and Disability Program at Columbia University. The data are reported as percentages of needed facilities based on country populations. Data on geographic distribution, though available for several countries, are not reported. Twenty-seven countries had comparable data that the Countdown could use. Of those 27, 11 had at least half of the recommended minimum number of functioning emergency obstetric care facilities. The remaining 16 countries with comparable and usable data had between 14 per cent and 48 per cent of the minimum. Even without knowing the geographical distribution of facilities within countries, one can see that a much greater investment is needed for emergency obstetric care services to reach all the women who need them. (Eighteen countries either had conducted smaller assessments, had not yet analysed their data or had conducted different types of facility surveys that were not comparable. For 23 other countries no data were available.) All countries should be encouraged to conduct a national assessment and to routinely collect information on the signal functions and the availability, functioning and quality of care at emergency obstetric care facilities. It is expected that this set of indicators will be integrated into national health information systems so that the availability and quality of these services can be monitored more regularly. Notification of maternal death Maternal death is a rare event. It is also a very sensitive indicator of the health system functionality. A national policy requiring specific notification of maternal deaths can be a powerful instrument to examine the quality and responsiveness of health services and to help identify critical barriers in the continuum of care. In this cycle of the Countdown, 23 countries reported having a policy requiring notification of maternal death, 14 countries reported having a policy but no systematic implementation, and 18 countries reported having no such policy. No information was available for 13 countries. Integrated management of childhood illness adapted to cover newborns 0–1 week old A cost-effective way to diagnose and treat children with common illnesses, the integrated management of childhood illness approach (IMCI) has been adopted by over 100 countries. The first generic version of its guidelines was developed for children up to five years of age; it did not address newborns in the first week of life. Based on new evidence, revised generic guidelines have been promoted since 2006 to cover infants 0–2 months old.66 In this Countdown cycle, 39 of the 68 priority countries reported having national guidelines covering infants in the first week of life, in line with the generic guidelines. Three countries reported having partial adaptations for young infants; 21 reported having no such adaptations. Low osmolarity oral rehydration salts and zinc supplementation Strong evidence demonstrating the effectiveness of both a new, low osmolarity formulation of oral rehydration solution (oral rehydration salts) and zinc supplementation in reducing the duration and incidence and severity of diarrhoeal episodes resulted in an international call for action to countries to adopt the new guidelines and intensify efforts to increase coverage for oral rehydration therapy.67 By the end of 2007, 34 Countdown priority countries had adopted the new guidelines and 17 had adopted one of the two improved interventions (either low osmolarity oral rehydration salts or zinc supplementation but not both), while 10 had not changed their policy to reflect the new technical advances. That was a marked improvement from 2005, when just 6 of 50 priority countries had adopted the new policy and 36 reported no policy (figure 3.17). Although it might be too early to find nationwide increases in coverage for low osmolarity oral rehydration salts in countries that have updated their and non-discrimination and rights to breastfeeding breaks for nursing mothers. The Social Security (Minimum Standards) Convention, 1952 (No. 102), is also relevant to maternal health, setting minimum requirements for the provision of health care during pregnancy and confinement, cash maternity benefits replacing lost income and minimum standards for access to preventive and curative health services in general. Conventions are binding in ratifying countries. To date, none of the 68 priority countries has ratified Convention No. 183, while 21 have ratified one of the earlier maternity protection conventions. Of the countries that have ratified none of the maternity protection conventions, five have ratified Convention No. 102. Forty-seven countries had not ratified any convention on maternity protection. Intensified advocacy is needed in this area. Measures stipulated under the Convention are critical for ensuring direct protection, maternity leave, cash and medical benefits, employment security and non-discrimination for women and newborns. Midwives authorised to administer a core set of life-saving interventions Midwives are the primary skilled care providers at birth in many countries. Often, though, they are not authorised to perform life-saving skills that can affect the survival of the mother or her newborn. As early as 1997 global guidelines called for authorising midwives, among others, to perform a set of signal functions.63 Essential care for women and newborns requires that midwives be authorised to administer perenteral antibiotics, perenteral oxytocics and perenteral anticonvulsants, to manually remove the placenta, to remove retained products of conception, to assist with vaginal delivery and to resuscitate newborns. Of the 68 Countdown priority countries, 27 reported having a policy authorising midwives to perform these seven functions, 25 countries reported having a policy allowing midwives to perform part of them and 5 reported having no policy. For 11 countries no data were available. Emergency obstetric care service availability Three-quarters of maternal deaths are caused by direct obstetric complications including haemorrhage, sepsis, eclampsia and prolonged or obstructed labour.64 The occurrence of these life-threatening complications is unpredictable and often unpreventable. But nearly all deaths from these causes can be averted through timely and appropriate intervention with quality emergency obstetric care, including caesarean section. It is critical that all pregnant women have access both to a basic emergency obstetric care facility for Progress on Three Key Policies Source: Compiled by WHO and UNICEF, 2008 Figure 3.17. Progress in implementing three policies (International Code of Marketing of Breastmilk Substitutes, low osmolarity oral rehydration salts and zinc supplementation and community treatment of pneumonia with antibiotics) in the 68 Countdown priority countries (2005–2007) 0 10 20 30 40 45 International Code of Marketing of Breastmilk 2005 International Code of Marketing of Breastmilk 2007 Low osmolarity ORS and zinc supplement for management of diarrhoea Low osmolarity ORS and zinc supplement for management of diarrhoea Community management of pneumonia with antibiotics 2007 Community management of pneumonia with antibiotics 2005 Yes Partial No No data No. of countries not included TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �� TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �� policy, future progress should be tracked to assess whether and how policy changes can affect coverage for an intervention. Community treatment of pneumonia with antibiotics Pneumonia remains the leading killer of children under five years of age.68 As table 3.5 shows, coverage levels for careseeking and the treatment of pneumonia with an effective antibiotic are alarmingly low in most of the 68 Countdown priority countries. Community health workers can manage uncomplicated pneumonia effectively and bring treatment closer to the home. In 2004, the World Health Organization and UNICEF called on countries to adopt and promote policies that would support community health workers in identifying and treating pneumonia, while improving service at first-level heath facilities.69 In 2005, of 60 Countdown priority countries, 16 had policies authorising community health workers to identify and manage pneumonia; 2 had no policies, but were implementing the approach in selected geographic areas; 41 explicitly prohibited community-based pneumonia management (one country lacked data). For the 2008 Countdown, 18 of 68 priority countries reported having community case management policies; 11 reported having no policies, but some implementation of the approach in selected areas; 31 reported having no policies or explicit prohibitions (figure 3.17). Country respondents to the Countdown survey offered reasons for the lack of progress, focusing on the complexities of decisions about which cadres of health providers would be permitted to administer antibiotics. Costed implementation plan For the 2008 Countdown, 31 countries reported having developed costed implementation plans for maternal, newborn and child health; 18 countries reported having partial plans that were either not costed or did not cover the entire continuum of care; 14 countries indicated having no such plans. Information was not available for 5 countries. Interpretations of this indicator varied between countries, since in some an investment case has been made for achieving the Millennium Development Goals while in others it has not. For countries in which it has not, the indicator was rated as full when medium-term plans and related programme costs were available. Human resources and financing Density of health workers per 1,000 people The World Health Organization estimates that to ensure adequate coverage for basic maternal and child health services, at least 2.5 health workers are needed per 1,000 people. Results from global databases that include both facility- and community-based health workers show that in 54 out of the 68 Countdown priority countries (80 per cent), the numbers of such workers are too few to improve country prospects for achieving the health-related Millennium Development Goals. There is no demonstrated association between health worker density and coverage for interventions. But these data show that many countries are facing a health worker crisis that could obstruct coverage increases. Per capita total expenditure on health It has been estimated that less than $45 per capita total expenditure on health is insufficient to ensure access to a very basic set of needed services. Among the 68 Countdown priority countries, 21 had a total per capita expenditure smaller than $45. General expenditure on health as a percentage of total expenditure This indicator reflects government commitment to health. While there is no threshold, African heads of state have made a commitment to allocate at least 15 per cent of the overall budget to health. An ideal target, it has only been achieved by 7 of the 68 Countdown priority countries. Out-of-pocket expenditure as a percentage of total expenditure Very high out-of-pocket payments prevent many people from seeking care. And they impoverish households. Where such payments comprise less than 15 per cent of total health spending, very few households tend to be harmed by catastrophic payments. Of the 68 Countdown priority countries, only 6 have a rate of out- of-pocket payments of less than 15 percent. Financial flows to maternal, newborn and child health The Countdown Financial Flows Working Group developed two new indicators for use in monitoring progress across the 68 priority countries: official development assistance to child health per child and official development assistance to maternal and neonatal health per live birth. Both indicators are included in the 2008 country profiles, with estimates for 2005. Official Development Assistance to Child and Maternal Health Table 3.12. Official development assistance to child health per child and official development assistance to maternal and newborn health per live birth for the 68 Countdown priority countries (2004–2005) Source: Compiled by WHO, 2008 Official development assistance to child health per child (2005 dollars) Official development assistance to maternal and newborn health per live birth (2005 dollars) Recipient country 2004 2005 2004 2005 Afghanistan 5.51 8.6 4.30 8.43 Angola 7.12 11.34 10.28 16.11 Azerbaijan 1.24 3.87 4.61 2.18 Bangladesh 0.84 1.58 8.42 9.56 Benin 9.93 7.36 13.32 3.76 Bolivia 9.67 6.43 22.74 11.04 Botswana 1.50 0.05 2.43 0.45 Brazil 0.12 0.1 1.51 0.16 Burkina Faso 6.06 8.17 7.23 6.72 Burundi 6.19 8.57 5.32 5.73 Cambodia 2.93 6.38 5.46 19.05 Cameroon 4.20 6.87 3.41 4.45 Central African Republic 8.57 6.72 9.14 5.49 Chad 4.34 4.22 3.11 5.41 China 0.39 0.32 0.66 0.4 Congo 12.13 2.42 4.28 2.73 Congo, Democratic Republic of the 6.56 3.21 3.82 2.97 Cote D’Ivoire 3.98 2.9 1.53 1.63 Djibouti 7.42 24.89 18.03 22.27 Egypt 0.72 1.26 0.35 3.3 Equatorial Guinea 10.75 14.28 11.87 12.73 Eritrea 4.47 3.77 4.77 2.36 Ethiopia 2.70 3.56 4.81 9.96 Gabon 11.04 17.09 15.57 20.65 Gambia 7.50 17.79 5.80 11.05 Ghana 12.74 11.24 14.63 12.01 Guatemala 2.04 3.41 10.53 14.49 Guinea 3.65 6.17 2.75 11.34 Guinea-Bissau 5.73 6.27 18.49 11.87 Haiti 8.57 4.18 7.86 15.53 India 0.90 1.1 1.78 3.24 Indonesia 1.15 1.11 4.25 2.8 Iraq 4.08 20.47 3.70 26.87 Kenya 7.71 8.98 6.04 14.7 Korea, Democratic Republic of 1.57 1.75 0.73 0.62 Laos 3.93 8.41 8.66 17.88 Lesotho 9.50 4.77 13.32 5.01 Liberia 12.91 7.81 14.32 7.54 Madagascar 4.90 5.91 8.46 6.95 Malawi 13.0 11.18 13.67 13.57 Mali 6.69 6.51 6.23 13 Mauritania 3.38 3.2 9.74 7.59 Mexico 0.17 0.12 0.81 0.51 Morocco 1.01 1.5 4.31 5.61 Mozambique 14.20 9.4 26.57 20.15 Myanmar 0.28 3.01 0.79 1.82 Nepal 5.25 3 11.96 3.39 Niger 4.15 5.32 2.77 5.32 Nigeria 1.91 2.23 1.12 2.99 Pakistan 3.58 1.88 1.93 4.4 Papua New Guinea 9.21 3.26 30.37 6.42 Peru 3.17 4.9 5.50 12.46 Philippines 0.97 0.4 1.51 1.58 Rwanda 13.91 13.47 14.47 12.68 Senegal 9.56 9.83 11.44 16.73 Sierra Leone 5.79 5.48 5.30 5.64 Somalia 4.87 4.39 4.86 4.19 South Africa 1.82 3.6 4.09 6.21 Sudan 4.86 9.05 7.35 15.21 Swaziland 3.24 15.09 1.56 1.41 Tajikistan 6.55 4.83 5.09 5.19 Tanzania 8.79 15.62 11.87 14.8 Togo 5.07 5.72 6.89 4.63 Turkmenistan 1.82 2.12 4.25 1.01 Uganda 11.09 9.89 6.59 8.4 Yemen 4.45 6.01 11.81 17.49 Zambia 21.24 26.55 22.43 44.77 Zimbabwe 3.61 7.11 8.88 18.32 TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �� TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �� The two new indicators are presented next to more established general health expenditure indicators. Unlike the coverage indicators, there is little agreement on what makes a funding target desirable or adequate. The evidence points broadly towards a substantial funding gap in maternal, newborn and child health in developing countries, which must be filled partly by increased funding from donors.70 While acknowledging the unpredictability of international aid, the authors of this report make a tentative assessment of progress to increase official development assistance to maternal, newborn and child health by making a comparison across years. Table 3.12 presents estimates of the two official development assistance indicators by country for 2004–2005, expressed in constant 2005 dollars. The volume of official development assistance to child, newborn and maternal health increased by 28 per cent worldwide in 2005, representing increases of 49 per cent in official development assistance to child health and 21 per cent in official development assistance to maternal and newborn health. Of the 68 Countdown countries, 38 experienced increases in official development assistance to child health per capita in 2005; 39 countries also saw official development assistance to maternal and newborn health per live birth rise from 2004–2005. The Countdown Financial Flows Working Group is doing further statistical analysis of aid flow determinants. Conclusions and recommendations This second Countdown report, issued three years after the first report of findings at the 2005 conference,71 documents what can be done and what needs to be done. Coverage for selected interventions – such as vitamin A supplementation and the use of insecticide-treated bed nets to prevent malaria – has increased rapidly in many countries, but not in all. And coverage levels for other interventions have stagnated or even deteriorated. Examining country-by- country progress can yield important knowledge about hindrances to progress, spurring further action. The power of the Countdown depends on the quality of the coverage data in the priority countries. Let us be the first to say that many improvements can and should be made in defining indicators, measuring them and interpreting the results. We, better than most, recognise that there is an urgent technical agenda to be pursued in strengthening the measurement of coverage. But do the methodological weaknesses invalidate the massive amounts of information presented in the country profiles? We believe not. Millions of person-hours have been invested in defining measurement strategies, developing protocols, The continuum of care for maternal, newborn and child health requires multiple delivery approaches. Progress towards the Millennium Development Goals will require a range of interventions to be delivered in different points in the life-cycle. Services that contribute to the achievement of one Millennium Development Goal will not necessarily advance progress towards another. Of particular concern today is a serious breakdown in the continuum of care at several points in the pre-pregnancy to two-year postnatal period when opportunities to deliver essential services are being lost. Undernutrition is an area of little or no progress. More than one-third of deaths in children under age five are attributable to undernutrition – the underlying cause of 3.5 million child deaths annually. And maternal undernutrition increases the mother’s risk of death at delivery, accounting for at least 20 per cent of such deaths.72 In 33 of the 68 priority countries, at least 20 percent of children are moderately or severely underweight, and 62 countries have stunting prevalence rates exceeding 20 per cent. Weak health systems and broader contextual factors obstruct progress. Health systems in many countries cannot now deliver essential interventions and approaches widely or well enough to reduce mortality nationwide. Indicators of health financing and health worker density are useful markers of health system strength. Of the 68 Countdown priority countries, 54 – or 80 percent – have workforce densities below the critical threshold for improved prospects for achieving the health-related Millennium Development Goals. It has been estimated that annual per capita total health expenditures of less than $45 are insufficient to ensure access to a very basic set of needed services. Of the 68 priority countries, 21 had less than $45. In addition, 11 out of the 14 countries with reversed progress towards Millennium Development Goal 4, contextual challenges – such as armed conflict, high HIV burdens and low female literacy rates – contribute to stagnating or deteriorating coverage. Inequities obstruct progress. Mortality in children under age five is now concentrated in sub-Saharan Africa (almost 50 per cent) and South Asia (30 per cent).73 Maternal and newborn mortality are similarly concentrated in those regions. Meanwhile, the inequity analyses show that within countries the richest quintile is gaining access to key interventions more quickly than the poorest.74 Reducing both types of inequity – between regions and within countries – is a crucial part of achieving the health-related Millennium Development Goals. visiting randomly selected villages and knocking on doors to ask family members to participate in building an information base sufficient to guide policy. The answers have been recorded, checked, summarised, shared and interpreted in districts and capital cities throughout the world. If there is a better way to do things, let’s do it together – not just as a ‘community of practice,’ aiming at improving the health of women and children, but also as scientists wanting a fuller understanding and as policy makers and programme managers hoping to learn more about how to make programmes and services more effective. The Countdown is an informal ‘community of practice’ that brings together information and interprets it for several purposes: for science, for policy and governance, for better development assistance and for easier access and ownership by women and children. Any conclusions drawn from the information in these pages is in a sense premature, since a full understanding requires more input from those working to achieve high, sustained and equitable coverage in individual countries, districts and communities. But the community of practice also includes those responsible for the international Countdown movement. In that spirit we present a summary of what we see as the most important conclusions of this Countdown cycle and what those conclusions might mean for the immediate next steps towards the health-related Millennium Development Goals. Country representatives who participate in the April, 2008 Countdown conference in Cape Town, South Africa will issue a statement. We see that statement as a companion to this section and an essential complement to the remainder of the chapter. Preliminary conclusions proposed by the Countdown Core Group Countries, while rapidly increasing coverage for some interventions, are making little or no progress with others. Coverage trends are most promising for many preventive interventions, such as vitamin A supplementation, immunisation (including measles, neonatal tetanus protection, Hib3 and DPT3) and insecticide-treated bed nets to prevent malaria. But progress is lagging for most curative interventions and interventions requiring 24-hour service availability, such as antenatal, postnatal and delivery care or treatment for pneumonia, diarrhoea and malaria. Postnatal care is an especially important gap in the first week of life when mothers and newborns are at the highest risk. Progress on nutrition indicators requiring behavioural and social change – such as exclusive breastfeeding and complementary feeding practices – is mixed and often insufficient. Aid needs to increase and become more predictable. Overseas development assistance to child, newborn and maternal health increased by 28 percent from 2004 to 2005, including increases of 49 per cent to child health and 21 per cent to maternal and newborn health. Such aid for maternal, newborn and child health and nutrition has increased in most Countdown priority countries, but has decreased in some. Of the 68 countries, 38 received more per capita official development assistance to child health, and 39 received more to maternal and newborn health per live birth, in 2005 than in 2004. Countries need more and better coverage estimates and research on local implementation. Since the first Countdown report in 2005, an unprecedented amount of household surveys have been conducted and include new MICS data from 54 countries and new DHS data for 35 countries. However, many countries are still determining coverage levels for essential interventions using data that is 5, 10 or even 15 years old. In consequence, the knowledge gained through current and ongoing efforts to promote maternal, newborn and child health and nutrition has not been adequately disseminated. The Countdown is drawing attention to the fact that data collection and dissemination need improvement to make timely data more readily available, which is crucial for planning and implementation. TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �� TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �� The Countdown call to action All people involved in the Countdown, who together constitute a ‘community of practice’ for achieving the health-related Millennium Development Goals, are encouraged to use the Countdown results and products to improve their effectiveness in reducing mortality and improving nutrition among women, newborns and children – each in their own way, applying their diverse skills and resources. Participants in this round of data review for the Countdown effort identified the following immediate actions to be promoted and discussed at the second international Countdown conference, Cape Town, South Africa, 17–19 April 2008. Sustain and expand successful efforts to achieve high and equitable coverage for priority interventions. Recent areas of progress – especially immunisations, vitamin A supplementation and insecticide-treated bed nets – represent a major success for governments and their development partners. Such efforts should continue. But comparable efforts and investments are required for childbirth care and the case management of childhood illness. Focus on the priority period within the continuum of care, from pre-pregnancy through 24 months – especially around the time of birth. To reduce mortality during childbirth and in newborns, programming efforts must focus on the effective and integrated delivery of interventions and approaches associated with this crucial period. Examples include contraceptive services, antenatal, delivery, and postnatal care and infant feeding practices. Within increased efforts to achieve the health- related Millennium Development Goals, make improving maternal and child nutrition a priority. Nutrition must be central to both national and subnational development strategies. Strengthen health systems, focusing on measurable results. Health systems need to deliver on demand, creating a functional continuum of care over time and in different places. All new initiatives must focus on outcomes that measurably advance this aim. • • • • Notes 1 Boerma, Bryce, Kinfu and others (forthcoming). 2 Graham, Bell and Bullough 2001, pp.97–129; WHO, UNICEF, UNFPA and AMDD 2006. 3 UNICEF 2007b. 4 Lawn, Cousens and Zupan 2005. 5 Ibid. 6 Stanton, Lawn, Rahman and others 2006. 7 Black, Allen, Bhutta and others 2008. 8 World Bank 2006. 9 United Nations n.d. 10 Black, Allen, Bhutta and others 2008. 11 Ibid. 12 WHO 2006a. 13 Bhutta, Ahmed, Black and others 2008. 14 Black, Allen, Bhutta and others 2008. 15 Blanc and Wardlaw 2005. 16 UNICEF and WHO 2004. 17 UNICEF 2007c. 18 Victora, Adair, Fall and others 2008. 19 UNICEF n.d. 20 Measure DHS, MACRO International, Inc. n.d. 21 Bryce, Coitinho, Darnton-Hill and others 2008. 22 WHO and UNICEF 2003. 23 Bhutta, Ahmed, Black and others 2008. 24 Black, Allen, Bhutta and others 2008. 25 Bhutta, Ahmed, Black and others 2008. 26 Black, Allen, Bhutta and others 2008. 27 Bhutta, Ahmed, Black and others 2008; Bryce, Coitinho, Darnton-Hill and others 2008. 28 Arimond, Daelmans and Dewey 2008. 29 UNICEF 2007c. 30 UNICEF 2007d. 31 Dabbagh, Gacic-Dobo, Wolfson and others 2007. 32 UNICEF 2007b. 33 Ibid. 34 WHO 2006b. 35 Waddington, Martin, Walford and others 2005. 36 WHO 2007a. 37 UNICEF and Roll Back Malaria 2007. 38 UNICEF 2007b 39 Ibid. 40 UNICEF 2006a; Wardlaw, Salama, Johansson and others 2006. 41 Bryce, Boschi-Pinto, Shibuya and others 2005; WHO 2007b. 42 Bryce, Boschi-Pinto, Shibuya and others 2005. 43 Cleland, Bernstein, Ezeh and others 2006. 44 WHO and UNICEF 2003. 45 United Nations 2008a. 46 WHO 2007a. 47 UNICEF and Roll Back Malaria 2007. 48 Graham, Bell and Bullough 2001, pp.97-129; WHO, UNICEF, UNFPA and AMDD 2006. 49 UNICEF 2007b. 50 UNICEF, WHO and UNFPA 1997. 51 Villar, Carroli and Zavaleta 2007. 52 Lawn, Cousens and Zupan 2005. 53 Darmstadt, Bhutta, Cousens 2005. 54 Bacqui, Ahmed, Arifeen and others n.d. 55 Bacqui, Ahmed, Arifeen and others 2007. 56 Lawn, and Kerber 2006. 57 Tinker, ten Hoope-Bender, Azfar and others 2005; Kerber, de Graft- Johnson, Bhutta and others 2007. 58 Travis, Bennett, Haines and others 2004. 59 UNICEF 2007b. 60 WHO and UNICEF 2003. 61 Bryce, Terreri, Victora 2006. 62 ILO 2007. 63 UNICEF, WHO and UNFPA 1997. 64 Khan, Wojdyla, Say and others 2006; Ronsmans and Graham 2006. 65 UNICEF, WHO and UNFPA 1997. 66 The Young Infants Clinical Signs Study Group 2008. 67 WHO and UNICEF 2004. 68 Wardlaw, Salama, Johansson and others 2006. 69 WHO and UNICEF 2006. 70 Johns, Sigurbjörnsdóttir, Fogstad and others 2007; Stenberg, Johns, Scherpbier and others 2007; Greco, Powell-Jackson, Borghi and others (forthcoming). 71 Bryce, Terreri, Victora and others 2006. 72 Black, Allen, Bhutta and others 2008. 73 UNICEF 2007b. 74 Victora, Wagstaff, Armstrong-Schellenberg and others 2003. Set geographic and population priorities, and stick to them. The health-related Millennium Development Goals cannot be met globally without faster progress in sub-Saharan Africa and South Asia. Development efforts and official development assistance must increasingly target countries in these regions with large populations and poor performance. Programme for equity. Describing inequities, though an important first step, is not enough. Programmatic efforts to address inequities must be supported by strong monitoring and evaluation activities. Do even more to ensure predictable long- term aid flows for maternal, newborn and child health. Governments and their development partners cannot meet the health-related Millennium Development Goals unless assistance is adequate, predictable and targeted to those goals. Monitor. Evaluate. Conduct locally driven implementation research. And act on the results. The ‘community of practice’ for maternal, newborn and child health must lead the change by improving monitoring, evaluation and dissemination. Lead the change for maternal, newborn and child survival. It is time for all to work together as partners to improve the lives of women, newborns and children. • • • • • TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �0 TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �� 4The country profiles © U N IC EF /H Q 06 -0 15 2/ M ic ha el K am be r Chapter 4 introduces the individual country profiles. These profiles represent the basic information to be analysed at Countdown conferences, and evidence for assessing progress since the first Countdown Report in 2005. Each profile presents the most recent available information on selected demographic measures of maternal, newborn and child survival and nutritional status, coverage rates for priority interventions, and selected indicators of equity, policy support, human resources and financial flows. The information summarised in these pages is intended to help policy makers and their partners assess progress and prioritise actions in the effort to reduce maternal, newborn and child mortality. Afghanistan Angola Azerbaijan Bangladesh Benin Bolivia Botswana Brazil Burkina Faso Burundi Cambodia Cameroon Central African Republic Chad China Congo Congo, Democratic Republic of the Côte d’Ivoire Djibouti Egypt Equatorial Guinea Eritrea Ethiopia Gabon Gambia, The Ghana Guatemala Guinea Guinea-Bissau Haiti India Indonesia Iraq Kenya Korea, Democratic People’s Republic of Lao People’s Democratic Republic Lesotho Liberia Madagascar Malawi Mali Mauritania Mexico Morocco Mozambique Myanmar Nepal Niger Nigeria Pakistan Papua New Guinea Peru Philippines Rwanda Senegal Sierra Leone Somalia South Africa Sudan Swaziland Tajikistan Tanzania, United Republic of Togo Turkmenistan Uganda Yemen Zambia Zimbabwe DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Afghanistan Underweight prevalence Percent children < 5 years underweight for age* 59 8 *Based on 2006 WHO reference population Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 1990 1995 2000 2005 2006 26,088 4,823 1,272 6 257 165 60 327 1,800 8 26,000 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) (2004) (2004) 29 --- (2003) P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) --- --- --- ---, ---, --- --- --- Causes of maternal deaths Regional estimates for Asia, 1997-2002 *See Annex for indicator definition WATER AND SANITATION EQUITY SYSTEMSPOLICIES Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities Financial Flows and Human Resources Coverage gap by wealth quintile Afghanistan TotalRural Urban Skilled attendant at delivery Percent live births attended by skilled health personnel Neonatal tetanus protection Percent of newborns protected against tetanus 1990 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Partial Partial Yes No Yes Yes No No Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 19 2 81 0.4 9 8 --- (2007) (2007) (2007) (2001) (2005) (2005) Coverage gap (%) Ratio poorest/wealthiest Difference poorest-wealthiest (%) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy Malaria prevention Percent children < 5 years sleeping under ITNs Malaria treatment Percent febrile children < 5 years using antimalarials MDG Target Under-five mortality rate Deaths per 1000 live births 87 257 260 Source: WHO, 2006 Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition Causes of neonatal deaths Source: WHO, 2006Source: UNICEF, 2006 Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Diarrhoea 5% Tetanus 10% Other 6% Congenital 7% Asphyxia 20% Infection 36% Preterm 17% Pneumonia 25% Other 22% Diarrhoea 19% Malaria 1% HIV/AIDS 0% Injuries 1%Measles 6% Neonatal 26% No data 2000 MICS 2004 Other NS 37 35 68 77 No data No data 48 2003 MICS No data P er ce nt 20 0 40 60 80 100 2003 MICS 28 No data No data 2 7 3 29 49 34 1990 2004 TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 3 10 4 31 63 39 Coverage along the continuum of care Source: DHS, MICS, Other NS Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care 14 68 16 10 Other causes 21%Anaemia13% Haemorrhage 31% Abortion 6% Obstructed labor 9% Hypertensive disorders 9% Sepsis/Infections, including AIDS 12% Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1980 1985 19951990 2000 2006 88 P er ce nt 20 0 40 60 80 100 2000 MICS 12 2003 MICS 14 P er ce nt 20 0 40 60 80 100 2000 MICS 37 2003 MICS 16 1999 2000 2001 2002 2003 2004 2005 Source: UNICEF P er ce nt 20 0 40 60 80 100 Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses At least one dose Two dosesAt least one dose Two doses 91 9596 868484 76 70 58 67 78 85 95 1990 0 50 100 150 200 250 1995 2000 2005 2010 2015 0 DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Angola 1999 2000 2001 2002 2003 2004 2005 32 2001 MICS At least one dose Two doses Source: WHO, 2006 Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Source: UNICEF Underweight prevalence Percent children < 5 years underweight for age* 51 8 *Based on 2006 WHO reference population 28 1996 MICS 37 2001 MICS 94 14 100 75 88 64 68 68 65 7977 Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 48 44 2005 Other NS 2006 Other NS 0 5 10 15 20 25 2001 MICS 58 16,557 3,082 792 29 260 154 54 206 1,400 12 11,000 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2001) (2001) 77 12 (2001) (2000) P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 2001 MICS 11 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) --- --- --- ---, ---, --- --- --- Coverage along the continuum of care Source: DHS, MICS, Other NS *See Annex for indicator definition Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 6 66 45 11 48 WATER AND SANITATION EQUITY SYSTEMSPOLICIES Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities Financial Flows and Human Resources Coverage gap by wealth quintile Angola 1990 2004 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 Skilled attendant at delivery Percent live births attended by skilled health personnel Neonatal tetanus protection Percent of newborns protected against tetanus 23 45 1996 MICS 2001 MICS P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF 80 P er ce nt 20 40 60 80 100 1983 1988 19981993 2003 2006 23 36 40 75 53 40 1990 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 18 61 16 56 3129 Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths No No No No Partial Yes No Yes Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 38 4 21 1.4 11 16 --- (2007) (2007) (2007) (2004) (2005) (2005) Coverage gap (%) 2001 MICS 55 1.6 25 Ratio poorest/wealthiest Difference poorest-wealthiest (%) Diarrhoea 5% Tetanus 6% Other 7% Congenital 5% Asphyxia 24% Infection 29% Preterm 25% Diarrhoea 19% Other 17% Malaria 8% Measles 5% HIV/AIDS 2% Injuries 1% Pneumonia 25% Neonatal 22% Causes of neonatal deaths Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care MDG Target 1990 1995 2000 2005 2010 2015 50 0 100 150 200 250 Source: UNICEF, 2006 Under-five mortality rate Deaths per 1000 live births Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 Malaria prevention Percent children < 5 years sleeping under ITNs Malaria treatment Percent febrile children < 5 years using antimalarials 2001 MICS 260260 87 No data No data 3 Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% 66 0 0 00 1990 1995 2000 2005 2006 DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Azerbaijan Source: WHO, 2006 Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Underweight prevalence Percent children < 5 years underweight for age* 18 3 *Based on 2006 WHO reference population 2000 MICS 36 8,406 547 129 97 88 73 36 11 82 670 110 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) (2001) (2001) 39 12 (2000) (2001) 2000 MICS 7 P er ce nt 20 0 40 60 80 100 40 2000 MICS P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth,%) Postnatal visit for baby (within 2 days for home births ,%) 12 30 --- 3, 4, 1 --- --- (2001) (1996-2001) (2001) Causes of maternal deaths Regional estimates for Asia, 1997-2002 Coverage along the continuum of care Source: DHS, MICS, Other NS *See Annex for indicator definition Pre-pregnancy Pregnancy Neonatal period Infancy 0 20 40 60 80 100 55 70 100 7 WATER AND SANITATION EQUITY SYSTEMSPOLICIES Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities Financial Flows and Human Resources Coverage gap by wealth quintile Azerbaijan 1990 2004 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 Neonatal tetanus protection Percent of newborns protected against tetanus 51 82 59 95 7768 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 2004 36 73 54 Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Partial No Partial No No Partial Partial Yes Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 138 3 70 11.8 4 2 --- (2007) (2007) (2007) (2003) (2005) (2005) Coverage gap (%) 2000 MICS 51 1.2 9 Ratio poorest/wealthiest Difference poorest-wealthiest (%) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 66 2000 MICS 70 2001 Other NS 88 105 35 MDG Target Under-five mortality rate Deaths per 1000 live births Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition Diarrhoea 2% Other 6% Congenital 11% Infection 20% Asphyxia 22% Preterm 35% Other 20% Pneumonia 18% Diarrhoea 15% Injuries 1% Malaria 1% Measles 0% HIV/AIDS 0% Neonatal 44% Causes of neonatal deaths 14 2000 MICS 6 2001 Other NS 8 2006 DHS P er ce nt 20 0 40 60 80 100 Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: UNICEF 29 14 29 P er ce nt 20 0 40 60 80 100 Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF 19951990 2000 2005 2006 96 95 No data P er ce nt 20 0 40 60 80 100 2000 MICS 1 2000 MICS 1 Other causes 21%Anaemia13% Haemorrhage 31% Abortion 6% Obstructed labor 9% Hypertensive disorders 9% Sepsis/Infections, including AIDS 12% Birth 96 No data Skilled attendant at delivery Percent live births attended by skilled health personnel 100 84 88 100 100 100 1998 Other NS 2000 MICS 2002 Other NS 2001 Other NS 2003 Other NS 2004 Other NS P er ce nt 20 0 40 60 80 100 Source: UNICEF, 2006 1990 0 20 40 60 80 100 1995 2000 2005 2010 2015 0 0 0 000 Malaria prevention Percent children < 5 years sleeping under ITNs* Malaria treatment Percent febrile children < 5 years using antimalarials* *Very limited risk of malaria transmission *Very limited risk of malaria transmission DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Bangladesh Source: WHO, 2006 51 15 *Based on 2006 WHO reference population 35 1999-2000 DHS 53 2004 DHS 49 2006 MICS 155,991 18,951 4,013 10 69 52 36 277 570 51 21,000 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2004) (2004) 52 22 (2006) (2006) P er ce nt 20 0 40 60 80 100 Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics 1993-94 DHS 1996-97 DHS 2004 DHS 2006 MICS 28 33 27 20 30 22 1999-00 DHS P er ce nt 20 0 40 60 80 100 Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 11 16 --- 4, 11, 2 36 22 (2004) (2004) (2004) (2006) (2007) Causes of maternal deaths Regional estimates for Asia, 1997-2002 Coverage along the continuum of care Source: DHS, MICS, Other NS *See Annex for indicator definition Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 58 48 20 20 37 81 WATER AND SANITATION EQUITY SYSTEMSPOLICIES Sanitation Percent population using improved sanitation facilities Financial Flows and Human Resources Coverage gap by wealth quintile Bangladesh TotalRural Urban Skilled attendant at delivery Percent live births attended by skilled health personnel Neonatal tetanus protection Percent of newborns protected against tetanus Water Percent population using improved drinking water sources 1990 2004 TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 69 83 7272 82 74 1990 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 12 55 35 51 39 20 Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Partial Partial Partial Yes Partial Yes No Partial Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 64 6 63 0.6 2 10 54 (2007) (2007) (2007) (2004) (2005) (2005) (2007) Coverage gap (%) 1997 DHS 2000 DHS 2004 DHS 2007 MICS 50 1.7 24 48 1.9 27 41 2.0 27 38 Ratio poorest/wealthiest Difference poorest-wealthiest (%) Diarrhoea 20% Malaria 1% HIV/AIDS 0%Other11% Injuries 3% Measles 2% Pneumonia 18% Neonatal 45% Causes of neonatal deaths Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy Malaria prevention Percent children < 5 years sleeping under ITNs Malaria treatment Percent febrile children < 5 years using antimalarials 69 149 50 MDG Target Under-five mortality rate Deaths per 1000 live births Underweight prevalence Percent children < 5 years underweight for age* P er ce nt 20 0 40 60 80 100 2004 DHS 2005 Other NS 43 39 Pe rc en t 20 0 40 60 80 100 46 45 46 36 37 1993-94 DHS 1996-97 DHS 2004 DHS 1999-00 DHS 2006 MICS Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: UNICEF 79 99 85 85 90 90 87 0 87 83 8384 82 83 P er ce nt 20 0 40 60 80 100 No data No data No data Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 1990 1995 2000 2005 2006 88 81 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF P er ce nt 20 0 40 60 80 100 26 26 49 40 33 40 48 1993-94 DHS 1996-97 DHS 2004 DHS 2003 MICS 1999-00 DHS 2001 Other NS 2006 MICS 1993-94 DHS 1996-97 DHS 2004 DHS 2003 MICS 1999-00 DHS 2001 Other NS 2006 MICS P er ce nt 20 0 40 60 80 100 10 8 13 1412 12 20 P er ce nt 20 40 60 80 100 Source: WHO/UNICEF 92 1980 1985 19951990 2000 2006 Other causes 21%Anaemia13% Haemorrhage 31% Abortion 6% Obstructed labor 9% Hypertensive disorders 9% Sepsis/Infections, including AIDS 12% No data Source: UNICEF, 2006 1990 0 30 60 90 120 150 1995 2000 2005 2010 2015 DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Benin 1999 2000 2001 2002 2003 2004 2005 23 42 1996 DHS 2001 DHS At least one dose Two doses Source: WHO, 2006 Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Source: UNICEF Underweight prevalence Percent children < 5 years underweight for age* 44 9 *Based on 2006 WHO reference population 20 2001 DHS 22 2006 DHS 2001 DHS 38 70 2006 DHS 56 100 96 8595 98 95 89 92 94 94 Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 93 93 89 0 20 40 60 80 100 1996 DHS 2001 DHS 32 35 8,760 1,488 358 70 148 88 38 53 840 20 2,900 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2006) (2006) 50 16 (2006) (2001) P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 1996 DHS 10 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 27 62 3 3, 6, 2 49 --- (2001) (2001) (2006) (2001) (2001) Coverage along the continuum of care Source: DHS, MICS, Other NS *See Annex for indicator definition Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 17 88 78 70 89 WATER AND SANITATION EQUITY SYSTEMSPOLICIES Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities Financial Flows and Human Resources Coverage gap by wealth quintile Benin 1990 2004 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 Skilled attendant at delivery Percent live births attended by skilled health personnel Neonatal tetanus protection Percent of newborns protected against tetanus 1996 DHS 2001 DHS 2006 DHS P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1986 1991 20011996 2006 57 73 57 78 67 63 1990 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 2 32 11 59 33 12 Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Yes Yes Partial Yes Yes Partial No Yes Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 40 10 49 0.9 7 4 66 (2007) (2007) (2007) (2004) (2005) (2005) (2002) Coverage gap (%) 1996 DHS 2001 DHS 48 1.9 29 41 1.7 22 Ratio poorest/wealthiest Difference poorest-wealthiest (%) Diarrhoea 2% Tetanus 4% Other 5% Congenital 8% Asphyxia 19% Infection 34% Preterm 28% Pneumonia 21% Diarrhoea 17% Measles 5% HIV/AIDS 2% Injuries 2% Other 0% Malaria 27% Neonatal 25% Causes of neonatal deaths Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care 1990 1995 2000 2005 2010 2015 40 0 80 120 160 200 62 148 185 Source: UNICEF, 2006 MDG Target Under-five mortality rate Deaths per 1000 live births Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 66 Malaria prevention Percent children < 5 years sleeping under ITNs 2001 DHS 2006 MICS 20 7 P er ce nt 20 0 40 60 80 100 Malaria treatment Percent febrile children < 5 years using antimalarials 2006 DHS 2001 DHS 54 60 P er ce nt 20 0 40 60 80 100 1996 DHS 2001 DHS 2006 DHS 2005 Other NS 27 2006 Other NS 53 80 81 88 60 66 78 94 0 000 Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% 1990 1995 2000 2005 2006 DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Bolivia 30 34 59 54 1994 DHS 1998 DHS 2000 MICS 2003 DHS Source: WHO, 2006 Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Underweight prevalence Percent children < 5 years underweight for age* 33 2 *Based on 2006 WHO reference population 1998 DHS 2003 DHS Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 2003 DHS 1994 DHS 1998 DHS 2000 MICS 40 43 5254 9,354 1,243 264 82 61 50 27 16 290 89 760 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2003) (2003) 74 7 (2003) (2003) P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 1994 DHS 1998 DHS 2000 MICS 2003 DHS 43 50 54 39 6 6 81 81 Source: WHO/UNICEF Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 23 58 --- 15,21,6 61 --- (2003) (2003) (2003) (2003) Causes of maternal deaths Regional estimates for Latin America, 1997-2002 Coverage along the continuum of care Source: DHS, MICS, Other NS *See Annex for indicator definition Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 58 79 67 54 81 WATER AND SANITATION EQUITY SYSTEMSPOLICIES Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities Financial Flows and Human Resources Coverage gap by wealth quintile Bolivia 1990 2004 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 Skilled attendant at delivery Percent live births attended by skilled health personnel Neonatal tetanus protection Percent of newborns protected against tetanus 43 47 59 69 65 67 1989 DHS 1994 DHS 2002 Other NS 2003 DHS 2000 MICS 1998 DHS P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF 71 P er ce nt 20 40 60 80 100 1987 1992 20021997 2006 49 91 68 95 85 72 1990 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 14 49 22 60 46 33 Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Partial --- Yes Yes Partial --- Partial --- Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 186 13 32 3.3 6 11 48 (2007) (2007) (2007) (2001) (2005) (2005) (2003) Coverage gap (%) 1994 DHS 1998 DHS 2000 MICS 2003 DHS 48 44 2.5--- 38--- 33 2.4 30 33 2.8 30 Ratio poorest/wealthiest Difference poorest-wealthiest (%) Other 25% Diarrhoea 14% Injuries 5% Measles 0% Malaria 1% HIV/AIDS 0% Neonatal 38% Causes of neonatal deaths Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care Haemorrhage 21%Other causes 21% Hypertensive disorders 26% Abortion 12% Anaemia 0% Sepsis/Infections, including AIDS 8% Obstructed labor 13% Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 46 53 69 83 79 1989 DHS 1994 DHS 2000 MICS 2003 DHS 1998 DHS Pneumonia 17% No data No data No data Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: UNICEF P er ce nt 20 0 40 60 80 100 85 35 68 73 31 31 38 38 42 42 39 39 33 50 1990 1995 2000 2005 2010 2015 30 0 60 90 120 150 Source: UNICEF, 2006 Under-five mortality rate Deaths per 1000 live births Diarrhoea 2% Other 8% Congenital 9% Tetanus 2% Infection 23% Preterm 31% Asphyxia 26% 61 125 42 81 MDG Target Malaria prevention Percent children < 5 years sleeping under ITNs* Malaria treatment Percent febrile children < 5 years using antimalarials* *Sub-national risk of malaria transmission *Sub-national risk of malaria transmission 1990 1995 2000 2005 2006 DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Botswana 2000 MICS Source: WHO, 2006 Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Underweight prevalence Percent children < 5 years underweight for age* 29 6 *Based on 2006 WHO reference population 1996 Other NS 2000 Other NS Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 2000 MICS 14 1,858 216 47 58 124 90 40 6 380 130 170 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2000) (2000) 57 10 (2000) (2000) P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 2000 MICS 34 15 7 11 97 90 Source: WHO/UNICEF Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) --- --- --- ---, ---, --- --- --- Coverage along the continuum of care Source: DHS, MICS, Other NS *See Annex for indicator definition Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 48 97 94 34 90 WATER AND SANITATION EQUITY SYSTEMSPOLICIES Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities Financial Flows and Human Resources Coverage gap by wealth quintile Botswana 1990 2004 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 Skilled attendant at delivery Percent live births attended by skilled health personnel Neonatal tetanus protection Percent of newborns protected against tetanus 94 87 78 1988 DHS 2000 MICS 1996 Other NS P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF 84 P er ce nt 20 40 60 80 100 1981 1986 19961991 2001 2006 88 90 100100 9593 1990 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 21 61 25 57 4238 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Yes Partial --- --- --- --- No --- Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 504 11 10 3.1 0 0 --- (2007) (2007) (2007) (2004) (2005) (2005) Coverage gap (%) Ratio poorest/wealthiest Difference poorest-wealthiest (%) Injuries 3% Diarrhoea 1% Measles 0% Malaria 0% Other 0% HIV/AIDS 54% Neonatal 40% Causes of neonatal deaths Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 Malaria prevention Percent children < 5 years sleeping under ITNs Malaria treatment Percent febrile children < 5 years using antimalarials 1998 Other NS 2000 MICS Pneumonia 1% 1990 1995 2000 2005 2006 No data No data No data No data Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: UNICEF P er ce nt 20 0 40 60 80 100 85 85 92 97 62 0 0 0 0 0 0 000 0 1990 1995 2000 2005 2010 2015 30 0 60 90 120 150 Source: UNICEF, 2006 Under-five mortality rate Deaths per 1000 live births MDG Target Tetanus 3% Other 6% Congenital 7% Diarrhoea 3% Asphyxia 21% Preterm 36% Infection 24% 124 58 19 87 114 2004 Other NS 2005 Other NS 2006 Other NS 0 20 40 60 80 100 P er ce nt 64 87 >95 Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Brazil Source: WHO, 2006 Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Underweight prevalence Percent children < 5 years underweight for age* 14 3 *Based on 2006 WHO reference population 189,323 18,092 3,720 89 20 19 15 74 110 370 4,100 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) (1996) (1996) 30 8 (1996) (2004) P er ce nt 20 0 40 60 80 100 Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 7 76 --- 36, 42, 20 33 --- (1996) (1996) (1996) (1996) WATER AND SANITATION EQUITY SYSTEMSPOLICIES Water Percent population using improved drinking water sources Financial Flows and Human Resources Coverage gap by wealth quintile Brazil TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 Neonatal tetanus protection Percent of newborns protected against tetanus Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Yes No No Yes No Partial Partial Yes Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 1520 14 29 5.0 0 0 --- (2007) (2007) (2007) (2000) (2005) (2005) Coverage gap (%) 1996 DHS 24 2.4 20 Ratio poorest/wealthiest Difference poorest-wealthiest (%) Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition Other 33% Pneumonia 13% Diarrhoea 12% Injuries 3% Malaria1% HIV/AIDS 0% Measles 0% Neonatal 38% Causes of neonatal deaths Skilled attendant at delivery Percent live births attended by skilled health personnel Coverage along the continuum of care Source: DHS, MICS, Other NS *See Annex for indicator definition Pre-pregnancy Pregnancy Neonatal period Infancy 0 20 40 60 80 100 77 97 Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care Birth 99 70 1991 DHS 88 1996 DHS P er ce nt 20 0 40 60 80 100 1990 2004 P er ce nt 20 0 40 60 80 100 55 93 57 96 90 83 1990 2004 P er ce nt 20 0 40 60 80 100 Sanitation Percent population using improved sanitation facilities Source: WHO/UNICEF JMP, 2006 37 37 83 7571 82 Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding 28 1996 DHS P er ce nt 20 0 40 60 80 100 MDG Target Under-five mortality rate Deaths per 1000 live births 20 57 19 P er ce nt 20 0 40 60 80 100 1996 DHS 2002-2003 Other NS 5 4 Exclusive breastfeeding Percent infants < 6 months exclusively breastfed No data No data Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses No data No data Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF 1990 1995 2000 20062005 99 99 99 Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT 3 7175 2004 Other NS 2005 Other NS 2006 Other NS 0 20 40 60 80 100 P er ce nt 80 75 71 1991 DHS 1996 DHS 13 46 15 P er ce nt 20 40 60 80 100 Source: WHO/UNICEF 92 1987 1992 20021997 2006 P er ce nt 20 0 40 60 80 100 86 74 9797 1986 DHS 1996 DHS 2003 Other NS 2004 Other NS Other 6% Congenital 13% Infection 28% Asphyxia 10% Preterm 43% Source: UNICEF, 2006 1990 0 20 40 60 80 100 1995 2000 2005 2010 2015 88 Causes of maternal deaths Regional estimates for Latin America, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Abortion 12% Anaemia 0% Haemorrhage 21% Obstructive labor 13% Other causes 21% Hypertensive disorders 26% Sepsis/Infections, including AIDS 8% Malaria prevention Percent children < 5 years sleeping under ITNs* Malaria treatment Percent febrile children < 5 years using antimalarials* *Sub-national risk of malaria transmission *Sub-national risk of malaria transmission DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Burkina Faso Source: WHO, 2006 41 25 *Based on 2006 WHO reference population 14,359 2,605 641 64 204 122 36 131 700 22 4,300 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2006) (2006) 50 16 (2006) (2006) Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics 1992-1993 DHS 19 12 1998-1999 DHS 22 2006 MICS 39 15 36 2003 DHS P er ce nt 20 0 40 60 80 100 Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 29 18 1 1, 3, 0 33 --- (2003) (2003) (2006) (2003) (2003) WATER AND SANITATION EQUITY SYSTEMSPOLICIES Sanitation Percent population using improved sanitation facilities Financial Flows and Human Resources Coverage gap by wealth quintile Burkina Faso TotalRural Urban Skilled attendant at delivery Percent live births attended by skilled health personnel Neonatal tetanus protection Percent of newborns protected against tetanus 1990 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 3 32 6 42 13 7 Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Yes Yes No Yes Yes Yes Partial Yes Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 77 15 44 0.5 8 7 --- (2007) (2007) (2007) (2004) (2005) (2005) Diarrhoea 19% Malaria 20% HIV/AIDS 4% Other 10% Injuries 2% Measles 3% Pneumonia 23% Neonatal 18% Causes of neonatal deaths Coverage gap (%) 1999 DHS 2003 DHS 61 1.8 31 52 2.3 37 Ratio poorest/wealthiest Difference poorest-wealthiest (%) Underweight prevalence Percent children < 5 years underweight for age* P er ce nt 20 0 40 60 80 100 3 1992-1993 DHS 6 1998-1999 DHS 7 2006 MICS 19 2003 DHS P er ce nt 20 0 40 60 80 100 2003 DHS 2006 MICS 35 32 Water Percent population using improved drinking water sources 1990 2004 TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 34 61 54 38 94 61 MDG Target Under-five mortality rate Deaths per 1000 live births 69 204206 P er ce nt 20 40 60 80 100 Source: WHO/UNICEF 80 1983 1988 19981993 2003 2006 Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 1990 1995 2000 2005 2006 95 88 76 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF Malaria prevention Percent children < 5 years sleeping under ITNs P er ce nt 20 0 40 60 80 100 2003 DHS 2 2006 MICS 10 Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT 2004 Other NS 2005 Other NS 2006 Other NS 0 20 40 60 80 100 P er ce nt Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding 19 1992-1993 DHS 47 2003 DHS 42 2006 MICS P er ce nt 20 0 40 60 80 100 Malaria treatment Percent febrile children < 5 years using antimalarials P er ce nt 20 0 40 60 80 100 1992-1993 DHS 32 2006 MICS 48 2003 DHS 50 Coverage along the continuum of care Source: DHS, MICS, Other NS *See Annex for indicator definition Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 17 85 54 7 88Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 6159 85 73 P er ce nt 20 0 40 60 80 100 31 42 54 38 1992-1993 DHS 1998-1999 DHS 2003 DHS 2006 MICS 1992-1993 DHS 1998-1999 DHS 2003 DHS 2006 MICS Source: UNICEF, 2006 1990 0 50 100 150 200 250 1995 2000 2005 2010 2015 Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: UNICEF P er ce nt 20 0 40 60 80 100 99 0 12 29 53 61 91 80 95 9593 20 97 97 95 95 95 Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% Diarrhoea 2% Tetanus 5% Congenital 5% Other 6% Asphyxia 20% Infection 39% Preterm 23% DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Burundi Source: WHO, 2006 Source: Lawn JE, Cousens SN for CHERG (Nov 2006) 58 9 *Based on 2006 WHO reference population 8,173 1,461 381 60 181 109 41 69 1,100 16 3,900 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2005) (2005) 88 11 (2005) (2005) P er ce nt 20 0 40 60 80 100 Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) --- --- --- ---, ---, --- --- --- WATER AND SANITATION SYSTEMSPOLICIES Financial Flows and Human Resources Burundi Skilled attendant at delivery Percent live births attended by skilled health personnel Neonatal tetanus protection Percent of newborns protected against tetanus Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths No Partial No Partial Partial No No Partial Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 16 2 74 0.2 9 6 --- (2007) (2007) (2007) (2004) (2005) (2005) Diarrhoea 3% Tetanus 5% Other 7% Congenital 5% Asphyxia 25% Infection 31% Preterm 23% Diarrhoea 18% Malaria 8% HIV/AIDS 8% Other 15% Injuries 2% Measles 3% Pneumonia 23% Neonatal 23% Causes of neonatal deaths Underweight prevalence Percent children < 5 years underweight for age* P er ce nt 20 0 40 60 80 100 2000 MICS 2005 Other NS 39 35 Sanitation Percent population using improved sanitation facilities TotalRural Urban 1990 2004 44 42 35 47 3644 Water Percent population using improved drinking water sources 1990 2004 TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 67 97 77 69 92 79 P er ce nt 20 40 60 80 100 Source: WHO/UNICEF 1983 1988 19981993 2003 2006 Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 1990 1995 2000 20062005 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF Malaria prevention Percent children < 5 years sleeping under ITNs 2000 MICS 2005 MICS P er ce nt 20 0 40 60 80 100 1 8 Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT 2004 Other NS 2005 Other NS 2006 Other NS 0 5 10 15 20 25 P er ce nt Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding P er ce nt 20 0 40 60 80 100 Malaria treatment Percent febrile children < 5 years using antimalarials P er ce nt 20 0 40 60 80 100 2000 MICS 31 2005 MICS 30 Coverage along the continuum of care Source: DHS, MICS, Other NS *See Annex for indicator definition Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 9 92 34 45 75Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care P er ce nt 20 0 40 60 80 100 1987 DHS 2000 MICS 2005 MICS Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy 7879 92 P er ce nt 20 0 40 60 80 100 25 19 34 1987 DHS 2000 MICS 2005 MICS EQUITY Coverage gap by wealth quintile Coverage gap (%) 2000 MICS 51 1.3 15 Ratio poorest/wealthiest Difference poorest-wealthiest (%) 84 Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics 1987 DHS 2000 MICS 2005 MICS 1 38 26 40 2000 MICS 2005 MICS 16 23 75 74 74 Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: UNICEF P er ce nt 20 0 40 60 80 100 92 0 4 6 14 0 0 0 0 0 96 95 89 95 94 69 17 P er ce nt 20 0 40 60 80 100 2000 MICS 2005 Other NS 62 45 Under-five mortality rate Deaths per 1000 live births MDG Target 63 181 190 Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% 1990 1995 2000 2005 2010 2015 40 0 80 120 160 200 Source: UNICEF, 2006 DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Cambodia 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: WHO, 2006 Source: UNICEF Underweight prevalence Percent children < 5 years underweight for age* 44 8 *Based on 2006 WHO reference population 40 28 43 2005 DHS 1996 Other NS 2000 DHS 2005 DHS 60 9 14 21 30 79 55 63 34 34 57 57 47 47 72 72 79 65 Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 1990 1995 2000 2005 2006 80 78 0 6 12 18 24 30 59 2000 DHS 2005 DHS 37 48 14,197 1,690 377 66 82 65 40 31 540 48 2,300 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2005) (2005) 82 11 (2005) (2000) P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 2000 DHS 12 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 33 27 --- 2, 6, 1 35 --- (2000) (2005) (2005) (2005) Causes of maternal deaths Regional estimates for Asia, 1997-2002 Coverage along the continuum of care Source: DHS, MICS, Other NS *See Annex for indicator definition Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 40 69 44 60 64 78 WATER AND SANITATION EQUITY SYSTEMSPOLICIES Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities Financial Flows and Human Resources Coverage gap by wealth quintile Cambodia 2004 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 Skilled attendant at delivery Percent live births attended by skilled health personnel Neonatal tetanus protection Percent of newborns protected against tetanus 1998 Other NS 2000 DHS 2005 DHS P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1983 1988 19981993 20062003 35 64 41 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 8 53 17 Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Partial Yes Partial Yes Partial No No Partial Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 140 11 63 1.0 10 50 --- (2007) (2007) (2007) (2000) (2005) (2005) Coverage gap (%) 2000 DHS 2005 DHS 54 2.0 31 37 1.8 22 Ratio poorest/wealthiest Difference poorest-wealthiest (%) Other 26% Pneumonia 21% Measles 2% HIV/AIDS 2% Injuries 2% Diarrhoea 17% Malaria 1% Neonatal 30% Causes of neonatal deaths Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care Other causes 21%Anaemia 13% Haemorrhage 31% Abortion 6% Obstructed labor 9% Hypertensive disorders 9% Sepsis/Infections, including AIDS 12% 1990 1995 2000 2005 2010 2015 30 0 60 90 120 150 39 116 82 Source: UNICEF, 2006 MDG Target Under-five mortality rate Deaths per 1000 live births Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 34 Malaria prevention Percent children < 5 years sleeping under ITNs 2005 DHS 4 P er ce nt 20 0 40 60 80 100 Malaria treatment Percent febrile children < 5 years using antimalarials 1998 Other NS 2000 DHS 2005 DHS 2004 Other NS 2005 Other NS 2006 Other NS 38 69 34 32 44 82 Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT 2000 DHS No data P er ce nt 20 0 40 60 80 100 2005 DHS 0.2 DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Cameroon 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: WHO, 2006 Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Source: UNICEF Underweight prevalence Percent children < 5 years underweight for age* 36 7 0 0 000 *Based on 2006 WHO reference population 1615 2004 DHS 2006 MICS 10 22 100 100 86 86100 21 81 95 95 0 6 12 18 24 30 31 32 22 43 1998 DHS 2000 MICS 2004 DHS 2006 MICS 1991 DHS 1998 DHS 2000 MICS 2004 DHS 2006 MICS 18,175 2,851 649 70 149 87 40 97 1,000 24 5,700 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2006) (2006) 64 11 (2006) (2006) P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 7 24 21 12 1991 DHS 1998 DHS 2004 DHS 2006 MICS P er ce nt 20 0 40 60 80 100 Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 20 60 6 2, 4, 1 32 --- (2004) (2004) (2006) (2004) (2004) Coverage along the continuum of care Source: DHS, MICS, Other NS *See Annex for indicator definition Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 29 82 63 21 73 WATER AND SANITATION EQUITY SYSTEMSPOLICIES Financial Flows and Human Resources Cameroon Skilled attendant at delivery Percent live births attended by skilled health personnel Neonatal tetanus protection Percent of newborns protected against tetanus Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1984 1989 19991994 20062004 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Yes Yes No Yes Yes Yes Partial No Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 83 11 68 1.8 7 4 29 (2007) (2007) (2007) (2004) (2005) (2005) (2000) Other 0% Pneumonia 22% Measles 4% HIV/AIDS 7% Injuries 2%Diarrhoea 17% Malaria 23% Neonatal 25% Causes of neonatal deaths Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care 1990 1995 2000 2005 2010 2015 30 0 60 90 120 150 46 149139 Source: UNICEF, 2006 MDG Target Under-five mortality rate Deaths per 1000 live births Malaria prevention Percent children < 5 years sleeping under ITNs 2000 MICS 2004 DHS 2006 MICS 1 1 13 P er ce nt 20 0 40 60 80 100 Malaria treatment Percent febrile children < 5 years using antimalarials 2004 Other NS 2005 Other NS 2006 Other NS 80 Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 1990 1995 2000 20052006 81 73 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF Diarrhoea 2% Other 7% Congenital 8% Tetanus 3% Asphyxia 25% Preterm 30% Infection 25% 11 2004 DHS 2006 MICS 2000 MICS 58 13 34 25 40 35 38 44 53 66 P er ce nt 20 0 40 60 80 100 Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 79 79 75 83 82 1991 DHS 1998 DHS 2004 DHS 2006 MICS 2000 MICS P er ce nt 20 0 40 60 80 100 64 58 60 62 63 1991 DHS 1998 DHS 2004 DHS 2006 MICS 2000 MICS Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities 1990 2004 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 1990 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 40 59 43 58 5148 77 50 44 86 66 31 Coverage gap by wealth quintile Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap (%) 1991 DHS 1998 DHS 2000 MICS 2004 DHS 48 52 1.91.9 3132 53 1.8 29 40 2.2 32 Ratio poorest/wealthiest Difference poorest-wealthiest (%) 2006 MICS 44 2.2 33 Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Central African Republic 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: WHO, 2006 Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Source: UNICEF Underweight prevalence Percent children < 5 years underweight for age* 43 12 *Based on 2006 WHO reference population 2422 2000 MICS 2006 MICS 7 18 18 100 0 2 3 0 0 00 100 90 84 90 79 66 0 4 8 12 16 20 29 47 47 1994-1995 DHS 2000 MICS 2006 MICS 1994-1995 DHS 2000 MICS 2006 MICS 4,265 668 157 49 175 115 48 27 980 25 1,500 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2006) (2006) 55 13 (2006) (2006) P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 3 23 17 1994-1995 DHS 2000 MICS 2006 MICS P er ce nt 20 0 40 60 80 100 Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 16 40 9 2, 2, 2 39 --- (1994-1995) (1994-1995) (2006) (1994-1995) (2006) Coverage along the continuum of care Source: DHS, MICS, Other NS *See Annex for indicator definition Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 19 69 53 23 35 WATER AND SANITATION EQUITY SYSTEMSPOLICIES Financial Flows and Human Resources Central African Republic Skilled attendant at delivery Percent live births attended by skilled health personnel Neonatal tetanus protection Percent of newborns protected against tetanus Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1980 1985 19951990 20062000 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths No --- No Yes Yes Yes Partial No Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 54 11 60 0.5 7 5 --- (2007) (2007) (2007) (2004) (2005) (2005) Other 0% Pneumonia 19% Measles 7%HIV/AIDS 12% Injuries 2% Diarrhoea 15% Malaria 19% Neonatal 27% Causes of neonatal deaths Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care 1990 1995 2000 2005 2010 2015 40 0 80 120 160 200 58 175173 Source: UNICEF, 2006 MDG Target Under-five mortality rate Deaths per 1000 live births Malaria prevention Percent children < 5 years sleeping under ITNs 2000 MICS 2006 MICS 2 15 P er ce nt 20 0 40 60 80 100 Malaria treatment Percent febrile children < 5 years using antimalarials 2004 Other NS 2005 Other NS 2006 Other NS 52 Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 1990 1995 2000 20052006 40 35 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF Diarrhoea 4% Congenital 6% Tetanus 10% Other 6% Asphyxia 22% Infection 29% Preterm 23% 2 7 2000 MICS 2006 MICS 57 39 32 41 32 69 P er ce nt 20 0 40 60 80 100 Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 67 62 69 1994-1995 DHS 2000 MICS 2006 MICS P er ce nt 20 0 40 60 80 100 Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities 1990 2004 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 1990 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 17 34 12 47 2723 74 52 61 93 75 39 Coverage gap by wealth quintile Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap (%) 1995 DHS 2000 MICS 2006 MICS 56 58 1.91.9 3334 53 1.9 30 Ratio poorest/wealthiest Difference poorest-wealthiest (%) 46 44 53 1994-1995 DHS 2000 MICS 2006 MICS Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% Coverage gap by wealth quintile Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap (%) 1997 DHS 2000 MICS 2004 DHS 75 1.5 30 69 1.4 23 79 1.6 37 Ratio poorest/wealthiest Difference poorest-wealthiest (%) DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Chad 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: WHO, 2006 Source: UNICEF Underweight prevalence Percent children < 5 years underweight for age* 45 16 *Based on 2006 WHO reference population 34 29 2000 MICS 2004 DHS 2004 DHS 2000 MICS 10 2 2 1 92 92 93 99 91 88 85 0 0 0 84 95 93 Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 1990 1995 2000 20062005 23 20 0 1 2 3 4 5 2004 DHS 2000 MICS 1996-1997 DHS 10,468 1,943 482 9 209 124 45 101 1,500 11 6,900 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2004) (2004) 77 22 (2004) (2004) P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 1996-1997 DHS 2 50 2723 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 23 18 --- 0, 1, 0 34 --- (2004) (2004) (2004) (2004) Coverage along the continuum of care Source: DHS, MICS, Other NS *See Annex for indicator definition Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 3 39 14 2 2 23 WATER AND SANITATION EQUITY SYSTEMSPOLICIES Financial Flows and Human Resources Chad Skilled attendant at delivery Percent live births attended by skilled health personnel Neonatal tetanus protection Percent of newborns protected against tetanus P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1987 1992 20021997 2006 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths No Yes No No Yes Partial No No Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 42 10 60 0.5 4 5 40 (2007) (2007) (2007) (2004) (2005) (2005) (2002) Other 0% Pneumonia 23% Measles 7% HIV/AIDS 4% Injuries 2% Diarrhoea 18% Malaria 22% Neonatal 24% Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care 1990 1995 2000 2005 2010 2015 40 0 80 120 160 200 201 209 67 Source: UNICEF, 2006 MDG Target Under-five mortality rate Deaths per 1000 live births Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 Malaria prevention Percent children < 5 years sleeping under ITNs 2000 MICS 1 P er ce nt 20 0 40 60 80 100 2005 Other NS 2006 Other NS 15 1996-1997 DHS 2000 MICS 2004 DHS 16 14 23 1996-1997 DHS 2000 MICS 2004 DHS 42 39 60 Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Diarrhoea 3% Other 8% Tetanus 10% Congenital 5% Preterm 18% Infection 28% Asphyxia 27% Causes of neonatal deaths 79 Malaria treatment Percent febrile children < 5 years using antimalarials 2000 MICS 32P er ce nt 20 0 40 60 80 100 Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics 1996-1997 DHS 2000 MICS 2004 DHS 19 22 12 P er ce nt 20 0 40 60 80 100 Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities 1990 2004 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 41 19 43 41 42 13 1990 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 2 28 4 24 97 Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths MDG Target Under-five mortality rate Deaths per 1000 live births 24 45 15 Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report China Source: WHO, 2006 15 --- *Based on 2006 WHO reference population 1,320,864 84,390 17,309 --- 24 20 21 415 45 1,300 7,800 (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2005) 32 2 (2003) (2005) Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) --- --- --- ---, ---, --- --- --- WATER AND SANITATION EQUITY SYSTEMSPOLICIES Sanitation Percent population using improved sanitation facilities Financial Flows and Human Resources Coverage gap by wealth quintile China TotalRural Urban Skilled attendant at delivery Percent live births attended by skilled health personnel 1990 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 7 64 28 69 44 23 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Partial Partial Partial Yes Partial Partial No Yes Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 277 10 54 2.1 0 0 --- (2007) (2007) (2007) (2001) (2005) (2005) Diarrhoea 12% Malaria 0% HIV/AIDS 0% Other 16% Injuries 8% Measles 0% Pneumonia 13% Neonatal 49% Causes of neonatal deaths Coverage gap (%) Ratio poorest/wealthiest Difference poorest-wealthiest (%) Underweight prevalence Percent children < 5 years underweight for age* No data P er ce nt 20 0 40 60 80 100 2002 Other NS 2005 Other NS 7 6 Exclusive breastfeeding Percent infants < 6 months exclusively breastfed P er ce nt 20 0 40 60 80 100 51 2003 Other NS Water Percent population using improved drinking water sources 1990 2004 TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 59 99 6770 93 77 Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 1990 1995 2000 20062005 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding P er ce nt 20 0 40 60 80 100 50 94 94 67 97 97 97 97 97 9896 89 1988 1990 1995 1997 1998 1999 2000 2001 2002 2003 2004 2005 Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses No data No data No data No data No data No data No data Neonatal tetanus protection Percent of newborns protected against tetanus No data Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT 2004 Other NS 2005 Other NS 2006 Other NS 0 4 8 12 16 20 P er ce nt 9 22 93 93 Coverage along the continuum of care Source: DHS, MICS, Other NS *See Annex for indicator definition 0 20 40 60 80 100 87 90 98 51 93Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care Pre-pregnancy Pregnancy Birth Neonatal period Infancy Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 90 90 89 90 90 2001 Other NS 2002 Other NS 2004 Other NS 2005 Other NS 2003 Other NS 1990 1995 2000 2005 2010 2015 10 0 20 30 40 50 Source: UNICEF, 2006 Causes of maternal deaths Regional estimates for Asia, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 21%Anaemia 13% Haemorrhage 31% Abortion 6%Obstructed labor 9% Hypertensive disorders 9% Sepsis/Infections, including AIDS 12% Source: Other NS Malaria prevention Percent children < 5 years sleeping under ITNs* Malaria treatment Percent febrile children < 5 years using antimalarials* *Sub-national risk of malaria transmission *Sub-national risk of malaria transmission DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Congo Source: WHO, 2006 Source: Lawn JE, Cousens SN for CHERG (Nov 2006) 31 8 *Based on 2006 WHO reference population 3,689 587 132 81 126 79 32 17 740 22 1,300 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) (2005) (2005) 78 13 (2005) (2005) Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics 2005 DHS 48 P er ce nt 20 0 40 60 80 100 Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 16 75 --- 3, 4, 2 39 --- (2005) (2005) (2005) (2005) WATER AND SANITATION EQUITY SYSTEMSPOLICIES Sanitation Percent population using improved sanitation facilities Financial Flows and Human Resources Congo TotalRural Urban Skilled attendant at delivery Percent live births attended by skilled health personnel Source: WHO/UNICEF JMP, 2006 Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths No Yes No Yes Yes Yes No No Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 30 21 51 1.2 2 3 --- (2007) (2007) (2007) (2004) (2005) (2005) Underweight prevalence Percent children < 5 years underweight for age* P er ce nt 20 0 40 60 80 100 19 2005 DHS Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 P er ce nt 20 0 40 60 80 100 1987 Other NS 2005 DHS 21 12 P er ce nt 20 0 40 60 80 100 2004 25 28 27 Water Percent population using improved drinking water sources TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 40 60 80 100 Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 1990 1995 2000 2005 2006 79 66 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF Malaria prevention Percent children < 5 years sleeping under ITNs P er ce nt 20 0 40 60 80 100 2005 DHS 6 Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding 39 2005 DHS P er ce nt 20 0 40 60 80 100 Malaria treatment Percent febrile children < 5 years using antimalarials P er ce nt 20 0 40 60 80 100 2005 DHS 48 Coverage along the continuum of care Source: DHS, MICS, Other NS *See Annex for indicator definition Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 44 86 83 24 19 66Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 83 2005 DHS Coverage gap by wealth quintile Coverage gap (%) 2005 DHS 33 2.2 24 Ratio poorest/wealthiest Difference poorest-wealthiest (%) P er ce nt 20 0 40 60 80 100 2004 27 84 58 86 2005 DHS Neonatal tetanus protection Percent of newborns protected against tetanus Source: WHO/UNICEF 88 1986 1991 20011996 2006 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: UNICEF 90 9 94 8986100100 74 0 0 0 0 0 0 P er ce nt 20 0 40 60 80 100 Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT 2004 Other NS 2005 Other NS 2006 Other NS 0 6 12 18 24 30 P er ce nt 7 23 7 Under-five mortality rate Deaths per 1000 live births MDG Target Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition Diarrhoea 2% Tetanus 2% Other 7% Congenital 8% Asphyxia 26% Infection 23% Preterm 31% Diarrhoea 11% Malaria 26% HIV/AIDS 9% Injuries 3% Other 0% Measles 7% Pneumonia 14% Neonatal 31% Causes of neonatal deaths150 120 90 60 30 0 1990 1995 2000 2005 2010 2015 34 126 103 Source: UNICEF, 2006 DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Congo DR Source: WHO, 2006 Source: Lawn JE, Cousens SN for CHERG (Nov 2006) 44 21 *Based on 2006 WHO reference population 60,644 11,843 3,026 34 205 129 47 620 1,100 13 32,000 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) (2001) (2001) 79 12 (2001) (2000) Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics 2001 MICS 36Pe rc en t 20 0 40 60 80 100 Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) --- --- --- ---, ---, --- --- --- WATER AND SANITATION EQUITY SYSTEMSPOLICIES Sanitation Percent population using improved sanitation facilities Financial Flows and Human Resources Congo DR TotalRural Urban Skilled attendant at delivery Percent live births attended by skilled health personnel Source: WHO/UNICEF JMP, 2006 Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Yes Yes Yes Yes Yes Yes Partial Yes Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 15 7 72 0.6 3 3 --- (2007) (2007) (2007) (2004) (2005) (2005) Underweight prevalence Percent children < 5 years underweight for age* Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Water Percent population using improved drinking water sources TotalRural Urban Source: WHO/UNICEF JMP, 2006 Malaria prevention Percent children < 5 years sleeping under ITNs P er ce nt 20 0 40 60 80 100 2001 MICS 1 Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding 17 2001 MICS P er ce nt 20 0 40 60 80 100 Malaria treatment Percent febrile children < 5 years using antimalarials P er ce nt 20 0 40 60 80 100 2001 MICS 52 Coverage along the continuum of care Source: DHS, MICS, Other NS *See Annex for indicator definition Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 31 68 61 24 73Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 61 2001 MICS Coverage gap by wealth quintile Coverage gap (%) 2001 MICS 60 1.6 25 Ratio poorest/wealthiest Difference poorest-wealthiest (%) 68 2001 MICS Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% Under-five mortality rate Deaths per 1000 live births Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition Diarrhoea 3% Tetanus 5% Other 7% Congenital 7% Asphyxia 23% Infection 27% Preterm 28% Diarrhoea 18% Malaria 17% HIV/AIDS 4% Other 6% Injuries 2% Measles 5% Pneumonia 23% Neonatal 26% Causes of neonatal deaths 1990 1995 2000 2005 2010 2015 1990 2004 P er ce nt 20 0 40 60 80 100 1 53 25 42 30 16 1990 2004 P er ce nt 20 0 40 60 80 100 25 90 29 43 82 46 P er ce nt 20 40 60 80 100 Neonatal tetanus protection Percent of newborns protected against tetanus Source: WHO/UNICEF 77 1984 1989 19991994 2004 2006 Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 1990 1995 2000 2005 2006 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT 2004 Other NS 2005 Other NS 2006 Other NS 0 2 4 6 8 10 P er ce nt 1 2 4 Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: UNICEF P er ce nt 20 0 40 60 80 100 0 0 11 7072 80 81 9293 9878 62 87 0 P er ce nt 20 0 40 60 80 100 1995 MICS 2001 MICS 24 24 P er ce nt 20 0 40 60 80 100 1995 MICS 2001 MICS 31 34 77 73 200 160 120 80 40 0 68 205205 MDG Target Source: UNICEF, 2006 DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Côte d’Ivoire 26 31 34 45 1994 DHS 1998-1999 DHS 2000 MICS 2006 MICS Source: WHO, 2006 Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Underweight prevalence Percent children < 5 years underweight for age* 40 8 *Based on 2006 WHO reference population 1998-1999 DHS 2006 MICS Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 18,914 2,849 684 55 127 90 65 87 810 27 5,400 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2006) (2006) 54 17 (2006) (2006) P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 1994 DHS 1998-1999 DHS 2000 MICS 2006 MICS 2003-2004 Other NS 3 4 45 10 18 16 73 77 Source: WHO/UNICEF Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 28 45 8 6, 8, 6 25 --- (1998-99) (2005) (2006) (2005) (2006) Coverage along the continuum of care Source: DHS, MICS, Other NS *See Annex for indicator definition Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 13 85 57 4 73 WATER AND SANITATION EQUITY SYSTEMSPOLICIES Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities Financial Flows and Human Resources Coverage gap by wealth quintile Côte d’Ivoire 1990 2004 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 Skilled attendant at delivery Percent live births attended by skilled health personnel Neonatal tetanus protection Percent of newborns protected against tetanus 45 47 63 68 55 57 1994 DHS 1998-1999 DHS 2005 Other NS 2006 MICS 2003-2004 Other NS 2000 MICS P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1989 1994 2004 20061999 67 73 74 97 84 69 1990 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 10 37 29 46 37 21 Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Partial Partial No No Partial Partial Partial Partial Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 64 5 68 0.7 3 2 --- (2007) (2007) (2007) (2004) (2005) (2005) Coverage gap (%) 1994 DHS 1999 DHS 2000 MICS 2006 MICS 55 49 2.0 35 49 40 2.6 34 Ratio poorest/wealthiest Difference poorest-wealthiest (%) Other 0% Diarrhoea 15% Injuries 2% Measles 3% Malaria 21% HIV/AIDS 6% Neonatal 35% Causes of neonatal deaths Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 83 84 88 87 85 1994 DHS 1998-1999 DHS 2005 Other NS 2006 MICS 2000 MICS Pneumonia 20% 1990 1995 2000 2005 2006 Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: UNICEF P er ce nt 20 0 40 60 80 100 97 97 95 16 0 0 0 0 0 0 60 89 1990 1995 2000 2005 2010 2015 30 0 60 90 120 150 Source: UNICEF, 2006 Under-five mortality rate Deaths per 1000 live births MDG Target Diarrhoea 6% Other 6% Congenital 5% Tetanus 12% Infection 23% Preterm 29% Asphyxia 19% 153 127 51 Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics 9 0 3 6 9 12 15 1994 DHS 1998-1999 DHS 2000 MICS 2006 MICS P er ce nt 20 0 40 60 80 100 P er ce nt Malaria prevention Percent children < 5 years sleeping under ITNs 2000 MICS 2003-2004 Other NS 2006 MICS 1 4 6 P er ce nt 20 0 40 60 80 100 Malaria treatment Percent febrile children < 5 years using antimalarials 2005 Other NS 2006 Other NS Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT 8 2000 MICS 2006 MICS 36 35 19 3539 38 58 P er ce nt 20 0 40 60 80 100 52 Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Djibouti 33 2006 MICS Source: WHO, 2006 Underweight prevalence Percent children < 5 years underweight for age* 34 26 *Based on 2006 WHO reference population 1990 Other NS 2002 Other NS 2006 MICS 1996 Other NS 2 2004 Other NS 2005 Other NS 2006 Other NS 0 2 4 6 8 10 2006 MICS 62 43 819 107 24 89 130 86 38 3 650 35 180 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2006) (2006) 23 10 (2006) (2006) P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 16 16 24 Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) --- --- --- ---,---,--- 55 --- (2006) Coverage along the continuum of care Source: DHS, MICS, Other NS *See Annex for indicator definition Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 9 67 61 1 67 WATER AND SANITATION EQUITY SYSTEMSPOLICIES Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities Financial Flows and Human Resources Coverage gap by wealth quintile Djibouti 1990 2004 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 Skilled attendant at delivery Percent live births attended by skilled health personnel 2003 Other NS P er ce nt 20 0 40 60 80 100 59 76 59 76 7372 1990 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 50 50 88 88 No data No data 8279 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Partial --- No No Yes Partial No Yes Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 87 12 30 0.6 25 22 50 (2007) (2007) (2007) (2004) (2005) (2005) (2004) Coverage gap (%) Ratio poorest/wealthiest Difference poorest-wealthiest (%) Diarrhoea 17% Other 26% Measles 4% Injuries2% Malaria 1% HIV/AIDS 3% Neonatal 27% Causes of neonatal deaths Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care 1990 1995 2000 2005 2010 2015 40 0 80 120 160 200 130 175 58 Source: UNICEF, 2006 Under-five mortality rate Deaths per 1000 live births Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 67 61 Malaria treatment Percent febrile children < 5 years using antimalarials 2006 MICS 10 P er ce nt 20 0 40 60 80 100 2003 Other NS Pneumonia 20% Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib P er ce nt 20 0 40 60 80 100 72 67 Source: WHO/UNICEF 1990 1995 2000 2005 2006 MDG Target Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Diarrhoea 3% Tetanus 6% Other 6% Congenital 15% Asphyxia 20% Infection 27% Preterm 24% Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: UNICEF P er ce nt 20 0 40 60 80 100 91 91 75 52 0 0 0 0 000 Malaria prevention Percent children < 5 years sleeping under ITNs P er ce nt 20 0 40 60 80 100 1 2006 MICS 1 2006 MICS 66 Neonatal tetanus protection Percent of newborns protected against tetanus Source: WHO/UNICEF 77 P er ce nt 20 40 60 80 100 1984 1989 19991994 2004 2006 Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Egypt 19 29 26 27 1995 DHS 2000 DHS 2003 DHS 2005 DHS Source: WHO, 2006 Underweight prevalence Percent children < 5 years underweight for age* 24 5 *Based on 2006 WHO reference population 1995 DHS 1992 DHS 1995 DHS 2000 DHS 2003 DHS 2005 DHS 2005 DHS 2003 DHS 74,166 8,634 1,828 --- 35 29 21 64 130 230 2,400 (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2005) (2005) 67 14 (2005) (2005) P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 11 56 57 30 38 46 9 5 Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth,%) Postnatal visit for baby (within 2 days for home births, %) 10 59 --- 20,29,15 43 9 (2005) (2005) (2005) (2005) (2005) Coverage along the continuum of care Source: DHS, MICS, Other NS *See Annex for indicator definition Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 59 70 74 56 38 98 WATER AND SANITATION SYSTEMSPOLICIES Sanitation Percent population using improved sanitation facilities Financial Flows and Human Resources Egypt TotalRural Urban Skilled attendant at delivery Percent live births attended by skilled health personnel P er ce nt 20 0 40 60 80 100 1990 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 42 58 70 86 70 54 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Partial Yes No Yes Yes Partial No Yes Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 258 8 58 2.5 1 3 --- (2007) (2007) (2007) (2004) (2005) (2005) Diarrhoea 13% Other 26% Measles 0% Injuries 2% Malaria 0% HIV/AIDS 0% Neonatal 44% Causes of neonatal deaths Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care 1990 1995 2000 2005 2010 2015 20 0 40 60 80 100 35 91 30 Source: UNICEF, 2006 Under-five mortality rate Deaths per 1000 live births Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 1988 DHS 1992 DHS 1995 DHS 1997 DHS 1998 DHS 2000 DHS 2003 DHS 2005 DHS 1991 Other NS Pneumonia 15% Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib P er ce nt 20 0 40 60 80 100 98 98 Source: WHO/UNICEF 1990 1995 2000 2005 2006 MDG Target Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Diarrhoea 1% Tetanus 2% Other 6% Congenital 14% Asphyxia 22% Infection 26% Preterm 30% Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses Neonatal tetanus protection Percent of newborns protected against tetanus Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1981 1986 19961991 2001 2006 No data No data No data No data Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics 1992 DHS 1995 DHS 2000 DHS 2003 DHS 2005 DHS P er ce nt 20 0 40 60 80 100 75 59 25 62 66 70 63 53 52 53 39 52 47 53 69 70 1988 DHS 1992 DHS 1995 DHS 1997 DHS 1998 DHS 2000 DHS 2003 DHS 2005 DHS 1991 Other NS 35 37 41 46 56 55 61 69 74 86 Water Percent population using improved drinking water sources 1990 2004 TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 92 97 97 99 98 94 EQUITY Coverage gap by wealth quintile Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap (%) 1995 DHS 2000 DHS 2005 DHS 38 29 2.2 21 24 1.9 15 2.4 31 Ratio poorest/wealthiest Difference poorest-wealthiest (%) Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% Malaria prevention Percent children < 5 years sleeping under ITNs* Malaria treatment Percent febrile children < 5 years using antimalarials* *Very limited risk of malaria transmission *Very limited risk of malaria transmission DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Equatorial Guinea Source: WHO, 2006 Source: Lawn JE, Cousens SN for CHERG (Nov 2006) 43 9 *Based on 2006 WHO reference population 496 81 19 32 206 124 40 4 680 28 150 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) (2000) (2000) --- 13 (2000) Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) --- --- --- ---, ---, --- --- --- WATER AND SANITATION EQUITY SYSTEMSPOLICIES Financial Flows and Human Resources Equatorial Guinea Skilled attendant at delivery Percent live births attended by skilled health personnel International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Partial Yes Yes No Partial Partial Partial Partial Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 223 7 17 0.8 14 13 --- (2007) (2007) (2007) (2004) (2005) (2005) Underweight prevalence Percent children < 5 years underweight for age* Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Water Percent population using improved drinking water sources Malaria prevention Percent children < 5 years sleeping under ITNs P er ce nt 20 0 40 60 80 100 2000 MICS 1 Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding 2000 MICS P er ce nt 20 0 40 60 80 100 Malaria treatment Percent febrile children < 5 years using antimalarials P er ce nt 20 0 40 60 80 100 2000 MICS 49 Coverage along the continuum of care Source: DHS, MICS, Other NS *See Annex for indicator definition Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 86 65 24 51Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 Coverage gap by wealth quintile Coverage gap (%) Ratio poorest/wealthiest Difference poorest-wealthiest (%) P er ce nt 20 0 40 60 80 100 37 1994 Other NS 86 2000 MICS Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition Diarrhoea 4% Tetanus 5% Other 7% Congenital 4% Asphyxia 25% Infection 23% Preterm 33% Diarrhoea 14% Malaria 24% HIV/AIDS 7% Other 0% Injuries 3% Measles 7% Pneumonia 17% Neonatal 28% Causes of neonatal deaths Source: WHO/UNICEF JMP, 2006 Sanitation Percent population using improved sanitation facilities TotalRural Urban P er ce nt 20 0 40 60 80 100 2004 46 60 53 P er ce nt 20 40 60 80 100 Neonatal tetanus protection Percent of newborns protected against tetanus Source: WHO/UNICEF 59 1985 1990 20001995 2006 1990 1995 2000 2005 2006 P er ce nt 20 0 40 60 80 100 Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT 0 5 10 15 20 25 P er ce nt 2006 Other NS 14 Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: UNICEF P er ce nt 20 0 40 60 80 100 0 0 0 0 0 0 0 P er ce nt 20 0 40 60 80 100 2000 MICS 24 P er ce nt 20 0 40 60 80 100 2000 MICS 16 TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 2004 42 45 43 5 1994 Other NS 65 2000 MICS Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics No data 36 Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib Source: WHO/UNICEF 1990 1995 2000 2005 2010 2015 200 160 120 80 40 0 Under-five mortality rate Deaths per 1000 live births 57 206170 MDG Target No data No data 51 33 Source: UNICEF, 2006 DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Eritrea Source: WHO, 2006 Source: Lawn JE, Cousens SN for CHERG (Nov 2006) 44 15 4,692 808 186 --- 74 48 25 14 450 44 760 (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) 43 14 (2002) (2002) Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) WATER AND SANITATION SYSTEMSPOLICIES Financial Flows and Human Resources Eritrea Skilled attendant at delivery Percent live births attended by skilled health personnel International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Yes Partial Partial Yes Partial Partial No No Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 27 4 61 0.6 4 2 --- (2007) (2007) (2007) (2004) (2005) (2005) Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Malaria prevention Percent children < 5 years sleeping under ITNs P er ce nt 20 0 40 60 80 100 2002 DHS 4 Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding P er ce nt 20 0 40 60 80 100 Malaria treatment Percent febrile children < 5 years using antimalarials P er ce nt 20 0 40 60 80 100 2002 DHS 4 Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 49 1995 DHS 70 2002 DHS Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition Diarrhoea 1% Tetanus 3% Other 7% Congenital 5% Asphyxia 26% Infection 30% Preterm 27% Diarrhoea 16% Malaria 14% HIV/AIDS 6%Other 13% Injuries 3% Measles 3% Pneumonia 19% Neonatal 27% Causes of neonatal deaths P er ce nt 20 40 60 80 100 Coverage along the continuum of care Source: DHS, MICS, Other NS Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 70 8 28 52 95Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care P er ce nt 20 0 40 60 80 100 21 1995 DHS 28 2002 DHS Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics 2002 DHS 54 1995 DHS 15 Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib Source: WHO/UNICEF Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap by wealth quintile Coverage gap (%) 1995 DHS 2002 DHS 66 2.2 42 53 2.1 33 Ratio poorest/wealthiest Difference poorest-wealthiest (%) EQUITY Sanitation Percent population using improved sanitation facilities TotalRural Urban 1990 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 0 44 3 32 97 Water Percent population using improved drinking water sources 1990 2004 TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 39 62 57 43 74 60 *See Annex for indicator definition Neonatal tetanus protection Percent of newborns protected against tetanus Source: WHO/UNICEF 79 1993 1998 2003 2006 P er ce nt 20 0 40 60 80 100 2002 DHS 44 1993 1998 2003 2006 95 97 Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT 2004 Other NS 2005 Other NS 2006 Other NS 0 2 4 6 8 10 P er ce nt P er ce nt 20 0 40 60 80 100 1995 DHS 2002 DHS 59 52 *Based on 2006 WHO reference population (2002) (2002) Underweight prevalence Percent children < 5 years underweight for age* P er ce nt 20 0 40 60 80 100 33 2002 DHS 38 1995 DHS 37 1993 Other NS Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: UNICEF P er ce nt 20 0 40 60 80 100 50 35 42 51 61 7494 52 50 57 0 0 0 0 1990 1995 2000 2005 2010 2015 150 120 90 60 30 0 Under-five mortality rate Deaths per 1000 live births 49 74 147 MDG Target Source: UNICEF, 2006 27 41 --- 3, 7, 1 78 --- (2002) (2002) (2002) (2002) 3 4 3 DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Ethiopia Source: WHO, 2006 Source: Lawn JE, Cousens SN for CHERG (Nov 2006) 51 12 81,021 13,439 3,159 7 123 77 51 389 720 27 22,000 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) 54 20 (2005) (2005) Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) WATER AND SANITATION SYSTEMSPOLICIES Financial Flows and Human Resources Ethiopia Skilled attendant at delivery Percent live births attended by skilled health personnel International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Partial Yes No Yes Yes Yes No No Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 21 9 38 0.3 4 10 --- (2007) (2007) (2007) (2003) (2005) (2005) Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding Malaria treatment Percent febrile children < 5 years using antimalarials Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 27 2000 DHS 28 2005 DHS Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition Diarrhoea 4% Tetanus 9% Other 7% Congenital 4% Asphyxia 24% Infection 36% Preterm 16% Diarrhoea 17% Malaria 6% HIV/AIDS 4% Other 14% Injuries 2% Measles 4% Pneumonia 22% Neonatal 30% Causes of neonatal deaths P er ce nt 20 40 60 80 100 Coverage along the continuum of care Source: DHS, MICS, Other NS Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 28 15 6 5 49 63Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care P er ce nt 20 0 40 60 80 100 6 2000 DHS 6 2005 DHS P er ce nt 20 0 40 60 80 100 2005 DHS 15 2000 DHS 38 Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib Source: WHO/UNICEF Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap (%) 2000 DHS 2005 DHS 78 1.5 26 74 1.6 31 Ratio poorest/wealthiest Difference poorest-wealthiest (%) EQUITY Sanitation Percent population using improved sanitation facilities TotalRural Urban 1990 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 2 13 7 44 13 3 Water Percent population using improved drinking water sources 1990 2004 TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 15 81 11 23 81 22 Source: WHO/UNICEF Malaria prevention Percent children < 5 years sleeping under ITNs P er ce nt 20 0 40 60 80 100 2005 DHS 2 1990 1995 2000 20062005 63 72 Exclusive breastfeeding Percent infants < 6 months exclusively breastfed P er ce nt 20 0 40 60 80 100 2000 DHS 2005 DHS 54 49 Underweight Prevalence Percent children < 5 years underweight for age* P er ce nt 20 0 40 60 80 100 2000 DHS 2005 DHS 42 35 *Based on 2006 WHO reference population (2005) (2005) Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses At least one dose Two doses Source: UNICEF P er ce nt 20 0 40 60 80 100 200 160 120 80 40 0 Under-five mortality rate Deaths per 1000 live births Source: UNICEF, 2006 34 12 --- 1, 9, 0 69 2 (2005) (2005) (2005) (2005) (2005) Coverage gap by wealth quintile 80 *See Annex for indicator definition Neonatal tetanus protection Percent of newborns protected against tetanus 1981 1986 1991 1996 2001 2006 Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics P er ce nt 20 0 40 60 80 100 2000 DHS 2005 DHS 16 19 P er ce nt 20 0 40 60 80 100 2005 DHS 3 2000 DHS 3 Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT 2004 Other NS 2005 Other NS 2006 Other NS 0 2 4 6 8 10 P er ce nt 2 4 4 1999 2000 2001 2002 2003 2004 2005 59 59 022000 88 65 65 16 16 52 86 1990 1995 2000 2005 2010 2015 68 123 204 MDG Target DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Gabon 44 2000 DHS Source: WHO, 2006 Underweight prevalence Percent children < 5 years underweight for age* 26 4 *Based on 2006 WHO reference population 2000 DHS 2000 DHS 1,311 158 34 89 91 60 31 3 520 53 220 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2000) (2000) 62 14 (2000) (2000) P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 9 6 Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 28 63 --- 6,6,4 71 --- (2000) (2000) (2000) (2000) Coverage along the continuum of care Source: DHS, MICS, Other NS *See Annex for indicator definition Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 33 94 86 6 55 WATER AND SANITATION SYSTEMSPOLICIES Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities Financial Flows and Human Resources Gabon 1990 2004 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 Skilled attendant at delivery Percent live births attended by skilled health personnel P er ce nt 20 0 40 60 80 100 95 95 47 88 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 30 37 36 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Yes Yes No Yes Yes Yes Partial No Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 264 14 31 5.3 17 21 123 (2007) (2007) (2007) (2004) (2005) (2005) (2001) Diarrhoea 9% Other 0% Measles 4% Injuries 3% Malaria 28% HIV/AIDS 10% Neonatal 35% Causes of neonatal deaths Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care 1990 1995 2000 2005 2010 2015 20 0 40 60 80 100 9192 31 Source: UNICEF, 2006 Under-five mortality rate Deaths per 1000 live births Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 Malaria treatment Percent febrile children < 5 years using antimalarials 2000 DHS Pneumonia 11% Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib P er ce nt 20 0 40 60 80 100 55 38 Source: WHO/UNICEF 1990 1995 2000 2005 2006 MDG Target Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Diarrhoea 2% Tetanus 3% Other 6% Congenital 9% Asphyxia 21% Infection 22% Preterm 37% Malaria prevention Percent children < 5 years sleeping under ITNs Neonatal tetanus protection Percent of newborns protected against tetanus Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1985 1990 20001995 2006 No data No data Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics 2000 DHS P er ce nt 20 0 40 60 80 100 48 94 86 2000 DHS 63 EQUITY Coverage gap by wealth quintile Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap (%) 2000 DHS 39 1.5 19 Ratio poorest/wealthiest Difference poorest-wealthiest (%) Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: UNICEF P er ce nt 20 0 40 60 80 100 100 89 87 0 0 0 0 0 00 30 4 0 2 4 6 8 10 P er ce nt 2005 Other NS 2006 Other NS Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT 4 Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report The Gambia 38 38 2000 MICS 2006 MICS Source: WHO, 2006 Underweight prevalence Percent children < 5 years underweight for age* 28 7 *Based on 2006 WHO reference population 2000 MICS 2006 MICS 2000 MICS 2006 MICS 1,663 261 60 55 113 84 46 7 690 32 360 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2006) (2006) 44 20 (2006) (2006) P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 15 16 26 41 Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) --- --- 33 ---,---,--- 48 --- (2006) (2006) Coverage along the continuum of care Source: DHS, MICS, Other NS Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 18 98 57 41 95 WATER AND SANITATION SYSTEMSPOLICIES Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities Financial Flows and Human Resources The Gambia 1990 2004 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 Skilled attendant at delivery Percent live births attended by skilled health personnel P er ce nt 20 0 40 60 80 100 95 95 77 82 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 46 72 53 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Yes --- Yes Yes Yes Yes No No Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 88 6 50 1.4 18 11 86 (2007) (2007) (2007) (2003) (2005) (2005) (2002) Diarrhoea 12% Other 0% Measles 3%Injuries3% Malaria 29% HIV/AIDS 1% Neonatal 37% Causes of neonatal deaths Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care 1990 1995 2000 2005 2010 2015 30 0 60 90 120 150 113 153 51 Source: UNICEF, 2006 Under-five mortality rate Deaths per 1000 live births Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 2000 MICS 2006 MICS Pneumonia 16% Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib P er ce nt 20 0 40 60 80 100 9595 95 Source: WHO/UNICEF 1990 1995 2000 2005 2006 MDG Target Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Diarrhoea 3% Tetanus 4% Other 6% Congenital 5% Asphyxia 20% Infection 35% Preterm 27% 91 98 44 55 57 1990 Other NS 2000 MICS 2006 MICS EQUITY Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: UNICEF P er ce nt 20 0 40 60 80 100 87 91 91 91 95 0 0 0 0 160 52 27 0 10 20 30 40 50 P er ce nt 2006 Other NS Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT 21 *See Annex for indicator definition Neonatal tetanus protection Percent of newborns protected against tetanus Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1981 1986 19961991 2001 2006 94 Malaria prevention Percent children < 5 years sleeping under ITNs 2000 MICS 2006 MICS 15 49 P er ce nt 20 0 40 60 80 100 Malaria treatment Percent febrile children < 5 years using antimalarials 2000 MICS 2006 MICS 63 55 P er ce nt 20 0 40 60 80 100 Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics 2000 MICS 2006 MICS P er ce nt 20 0 40 60 80 100 32 75 69 61 Coverage gap by wealth quintile Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap (%) 2000 MICS 2006 MICS 38 36 1.3 9 1.4 12 Ratio poorest/wealthiest Difference poorest-wealthiest (%) Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Ghana 24 40 29 1998 DHS 2003 DHS 2006 MICS Source: WHO, 2006 Underweight prevalence Percent children < 5 years underweight for age* *Based on 2006 WHO reference population 2003 DHS 2006 MICS 1993 DHS 1998 DHS 2003 DHS 2006 MICS 23,008 3,195 700 51 120 76 27 84 560 45 3,800 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition 28 6 (2006) (2006) P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 19 13 7 31 53 54 Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 34 69 27 4, 8, 2 46 --- (2003) (2003) (2006) (2003) (2003) Coverage along the continuum of care Source: DHS, MICS, Other NS *See Annex for indicator definition Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 17 92 50 54 85 WATER AND SANITATION SYSTEMSPOLICIES Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities Financial Flows and Human Resources Ghana 1990 19902004 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 Skilled attendant at delivery Percent live births attended by skilled health personnel P er ce nt 20 0 40 60 80 100 37 86 55 88 64 47 75 10 23 15 11 27 18 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Yes Partial No Yes Partial Yes Partial Yes Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 95 8 45 0.6 11 12 51 (2007) (2007) (2007) (2004) (2005) (2005) (2004-2005) Diarrhoea 12% Other 0% Measles 3% Injuries 3% Malaria 33% HIV/AIDS 6% Neonatal 29% Causes of neonatal deaths Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 1988 DHS 1993 DHS 1998 DHS 2003 DHS 2006 MICS Pneumonia 15% Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib P er ce nt 20 0 40 60 80 100 84 84 85 Source: WHO/UNICEF 1990 1995 2000 2005 2006 Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Diarrhoea 3% Tetanus 4% Other 6% Congenital 6% Asphyxia 23% Infection 32% Preterm 26% Neonatal tetanus protection Percent of newborns protected against tetanus Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1980 1985 19951990 2000 2006 Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics 1993 DHS 1998 DHS 2003 DHS 2006 MICS P er ce nt 20 0 40 60 80 100 43 26 16 44 59 33 24 82 86 88 92 92 40 44 44 47 50 1988 DHS 1993 DHS 1998 DHS 2003 DHS 2006 MICS 87 EQUITY Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: UNICEF P er ce nt 20 0 40 60 80 100 91 0 89 100 10089 99 99 78 78 95 95 95 50 8 0 2 4 6 8 10 P er ce nt 2005 Other NS 2004 Other NS 2006 Other NS Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT 1 7 Malaria prevention Percent children < 5 years sleeping under ITNs 2003 DHS 2006 MICS 4 22 P er ce nt 20 0 40 60 80 100 Malaria treatment Percent febrile children < 5 years using antimalarials 1998 DHS 2003 DHS 2006 MICS 61 63 61 P er ce nt 20 0 40 60 80 100 58 9 (2006) (2006) Coverage gap by wealth quintile Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap (%) 1993 DHS 1998 DHS 2003 DHS 2006 MICS 51 48 1.9 1.8 2.4 29 26 31 41 43 1.5 17 Ratio poorest/wealthiest Difference poorest-wealthiest (%) 1990 1995 2000 2005 2010 2015 30 0 60 90 120 150 120120 40 Source: UNICEF, 2006 Under-five mortality rate Deaths per 1000 live births MDG Target Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Guatemala 20 22 1995 DHS 1998-1999 DHS Source: WHO, 2006 Underweight prevalence Percent children < 5 years underweight for age* *Based on 2006 WHO reference population 1998-1999 DHS 2002 Other NS 1995 DHS 2002 Other NS 13,029 2,066 445 --- 41 31 19 18 290 71 1,300 (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition 54 2 (2002) (2002) P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 1820 46 51 Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 23 --- --- 11,19,8 49 --- (1999) (2002) (1998) Coverage along the continuum of care Source: DHS, MICS, Other NS *See Annex for indicator definition Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 40 84 41 51 95 WATER AND SANITATION SYSTEMSPOLICIES Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities Financial Flows and Human Resources Guatemala 1990 19902004 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 Skilled attendant at delivery Percent live births attended by skilled health personnel P er ce nt 20 0 40 60 80 100 37 89 79 72 959992 55 88 64 47 75 47 73 58 82 90 86 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Yes --- --- --- --- --- Partial --- Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 256 19 53 4.9 3 14 --- (2007) (2007) (2007) (1999) (2005) (2005) Diarrhoea 13% Other 30% Measles 0% Injuries 2% Malaria0% HIV/AIDS 3% Neonatal 37% Causes of neonatal deaths Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 1987 DHS 1995 DHS 1998-1999 DHS 2002 Other NS Pneumonia 15% Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib P er ce nt 20 0 40 60 80 100 80 80 95 Source: WHO/UNICEF 1990 1995 2000 2006 Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Diarrhoea 1% Tetanus 2% Other 8% Congenital 8% Asphyxia 27% Infection 28% Preterm 26% Neonatal tetanus protection Percent of newborns protected against tetanus Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1980 1985 19951990 2000 2006 Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics P er ce nt 20 0 40 60 80 100 35 53 60 84 35 35 29 41 41 1984 Other NS 1987 Other NS 1995 DHS 1998-1999 DHS 2002 Other NS 79 EQUITY Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: UNICEF P er ce nt 20 0 40 60 80 100 0 0 0 0 0 33 18 44 36 18 9 0 3 6 9 12 15 P er ce nt 2005 Other NS 2004 Other NS 2006 Other NS Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT 0.6 6 1995 DHS 41 1998-1999 DHS 37 2002 Other NS 64 67 12 (2002) (2002) Coverage gap by wealth quintile Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap (%) 1995 DHS 1999 DHS 48 44 2.8 2.6 40 37 Ratio poorest/wealthiest Difference poorest-wealthiest (%) 1990 1995 2000 2005 2010 2015 20 0 40 60 80 100 41 82 27 Source: UNICEF, 2006 Under-five mortality rate Deaths per 1000 live births MDG Target No data 1998-1999 DHS 1 P er ce nt 20 0 40 60 80 100 Malaria prevention Percent children < 5 years sleeping under ITNs* Malaria treatment Percent febrile children < 5 years using antimalarials* *Very limited risk of malaria transmission *Very limited risk of malaria transmission Causes of maternal deaths Regional estimates for Latin America, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 21% Anaemia 0% Haemorrhage 21% Abortion 12% Obstructed labor 13% Hypertensive disorders 26% Sepsis/Infections, including AIDS 8% DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Guinea 29 44 38 1999 DHS 2003 MICS 2005 DHS Source: WHO, 2006 Underweight prevalence Percent children < 5 years underweight for age* *Based on 2006 WHO reference population 1999 DHS 2005 DHS 1999 DHS 2005 DHS 9,181 1,544 374 43 161 98 48 60 910 19 3,500 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition 39 11 (2005) (2005) P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 21 23 11 27 Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 21 49 3 2, 5, 1 40 --- (2005) (2005) (2005) (2005) (2005) Coverage along the continuum of care Source: DHS, MICS, Other NS Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 9 82 38 27 67 WATER AND SANITATION SYSTEMSPOLICIES Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities Financial Flows and Human Resources Guinea 1990 19902004 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 Skilled attendant at delivery Percent live births attended by skilled health personnel P er ce nt 20 0 40 60 80 100 34 74 44 78 35 50 10 27 14 11 31 18 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Partial Yes No No No Partial Partial Partial Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 96 5 86 0.8 6 11 25 (2007) (2007) (2007) (2004) (2005) (2005) (2002) Diarrhoea 17% Other0% Measles 6% Injuries1% Malaria 25% HIV/AIDS 2% Neonatal 29% Causes of neonatal deaths Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 1992 DHS 1999 DHS 2003 MICS 2005 DHS Pneumonia 21% Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib P er ce nt 20 0 40 60 80 100 71 67 Source: WHO/UNICEF 1990 1995 2000 2005 2006 Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Diarrhoea 2% Tetanus 4% Other 7% Congenital 5% Asphyxia 23% Infection 29% Preterm 29% Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics 1999 DHS 2003 MICS 2005 DHS P er ce nt 20 0 40 60 80 100 39 33 42 58 71 84 82 31 35 56 38 1992 DHS 1999 DHS 2003 MICS 2005 DHS EQUITY Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: UNICEF P er ce nt 20 0 40 60 80 100 100 0 00 47 93 99 95 9595 93 95 95 8 0 3 6 9 12 15 P er ce nt 2005 Other NS 2004 Other NS 2006 Other NS Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT 3 1 Malaria treatment Percent febrile children < 5 years using antimalarials 2005 DHS 44 P er ce nt 20 0 40 60 80 100 *See Annex for indicator definition Neonatal tetanus protection Percent of newborns protected against tetanus Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1986 1991 20011996 2006 9141 12 (2005) (2005) Coverage gap by wealth quintile Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap (%) 1999 DHS 2005 DHS 59 54 1.9 1.8 32 28 Ratio poorest/wealthiest Difference poorest-wealthiest (%) 1990 1995 2000 2005 2010 2015 50 0 100 150 200 250 161 235 78 Source: UNICEF, 2006 Under-five mortality rate Deaths per 1000 live births MDG Target Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% 98 Malaria prevention Percent children < 5 years sleeping under ITNs P er ce nt 20 0 40 60 80 100 2005 DHS 0.3 Coverage gap by wealth quintile Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap (%) 2000 MICS 2006 MICS 56 1.5 21 49 1.7 25 Ratio poorest/wealthiest Difference poorest-wealthiest (%) DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Guinea-Bissau 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: WHO, 2006 Source: UNICEF Underweight prevalence Percent children < 5 years underweight for age* 47 8 *Based on 2006 WHO reference population 15 22 2000 MICS 2006 MICS 2000 MICS 2006 MICS 37 16 13 77 91 100 0 0 0000 80 34 Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 1990 1995 2000 2005 77 60 0 5 10 15 20 25 2000 MICS 2006 MICS 1,646 322 82 39 200 119 48 16 1,100 13 890 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2006) (2006) 35 24 (2006) (2006) P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 23 25 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) --- --- 7 ---, ---, --- 23 --- (2006) (2006) Coverage along the continuum of care Source: DHS, MICS, Other NS *See Annex for indicator definition Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 10 78 39 16 60 WATER AND SANITATION EQUITY SYSTEMSPOLICIES Financial Flows and Human Resources Guinea-Bissau Skilled attendant at delivery Percent live births attended by skilled health personnel Neonatal tetanus protection Percent of newborns protected against tetanus P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1984 1989 19991994 20062004 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Partial No No No Yes No No Yes Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 28 4 65 0.8 6 12 127 (2007) (2007) (2007) (2007) (2005) (2005) (2002) Other 6% Pneumonia 23% Measles 3% HIV/AIDS 3% Injuries 1%Diarrhoea 19% Malaria 21% Neonatal 24% Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care 1990 1995 2000 2005 2010 2015 50 0 100 150 200 250 240 200 80 Source: UNICEF, 2006 MDG Target Under-five mortality rate Deaths per 1000 live births Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 Malaria prevention Percent children < 5 years sleeping under ITNs 7 39 39 P er ce nt 20 0 40 60 80 100 2006 Other NS 25 1990-1995 Other NS 2000 MICS 2006 MICS 35 39 69 2000 MICS 2006 MICS 62 78 Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Diarrhoea 3% Other 6% Tetanus 9% Congenital 6% Preterm 24% Infection 33% Asphyxia 20% Causes of neonatal deaths 64 Malaria treatment Percent febrile children < 5 years using antimalarials P er ce nt 20 0 40 60 80 100 Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics 2000 MICS 2006 MICS 64 57 42 22 P er ce nt 20 0 40 60 80 100 Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 2004 49 79 59 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 2004 23 57 35 Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% 2000 MICS 2006 MICS 2006 2000 MICS 2006 MICS 58 46 DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Haiti Source: WHO, 2006 Source: Lawn JE, Cousens SN for CHERG (Nov 2006) 30 10 9,446 1,244 269 81 80 60 34 22 670 44 1,700 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) 87 25 (2005-2006) (2005-2006) Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) WATER AND SANITATION SYSTEMSPOLICIES Financial Flows and Human Resources Haiti Skilled attendant at delivery Percent live births attended by skilled health personnel International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Partial No No No No No No No Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 82 24 43 0.4 4 16 --- (2007) (2007) (2007) (1998) (2005) (2005) Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition Diarrhoea 2% Tetanus 5% Other 8% Congenital 6% Asphyxia 27% Infection 26% Preterm 26% Diarrhoea 17% Malaria 1% HIV/AIDS 8% Other 27% Injuries 0%Measles 1% Pneumonia 20% Neonatal 26% Causes of neonatal deaths P er ce nt 20 40 60 80 100 Coverage along the continuum of care Source: DHS, MICS, Other NS Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 85 32 26 30 41 58Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care P er ce nt 20 0 40 60 80 100 Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib Source: WHO/UNICEF Sanitation Percent population using improved sanitation facilities TotalRural Urban 1990 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 23 25 14 57 30 24 Water Percent population using improved drinking water sources 1990 2004 TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 42 60 56 47 52 54 Source: WHO/UNICEF 1990 1995 2000 20062005 53 58 Exclusive breastfeeding Percent infants < 6 months exclusively breastfed P er ce nt 20 0 40 60 80 100 2000 DHS 2005-2006 DHS 24 41Pe rc en t 20 0 40 60 80 100 1994-1995 DHS 2005-2006 DHS 2000 DHS *Based on 2006 WHO reference population (2005-2006) (2005-2006) Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses At least one dose Two doses Source: UNICEF 150 120 90 60 30 0 Under-five mortality rate Deaths per 1000 live births Source: UNICEF, 2006 40 54 --- 3, 6, 1 44 4 (2000) (2005-2006) (2005-2006) (2005-2006) (2005-2006) 31 *See Annex for indicator definition Neonatal tetanus protection Percent of newborns protected against tetanus 1980 1985 1990 1995 2000 2006 Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 2005-2006 DHS 5 2000 DHS 12 Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding P er ce nt 20 0 40 60 80 100 2005-2006 DHS 43 2000 DHS 41 Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT 2004 Other NS 2005 Other NS 2006 Other NS 0 6 12 18 24 30 P er ce nt 1990 1995 2000 2005 2010 2015 51 MDG Target 152 80 EQUITY Coverage gap by wealth quintile Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap (%) 1995 DHS 2000 DHS 2005 DHS 57 1.8 30 54 1.7 24 54 1.7 29 Ratio poorest/wealthiest Difference poorest-wealthiest (%) P er ce nt 20 0 40 60 80 100 1999 2000 2001 2002 2003 2004 2005 42 4225 32 0 00 00 0 24 1914 No data 13 17 20 1994-1995 DHS 2000 DHS 2005-2006 DHS 3 3126 17 P er ce nt 20 0 40 60 80 100 6871 85 79 1984-1989 Other NS 1994-1995 DHS 2000 DHS 2005-2006 DHS P er ce nt 20 0 40 60 80 100 2123 2624 1989 Other NS 1994-1995 DHS 2000 DHS 2005-2006 DHS Causes of maternal deaths Regional estimates for Latin America, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 21% Anaemia 0% Haemorrhage 21% Abortion 12% Obstructed labor 13% Hypertensive disorders 26% Sepsis/Infections, including AIDS 8% Underweight prevalence Percent children < 5 years underweight for age* Malaria prevention Percent children < 5 years sleeping under ITNs* Malaria treatment Percent febrile children < 5 years using antimalarials* *Sub-national risk of malaria transmission *Sub-national risk of malaria transmission DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report India 22 32 1998-1999 NFHS 2005-2006 NFHS Source: WHO, 2006 Underweight prevalence Percent children < 3 years underweight for age* 48 20 *Based on 2006 WHO reference population 1998-1999 NFHS 2005-2006 NFHS 3 5 10 Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 2004 Other NS 2005 Other NS 2006 Other NS 0 4 8 12 16 20 1992-1993 NFHS 1998-1999 NFHS 2005-2006 NFHS 69 33 6967 1,151,751 126,843 27,195 41 76 57 43 2,067 450 70 117,000 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2005-2006) (2005-2006) 56 30 1990 1995 2000 2005 2006 (2005-2006) (1998-1999) P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 1992-1993 NFHS 1998-1999 NFHS 2000 MICS 2005-2006 NFHS 44 46 46 37 44 41 59 55 Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: UNICEF P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 13 51 --- 9,17,6 25 --- (2005-2006) (2005-2006) (2005-2006) (2005-2006) Causes of maternal deaths Regional estimates for Asia, 1997-2002 Coverage along the continuum of care Source: DHS, MICS, Other NS *See Annex for indicator definition Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 56 74 47 37 46 59 WATER AND SANITATION EQUITY SYSTEMSPOLICIES Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities Financial Flows and Human Resources Coverage gap by wealth quintile India 1990 2004 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 Skilled attendant at delivery Percent live births attended by skilled health personnel Neonatal tetanus protection Percent of newborns protected against tetanus 55 34 42 43 47 1992-1993 NFHS 1998-1999 NFHS 2005-2006 NFHS 2000 MICS P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF 86 P er ce nt 20 40 60 80 100 1980 1985 19951990 2000 2006 64 89 83 95 86 70 1990 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 3 45 22 59 33 14 Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Yes Yes Yes Yes Yes Partial No Yes Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 91 3 78 1.9 1 3 --- (2007) (2007) (2007) (2004) (2005) (2005) Coverage gap (%) 1993 DHS 1999 DHS 2006 DHS 49 2.7 40 42 2.9 39 36 3.0 34 Ratio poorest/wealthiest Difference poorest-wealthiest (%) Diarrhoea 20% Other 9% Measles 4% Injuries 2% Malaria 1% HIV/AIDS 1% Neonatal 45% Causes of neonatal deaths Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care Other causes 21%Anaemia 13% Haemorrhage 31% Abortion 6%Obstructed labor 9% Hypertensive disorders 9% Sepsis/Infections, including AIDS 12% 1990 1995 2000 2005 2010 2015 30 0 60 90 120 150 76 115 38 Source: UNICEF, 2006 Under-five mortality rate Deaths per 1000 live births Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 49 60 62 74 2000 MICS 12 P er ce nt 20 0 40 60 80 100 1992-1993 NFHS 1998-1999 NFHS 2005-2006 NFHS 2000 MICS MDG Target Pneumonia 19% 15 22 25 27 45 45 51 51 64 64 27 000 No data No data Malaria prevention Percent children < 5 years sleeping under ITNs* Malaria treatment Percent febrile children < 5 years using antimalarials* *Sub-national risk of malaria transmission *Sub-national risk of malaria transmission DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Indonesia Source: WHO, 2006 --- --- 228,864 21,720 4,427 55 34 26 18 151 420 97 19,000 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) 75 9 (2002-2003) (2002-2003) Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) WATER AND SANITATION SYSTEMSPOLICIES Financial Flows and Human Resources Indonesia International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Partial Yes No Yes No Partial No No Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 118 5 49 1.0 1 3 --- (2007) (2007) (2007) (2003) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition Diarrhoea 18% Malaria 1% HIV/AIDS 0% Other 22% Injuries 3%Measles5% Pneumonia 14% Neonatal 38% Causes of neonatal deaths P er ce nt 20 40 60 80 100 P er ce nt 20 0 40 60 80 100 Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib Source: WHO/UNICEF 1990 1995 2000 20062005 Exclusive breastfeeding Percent infants < 6 months exclusively breastfed P er ce nt 20 0 40 60 80 100 100 80 60 40 20 0 9 81 --- 4,7,2 39 --- (2002-2003) (2002-2003) (2002-2003) (2002-2003) Coverage along the continuum of care Source: DHS, MICS, Other NS Pre-pregnancy Pregnancy Neonatal period Infancy 0 20 40 60 80 100 57 72 92 40 72Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care *See Annex for indicator definition Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics 1990 1995 2000 2005 2010 2015 EQUITY Causes of maternal deaths Regional estimates for Asia, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 21% Anaemia 13% Haemorrhage 31% Abortion 6%Obstructed labor 9% Hypertensive disorders 9% Sepsis/Infections, including AIDS 12% Source: UNICEF, 2006 No data Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses At least one dose Two doses Source: UNICEF P er ce nt 20 0 40 60 80 100 40 Birth Neonatal tetanus protection Percent of newborns protected against tetanus P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 72 70 *Based on 2006 WHO reference population Under-five mortality rate Deaths per 1000 live births 3034 MDG Target 91 Coverage gap by wealth quintile Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap (%) 1997 DHS 2003 DHS 30 2.7 27 27 2.4 22 Ratio poorest/wealthiest Difference poorest-wealthiest (%) Sanitation Percent population using improved sanitation facilities TotalRural Urban 1990 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 37 65 40 73 55 46 Water Percent population using improved drinking water sources 1990 2004 TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 63 92 6972 87 77 Source: WHO/UNICEF 83 1980 1985 1990 1995 2000 2006 Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 82 76 9289 1991 DHS 1994 DHS 1997 DHS 2002-2003 DHS Skilled attendant at delivery Percent live births attended by skilled health personnel P er ce nt 20 0 40 60 80 100 36 41 37 50 43 56 56 67 68 66 72 64 32 1987 Other NS 1999 Other NS 1991 DHS 1994 DHS 1995 Other NS 1997 DHS 1998 Other NS 1999 Other NS 2000 Other NS 2001 Other NS 2002 Other NS 02-03 DHS 2004 DHS Underweight prevalence Percent children < 5 years underweight for age* P er ce nt 20 0 40 60 80 100 1995 Other NS 2003 Other NS 27 23 1991 DHS 1994 DHS 1997 DHS 2002-2003 DHS 4237 45 1999 2000 2001 2002 2003 2004 2005 7673 7673 62 82 61 57 68 71 64 0 6263 Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT 2004 Other NS 2005 Other NS 2006 Other NS 0 2 4 6 8 10 P er ce nt 0.8 0.2 2 1991 DHS 1994 DHS 1997 DHS 2002-2003 DHS 61 69 6364 P er ce nt 20 0 40 60 80 100 2002-2003 DHS 2000 MICS 0.1 1 2000 MICS 4 Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding 37 1994 DHS 37 1997 DHS 61 2000 MICS 56 2002-2003 DHS P er ce nt 20 0 40 60 80 100 Malaria prevention Percent children < 5 years sleeping under ITNs* Malaria treatment Percent febrile children < 5 years using antimalarials* *Sub-national risk of malaria transmission *Sub-national risk of malaria transmission DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Iraq Source: WHO, 2006 Source: Lawn JE, Cousens SN for CHERG (Nov 2006) 26 6 28,506 4,223 937 95 46 37 63 43 300 72 2,900 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) 51 15 (2006) (2006) Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) WATER AND SANITATION SYSTEMSPOLICIES Financial Flows and Human Resources Iraq Skilled attendant at delivery Percent live births attended by skilled health personnel International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths No No No Yes Yes No No Yes Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 135 3 22 2.0 20 27 --- (2007) (2007) (2007) (2004) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition Diarrhoea 5% Tetanus 7% Other 5% Congenital 9% Asphyxia 17% Infection 30% Preterm 26% Diarrhoea 13% Malaria 1% HIV/AIDS 0%Other 11% Injuries 6% Measles 1% Pneumonia 18% Neonatal 51% Causes of neonatal deaths P er ce nt 20 40 60 80 100 P er ce nt 20 0 40 60 80 100 Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib Source: WHO/UNICEF TotalRural Urban P er ce nt 20 0 40 60 80 100 Sanitation Percent population using improved sanitation facilities Source: WHO/UNICEF JMP, 2006 48 95 48 95 7981 Water Percent population using improved drinking water sources 1990 2004 1990 2004 TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 50 97 50 83 97 81 1990 1995 2000 20062005 60 60 Exclusive breastfeeding Percent infants < 6 months exclusively breastfed P er ce nt 20 0 40 60 80 100 2000 MICS 2006 MICS 12 25 *Based on 2006 WHO reference population (2006) (2006) 60 48 36 24 12 0 Under-five mortality rate Deaths per 1000 live births Source: UNICEF, 2006 --- --- --- ---, ---, --- 31 --- (2006) Coverage along the continuum of care Source: DHS, MICS, Other NS Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 84 50 89 25 60Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care *See Annex for indicator definition Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 2000 MICS 1 Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding P er ce nt 20 0 40 60 80 100 2006 MICS 64 2000 MICS 54 1990 1995 2000 2005 2010 2015 18 MDG Target 53 46 EQUITY Coverage gap by wealth quintile Coverage gap (%) Ratio poorest/wealthiest Difference poorest-wealthiest (%) Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT No data Causes of maternal deaths Regional estimates for Asia, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 21% Anaemia 13% Haemorrhage 31% Abortion 6%Obstructed labor 9% Hypertensive disorders 9% Sepsis/Infections, including AIDS 12% Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 1996 Other NS 2000 MICS 2006 MICS 7778 84 P er ce nt 20 0 40 60 80 100 1989 Other NS 2000 MICS 2006 MICS 72 54 89 89 Neonatal tetanus protection Percent of newborns protected against tetanus Source: WHO/UNICEF 1980 1985 1990 1995 2000 2006 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 2000 MICS 2006 MICS 13 6 Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses No data 2000 MICS 2000 MICS 2006 MICS 82 76 82 No data No data Underweight prevalence Percent children < 5 years underweight for age* Malaria prevention Percent children < 5 years sleeping under ITNs* Malaria treatment Percent febrile children < 5 years using antimalarials* *Very limited risk of malaria transmission *Very limited risk of malaria transmission 0.1 DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Kenya Source: WHO, 2006 Source: Lawn JE, Cousens SN for CHERG (Nov 2006) 36,553 6,161 1,447 48 121 79 29 175 560 39 7,700 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) 36 6 (2003) (2003) 84 10 (2003) (2003) Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) WATER AND SANITATION SYSTEMSPOLICIES Financial Flows and Human Resources Kenya International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Partial Yes No Yes Partial Yes No Yes Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 86 8 47 1.3 9 15 --- (2007) (2007) (2007) (2002) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition Diarrhoea 17% Malaria 14% HIV/AIDS 15% Other 5% Injuries 3% Measles 3% Pneumonia 20% Neonatal 24% Causes of neonatal deaths P er ce nt 20 40 60 80 100 P er ce nt 20 0 40 60 80 100 Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib Source: WHO/UNICEF 1990 1995 2000 20062005 Exclusive breastfeeding Percent infants < 6 months exclusively breastfed 150 120 90 60 30 0 Coverage along the continuum of care Source: DHS, MICS, Other NS Pre-pregnancy Pregnancy Neonatal period Infancy 0 20 40 60 80 100 39 42 88 13 77Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care *See Annex for indicator definition Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics 1990 1995 2000 2005 2010 2015 Source: UNICEF, 2006 Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses At least one dose Two doses Source: UNICEF P er ce nt 20 0 40 60 80 100 Birth Neonatal tetanus protection Percent of newborns protected against tetanus P er ce nt 20 0 40 60 80 100 Malaria prevention Percent children < 5 years sleeping under ITNs Under-five mortality rate Deaths per 1000 live births 32 121 MDG Target 97 Sanitation Percent population using improved sanitation facilities TotalRural Urban 1990 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 37 48 41 46 4340 Water Percent population using improved drinking water sources 1990 2004 TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 30 91 49 57 22 52 4645 83 61 Source: WHO/UNICEF 1985 1990 1995 2000 2006 Skilled attendant at delivery Percent live births attended by skilled health personnel P er ce nt 20 0 40 60 80 100 *Based on 2006 WHO reference population Underweight prevalence Percent children < 5 years underweight for age* 1993 DHS 20 2000 MICS 18 2003 DHS 17 2003 DHS 13 1998 DHS 12 1993 DHS 12 1999 2000 2001 2002 2003 2004 2005 80 33 63 69 69 46 0000 919090 41 Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT 2004 Other NS 2005 Other NS 2006 Other NS 0 10 20 30 40 50 P er ce nt 2425 48 1993 DHS 1998 DHS 2003 DHS Malaria treatment Percent febrile children < 5 years using antimalarials Diarrhoea 2% Tetanus 2% Other 8% Congenital 7% Asphyxia 27% Infection 27% Preterm 25% 25 52 4 4, 9, 3 52 --- (2003) (2003) (2003) (2003) (2003) Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% P er ce nt 20 0 40 60 80 100 4550 4244 1989 DHS 1993 DHS 1998 DHS 2003 DHS Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 77 95 92 76 88 1989 DHS 1993 DHS 2000 MICS 2003 DHS 1998 DHS Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 EQUITY Coverage gap by wealth quintile Coverage gap (%) 1998 DHS 2000 MICS 2003 DHS 34 2.4 27 39 2.0 26 39 2.1 29 Ratio poorest/wealthiest Difference poorest-wealthiest (%)Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding 40 1998 DHS 65 2000 MICS 27 2003 DHS P er ce nt 20 0 40 60 80 100 43 1998 DHS 15 2000 MICS 33 2003 DHS P er ce nt 20 0 40 60 80 100 80 77 80 P er ce nt 20 0 40 60 80 100 2000 MICS 3 2003 DHS 5 P er ce nt 20 0 40 60 80 100 74 DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Korea DPR Source: WHO, 2006 45 9 23,708 1,606 321 99 55 42 22 18 370 140 1,300 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) 31 7 (2004) (2002) Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth,%) Postnatal visit for baby (within 2 days for home births, %) WATER AND SANITATION SYSTEMSPOLICIES Financial Flows and Human Resources Korea DPR International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Partial Yes --- --- --- Partial No --- Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 47 6 14 7.4 2 1 --- (2007) (2007) (2007) (2003) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition Diarrhoea 19% Malaria 1% HIV/AIDS 1% Other 19% Injuries 3% Measles 1% Pneumonia 15% Neonatal 42% Causes of neonatal deaths P er ce nt 20 40 60 80 100 P er ce nt 20 0 40 60 80 100 Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib Source: WHO/UNICEF Water Percent population using improved drinking water sources 1990 2004 TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 100100 100 100 100 100 1990 1995 2000 20062005 Exclusive breastfeeding Percent infants < 6 months exclusively breastfed P er ce nt 20 0 40 60 80 100 2004 Other NS 65 *Based on 2006 WHO reference population (2002) (2002) 100 80 60 40 20 0 --- --- --- ---, ---, --- --- --- Coverage along the continuum of care Source: DHS, MICS, Other NS Pre-pregnancy Pregnancy Neonatal period Infancy 0 20 40 60 80 100 62 97 65 96Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care *See Annex for indicator definition Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics P er ce nt 20 0 40 60 80 100 Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding 1990 1995 2000 2005 2010 2015 EQUITY Coverage gap by wealth quintile Coverage gap (%) Ratio poorest/wealthiest Difference poorest-wealthiest (%) No data Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT No data Causes of maternal deaths Regional estimates for Asia, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 21% Anaemia 13% Haemorrhage 31% Abortion 6%Obstructed labor 9% Hypertensive disorders 9% Sepsis/Infections, including AIDS 12% Neonatal tetanus protection Percent of newborns protected against tetanus Source: WHO/UNICEF 2004 Other NS 93 Under-five mortality rate Deaths per 1000 live births Source: UNICEF, 2006 18 5555 MDG Target No data P er ce nt 20 0 40 60 80 100 25 56 2118 1998 Other NS 2000 MICS 2002 Other NS 2004 Other NS Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses At least one dose Two doses Source: UNICEF P er ce nt 20 0 40 60 80 100 1999 2000 2001 2002 2003 2004 2005 99 100 96 89 96 99 99 95 95 95 96 99 99 95 95 95 No dataNo data Birth Skilled attendant at delivery Percent live births attended by skilled health personnel P er ce nt 20 0 40 60 80 100 2000 MICS 97 2004 Other NS 97 Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy No data 90 1989 1994 1999 2004 2006 Sanitation Percent population using improved sanitation facilities TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 2004 60 58 59 No data No data Underweight prevalence Percent children < 5 years underweight for age* Malaria prevention Percent children < 5 years sleeping under ITNs* Malaria treatment Percent febrile children < 5 years using antimalarials* *Very limited risk of malaria transmission *Very limited risk of malaria transmission DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Lao PDR Source: WHO, 2006 48 18 5,759 715 156 59 75 59 35 12 660 33 1,300 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) 10 14 (2000) (2000) (2000) (2000) Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) WATER AND SANITATION SYSTEMSPOLICIES Financial Flows and Human Resources Lao PDR International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Partial No --- No No --- No --- Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 74 5 72 1.6 8 18 --- (2007) (2007) (2007) (1996) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition Diarrhoea 16% Malaria 1% HIV/AIDS 0% Other 22% Injuries 2%Measles6% Pneumonia 19% Neonatal 35% Causes of neonatal deaths P er ce nt 20 40 60 80 100 P er ce nt 20 0 40 60 80 100 Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib Source: WHO/UNICEF Water Percent population using improved drinking water sources Source: WHO/UNICEF JMP, 2006 1990 1995 2000 20062005 Exclusive breastfeeding Percent infants < 6 months exclusively breastfed P er ce nt 20 0 40 60 80 100 2000 MICS 23 200 160 120 80 40 0 40 --- --- ---, ---, --- --- --- (2000) Coverage along the continuum of care Source: DHS, MICS, Other NS Pre-pregnancy Pregnancy Neonatal period Infancy 0 20 40 60 80 100 32 19 27 23 48Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care *See Annex for indicator definition Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding 1990 1995 2000 2005 2010 2015 EQUITY Malaria prevention Percent children < 5 years sleeping under ITNs Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT No data Causes of maternal deaths Regional estimates for Asia, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 21% Anaemia 13% Haemorrhage 31% Abortion 6%Obstructed labor 9% Hypertensive disorders 9% Sepsis/Infections, including AIDS 12% Source: UNICEF, 2006 No data Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses At least one dose Two doses Source: UNICEF P er ce nt 20 0 40 60 80 100 1999 2000 2001 2002 2003 2004 2005 63 62 0 64 64 70 70 58 58 5873 48 43 80 Birth Neonatal tetanus protection Percent of newborns protected against tetanus Source: WHO/UNICEF 52 1985 1990 1995 2000 2006 Sanitation Percent population using improved sanitation facilities Source: WHO/UNICEF JMP, 2006 TotalRural Urban P er ce nt 20 0 40 60 80 100 2004 20 67 30 Coverage gap by wealth quintile Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap (%) 2000 MICS 70 1.1 10 Ratio poorest/wealthiest Difference poorest-wealthiest (%) TotalRural Urban P er ce nt 20 0 40 60 80 100 79 2004 43 51 Skilled attendant at delivery Percent live births attended by skilled health personnel Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 19 2000 MICS 27 2000 MICS P er ce nt 20 0 40 60 80 100 2000 MICS 36 Malaria treatment Percent febrile children < 5 years using antimalarials P er ce nt 20 0 40 60 80 100 2000 MICS 9 P er ce nt 20 0 40 60 80 100 2000 MICS 18 P er ce nt 20 0 40 60 80 100 2000 MICS 37 57 48 Underweight prevalence Percent children < 5 years underweight for age* P er ce nt 20 0 40 60 80 100 *Based on 2006 WHO reference population 1993 Other NS 2000 Other NS 1994 Other NS 40 3636 Under-five mortality rate Deaths per 1000 live births 54 75 MDG Target 163 DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Lesotho Source: WHO, 2006 Underweight prevalence Percent children < 5 years underweight for age* 45 6 *Based on 2006 WHO reference population 1715 1,995 272 59 26 132 102 28 8 960 45 480 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2004) (2004) P er ce nt 20 0 40 60 80 100 Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 31 70 --- 5, 8, 5 63 --- WATER AND SANITATION EQUITY SYSTEMSPOLICIES Financial Flows and Human Resources Lesotho Skilled attendant at delivery Percent live births attended by skilled health personnel P er ce nt 20 0 40 60 80 100 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Yes Yes --- Yes Yes Partial No Yes Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 139 13 3 0.5 5 5 29 (2007) (2007) (2007) (2003) (2005) (2005) (2004) Other 0% Pneumonia 5% Measles 0% HIV/AIDS 56% Injuries 2% Diarrhoea 4% Malaria 0% Neonatal 33% 1990 1995 2000 2005 2010 2015 30 0 60 90 120 150 101 132 34 Source: UNICEF, 2006 MDG Target Under-five mortality rate Deaths per 1000 live births Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Diarrhoea 2% Other 8% Tetanus 2% Congenital 8% Preterm 34% Infection 20% Causes of neonatal deaths Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities 2004 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 76 92 79 20041990 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 32 61 37 61 32 37 Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% Asphyxia 27% Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: UNICEF P er ce nt 20 0 40 60 80 100 17 75 9 2 71 0 00 0 0 Coverage along the continuum of care Source: DHS, MICS, Other NS Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 37 90 55 23 36 85Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care *See Annex for indicator definition Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 6061 55 1993 Other NS 1995 Other NS 1993 Other NS 2000 MICS 2004 DHS 2000 MICS 2004 DHS Exclusive breastfeeding Percent infants < 6 months exclusively breastfed 79 13 (2004) (2004) P er ce nt 20 0 40 60 80 100 2004 DHS 2000 MICS 1996 MICS 2000 MICS 2004 DHS Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 1990 1995 2000 2005 85 83 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF 2006 Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding 2000 MICS 2004 DHS P er ce nt 20 0 40 60 80 100 (2004) (2004) (2004) (2004) 16 15 36 75 No data No data 15 17 3 0 4 8 12 16 20 P er ce nt 2004 Other NS 2005 Other NS 2006 Other NS Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT 7 Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics 2000 MICS 2004 DHS P er ce nt 20 0 40 60 80 100 32 59 49 29 53 91 88 85 90 Coverage gap by wealth quintile Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap (%) 2000 MICS 2004 DHS 36 1.7 18 33 2.0 23 Ratio poorest/wealthiest Difference poorest-wealthiest (%) Neonatal tetanus protection Percent of newborns protected against tetanus Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1991 1996 2001 2006 72 Malaria prevention Percent children < 5 years sleeping under ITNs* Malaria treatment Percent febrile children < 5 years using antimalarials* *Very limited risk of malaria transmission *Very limited risk of malaria transmission Coverage gap by wealth quintile Coverage gap (%) Ratio poorest/wealthiest Difference poorest-wealthiest (%) DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Liberia Source: WHO, 2006 Underweight prevalence Percent children < 5 years underweight for age* 45 7 *Based on 2006 WHO reference population 5 3 Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 2000 2001 2002 2003 2004 2005 53 75 0 2 4 6 8 10 3,579 690 184 --- 235 157 66 43 1,200 12 2,100 (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (1999-2000) (1999-2000) 70 --- P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt Source: WHO/UNICEF Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) --- --- --- ---, ---, --- --- --- WATER AND SANITATION EQUITY SYSTEMSPOLICIES Financial Flows and Human Resources Liberia Skilled attendant at delivery Percent live births attended by skilled health personnel Neonatal tetanus protection Percent of newborns protected against tetanus P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1981 1986 19961991 2001 2006 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths --- Partial No Yes Yes Yes No Partial Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 22 20 36 0.3 8 8 --- (2007) (2007) (2007) (2004) (2005) (2005) Other 0% Pneumonia 23% Measles 6% HIV/AIDS4% Injuries 2%Diarrhoea 17% Malaria 19% Neonatal 29% 1990 1995 2000 2005 2010 2015 50 0 100 150 200 250 235 235 78 Source: UNICEF, 2006 MDG Target Under-five mortality rate Deaths per 1000 live births Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 23 1999-2000 Other NS 2004 Other NS 2005 Other NS 2006 Other NS 58 51 72 1986 DHS 1999-2000 DHS 1986 DHS 1999-2000 DHS 83 84 Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Diarrhoea 6% Other 5% Tetanus 14% Congenital 4% Preterm 27% Asphyxia 19% Causes of neonatal deaths Malaria treatment Percent febrile children < 5 years using antimalarials Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities 20041990 1990 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 52 34 85 55 72 61 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 24 59 39 49 7 27 Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% 2006 No data No data No data No data Infection 25% Exclusive breastfeeding Percent infants < 6 months exclusively breastfed (1999-2000) P er ce nt 20 0 40 60 80 100 35 1999-2000 Other NS Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: UNICEF P er ce nt 20 0 40 60 80 100 93 83 100 83 9595 40 79 0 0 0 0 Malaria prevention Percent children < 5 years sleeping under ITNs 2005 Other NS 3 94 88 0.1 P er ce nt 20 0 40 60 80 100 Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics 1986 DHS 1999-2000 DHS P er ce nt 20 0 40 60 80 100 32 2 70 Coverage along the continuum of care Source: DHS, MICS, Other NS Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 10 84 51 35 94Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care *See Annex for indicator definition DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Madagascar Source: WHO, 2006 Underweight prevalence Percent children < 5 years underweight for age* 53 15 *Based on 2006 WHO reference population 3736 1992 DHS 19,159 3,142 714 75 115 72 33 82 510 38 3,600 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2003-2004) (2003-2004) P er ce nt 20 0 40 60 80 100 Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 24 40 --- 1,2,1 62 --- WATER AND SANITATION SYSTEMSPOLICIES Financial Flows and Human Resources Madagascar Skilled attendant at delivery Percent live births attended by skilled health personnel Neonatal tetanus protection Percent of newborns protected against tetanus P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1982 1987 19971992 2002 2006 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Partial Yes Yes Yes No Partial No Partial Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 29 9 21 0.6 6 7 30 (2007) (2007) (2007) (2004) (2005) (2005) (2002-2003) Other 8% Pneumonia 21% Measles 5% HIV/AIDS 1% Injuries 2% Diarrhoea 17% Malaria 20% Neonatal 26% 1990 1995 2000 2005 2010 2015 40 0 80 120 160 200 168 115 56 Source: UNICEF, 2006 MDG Target Under-five mortality rate Deaths per 1000 live births 67 Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Diarrhoea 3% Other 7% Tetanus 4% Congenital 6% Preterm 31% Asphyxia 25% Causes of neonatal deaths Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities 20041990 1990 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 35 27 80 40 77 50 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 10 27 14 48 26 34 Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% Infection 24% Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: UNICEF P er ce nt 20 0 40 60 80 100 94 95 91 58 38 73 47 89 84 87 95 95 0 0 Coverage along the continuum of care Source: DHS, MICS, Other NS Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 27 80 51 67 59Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care *See Annex for indicator definition Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 78 77 71 80 57 47 46 51 1992 DHS 1997 DHS 2000 MICS 2003-2004 DHS 1992 DHS 1997 DHS 2000 MICS 2003-2004 DHS Exclusive breastfeeding Percent infants < 6 months exclusively breastfed 38 48 41 67 78 17 (2003-2004) (2003-2004) P er ce nt 20 0 40 60 80 100 2003-2004 DHS 1992 DHS 1997 DHS 2000 MICS 2003-2004 DHS Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 61 59 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF Malaria treatment Percent febrile children < 5 years using antimalarials 2000 MICS 2003-2004 DHS 34 61 P er ce nt 20 0 40 60 80 100 Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT No data Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding 19 47 47 1997 DHS 2000 MICS 2003-2004 DHS P er ce nt 20 0 40 60 80 100 Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics 1992 DHS 1997 DHS 2000 MICS 2003-2004 DHS P er ce nt 20 0 40 60 80 100 35 48 37 47 20 42 38 (2003-2004) (2003-2004) (2003-2004) (2003-2004) Coverage gap by wealth quintile Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap (%) 1997 DHS 2000 MICS 2004 DHS 54 2.1 34 47 1.9 24 44 3.1 42 Ratio poorest/wealthiest Difference poorest-wealthiest (%) EQUITY 1990 1995 2000 2005 2006 Malaria prevention Percent children < 5 years sleeping under ITNs P er ce nt 20 0 40 60 80 100 2000 MICS 0.2 DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths 0 0 000 Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Malawi 1999 2000 2001 2002 2003 2004 2005 51 54 26 2000 DHS 2004 DHS 2006 MICS At least one dose Two doses Source: WHO, 2006 Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Source: UNICEF Underweight prevalence Percent children < 5 years underweight for age* 53 4 *Based on 2006 WHO reference population 24 1992 DHS 22 2000 DHS 18 2004 DHS 15 2006 MICS 2004 DHS 53 2006 MICS 56 14 54 8 4 14 63 86 92 57 86 94 Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 1990 1995 2000 2005 2006 99 99 85 2004 Other NS 2005 Other NS 2006 Other NS 0 4 8 12 16 20 1992 DHS 2000 DHS 2004 DHS 2006 MICS 54 24 27 37 51 29 13,571 2,425 566 --- 120 76 40 68 1,100 18 6,000 (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2006) (2006) 89 13 (2006) (2006) P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 2000 DHS 44 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 28 57 45 3, 4, 3 61 --- (2004) (2004) (2006) (2004) (2006) Causes of maternal deaths Regional estimates for Africa, 1997-2002 Coverage along the continuum of care Source: DHS, MICS, Other NS *See Annex for indicator definition Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 42 92 54 56 85 WATER AND SANITATION EQUITY SYSTEMSPOLICIES Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities Financial Flows and Human Resources Coverage gap by wealth quintile Malawi 1990 2004 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 Skilled attendant at delivery Percent live births attended by skilled health personnel Neonatal tetanus protection Percent of newborns protected against tetanus 55 56 61 56 54 1992 DHS 2000 DHS 2004 DHS 2002 Other NS 2006 MICS P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF 88 P er ce nt 20 40 60 80 100 1983 1988 19981993 2003 2006 33 90 68 98 73 40 1990 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 45 64 61 62 61 47 Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 58 29 9 0.6 11 14 37 (2007) (2007) (2007) (2004) (2005) (2005) (2004) Coverage gap (%) 1992 DHS 2000 DHS 2004 DHS 2006 MICS 38 1.7 17 38 1.8 19 38 1.7 18 33 1.5 13 Ratio poorest/wealthiest Difference poorest-wealthiest (%) Diarrhoea 2% Tetanus 3% Other 6% Congenital 7% Asphyxia 23% Infection 29% Preterm 30%Diarrhoea 18% Malaria 14% HIV/AIDS 14% Other 8% Injuries 2% Measles 0% Pneumonia 23% Neonatal 22% Causes of neonatal deaths Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% 1990 1995 2000 2005 2010 2015 50 0 100 150 200 250 120 74 221 Source: UNICEF, 2006 MDG Target Under-five mortality rate Deaths per 1000 live births Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 90 91 94 92 92 Malaria prevention Percent children < 5 years sleeping under ITNs 2000 DHS 2004 DHS 2006 MICS 23 15 3 P er ce nt 20 0 40 60 80 100 Malaria treatment Percent febrile children < 5 years using antimalarials 2006 MICS 2004 DHS 2000 DHS 242827 P er ce nt 20 0 40 60 80 100 1992 DHS 2000 DHS 2004 DHS 2002 Other NS 2006 MICS International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Yes Partial Yes Yes Partial Yes No Partial Coverage gap by wealth quintile Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap (%) 1996 DHS 2001 DHS 61 60 2.2 2.2 42 36 Ratio poorest/wealthiest Difference poorest-wealthiest (%) DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Mali Source: WHO, 2006 Underweight prevalence Percent children < 3 years underweight for age* 43 13 *Based on 2006 WHO reference population 31 38 29 1987 DHS 11,968 2,247 579 47 217 119 55 126 970 15 6,400 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2001) (2001) (2001) (2001) P er ce nt 20 0 40 60 80 100 Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 29 30 --- 1, 3, 0 32 --- WATER AND SANITATION EQUITY SYSTEMSPOLICIES Financial Flows and Human Resources Mali Skilled attendant at delivery Percent live births attended by skilled health personnel Neonatal tetanus protection Percent of newborns protected against tetanus P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1981 1986 19961991 2001 2006 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Partial Partial Yes Yes Yes Partial No Yes Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 54 13 51 0.7 7 13 38 (2007) (2007) (2007) (2004) (2005) (2005) (2003) Other 6% Pneumonia 24% Measles 6% HIV/AIDS 2% Injuries 1% Diarrhoea 18% Malaria 17% Neonatal 26% 1990 1995 2000 2005 2010 2015 50 0 100 150 200 250 250 217 83 Source: UNICEF, 2006 MDG Target Under-five mortality rate Deaths per 1000 live births Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Diarrhoea 4% Other 5% Tetanus 10% Congenital 4% Preterm 24% Asphyxia 19% Causes of neonatal deaths Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities 20041990 1990 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 36 29 50 34 78 50 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 32 50 36 59 39 46 Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% Infection 34% Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: UNICEF P er ce nt 20 0 40 60 80 100 100 61 70 74 97 666761 24 41 66 0 10 Coverage along the continuum of care Source: DHS, MICS, Other NS Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 8 41 57 25 86Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care *See Annex for indicator definition Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 31 47 57 32 4140 84 1987 DHS 1987 DHS 1995-1996 DHS 2001 DHS 2001 DHS 1995-1996 DHS Exclusive breastfeeding Percent infants < 6 months exclusively breastfed 32 23 P er ce nt 20 0 40 60 80 100 2001 DHS 2001 DHS 1995-1996 DHS 1995-1996 DHS Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 1990 1995 2000 86 85 16 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF 2006 Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding 1995-1996 DHS 2001 DHS P er ce nt 20 0 40 60 80 100 (2001) (2001) (2001) (2001) 68 25 8 5 8 27 45 3 0 2 4 6 8 10 P er ce nt 2004 Other NS 2005 Other NS 2006 Other NS Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT 1 Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics 1987 DHS 1995-1996 DHS 2001 DHS P er ce nt 20 0 40 60 80 100 22 2 36 Malaria treatment Percent febrile children < 5 years using antimalarials Malaria prevention Percent children < 5 years sleeping under ITNs No data No data DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Mauritania Source: WHO, 2006 Underweight prevalence Percent children < 5 years underweight for age* 40 15 *Based on 2006 WHO reference population 30 20 43 1990 Other NS 3,044 456 102 55 125 78 70 13 820 22 1,000 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2000-2001) (2000-2001) P er ce nt 20 0 40 60 80 100 Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 32 16 --- 3,6,1 61 --- WATER AND SANITATION EQUITY SYSTEMSPOLICIES Financial Flows and Human Resources Mauritania Skilled attendant at delivery Percent live births attended by skilled health personnel Neonatal tetanus protection Percent of newborns protected against tetanus P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1981 1986 19961991 2001 2006 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths No No No No No Yes Partial Partial Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 43 5 31 0.8 3 8 31 (2007) (2007) (2007) (2004) (2005) (2005) (2000) Other 6% Pneumonia 22% Measles 2% HIV/AIDS 0% Injuries 2% Diarrhoea 16% Malaria 12% Neonatal 39% 1990 1995 2000 2005 2010 2015 30 0 60 90 120 150 133 125 44 Source: UNICEF, 2006 MDG Target Under-five mortality rate Deaths per 1000 live births Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Diarrhoea 3% Other 6% Tetanus 6% Congenital 7% Preterm 26% Asphyxia 23% Causes of neonatal deaths Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities 20041990 1990 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 4443 32 38 59 53 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 22 42 31 49 8 34 Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% Infection 30% Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: UNICEF P er ce nt 20 0 40 60 80 100 83 8981 98 95 57 92 96 0 0 0 0 Coverage along the continuum of care Source: DHS, MICS, Other NS Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 8 64 57 20 62Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care *See Annex for indicator definition Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 48 64 40 57 62 1990-1991 Other NS 1990-1991 Other NS 2000-2001 DHS 2000-2001 DHS Exclusive breastfeeding Percent infants < 6 months exclusively breastfed 20 78 --- (2000-2001) P er ce nt 20 0 40 60 80 100 2000-2001 DHS 1996 MICS 2000-2001 DHS Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 68 62 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF 2003-2004 DHS 33 P er ce nt 20 0 40 60 80 100 Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT No data Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding 9 2000-2001 DHS P er ce nt 20 0 40 60 80 100 Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics 2000-2001 DHS P er ce nt 20 0 40 60 80 100 41 (2000-2001) (2000-2001) (2000-2001) (2000-2001) Coverage gap by wealth quintile Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap (%) 2001 DHS 58 2.0 37 Ratio poorest/wealthiest Difference poorest-wealthiest (%) 89 2003-2004 DHS 2 P er ce nt 20 0 40 60 80 100 1990 1995 2000 2005 2006 Malaria prevention Percent children < 5 years sleeping under ITNs* Malaria treatment Percent febrile children < 5 years using antimalarials* *Sub-national risk of malaria transmission *Sub-national risk of malaria transmission Coverage gap by wealth quintile Coverage gap (%) Ratio poorest/wealthiest Difference poorest-wealthiest (%) DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Mexico Source: WHO, 2006 Underweight prevalence Percent children < 5 years underweight for age* 16 2 *Based on 2006 WHO reference population 36 14 1998-1999 Other NS 1989 Other NS 2006 Other NS 5 Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 1990 1995 2000 2005 96 98 98 0 3 6 9 12 15 105,342 10,445 2,109 --- 35 29 15 74 60 670 1,300 (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2005) (2005) 36 8 (1987) (2005) P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt Source: WHO/UNICEF Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 12 --- --- ---, ---, --- --- --- (2006) Coverage along the continuum of care Source: DHS, MICS, Other NS *See Annex for indicator definition Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 74 86 86 96 WATER AND SANITATION EQUITY SYSTEMSPOLICIES Financial Flows and Human Resources Mexico Skilled attendant at delivery Percent live births attended by skilled health personnel Neonatal tetanus protection Percent of newborns protected against tetanus P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1980 1985 19951990 2000 2006 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Yes No --- No No Partial Partial Yes Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 655 13 51 2.9 0 1 --- (2007) (2007) (2007) (2000) (2005) (2005) Other 27% Pneumonia 9% Measles 0% HIV/AIDS 0% Injuries 7% Diarrhoea 5% Malaria0% Neonatal 53% Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care 1990 1995 2000 2005 2010 2015 12 0 24 36 48 60 53 35 18 Source: UNICEF, 2006 MDG Target Under-five mortality rate Deaths per 1000 live births Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 2006 Other NS 84 1990 Other NS 1997 Other NS 86 87 1987 Other NS 1995 Other NS 78 86 Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Other 7% Congenital 18% Preterm 45% Infection 16% Asphyxia 14% Causes of neonatal deaths Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities 20041990 1990 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 87 64 89 82 100 97 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 13 75 58 91 41 79 2006 No data No data No data No data No data No data No data Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 2005 At least one dose Two doses Source: UNICEF P er ce nt 20 0 40 60 80 100 68 63 5 Causes of maternal deaths Regional estimates for Latin America, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 21% Anaemia 0% Haemorrhage 21% Abortion 12% Obstructed labor 13% Hypertensive disorders 26% Sepsis/Infections, including AIDS 8% Malaria prevention Percent children < 5 years sleeping under ITNs* Malaria treatment Percent febrile children < 5 years using antimalarials* *Very limited risk of malaria transmission *Very limited risk of malaria transmission Coverage gap by wealth quintile Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap (%) 1992 DHS 2004 DHS 46 28 2.5 2.6 38 25 Ratio poorest/wealthiest Difference poorest-wealthiest (%) DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Morocco Source: WHO, 2006 Underweight prevalence Percent children < 5 years underweight for age* 23 11 *Based on 2006 WHO reference population 10813 1987 DHS 30,853 2,978 635 85 37 34 21 23 240 150 1,700 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2003-2004) (2003-2004) (2003-2004) (2003-2004) P er ce nt 20 0 40 60 80 100 Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 10 31 --- 5,9,2 52 --- WATER AND SANITATION EQUITY SYSTEMSPOLICIES Financial Flows and Human Resources Morocco Skilled attendant at delivery Percent live births attended by skilled health personnel Neonatal tetanus protection Percent of newborns protected against tetanus P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1987 1992 20021997 2006 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths No No No Yes Partial --- No --- Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 234 6 50 1.3 2 6 69 (2007) (2007) (2007) (2004) (2005) (2005) (2000) Other 24% Pneumonia 14% HIV/AIDS 0% Injuries 4%Diarrhoea 12% Malaria 0% Measles 0% Neonatal 45% 1990 1995 2000 2005 2010 2015 20 0 40 60 80 100 89 Source: UNICEF, 2006 MDG Target Under-five mortality rate Deaths per 1000 live births Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Diarrhoea 1% Other 6% Tetanus 2% Congenital 12% Preterm 27% Asphyxia 22% Causes of neonatal deaths Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities 20041990 1990 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 5658 94 75 99 81 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 27 87 56 88 52 73 Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% Infection 29% Coverage along the continuum of care Source: DHS, MICS, Other NS Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 63 63 68 31 95Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care *See Annex for indicator definition Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 25 32 45 42 68 85 1987 DHS 1992 DHS 2003-2004 DHS 1995 DHS 1997 Other NS Exclusive breastfeeding Percent infants < 6 months exclusively breastfed 66 15 P er ce nt 20 0 40 60 80 100 2003-2004 DHS 1992 DHS Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 95 10 97 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding 2003-2004 DHS P er ce nt 20 0 40 60 80 100 (2003-2004) (2003-2004) (2003-2004) (2003-2004) 1995 DHS 25 2003-2004 DHS 31 1992 DHS 50 46 Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics 1992 DHS 1997 Other NS 2003-2004 DHS P er ce nt 20 0 40 60 80 100 28 7 17 38 No data No data No data No data 37 30 Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 24 26 31 40 63 1984 Other NS 1987 DHS 2003-2004 DHS 1992 DHS 1995 DHS 1990 1995 2000 2005 2006 Malaria prevention Percent children < 5 years sleeping under ITNs* Malaria treatment Percent febrile children < 5 years using antimalarials* *Very limited risk of malaria transmission *Very limited risk of malaria transmission Coverage gap by wealth quintile Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap (%) 1997 DHS 2003 DHS 56 40 2.2 2.7 39 35 Ratio poorest/wealthiest Difference poorest-wealthiest (%) DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Mozambique Source: WHO, 2006 Underweight prevalence Percent children < 5 years underweight for age* 47 5 *Based on 2006 WHO reference population 212324 1995 MICS 20,971 3,670 856 --- 138 96 48 118 520 45 4,000 Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2003) (2003) (2003) (2003) P er ce nt 20 0 40 60 80 100 Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 18 53 --- 2,5,1 65 --- WATER AND SANITATION EQUITY SYSTEMSPOLICIES Financial Flows and Human Resources Mozambique Skilled attendant at delivery Percent live births attended by skilled health personnel Neonatal tetanus protection Percent of newborns protected against tetanus P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1982 1987 19971992 2002 2006 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Yes Partial Partial Yes Partial Yes No Partial Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 42 9 12 0.4 9 20 --- (2007) (2007) (2007) (2004) (2005) (2005) Other 0% Pneumonia 21% HIV/AIDS 13% Injuries 1% Diarrhoea 17% Malaria 19% Measles 0% Neonatal 29% 1990 1995 2000 2005 2010 2015 50 0 100 150 200 250 235 Source: UNICEF, 2006 MDG Target Under-five mortality rate Deaths per 1000 live births Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Diarrhoea 2% Other 6% Tetanus 5% Congenital 6% Preterm 26% Asphyxia 23% Causes of neonatal deaths Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities 20041990 1990 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 2624 83 36 72 43 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 12 49 20 53 19 32 Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% Infection 32% Coverage along the continuum of care Source: DHS, MICS, Other NS Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 17 48 85 30 77Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care *See Annex for indicator definition Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 71 76 85 87 1997 DHS 2000 Other NS 2003 DHS Exclusive breastfeeding Percent infants < 6 months exclusively breastfed 80 15 P er ce nt 20 0 40 60 80 100 2003 DHS 2003 DHS 2000 Other NS 1997 DHS Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 1990 1995 2000 2005 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF 2006 Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding 1997 DHS 2003 DHS P er ce nt 20 0 40 60 80 100 (2003-2004) (2003) (2003) (2003) 3030 77 72 33 47 Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics 1997 DHS 2003 DHS P er ce nt 20 0 40 60 80 100 55 39 Malaria prevention Percent children < 5 years sleeping under ITNs No data 138 78 44 48 1997 DHS 2003 DHS Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: UNICEF 100 92 71 71 26 50 95 0 16 00000 P er ce nt 20 0 40 60 80 100 10 13 9 0 4 8 12 16 20 P er ce nt 2004 Other NS 2005 Other NS 2006 Other NS Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT 3 Malaria treatment Percent febrile children < 5 years using antimalarials P er ce nt 20 0 40 60 80 100 2003 DHS 15 (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Coverage gap by wealth quintile Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap (%) 2000 MICS 61 1.1 8 Ratio poorest/wealthiest Difference poorest-wealthiest (%) DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Myanmar Source: WHO, 2006 Underweight prevalence Percent children < 5 years underweight for age* 41 11 *Based on 2006 WHO reference population 48,379 4,146 897 65 104 74 40 93 380 110 3,700 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2003) (2003) (2003) (2000) P er ce nt 20 0 40 60 80 100 Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 19 22 --- ---, ---, --- --- --- WATER AND SANITATION EQUITY SYSTEMSPOLICIES Financial Flows and Human Resources Myanmar Skilled attendant at delivery Percent live births attended by skilled health personnel Neonatal tetanus protection Percent of newborns protected against tetanus P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1980 1985 1995 20001990 2006 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths No Yes Yes --- --- --- No --- Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 38 1 87 1.4 3 2 --- (2007) (2007) (2007) (2004) (2005) (2005) Other 6% Pneumonia 19% HIV/AIDS 1% Injuries 2% Diarrhoea 21% Malaria 9% Measles 2% Neonatal 39% 1990 1995 2000 2005 2010 2015 30 0 60 90 120 150 130 Source: UNICEF, 2006 MDG Target Under-five mortality rate Deaths per 1000 live births Causes of neonatal deaths Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities 20041990 1990 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 77 47 86 57 80 78 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 16 48 24 88 72 77 Coverage along the continuum of care Source: DHS, MICS, Other NS Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 34 57 76 15 78Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care *See Annex for indicator definition Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 7676 87 1997 Other NS 2001 Other NS Exclusive breastfeeding Percent infants < 6 months exclusively breastfed 66 15 P er ce nt 20 0 40 60 80 100 2003 MICS 2000 MICS 2003 MICS Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 1990 1995 2000 2005 78 82 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF 2006 Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding 2000 MICS 2003 MICS P er ce nt 20 0 40 60 80 100 (2001) (2001) 30 30 15 Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics 2000 MICS 2003 MICS P er ce nt 20 0 40 60 80 100 28 48 17 66 Malaria treatment Percent febrile children < 5 years using antimalarials Malaria prevention Percent children < 5 years sleeping under ITNs No data No data 104 43 46 56 31 57 1991 Other NS 1997 Other NS 2001 Other NS Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: UNICEF 67 42 00 97 96 92 92 87 87 95 96 96 95 P er ce nt 20 0 40 60 80 100 0 10 20 30 40 50 P er ce nt 2004 Other NS 2005 Other NS 2006 Other NS Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT 8 20 34 65 48 No data Causes of maternal deaths Regional estimates for Asia, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 21% Anaemia 13% Haemorrhage 31% Abortion 6%Obstructed labor 9% Hypertensive disorders 9% Sepsis/Infections, including AIDS 12% DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Nepal Source: WHO, 2006 Underweight prevalence Percent children < 5 years underweight for age* 49 13 *Based on 2006 WHO reference population 27,641 3,626 791 35 59 46 40 47 830 31 6,500 Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2006) (2006) (2006) (2001) P er ce nt 20 0 40 60 80 100 Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 25 29 --- 3, 8, 2 35 2 WATER AND SANITATION SYSTEMSPOLICIES Financial Flows and Human Resources Nepal Skilled attendant at delivery Percent live births attended by skilled health personnel Neonatal tetanus protection Percent of newborns protected against tetanus P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1980 1985 19951990 2000 2006 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Yes Yes Yes Partial Yes Partial No Partial Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 71 8 65 0.7 3 3 46 (2007) (2007) (2007) (2004) (2005) (2005) (2007) Other 12% HIV/AIDS 0% Injuries 2% Diarrhoea 21% Malaria 1% Measles 3% Neonatal 44% 1990 1995 2000 2005 2010 2015 30 0 60 90 120 150 142 Source: UNICEF, 2006 MDG Target Under-five mortality rate Deaths per 1000 live births Causes of neonatal deaths Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities 20041990 1990 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 89 67 95 70 96 90 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 7 48 11 62 30 35 Coverage along the continuum of care Source: DHS, MICS, Other NS Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 48 19 24 44 53 85Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care *See Annex for indicator definition Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 15 24 27 28 44 7 9 12 20 19 83 11 1991 Other NS 1996 DHS 2001 DHS 2006 DHS 2000 Other NS Exclusive breastfeeding Percent infants < 6 months exclusively breastfed 75 21 P er ce nt 20 0 40 60 80 100 2001 DHS 2006 DHS 1996 DHS Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 1990 1995 2000 2005 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF 2006 Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding 1996 DHS 2000 DHS P er ce nt 20 0 40 60 80 100 (2006) (2006) (2006) (2006) (2006) 53 74 68 85 89 15 43 Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics 1996 DHS 2001 DHS 2006 DHS P er ce nt 20 0 40 60 80 100 18 26 43 25 No data 59 47 1991 Other NS 1996 DHS 2000 Other NS 2001 DHS 2006 DHS 2003-2004 Other NS Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: UNICEF 90 85 82 73 98 96 83 96 96 96 96 96 97 0 P er ce nt 20 0 40 60 80 100 0 1 2 3 4 5 P er ce nt 2006 Other NS Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT 2 Pneumonia 19% No data (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) 38 1997-1998 Other NS 43 2001 DHS 39 2006 DHS No data Coverage gap by wealth quintile Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap (%) 1996 DHS 2001 DHS 2006 DHS 63 1.7 30 50 2.0 29 41 2.2 29 Ratio poorest/wealthiest Difference poorest-wealthiest (%) EQUITY Causes of maternal deaths Regional estimates for Asia, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 21% Anaemia 13% Haemorrhage 31% Abortion 6%Obstructed labor 9% Hypertensive disorders 9% Sepsis/Infections, including AIDS 12% Malaria prevention Percent children < 5 years sleeping under ITNs* Malaria treatment Percent febrile children < 5 years using antimalarials* *Sub-national risk of malaria transmission *Sub-national risk of malaria transmission DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Niger Source: WHO, 2006 Underweight prevalence Percent children < 5 years underweight for age* 55 12 *Based on 2006 WHO reference population 13,737 2,713 683 32 253 148 43 173 1,800 7 14,000 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2006) (2006) (2006) (2000) P er ce nt 20 0 40 60 80 100 Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 16 15 0 1, 5, 0 48 --- WATER AND SANITATION EQUITY SYSTEMSPOLICIES Financial Flows and Human Resources Niger Skilled attendant at delivery Percent live births attended by skilled health personnel Neonatal tetanus protection Percent of newborns protected against tetanus P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1981 1986 1996 20011991 2006 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Partial Yes Yes Yes Yes Yes Partial No Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 26 10 40 0.3 5 5 68 (2007) (2007) (2007) (2004) (2005) (2005) (2000) Other 15% Pneumonia 25% HIV/AIDS 1% Injuries 1% Diarrhoea 20% Malaria 14% Measles 7% Neonatal 17% 1990 1995 2000 2005 2010 2015 60 0 120 180 240 300 320 Source: UNICEF, 2006 MDG Target Under-five mortality rate Deaths per 1000 live births Causes of neonatal deaths Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities 20041990 1990 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 3635 62 39 80 46 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 2 35 7 43 4 13 Coverage along the continuum of care Source: DHS, MICS, Other NS Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 11 33 46 14 47Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care *See Annex for indicator definition Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 71 Exclusive breastfeeding Percent infants < 6 months exclusively breastfed 62 13 P er ce nt 20 0 40 60 80 100 2000 MICS 2006 DHS 1992 DHS 1992 DHS 1998 DHS 2000 MICS 2006 DHS Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 1990 1995 2000 2005 2006 39 47 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding 1992 DHS 1998 DHS 2000 MICS P er ce nt 20 0 40 60 80 100 (2006) (2006) (2006) (2006) (2006) 41 44 40 3 1 1 14 253 107 Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: UNICEF 100 80 92 92 89 88 77 77 95 68 94 0 94 P er ce nt 20 0 40 60 80 100 0 2 4 6 8 10 P er ce nt 2005 Other NS 2006 Other NS Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT 2 7 27 43 12 Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Diarrhoea 3% Other 7% Tetanus 10% Congenital 5% Preterm 17% Asphyxia 23% Infection 36% 15 18 16 33 1992 DHS 1998 DHS 2000 MICS 2006 DHS 30 39 41 46 1992 DHS 1998 DHS 2000 MICS 2006 DHS Malaria prevention Percent children < 5 years sleeping under ITNs 2000 MICS 2006 DHS 71 P er ce nt 20 0 40 60 80 100 Malaria treatment Percent febrile children < 5 years using antimalarials 2006 DHS 2000 MICS 33 48 P er ce nt 20 0 40 60 80 100 Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics 1992 DHS 1998 DHS 2000 MICS 14 9 26 27 P er ce nt 20 0 40 60 80 100 Coverage gap by wealth quintile Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap (%) 1998 DHS 2000 MICS 2006 MICS 70 67 1.82.0 3440 60 1.8 29 Ratio poorest/wealthiest Difference poorest-wealthiest (%) Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Nigeria Source: WHO, 2006 Underweight prevalence Percent children < 5 years underweight for age* 43 11 *Based on 2006 WHO reference population 144,720 24,503 5,909 33 191 99 53 1,129 1,100 18 59,000 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2003) (2003) (2003) (2003) P er ce nt 20 0 40 60 80 100 Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 17 47 1 2, 4, 1 32 --- WATER AND SANITATION EQUITY SYSTEMSPOLICIES Financial Flows and Human Resources Nigeria Skilled attendant at delivery Percent live births attended by skilled health personnel Neonatal tetanus protection Percent of newborns protected against tetanus P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1981 1986 1996 20011991 2006 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Yes Yes No Yes Yes Yes No No Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 53 4 63 2.0 2 3 --- (2007) (2007) (2007) (2003) (2005) (2005) Other 1% Pneumonia 20% HIV/AIDS 5% Injuries 2% Diarrhoea 16% Malaria 24% Measles 6% Neonatal 26% 1990 1995 2000 2005 2010 2015 50 0 100 150 200 250 230 Source: UNICEF, 2006 MDG Target Under-five mortality rate Deaths per 1000 live births Causes of neonatal deaths Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities 20041990 1990 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 31 33 80 49 67 48 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 33 51 39 53 36 44 Coverage along the continuum of care Source: DHS, MICS, Other NS Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 13 35 58 17 62Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care *See Annex for indicator definition Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 53Exclusive breastfeeding Percent infants < 6 months exclusively breastfed 64 14 P er ce nt 20 0 40 60 80 100 2003 DHS 1990 DHS 1990 DHS 1999 DHS 2003 DHS Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 1990 1995 2000 2005 2006 54 62 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding 2003 DHS P er ce nt 20 0 40 60 80 100 (2003) (2003) (2003) (2003) (2003) 35 27 1 17 17 191 77 Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: UNICEF 23 79 77 60 79 31 85 76 27 000 73 73 P er ce nt 20 0 40 60 80 100 0 2 4 6 8 10 P er ce nt 2004 Other NS 2005 Other NS 2006 Other NS Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT 0.6 0.3 3 28 Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Diarrhoea 4% Other 8% Tetanus 8% Congenital 7% Preterm 25% Asphyxia 27% Infection 22% 31 42 35 1990 DHS 1999 DHS 2003 DHS 79 57 64 58 1986 DHS 1990 DHS 1999 DHS 2003 DHS Malaria prevention Percent children < 5 years sleeping under ITNs 2003 DHS 1 P er ce nt 20 0 40 60 80 100 Malaria treatment Percent febrile children < 5 years using antimalarials 34Pe rc en t 20 0 40 60 80 100 Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics 1990 DHS 2003 DHS 37 23 33Pe rc en t 20 0 40 60 80 100 Coverage gap by wealth quintile Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap (%) 1990 DHS 2003 DHS 65 62 2.41.9 4535 Ratio poorest/wealthiest Difference poorest-wealthiest (%) Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% 2003 DHS DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Pakistan Source: WHO, 2006 Underweight prevalence Percent children < 5 years underweight for age* 42 14 *Based on 2006 WHO reference population 160,943 19,012 4,358 --- 97 78 57 423 320 74 15,000 (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2001) (2001) (1995) (1991) P er ce nt 20 0 40 60 80 100 Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 33 14 --- 3,6,1 6 --- WATER AND SANITATION EQUITY SYSTEMSPOLICIES Financial Flows and Human Resources Pakistan Skilled attendant at delivery Percent live births attended by skilled health personnel Neonatal tetanus protection Percent of newborns protected against tetanus P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1981 1986 1996 20011991 2006 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Partial Yes Yes Yes Yes Partial No No Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 48 2 79 1.2 2 4 --- (2007) (2007) (2007) (2004) (2005) (2005) Other 6% Pneumonia 19% HIV/AIDS 0% Injuries 2% Diarrhoea 14% Malaria 1%Measles2% Neonatal 56% 1990 1995 2000 2005 2010 2015 30 0 60 90 120 150 130 Source: UNICEF, 2006 MDG Target Under-five mortality rate Deaths per 1000 live births Causes of neonatal deaths Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities 20041990 1990 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 89 78 83 96 91 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 17 82 37 92 41 59 Coverage along the continuum of care Source: DHS, MICS, Other NS Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 28 31 36 16 80Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care *See Annex for indicator definition Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 80 Exclusive breastfeeding Percent infants < 6 months exclusively breastfed 31 19 P er ce nt 20 0 40 60 80 100 2001 Other NS 1990-1991 DHS Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 80 83 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding 1990-1991 DHS P er ce nt 20 0 40 60 80 100 (2000-2001) (1990-1991) (1990-1991) (1996) 39 31 97 43 Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: UNICEF 88 95 95 100 95 95 95 95 95 95 95 95 0 P er ce nt 20 0 40 60 80 100 0 1 2 3 4 5 P er ce nt 2006 Other NS Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT 0.4 33 Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Diarrhoea 4% Other 6% Tetanus 7% Congenital 8% Preterm 20% Asphyxia 22% Infection 33% 26 26 28 43 36 1990-1991 DHS 1996-1997 Other NS 1999 Other NS 2001 Other NS 2004-2005 Other NS 19 18 18 23 31 1990-1991 DHS 1996-1997 Other NS 1998-1999 Other NS 2001 Other NS 2004-2005 Other NS Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics 1990-1991 DHS 66 16 P er ce nt 20 0 40 60 80 100 Coverage gap by wealth quintile Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap (%) 1991 DHS 60 2.0 37 Ratio poorest/wealthiest Difference poorest-wealthiest (%) 1995 MICS 16 Malaria prevention Percent children < 5 years sleeping under ITNs Malaria treatment Percent febrile children < 5 years using antimalarials No data No data 95 Causes of maternal deaths Regional estimates for Asia, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 21%Anaemia13% Haemorrhage 31% Abortion 6% Obstructed labor 9% Hypertensive disorders 9% Sepsis/Infections, including AIDS 12% 1990 1995 2000 2005 2006 DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Papua New Guinea Source: WHO, 2006 Underweight prevalence Percent children < 5 years underweight for age* 44 5 *Based on 2006 WHO reference population 6,202 898 191 --- 73 54 32 14 470 55 820 (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2005) (2005) (1996) (1996) P er ce nt 20 0 40 60 80 100 Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) --- --- --- ---, ---, --- --- --- WATER AND SANITATION EQUITY SYSTEMSPOLICIES Financial Flows and Human Resources Papua New Guinea International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Partial Partial No Partial No Partial Partial --- Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 147 10 7 0.6 3 6 --- (2007) (2007) (2007) (2000) (2005) (2005) Other 25% HIV/AIDS 0% Injuries 2% Diarrhoea 15% Malaria 1% Measles 2% Neonatal 35% 1990 1995 2000 2005 2010 2015 20 0 40 60 80 100 94 Source: UNICEF, 2006 MDG Target Under-five mortality rate Deaths per 1000 live births Causes of neonatal deaths Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities 20041990 1990 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 41 67 44 Coverage along the continuum of care Source: DHS, MICS, Other NS Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 26 41 78 59 65Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 Exclusive breastfeeding Percent infants < 6 months exclusively breastfed 74 11 P er ce nt 20 0 40 60 80 100 2005 Other NS 1982-1983 Other NS Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 65 75 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding 25 18 73 31 Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: UNICEF 90 32 10 0 0 0 0 0 P er ce nt 20 0 40 60 80 100 0 2 4 6 8 10 P er ce nt Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT 78 1996 DHS Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics 1996 DHS 75 P er ce nt 20 0 40 60 80 100 Coverage gap by wealth quintile Coverage gap (%) Ratio poorest/wealthiest Difference poorest-wealthiest (%) 1996 DHS 59 Malaria prevention Percent children < 5 years sleeping under ITNs Malaria treatment Percent febrile children < 5 years using antimalarials No data No data No data No data No data Neonatal tetanus protection Percent of newborns protected against tetanus Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1980 1985 1995 20001990 2006 *See Annex for indicator definition 57 32 39 88 32 39 88 Pneumonia 19% No data 2004 Other NS 5 2005 Other NS 4 Skilled attendant at delivery Percent live births attended by skilled health personnel P er ce nt 20 0 40 60 80 100 1996 DHS 2000 Other NS 41 53 41 67 44 1990 1995 2000 2005 2006 Causes of maternal deaths Regional estimates for Asia, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 21%Anaemia13% Haemorrhage 31% Abortion 6% Obstructed labor 9% Hypertensive disorders 9% Sepsis/Infections, including AIDS 12% DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Peru Source: WHO, 2006 Underweight prevalence Percent children < 5 years underweight for age* 30 1 *Based on 2006 WHO reference population 27,589 2,815 584 93 25 21 16 15 240 140 1,500 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2004) (2004) (2004) (2004) P er ce nt 20 0 40 60 80 100 Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 9 87 --- 16, 23, 6 42 --- WATER AND SANITATION EQUITY SYSTEMSPOLICIES Financial Flows and Human Resources Peru Skilled attendant at delivery Percent live births attended by skilled health personnel Neonatal tetanus protection Percent of newborns protected against tetanus P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1981 1986 1996 20011991 2006 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Yes Partial --- Yes No Yes Partial Yes Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 235 9 42 1.9 5 12 --- (2007) (2007) (2007) (2004) (2005) (2005) Other 25% Pneumonia 14% HIV/AIDS 1% Injuries 10% Malaria 0% Measles 0% Neonatal 39% 1990 1995 2000 2005 2010 2015 20 0 40 60 80 100 78 Source: UNICEF, 2006 MDG Target Under-five mortality rate Deaths per 1000 live births Causes of neonatal deaths Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities 20041990 1990 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 65 41 74 89 83 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 15 69 52 74 32 63 Coverage along the continuum of care Source: DHS, MICS, Other NS Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 71 73 92 64 99Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care *See Annex for indicator definition Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 82 Exclusive breastfeeding Percent infants < 6 months exclusively breastfed 81 11 P er ce nt 20 0 40 60 80 100 2000 DHS 2004 DHS 1991-1992 DHS 1996 DHS 2000 DHS 2004 DHS 1991-1992 DHS 1996 DHS Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 1990 1995 2000 2005 2006 94 94 99 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding 1991-1992 DHS 1996 DHS 2000 DHS 2004 DHS P er ce nt 20 0 40 60 80 100 (2004) (2004) (2004) (2004)25 26 Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 0 20 40 60 80 100 P er ce nt 2004 Other NS 2005 Other NS 2006 Other NS Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT 25 31 46 57 Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Diarrhoea 1% Other 8% Tetanus 2% Congenital 9% Preterm 32% Asphyxia 27% Infection 20% 56 64 67 84 92 1986 DHS 1991-1992 DHS 1996 DHS 2000 DHS 1991-1992 DHS 1996 DHS 2000 DHS 2004 DHS 2004 DHS 53 56 73 59 9 33 53 67 64 6 5 7 No data No data No data 89 Diarrhoea 12% 1 Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics 2004 DHS 1991-1992 DHS 1996 DHS 2000 DHS 33 46 68 58 P er ce nt 20 0 40 60 80 100 EQUITY Coverage gap by wealth quintile Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap (%) 1992 DHS 1996 DHS 2000 DHS 2004 DHS 35 32 2.5 32 25 3.2 29 19 2.8 19 Ratio poorest/wealthiest Difference poorest-wealthiest (%) 10 12 34 Causes of maternal deaths Regional estimates for Latin America, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 21% Anaemia 0% Haemorrhage 21% Abortion 12% Obstructed labor 13% Hypertensive disorders 26% Sepsis/Infections, including AIDS 8% Malaria prevention Percent children < 5 years sleeping under ITNs* Malaria treatment Percent febrile children < 5 years using antimalarials* *Sub-national risk of malaria transmission *Sub-national risk of malaria transmission DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Philippines Source: WHO, 2006 Underweight prevalence Percent children < 5 years underweight for age* 34 6 *Based on 2006 WHO reference population 86,264 11,027 2,295 83 32 24 15 73 230 140 4,600 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2003) (2003) (2003) (2003) P er ce nt 20 0 40 60 80 100 Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 17 70 --- 7, 10, 5 54 --- WATER AND SANITATION EQUITY SYSTEMSPOLICIES Financial Flows and Human Resources Philippines Skilled attendant at delivery Percent live births attended by skilled health personnel Neonatal tetanus protection Percent of newborns protected against tetanus P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1980 1985 1995 20001990 2006 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Yes Yes No No No --- No --- Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 203 6 47 2.7 0 2 --- (2007) (2007) (2007) (2000) (2005) (2005) Other 34% Pneumonia 13% HIV/AIDS 0% Injuries 3% Malaria 0% Measles 1% Neonatal 37% 1990 1995 2000 2005 2010 2015 20 0 40 60 80 100 62 Source: UNICEF, 2006 MDG Target Under-five mortality rate Deaths per 1000 live births Causes of neonatal deaths Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities 20041990 1990 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 8280 87 87 85 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 48 66 57 80 59 72 Coverage along the continuum of care Source: DHS, MICS, Other NS Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 49 60 88 34 92Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care *See Annex for indicator definition Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 64 Exclusive breastfeeding Percent infants < 6 months exclusively breastfed 58 20 P er ce nt 20 0 40 60 80 100 1987 Other NS 1989-1990 Other NS 1993 Other NS 1996 Other NS 2001 Other NS 2003 Other NS 2003 DHS 1993 DHS 1998 DHS Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 1990 1995 2000 2005 2006 88 92 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding 1998 DHS 2003 DHS P er ce nt 20 0 40 60 80 100 (2003) (2003) (2003) (2003) Causes of maternal deaths Regional estimates for Asia, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 21%Anaemia13% Haemorrhage 31% Abortion 6% Obstructed labor 9% Hypertensive disorders 9% Sepsis/Infections, including AIDS 12% 32 21 Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT 37 76 83 86 86 88 1993 DHS 1998 DHS 2000 MICS 1993 DHS 1998 DHS 1999 MICS 2000 MICS 2003 DHS 2003 DHS 53 56 60 46 58 26 37 34 29 26 25 27 21 30 No data No data No data 95 Diarrhoea 12% Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics 2003 DHS 1993 DHS 1998 DHS 2000 MICS 51 58 55 65 36 44 P er ce nt 20 0 40 60 80 100 EQUITY Coverage gap by wealth quintile Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap (%) 1998 DHS 2003 DHS 31 26 1.9 22 3.1 27 Ratio poorest/wealthiest Difference poorest-wealthiest (%) No data Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: UNICEF 85 90 84 86 86 76 76 85 85 85 85 76 8278 P er ce nt 20 0 40 60 80 100 Malaria prevention Percent children < 5 years sleeping under ITNs* Malaria treatment Percent febrile children < 5 years using antimalarials* *Sub-national risk of malaria transmission *Sub-national risk of malaria transmission DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Rwanda Source: WHO, 2006 Underweight prevalence Percent children < 5 years underweight for age* 52 5 *Based on 2006 WHO reference population 9,464 1,617 420 82 160 98 45 67 1,300 16 4,700 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2005) (2005) (2005) (2005) P er ce nt 20 0 40 60 80 100 Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 38 13 0 3, 8, 2 41 --- WATER AND SANITATION SYSTEMSPOLICIES Financial Flows and Human Resources Rwanda Skilled attendant at delivery Percent live births attended by skilled health personnel Neonatal tetanus protection Percent of newborns protected against tetanus P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1981 1986 1996 20011991 2006 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths No Yes Yes Yes Yes Yes No No Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 126 17 16 0.5 13 13 --- (2007) (2007) (2007) (2004) (2005) (2005) Other 24% Pneumonia 23% HIV/AIDS 5% Injuries 2% Diarrhoea 19% Malaria 5% Measles 2% Neonatal 22% 1990 1995 2000 2005 2010 2015 50 0 100 150 200 250 176 Source: UNICEF, 2006 MDG Target Under-five mortality rate Deaths per 1000 live births Causes of neonatal deaths Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities 20041990 1990 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 69 57 59 92 74 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 36 49 37 56 38 42 Coverage along the continuum of care Source: DHS, MICS, Other NS Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 17 39 94 88 95Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care *See Annex for indicator definition Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 82 Exclusive breastfeeding Percent infants < 6 months exclusively breastfed 69 6 P er ce nt 20 0 40 60 80 100 1992 DHS 2000 DHS 2005 DHS Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 95 99 99 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding 2000 DHS 2005 DHS P er ce nt 20 0 40 60 80 100 (2005) (2005) (2005) (2005) (2005) 24 20 18 888383 160 59 Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: UNICEF 93 75 94 59 36 8000 86 93 95 99 100 P er ce nt 20 0 40 60 80 100 0 15 30 45 60 75 P er ce nt 2004 Other NS 2005 Other NS 2006 Other NS Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT 25 38 55 20 24 Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Diarrhoea 4% Other 7% Tetanus 4% Congenital 6% Preterm 20% Asphyxia 26% Infection 32% 94 92 94 1992 DHS 2000 MICS 2005 DHS 1992 DHS 2000 DHS 2005 DHS 26 31 39 1992 DHS 2000 DHS 2005 DHS 88 Malaria prevention Percent children < 5 years sleeping under ITNs 2000 DHS 2005 DHS 13 4 P er ce nt 20 0 40 60 80 100 Malaria treatment Percent febrile children < 5 years using antimalarials 2005 DHS 2000 DHS 1213 P er ce nt 20 0 40 60 80 100 Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics 1992 DHS 2000 DHS 2005 DHS 30 4 16 28 P er ce nt 20 0 40 60 80 100 EQUITY Coverage gap by wealth quintile Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap (%) 2000 DHS 2005 DHS 52 1.4 15 47 1.5 16 Ratio poorest/wealthiest Difference poorest-wealthiest (%) Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% 1990 1995 2000 2005 2006 DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Senegal Source: WHO, 2006 Underweight prevalence Percent children < 5 years underweight for age* 20 9 *Based on 2006 WHO reference population 12,072 1,913 435 55 116 60 31 50 980 21 4,100 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2005) (2005) 61 19 (2005) (2005) Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) WATER AND SANITATION SYSTEMSPOLICIES Financial Flows and Human Resources Senegal International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Partial Yes Yes No Yes Yes Partial No Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 72 10 56 0.4 10 17 38 (2007) (2007) (2007) (2004) (2005) (2005) (2000) Other 0% Malaria 28% Measles 8% Diarrhoea 17% Pneumonia 21% Neonatal 23% Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Diarrhoea 2% Other 6% Tetanus 4% Congenital 6% Asphyxia 20% Infection 33% Preterm 28% Causes of neonatal deaths Coverage along the continuum of care Source: DHS, MICS, Other NS Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 12 87 52 34 80Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care Causes of maternal deaths Regional estimates for Africa, 1997-2002 P er ce nt 20 0 40 60 80 100 Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib HIV/AIDS 1% 1999 2000 2001 2002 2003 2004 2005 *See Annex for indicator definition At least one dose Two doses Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses Malaria treatment Percent febrile children < 5 years using antimalarials Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 32 40 9 3, 7, 1 23 --- (2005) (2005) (2005) (2005) (2005) 86 93 9595 83 83 85 93 87 93 0 00 Malaria prevention Percent children < 5 years sleeping under ITNs Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT 2005 Other NS 0 1 2 3 4 5 P er ce nt 2 Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding P er ce nt 20 0 40 60 80 100 2000 MICS 2005 DHS Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 Sanitation Percent population using improved sanitation facilities TotalRural Urban 1990 2004 19 53 34 79 57 33 Water Percent population using improved drinking water sources 1990 2004 TotalRural Urban Source: WHO/UNICEF JMP, 2006 49 89 6065 92 76 Skilled attendant at delivery Percent live births attended by skilled health personnel Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 74 63 79 87 82 1986 DHS 1992-1993 DHS 1997 DHS 2000 MICS 2005 DHS P er ce nt 20 0 40 60 80 100 47 47 41 48 58 58 52 1986 DHS 1993 DHS 1997 DHS 1999 DHS 2000 MICS 2002 Other NS 2005 DHS Coverage gap by wealth quintile Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap (%) 2005 DHS 45 1.8 26 Ratio poorest/wealthiest Difference poorest-wealthiest (%) EQUITY Neonatal tetanus protection Percent of newborns protected against tetanus Source: WHO/UNICEF 1985 1990 20001995 2006 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% P er ce nt 20 0 40 60 80 100 47 27 1992-1993 DHS 2000 MICS 2005 DHS 1990 1995 2000 2005 2010 2015 Source: UNICEF, 2006 40 0 80 120 160 200 Injuries 3% Source: WHO/UNICEF 89 89 80 2 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 2000 MICS 27 2005 DHS 3634 43 P er ce nt 20 40 60 80 100 Under-five mortality rate Deaths per 1000 live births 50 116 149 MDG Target 15 2022 1992-1993 DHS 2000 MICS 2005 DHS P er ce nt 20 0 40 60 80 100 34 12 6 1992-1993 DHS 1997 DHS 2005 DHS P er ce nt 20 0 40 60 80 100 2005 DHS 2000 MICS 7 18 31 P er ce nt 20 0 40 60 80 100 86 1990 1995 2000 2005 2006 DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Sierra Leone Source: WHO, 2006 Underweight prevalence Percent children < 5 years underweight for age* 45 10 *Based on 2006 WHO reference population 0.5 1 8 0 3 6 9 12 15 5,743 999 262 48 270 159 56 71 2,100 8 5,400 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2005) (2005) 52 24 (2005) (2005) P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) --- --- 2 ---, ---, --- 33 --- (2005) (2005) Coverage along the continuum of care Source: DHS, MICS, Other NS *See Annex for indicator definition Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 5 81 43 8 67 WATER AND SANITATION SYSTEMSPOLICIES Financial Flows and Human Resources Sierra Leone Skilled attendant at delivery Percent live births attended by skilled health personnel P er ce nt 20 0 40 60 80 100 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths No Partial Yes Yes Partial Partial No Partial Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 34 8 41 0.5 5 6 --- (2007) (2007) (2007) (2004) (2005) (2005) Other 13% Malaria 12% HIV/AIDS 1% Measles 5% Injuries 1% Diarrhoea 20% Pneumonia 26% Neonatal 22% Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 Malaria prevention Percent children < 5 years sleeping under ITNs P er ce nt 20 0 40 60 80 100 2000 MICS 2 2005 MICS 5 2004 Other NS 2005 Other NS Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Diarrhoea 4% Other 5% Tetanus 8% Congenital 4% Asphyxia 19% Infection 35% Preterm 25% Causes of neonatal deaths 2 2006 Other NS Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding P er ce nt 20 0 40 60 80 100 Malaria treatment Percent febrile children < 5 years using antimalarials P er ce nt 20 0 40 60 80 100 31 2000 MICS 39 2005 MICS 2000 MICS 61 52 2005 MICS 25 2000 MICS 25 2005 MICS 68 2000 MICS 81 2005 MICS 42 2000 MICS 43 2005 MICS 4 2000 MICS 8 2005 MICS Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics 2000 MICS 2005 MICS 50 48 21 P er ce nt 20 0 40 60 80 100 Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 2004 30 39 53 2004 46 57 75 Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% 1990 1995 2000 2005 2010 2015 60 0 120 180 240 300 290 270 97 Source: UNICEF, 2006 MDG Target Under-five mortality rate Deaths per 1000 live births Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: UNICEF P er ce nt 20 0 40 60 80 100 73 77 84 848791 7781 93 95 9595 20 0 Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 67 64 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF Neonatal tetanus protection Percent of newborns protected against tetanus 0 Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1980 1985 19951990 2000 2006 85 Coverage gap by wealth quintile Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap (%) 2000 MICS 2005 MICS 53 49 1.4 17 Ratio poorest/wealthiest Difference poorest-wealthiest (%) EQUITY 1999 2001 2003 2005 2006 Coverage gap by wealth quintile Coverage gap (%) Ratio poorest/wealthiest Difference poorest-wealthiest (%) DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Somalia Source: WHO, 2006 Underweight prevalence Percent children < 5 years underweight for age* 42 13 *Based on 2006 WHO reference population 0 1 2 3 4 5 8,445 1,507 371 3 145 90 49 54 1,400 12 5,200 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2006) (2006) 15 11 (2006) (2006) P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) --- --- 1 ---, ---, --- 26 --- (2006) (2006) Coverage along the continuum of care Source: DHS, MICS, Other NS *See Annex for indicator definition Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 15 26 33 9 35 WATER AND SANITATION EQUITY SYSTEMSPOLICIES Financial Flows and Human Resources Somalia Neonatal tetanus protection Percent of newborns protected against tetanus P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1981 1986 19961991 20062001 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths No --- --- No No --- No --- Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) --- --- --- 0.2 4 4 56 (1997) (2005) (2005) (2005) Other 20% Malaria 5% Measles 7% HIV/AIDS 1% Injuries 3% Diarrhoea 19% Pneumonia 24% Neonatal 23% Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care Malaria prevention Percent children < 5 years sleeping under ITNs P er ce nt 20 0 40 60 80 100 2006 MICS 9 2006 MICS 1997 MICS 1999 MICS Skilled attendant at delivery Percent live births attended by skilled health personnel 34 1999 MICS 2006 MICS 33 2002 Other NS 25 Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Diarrhoea 4% Other 7% Congenital 8% Tetanus 8% Asphyxia 25% Infection 26% Preterm 22% Causes of neonatal deaths 0.6 2006 Other NS Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding P er ce nt 20 0 40 60 80 100 2006 MICS 7 Malaria treatment Percent febrile children < 5 years using antimalarials P er ce nt 20 0 40 60 80 100 2006 MICS 8 Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics P er ce nt 20 0 40 60 80 100 Water Percent population using improved drinking water sources Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% 1990 1995 2000 2005 2010 2015 40 0 80 120 160 200 At least one dose Two doses P er ce nt 20 0 40 60 80 100 Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 1990 1995 2000 20062005 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF 32 2316 1999 MICS 2006 MICS 9 9 Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 Source: UNICEF No data No data Source: WHO/UNICEF JMP, 2006 Sanitation Percent population using improved sanitation facilities TotalRural Urban P er ce nt 20 0 40 60 80 100 2004 14 48 26 TotalRural Urban P er ce nt 20 0 40 60 80 100 2004 27 32 29 Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy 32 1999 MICS 26 2006 MICS P er ce nt 20 0 40 60 80 100 74 203 68 145 Source: UNICEF, 2006 MDG Target Under-five mortality rate Deaths per 1000 live births 6 00 56 50 45 63 62 100 60 15 35 35 13 32 2006 MICS DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report South Africa Source: WHO, 2006 Underweight prevalence Percent children < 5 years underweight for age* 31 4 *Based on 2006 WHO reference population 48,282 5,254 1,102 --- 69 56 21 76 400 110 4,300 (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (1999) (1999) 46 15 (2003) (1998) P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) --- 73 --- 16,19,12 45 --- (1998) (1998) (1998) Coverage along the continuum of care Source: DHS, MICS, Other NS *See Annex for indicator definition Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 60 92 92 7 85 WATER AND SANITATION EQUITY SYSTEMSPOLICIES Financial Flows and Human Resources South Africa Neonatal tetanus protection Percent of newborns protected against tetanus P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1992 1997 2002 2006 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Partial Yes No --- --- --- No --- Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 748 11 10 4.9 4 6 --- (2007) (2007) (2007) (2004) (2005) (2005) Other 1% Malaria 0% Measles 0% HIV/AIDS 57% Injuries 5% Diarrhoea 1% Pneumonia 1% Neonatal 35% Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care Skilled attendant at delivery Percent live births attended by skilled health personnel 82 1995 Other NS 2003 DHS 92 1998 DHS 84 Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Diarrhoea 1% Other 6% Congenital 10% Tetanus 1% Asphyxia 23% Infection 19% Preterm 39% Causes of neonatal deaths Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding P er ce nt 20 0 40 60 80 100 1998 DHS 37 Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% 1990 1995 2000 2005 2010 2015 20 0 40 60 80 100 At least one dose Two doses P er ce nt 20 0 40 60 80 100 Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 1990 1995 2000 20062005 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF 2003 DHS 7 1994 Other NS 1999 Other NS 8 10 Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 Source: UNICEF P er ce nt 20 0 40 60 80 100 73 60 20 69 Source: UNICEF, 2006 MDG Target Under-five mortality rate Deaths per 1000 live births 99 99 85 37 33 29 0 00000 0 20 40 60 80 100 P er ce nt Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT 15 34 50 No data No data P er ce nt 20 0 40 60 80 100 75 1998 DHS Coverage gap by wealth quintile Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap (%) 1998 DHS 23 1.9 15 Ratio poorest/wealthiest Difference poorest-wealthiest (%) Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities 1990 2004 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 1990 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 53 46 69 65 85 69 73 98 99 83 88 79 Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy 1994-1995 Other NS 2003 DHS 92 1998 DHS 94 89 2004 Other NS 2005 Other NS 2006 Other NS Malaria prevention Percent children < 5 years sleeping under ITNs* Malaria treatment Percent febrile children < 5 years using antimalarials* *Sub-national risk of malaria transmission *Sub-national risk of malaria transmission DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Sudan Source: WHO, 2006 Underweight prevalence Percent children < 5 years underweight for age* 48 18 *Based on 2006 WHO reference population 37,707 5,483 1,225 64 89 61 29 109 450 53 5,300 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2000) (2000) 47 31 (2000) (1999) P er ce nt 20 0 40 60 80 100 Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 26 --- --- 20,19,24 --- --- (1992-1993) (1992-1993) WATER AND SANITATION EQUITY SYSTEMSPOLICIES Financial Flows and Human Resources Sudan Neonatal tetanus protection Percent of newborns protected against tetanus Source: WHO/UNICEF P er ce nt 20 40 60 80 100 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Partial Yes Yes No Yes --- No --- Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 54 7 63 1.1 9 15 35 (2007) (2007) (2007) (2004) (2005) (2005) (2005) Other 6% Malaria 21% Measles 5% HIV/AIDS 57% Injuries 5% Diarrhoea 13% Pneumonia 16% Neonatal 31% Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Diarrhoea 1% Other 5% Congenital 8% Tetanus 3% Asphyxia 19% Infection 14% Preterm 50% Causes of neonatal deaths Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding P er ce nt 20 0 40 60 80 100 2000 MICS 38 Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics Coverage along the continuum of care Source: DHS, MICS, Other NS *See Annex for indicator definition Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 7 60 87 16 73Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% 1990 1995 2000 2005 2010 2015 30 0 60 90 120 150 At least one dose Two doses P er ce nt 20 0 40 60 80 100 Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib P er ce nt 20 0 40 60 80 100 Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses Source: UNICEF P er ce nt 20 0 40 60 80 100 72 Source: UNICEF, 2006 Under-five mortality rate Deaths per 1000 live births 79 99 92 93 93 88 15 34 0 0 70 90 90 31 Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT No data Malaria treatment Percent febrile children < 5 years using antimalarials Coverage gap by wealth quintile Coverage gap (%) Ratio poorest/wealthiest Difference poorest-wealthiest (%) Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities 1990 2004 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 1990 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 26 24 33 34 53 57 64 85 78 64 70 50 Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy 1989-1990 DHS 2000 MICS 60 1992-1993 Other NS 75 70 120 40 89 MDG Target HIV/AIDS 3% 1990 DHS 2000 MICS 13 16 P er ce nt 20 0 40 60 80 100 2000 MICS 1986 Other NS 1992 Other NS 38 31 17 1999 2000 2001 2002 2003 2004 2005 Malaria prevention Percent children < 5 years sleeping under ITNs P er ce nt 20 0 40 60 80 100 1990 1995 2000 20062005 Source: WHO/UNICEF 78 73 P er ce nt 20 0 40 60 80 100 2000 MICS 50 57 2000 MICS P er ce nt 20 0 40 60 80 100 No data No data 1981 1986 19961991 20062001 Skilled attendant at delivery Percent live births attended by skilled health personnel P er ce nt 20 0 40 60 80 100 1988-1993 Other NS 86 2000 MICS 87 2000 MICS 0.4 DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Swaziland Source: WHO, 2006 Underweight prevalence Percent children < 5 years underweight for age* 37 2 *Based on 2006 WHO reference population 1,134 147 33 53 164 112 38 5 390 120 120 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2000) (2000) 60 9 (2000) (2000) Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) --- --- --- ---,---,--- --- --- WATER AND SANITATION EQUITY SYSTEMSPOLICIES Financial Flows and Human Resources Swaziland Source: WHO/UNICEF P er ce nt 20 40 60 80 100 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Partial --- No No No Yes No Yes Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 367 11 15 6.5 15 1 --- (2007) (2007) (2007) (2004) (2005) (2005) Other 1% Malaria 0% Measles 0% HIV/AIDS 57% Injuries 4% Diarrhoea 10% Pneumonia 12% Neonatal 27% Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Diarrhoea 3% Other 7% Congenital 8% Tetanus 2% Asphyxia 25% Infection 23% Preterm 32% Causes of neonatal deaths Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding P er ce nt 20 0 40 60 80 100 2000 MICS 24 Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics Coverage along the continuum of care Source: DHS, MICS, Other NS Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 48 90 74 24 57Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% 1990 1995 2000 2005 2010 2015 40 0 80 120 160 200 At least one dose Two doses P er ce nt 20 0 40 60 80 100 Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib P er ce nt 20 0 40 60 80 100 Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses Source: UNICEF, 2006 Under-five mortality rate Deaths per 1000 live births 59 8680 68 0 0 0 0 40 00 Coverage gap by wealth quintileWater Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 2004 44 48 59 37 164 110 MDG Target HIV/AIDS 47% P er ce nt 20 0 40 60 80 100 2000 MICS 24 1999 2000 2001 2002 2003 2004 2005 P er ce nt 20 0 40 60 80 100 1990 1995 2000 20062005 Source: WHO/UNICEF 68 57 P er ce nt 20 0 40 60 80 100 2000 MICS 26 60 2000 MICS P er ce nt 20 0 40 60 80 100 No data Skilled attendant at delivery Percent live births attended by skilled health personnel P er ce nt 20 0 40 60 80 100 2000 MICS 2002 Other NS Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy 87 90 Source: UNICEF P er ce nt 20 0 40 60 80 100 1983 Other NS 9 2000 MICS 9 0 20 40 60 80 100 P er ce nt Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT 2004 Other NS 2005 Other NS 2006 Other NS 5 36 62 50 Coverage gap (%) 2000 MICS 35 Ratio poorest/wealthiest Difference poorest-wealthiest (%) Neonatal tetanus protection Percent of newborns protected against tetanus *See Annex for indicator definition 86 1989 1994 20041999 2006 2004 54 62 87 P er ce nt 20 0 40 60 80 100 1994 Other NS 2002 Other NS 74 2000 MICS 70 56 Malaria prevention Percent children < 5 years sleeping under ITNs* Malaria treatment Percent febrile children < 5 years using antimalarials* *Sub-national risk of malaria transmission *Sub-national risk of malaria transmission 2000 MICS 0.1 DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Tajikistan Source: WHO, 2006 Underweight prevalence Percent children < 5 years underweight for age* 33 9 *Based on 2006 WHO reference population 6,640 858 185 88 68 56 38 13 170 160 320 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2005) (2005) 15 10 (2005) (2005) Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) WATER AND SANITATION SYSTEMSPOLICIES Financial Flows and Human Resources Tajikistan International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths No Yes No Yes Yes Yes Partial Yes Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 54 5 76 7.2 5 5 86 (2007) (2007) (2007) (2003) (2005) (2005) (2005) Other 30% Malaria 1% Measles 0% Injuries 3% Diarrhoea 16% Pneumonia 20% Neonatal 30% Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Diarrhoea 2% Other 6% Congenital 11% Asphyxia 23% Infection 20% Preterm 34% Causes of neonatal deaths Coverage along the continuum of care Source: DHS, MICS, Other NS Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 38 77 83 25 87Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care 1990 1995 2000 2005 2010 2015 30 0 60 90 120 150 P er ce nt 20 0 40 60 80 100 Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib P er ce nt 20 0 40 60 80 100 Source: UNICEF, 2006 Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 2004 45 51 70 HIV/AIDS 0% 1999 2000 2001 2002 2003 2004 2005 P er ce nt 20 0 40 60 80 100 2005 MICS 1 1992 1997 2002 2006 Source: WHO/UNICEF 87 86 Skilled attendant at delivery Percent live births attended by skilled health personnel 2000 MICS 2005 MICS Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy 71 77 P er ce nt 20 0 40 60 80 100 2005 MICS 14 Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT Neonatal tetanus protection Percent of newborns protected against tetanus *See Annex for indicator definition 2004 48 59 92 1996 Other NS 2005 MICS 83 2000 MICS 71 79 Under-five mortality rate Deaths per 1000 live births 38 68 115 MDG Target P er ce nt 20 0 40 60 80 100 2000 MICS 14 2005 MICS 25 At least one dose Two doses Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 98 9898 96 00000 Source: UNICEF Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding P er ce nt 20 0 40 60 80 100 22 29 P er ce nt 20 0 40 60 80 100 2005 MICS 2005 MICS 2000 MICS 2 Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics P er ce nt 20 0 40 60 80 100 51 2000 MICS 64 2005 MICS 41 Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 EQUITY Coverage gap by wealth quintile Coverage gap (%) 2000 MICS 2005 MICS 37 1.4 12 31 1.4 10 Ratio poorest/wealthiest Difference poorest-wealthiest (%) P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 --- --- --- ---, ---, --- 61 --- No data (2005) No data Causes of maternal deaths Regional estimates for Asia, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 21%Anaemia13% Haemorrhage 31% Abortion 6% Obstructed labor 9% Hypertensive disorders 9% Sepsis/Infections, including AIDS 12% Malaria prevention Percent children < 5 years sleeping under ITNs* Malaria treatment Percent febrile children < 5 years using antimalarials* *Sub-national risk of malaria transmission *Sub-national risk of malaria transmission DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Tanzania, United Republic of Source: WHO, 2006 Underweight prevalence Percent children < 5 years underweight for age* 44 4 *Based on 2006 WHO reference population 39,459 6,953 1,589 8 118 74 43 188 950 24 13,000 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2004-2005) (2004-2005) 91 10 (2004-2005) (2004-2005) Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) WATER AND SANITATION SYSTEMSPOLICIES Financial Flows and Human Resources Tanzania, United Republic of International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Yes Yes No Yes Yes Yes No Yes Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 29 9 49 0.4 16 15 21 (2007) (2007) (2007) (2002) (2005) (2005) (2005) Other 0% Malaria 23% Measles 1% Injuries 2% Diarrhoea 17% Pneumonia 21% Neonatal 27% Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Diarrhoea 2% Other 7% Tetanus 2% Congenital 7% Asphyxia 26% Infection 29% Preterm 27% Causes of neonatal deaths Coverage along the continuum of care Source: DHS, MICS, Other NS Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 26 78 43 41 93Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care Causes of maternal deaths Regional estimates for Africa, 1997-2002 1990 1995 2000 2005 2010 2015 P er ce nt 20 0 40 60 80 100 Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib Source: UNICEF, 2006 HIV/AIDS 9% 1999 2000 2001 2002 2003 2004 2005 Source: WHO/UNICEF 93 90 *See Annex for indicator definition Under-five mortality rate Deaths per 1000 live births 54 118 161 MDG Target At least one dose Two doses Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses Malaria treatment Percent febrile children < 5 years using antimalarials Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 22 62 22 3,8,2 67 --- (2004-2005) (2004-2005) (2004-2005) (2004-2005) (2004-2005) 40 0 80 120 160 200 95 9594 919493 81 45 55 21 22 90 91 93 Source: UNICEF P er ce nt 20 0 40 60 80 100 1991-1992 DHS 2004-2005 DHS 17 1996 DHS 2725 2923 41 32 1991-1992 DHS 1996 DHS 1999 DHS 2004-2005 DHS P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 Malaria prevention Percent children < 5 years sleeping under ITNs 1999 DHS 2004-2005 DHS P er ce nt 20 0 40 60 80 100 2 16 Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT 2004 Other NS 2005 Other NS 2006 Other NS 0 4 8 12 16 20 P er ce nt 2 6 15 P er ce nt 20 0 40 60 80 100 58 53 2004-2005 DHS 1999 DHS Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding P er ce nt 20 0 40 60 80 100 54 1996 DHS 38 1999 DHS 53 2004-2005 DHS Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 Sanitation Percent population using improved sanitation facilities TotalRural Urban 1990 2004 45 52 43 53 4747 Water Percent population using improved drinking water sources 1990 2004 TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 35 85 4946 85 62 Skilled attendant at delivery Percent live births attended by skilled health personnel Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 50 62 78 49 1991-1992 DHS 1996 DHS 1999 DHS 2004-2005 DHS P er ce nt 20 0 40 60 80 100 38 44 43 36 1991-1992 DHS 1996 DHS 1999 Other NS 2004-2005 DHS Coverage gap by wealth quintile Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap (%) 1996 DHS 1999 DHS 2004 DHS 35 2.0 23 36 33 2.3 25 Ratio poorest/wealthiest Difference poorest-wealthiest (%) EQUITY Neonatal tetanus protection Percent of newborns protected against tetanus Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1980 1985 19951990 20062000 87 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% P er ce nt 20 0 40 60 80 100 65 22 70 68 59 1991-1992 DHS 1996 DHS 1999 DHS 2004-2005 DHS 1990 1995 2000 2005 2006 Coverage gap by wealth quintile Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap (%) 1998 DHS 2000 MICS 2006 MICS 54 1.7 27 53 1.8 28 49 1.6 22 Ratio poorest/wealthiest Difference poorest-wealthiest (%) DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Togo Source: WHO, 2006 Underweight prevalence Percent children < 3 years underweight for age* 28 16 *Based on 2006 WHO reference population 2 2 9 12 0 3 6 9 12 15 6,410 1,045 242 78 108 69 40 26 510 38 1,200 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2006) (2006) 35 12 (2006) (2006) P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 2000 MICS 18 2006 MICS 28 1998 DHS 10 Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 32 46 18 2, 5, 1 36 --- (1998) (1998) (2006) (1998) (2006) Coverage along the continuum of care Source: DHS, MICS, Other NS *See Annex for indicator definition Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 17 84 62 28 83 WATER AND SANITATION EQUITY SYSTEMSPOLICIES Financial Flows and Human Resources Togo Skilled attendant at delivery Percent live births attended by skilled health personnel Neonatal tetanus protection Percent of newborns protected against tetanus P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1988 1993 20031998 2006 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Partial Yes Partial No Partial Partial No Yes Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 63 7 67 0.4 6 5 --- (2007) (2007) (2007) (2004) (2005) (2005) Other 0% Malaria 25% Measles 7% HIV/AIDS 6% Injuries 3% Diarrhoea 14% Pneumonia 17% Neonatal 29% Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 Malaria prevention Percent children < 5 years sleeping under ITNs P er ce nt 20 0 40 60 80 100 2000 MICS 2 2006 MICS 38 22 2006 MICS 21 1988 DHS 23 1998 DHS 2004 Other NS 2005 Other NS 51 1998 DHS 2000 MICS 49 2003 Other NS 61 2006 MICS 62 43 1988 DHS 82 1998 DHS 2000 MICS 73 2003 Other NS 85 2006 MICS 84 84 Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Diarrhoea 2% Other 6% Congenital 6% Tetanus 4% Asphyxia 21% Infection 30% Preterm 30% Causes of neonatal deaths 2 2006 Other NS Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding 2006 MICS 2000 MICS 1998 DHS P er ce nt 20 0 40 60 80 100 25 2225 Malaria treatment Percent febrile children < 5 years using antimalarials P er ce nt 20 0 40 60 80 100 2000 MICS 60 2006 MICS 48 Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics 1998 DHS 2000 MICS 2006 MICS 26 2630 23 P er ce nt 20 0 40 60 80 100 Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities 1990 2004 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 1990 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 24 15 37 35 71 37 36 81 80 50 52 71 Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% 1990 1995 2000 2005 2010 2015 30 0 60 90 120 150 149 108 50 Source: UNICEF, 2006 MDG Target Under-five mortality rate Deaths per 1000 live births Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: UNICEF P er ce nt 20 0 40 60 80 100 9595 94 92 84 0 0 18 72 7 95 77100100 Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 1990 1995 2000 20062005 87 83 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF Coverage gap by wealth quintile Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap (%) 2006 MICS 16 0.9 -2 Ratio poorest/wealthiest Difference poorest-wealthiest (%) DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Turkmenistan Source: WHO, 2006 Underweight prevalence Percent children < 5 years underweight for age* 19 7 *Based on 2006 WHO reference population 4,899 491 108 96 51 45 35 6 130 290 140 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2006) (2006) 54 4 (2006) (2006) P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 10 83 --- 3, 4, 2 60 --- (2000) (2000) (2000) (2006) Coverage along the continuum of care Source: DHS, MICS, Other NS *See Annex for indicator definition Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 48 11 WATER AND SANITATION EQUITY SYSTEMSPOLICIES Financial Flows and Human Resources Turkmenistan Skilled attendant at delivery Percent live births attended by skilled health personnel Neonatal tetanus protection Percent of newborns protected against tetanus P er ce nt 20 0 40 60 80 100 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths --- Partial Yes No Yes Yes No No Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 245 15 31 13.2 2 1 --- (2007) (2007) (2007) (2002) (2005) (2005) Measles 0% Other 22% Injuries 5% Malaria 1% HIV/AIDS 0% Diarrhoea 16% Pneumonia 19% Neonatal 38% Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 2000 DHS 2006 MICS Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Diarrhoea 2% Other 6% Congenital 11% Asphyxia 22% Infection 20% Preterm 35% Causes of neonatal deaths Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding P er ce nt 20 0 40 60 80 100 Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics 2000 DHS 2006 MICS 51 50 83 P er ce nt 20 0 40 60 80 100 Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 2004 54 93 72 2004 50 62 77 1990 1995 2000 2005 2010 2015 20 0 40 60 80 100 99 51 33 Source: UNICEF, 2006 MDG Target Under-five mortality rate Deaths per 1000 live births Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: UNICEF P er ce nt 20 0 40 60 80 100 0 0 0 0 0 0 0 Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 1992 1997 2002 2006 99 98 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF 2000 DHS 11 2006 MICS 8 2000 DHS 21 2006 MICS 25 2000 DHS 13 11 2006 MICS No data No data No data Causes of maternal deaths Regional estimates for Asia, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 21%Anaemia13% Haemorrhage 31% Abortion 6% Obstructed labor 9% Hypertensive disorders 9% Sepsis/Infections, including AIDS 12% 99 99 100 98 99 No data 2000 DHS 97 1996 Other NS 96 2006 MICS 100 Malaria prevention Percent children < 5 years sleeping under ITNs* Malaria treatment Percent febrile children < 5 years using antimalarials* *Very limited risk of malaria transmission *Very limited risk of malaria transmission DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Uganda Source: WHO, 2006 Underweight prevalence Percent children < 5 years underweight for age* 38 6 *Based on 2006 WHO reference population 2 2 15 9 25 0 6 12 18 24 30 29,899 5,840 1,406 4 134 78 32 188 550 25 8,100 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2006) (2006) 80 12 (2006) (2000-2001) P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 2000-2001 DHS 63 2006 DHS 60 1995 DHS 57 Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 41 42 17 3,9,2 32 --- (2006) (2000-2001) (2006) (2006) (2000) Coverage along the continuum of care Source: DHS, MICS, Other NS *See Annex for indicator definition Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 24 94 42 60 23 89 WATER AND SANITATION SYSTEMSPOLICIES Financial Flows and Human Resources Uganda Skilled attendant at delivery Percent live births attended by skilled health personnel Neonatal tetanus protection Percent of newborns protected against tetanus P er ce nt 20 0 40 60 80 100 0 Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1981 1986 19961991 2001 2006 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Yes Yes Partial Yes Yes Partial No Partial Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 135 10 35 0.8 10 8 34 (2007) (2007) (2007) (2004) (2005) (2005) (2002-2003) Other 2% Malaria 23% HIV/AIDS 8% Measles 3% Injuries 2% Diarrhoea 17% Pneumonia 21% Neonatal 24% Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 Malaria prevention Percent children < 5 years sleeping under ITNs P er ce nt 20 0 40 60 80 100 2000-2001 DHS 0.2 2006 DHS 10 16 2006 DHS 20 1988-1989 DHS 19 2000-2001 DHS 2004 Other NS 2005 Other NS 88 Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Diarrhoea 2% Congenital 7% Other 7% Tetanus 2% Asphyxia 26% Infection 31% Preterm 25% Causes of neonatal deaths 2 2006 Other NS Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding P er ce nt 20 0 40 60 80 100 Malaria treatment Percent febrile children < 5 years using antimalarials P er ce nt 20 0 40 60 80 100 2006 DHS 62 1995 DHS 23 2000-2001 DHS 29 Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics 1995 DHS 2000-2001 DHS 61 67 P er ce nt 20 0 40 60 80 100 Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities 1990 2004 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 1990 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 41 4142 43 54 40 56 80 87 44 60 54 Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% 1990 1995 2000 2005 2010 2015 30 0 60 90 120 150 160 134 53 Source: UNICEF, 2006 MDG Target Under-five mortality rate Deaths per 1000 live births Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: UNICEF P er ce nt 20 0 40 60 80 100 68 79 42 37 46 78 78 55 31 0 0 0 0 Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 1990 1995 2000 20062005 89 80 80 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF 87 1988-1989 DHS 1995 DHS 2000-2001 DHS 2006 DHS 949291 38 1988-1989 DHS 1995 DHS 2000-2001 DHS 2006 DHS 423938 Coverage gap by wealth quintile Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap (%) 1995 DHS 2001 DHS 2006 DHS 48 1.8 25 46 1.9 25 43 1.6 19 Ratio poorest/wealthiest Difference poorest-wealthiest (%) EQUITY DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Yemen Source: WHO, 2006 Underweight prevalence Percent children < 5 years underweight for age* 58 14 *Based on 2006 WHO reference population 21,732 3,639 839 --- 100 75 37 84 430 39 3,600 (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2003) (2003) 76 32 (2003) (1997) P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 1997 DHS 18 2003 Other NS 12 1991-1992 DHS 13 Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 39 11 --- 1, 2, 1 47 --- (1997) (1997) (1997) (1997) Coverage along the continuum of care Source: DHS, MICS, Other NS *See Annex for indicator definition Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 23 41 27 12 80 WATER AND SANITATION SYSTEMSPOLICIES Financial Flows and Human Resources Yemen Skilled attendant at delivery Percent live births attended by skilled health personnel Neonatal tetanus protection Percent of newborns protected against tetanus P er ce nt 20 0 40 60 80 100 0 Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1985 1990 20001995 2006 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Yes Partial Partial No Yes --- No --- Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 82 6 59 1.0 6 17 14 (2007) (2007) (2007) (2004) (2005) (2005) (2004-2005) HIV/AIDS 0% Pneumonia 20% Malaria 8% Injuries 4% Measles 2% Diarrhoea 16% Other 17% Neonatal 33% Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 61 Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Diarrhoea 3% Tetanus 7% Congenital 8% Other 6% Asphyxia 21% Infection 25% Preterm 29% Causes of neonatal deaths Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding P er ce nt 20 0 40 60 80 100 1991-1992 DHS 23 1997 DHS 18 1997 DHS 42 2003 Other NS 48 Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics 1991-1992 DHS 1997 DHS 28 7 2003 Other NS 47 32 No data No data No data P er ce nt 20 0 40 60 80 100 Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities 1990 2004 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 1990 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 19 2832 43 82 68 65 84 7171 67 86 1990 1995 2000 2005 2010 2015 30 0 60 90 120 150 139 100 46 Source: UNICEF, 2006 MDG Target Under-five mortality rate Deaths per 1000 live births Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 At least one dose Two doses Source: UNICEF P er ce nt 20 0 40 60 80 100 100 10095 49 36 20 15 150 0 0 0 0 0 Causes of maternal deaths Regional estimates for Asia, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 21%Anaemia13% Haemorrhage 31% Abortion 6% Obstructed labor 9% Hypertensive disorders 9% Sepsis/Infections, including AIDS 12% 1997 DHS 34 2003 Other NS 41 1991-1992 DHS 26 1997 DHS 22 2003 Other NS 27 1991-1992 DHS 16 Coverage gap by wealth quintile Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap (%) 1997 DHS 67 1.8 36 Ratio poorest/wealthiest Difference poorest-wealthiest (%) EQUITY Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 1990 1995 2000 20062005 85 80 85 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF Malaria prevention Percent children < 5 years sleeping under ITNs* Malaria treatment Percent febrile children < 5 years using antimalarials* *Sub-national risk of malaria transmission *Sub-national risk of malaria transmission DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Zambia Source: WHO, 2006 Underweight prevalence Percent children < 5 years underweight for age* 55 7 *Based on 2006 WHO reference population 11,696 2,012 470 10 182 102 40 86 830 27 3,900 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2004) (2004) 87 12 (2001-2002) (2001-2002) Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) WATER AND SANITATION SYSTEMSPOLICIES Financial Flows and Human Resources Zambia International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Yes Yes Partial Yes Partial Partial Partial No Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 63 13 32 2.1 27 45 41 (2007) (2007) (2007) (2004) (2005) (2005) (2004-2005) Other 0% Malaria 19% Measles 1% Diarrhoea 18% Pneumonia 22% Neonatal 23% Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Diarrhoea 3% Other 7% Tetanus 3% Congenital 7% Asphyxia 25% Infection 31% Preterm 25% Causes of neonatal deaths Coverage along the continuum of care Source: DHS, MICS, Other NS Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 34 93 43 40 84Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care Causes of maternal deaths Regional estimates for Africa, 1997-2002 P er ce nt 20 0 40 60 80 100 Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib HIV/AIDS 16% 1999 2000 2001 2002 2003 2004 2005 *See Annex for indicator definition At least one dose Two doses Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses Malaria treatment Percent febrile children < 5 years using antimalarials Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 27 72 61 2,4,1 51 --- (2001-2002) (2001-2002) (2006) (2001-2002) (2001-2002) 66 66 50 50 73 0 0 71 75 86 83 80 75 73 19 10 40 27 1992 DHS 1996 DHS 1999 MICS 2001-2002 DHS P er ce nt 20 0 40 60 80 100 2021 1823 1992 DHS 1996 DHS 2001-2002 DHS 2004 Other NS P er ce nt 20 0 40 60 80 100 Malaria prevention Percent children < 5 years sleeping under ITNs Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT 2004 Other NS 2005 Other NS 2006 Other NS 0 10 20 30 40 50 P er ce nt 18 19 35 Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding P er ce nt 20 0 40 60 80 100 43 1996 DHS 24 1999 MICS 48 2001-2002 DHS Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 Sanitation Percent population using improved sanitation facilities TotalRural Urban 1990 2004 31 63 52 59 55 44 Water Percent population using improved drinking water sources 1990 2004 TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 27 86 40 50 90 58 Skilled attendant at delivery Percent live births attended by skilled health personnel Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 9692 93 83 1992 DHS 1996 DHS 1999 MICS 2001-2002 DHS P er ce nt 20 0 40 60 80 100 47 4751 43 1992 DHS 1996 DHS 1999 MICS 2001-2002 DHS Coverage gap by wealth quintile Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap (%) 1996 DHS 1999 MICS 2001 DHS 32 2.3 24 51 33 2.5 26 Ratio poorest/wealthiest Difference poorest-wealthiest (%) EQUITY Neonatal tetanus protection Percent of newborns protected against tetanus Source: WHO/UNICEF 1986 1991 20011996 2006 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% P er ce nt 20 0 40 60 80 100 62 14 71 14 69 1992 DHS 1996 DHS 1999 MICS 2001-2002 DHS 1990 1995 2000 2005 2010 2015 Source: UNICEF, 2006 Under-five mortality rate Deaths per 1000 live births 60 182180 MDG Target40 0 80 120 160 200 Injuries1% Source: WHO/UNICEF 80 84 80 P er ce nt 20 0 40 60 80 100 1 1999 MICS 7 2001-2002 DHS 23 2006 Other NS P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 58 1999 MICS 52 2001-2002 DHS 58 2006 Other NS 90 P er ce nt 20 40 60 80 100 1990 1995 2000 2005 2006 Coverage gap by wealth quintile Poorest 2nd 3rd 4th Wealthiest P er ce nt 20 0 40 60 80 100 Coverage gap (%) 1994 DHS 1999 DHS 2006 DHS 27 1.9 16 22 2.3 15 30 1.9 19 Ratio poorest/wealthiest Difference poorest-wealthiest (%) DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN NUTRITION Exclusive breastfeeding Percent infants < 6 months exclusively breastfed Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths Stunting prevalence (moderate and severe, %) Wasting prevalence (moderate and severe, %) Complementary feeding rate (6-9 months, %) Low birthweight incidence (%) CHILD HEALTH Countdown to 2015 2008 Report Zimbabwe Source: WHO, 2006 Underweight prevalence Percent children < 5 years underweight for age* 36 7 *Based on 2006 WHO reference population 28 13 17 0 4 8 12 16 20 13,228 1,703 372 42 105 68 33 39 880 43 3,400 (2006) (2006) (2006) (2006) (2006) (2006) (2000) (2006) (2005) (2005) (2005) Causes of under-five deaths Globally more than one third of child deaths are attributable to undernutrition (2005-2006) (2005-2006) 79 11 (2005-2006) (1999) P er ce nt 20 0 40 60 80 100 P er ce nt 20 0 40 60 80 100 P er ce nt 1999 DHS 2005-2006 DHS 22 1994 DHS 11 Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %) (Minimum target is 5% and maximum target is 15%) Early initiation of breastfeeding (within 1 hr of birth, %) Postnatal visit for baby (within 2 days for home births, %) 13 64 6 5,9,3 69 --- (1999) (1999) (2005-2006) (2005-2006) (2005-2006) Coverage along the continuum of care Source: DHS, MICS, Other NS *See Annex for indicator definition Pre-pregnancy Pregnancy Birth Neonatal period Infancy 0 20 40 60 80 100 60 95 80 22 30 90 WATER AND SANITATION EQUITY SYSTEMSPOLICIES Financial Flows and Human Resources Zimbabwe Neonatal tetanus protection Percent of newborns protected against tetanus P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF P er ce nt 20 40 60 80 100 1984 1989 19991994 20062004 International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Yes Yes No Yes Partial Yes No Yes Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) Official Development Assistance to maternal and neonatal health per live birth (US$) National availability of Emergency Obstetric Care services (% of recommended minimum) 139 9 26 0.9 7 18 --- (2007) (2007) (2007) (2004) (2005) (2005) Other 0% Malaria 0% Measles 3% HIV/AIDS 41% Injuries 1% Diarrhoea 12% Pneumonia 15% Neonatal 28% Measles Exclusive breastfeeding Skilled attendant at birth Antenatal visit (1 or more) Contraceptive prevalence rate *Postnatal care Antenatal care Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy P er ce nt 20 0 40 60 80 100 Malaria prevention Percent children < 5 years sleeping under ITNs P er ce nt 20 0 40 60 80 100 2005-2006 DHS 3 2005-2006 DHS 1988 DHS 1999 DHS 2004 Other NS 2005 Other NS Skilled attendant at delivery Percent live births attended by skilled health personnel 70 1988 DHS 1994 DHS 69 1999 DHS 73 2005-2006 DHS 80 91 1988 DHS 93 1994 DHS 1997 Other NS 88 1999 DHS 93 2005-2006 DHS 95 80 Prevention of mother to child transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT Source: Lawn JE, Cousens SN for CHERG (Nov 2006) Diarrhoea 2% Other 7% Congenital 9% Tetanus 2% Asphyxia 24% Infection 23% Preterm 33% Causes of neonatal deaths 2 2006 Other NS Diarrhoeal disease treatment Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding P er ce nt 20 0 40 60 80 100 1999 DHS 80 1994 DHS 42 Malaria treatment Percent febrile children < 5 years using antimalarials P er ce nt 20 0 40 60 80 100 2005-2006 DHS 5 Pneumonia treatment Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics 1999 DHS 50 P er ce nt 20 0 40 60 80 100 Water Percent population using improved drinking water sources Sanitation Percent population using improved sanitation facilities 1990 2004 TotalRural Urban TotalRural Urban Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 1990 2004 Source: WHO/UNICEF JMP, 2006 P er ce nt 20 0 40 60 80 100 42 4750 53 6969 72 100 98 78 81 63 Causes of maternal deaths Regional estimates for Africa, 1997-2002 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Other causes 30% Anaemia 4% Haemorrhage 34% Abortion 4% Obstructed labor 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% 1990 1995 2000 2005 2010 2015 20 0 40 60 80 100 76 25 105 Source: UNICEF, 2006 MDG Target Under-five mortality rate Deaths per 1000 live births At least one dose Two doses P er ce nt 20 0 40 60 80 100 Immunization Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib 1990 1995 2000 20062005 90 90 P er ce nt 20 0 40 60 80 100 Source: WHO/UNICEF 1412 8 32 Vitamin A supplementation Percent children 6-59 months receiving vitamin A doses 1999 2000 2001 2002 2003 2004 2005 Source: UNICEF 46 78 81 81 0 0000 20 20 TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT ��� TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT ��� References Al Gasseer, N., E. 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[http:// siteresources.worldbank.org/DATASTATISTICS/Resources/CLASS.XLS] 2 Feb 2008. World Bank, WHO (World Health Organization) and USAID (United States Agency for International Development). 2003. Guide to producing national health accounts: with special applications for low-income and middle income countries. Canada: WHO. © U N IC EF /H Q 07 -0 11 9/ G ia co m o Pi ro zz i TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT ��� TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT ��� Annex A Initiatives, resources and databases for monitoring progress towards the health- related Millennium Development Goals, with a special focus on maternal, newborn and child survival This list is not comprehensive but includes important resources, reports and databases related to monitoring progress towards the Millennium Development Goals for women, newborns and children. Reports The State of the World’s Children is UNICEF’s flagship publication. Each year the report focuses on a key issue affecting children and provides a set of detailed statistical tables that include individual country and regional estimates on a range of key indicators for monitoring the situation of women and children in the world. The report’s focus in 2008 is child survival (http://www.unicef.org/sowc/). This publication is the primary source for the coverage estimates used in the Countdown. Progress for Children (PFC) is a UNICEF flagship publication reporting on progress towards the Millennium Development Goals. The World Fit for Children (WFFC) Statistical Review was a special issue of PFC to report on progress towards the WFFC goals and targets included in the May 2002 Special Session of the United Nations General Assembly outcome document. Heads of state and government committed themselves to targets in vital areas of children’s well-being and development to be achieved by 2010, and UNICEF was specifically called upon to prepare a mid-decade progress report (http://www.unicef.org/publications/files/ Progress_for_Children_ No_6.pdf). State of the World’s Mothers has been published by Save the Children each year since 1999, as a complement to UNICEF’s The State of the World’s Children report. This document brings together information on the world’s mothers and newborns, with the aim of bringing attention to the urgent need to reduce maternal and infant mortality around the world. The report also identifies countries that are succeeding in improving the health and saving the lives of women and babies and shows that effective solutions to this challenge are affordable – even in the world’s poorest countries. (http://www.savethechildren.org/publications/mothers/2006/ SOWM_2006_final.pdf) The World Health Report is published annually by the World Health Organization (World Health Organization) (http://www.who.int/whr). Each year the report combines an expert assessment of global health, including statistics relating to all countries, with a focus on a specific subject (in 2008, primary health care). Some of the data and benchmarks presented here on health policy and health systems, including human resources and financial flows, were taken from previous reports. World Health Statistics Report (http://www.who.int/whosis): “This annual report presents comprehensive health data on all of the 193 World Health Organization Member States. The data, selected on the basis of quality and availability, relevance to global health, and comparability across member nations, cover over 50 core health indicators, which are organized into six major areas: mortality and burden of disease, health service coverage, risk factors, health system inputs, differentials in health outcome and coverage, as well as basic sociodemographic statistics.” The World Development Report, published by the World Bank, aims to provide a “guide to the economic, social and environmental state of the world today” (http://go.worldbank.org/LOTTGBE9I0, accessed 2 February 2008). Each year the WDR provides in-depth analysis of a specific aspect of development. Past reports have considered such topics as youth, equity, public services delivery, the role of the state, transition economies, labour, infrastructure, health, the environment and poverty. The most recent report examines the role of agriculture in development. The Global Millennium Development Goal Monitoring Report is published annually by the World Bank (http://go.worldbank.org/XE4070LV80m). This publication focuses on the responsibilities and accountability of donor countries, developing countries and the international financial institutions to support achievement of the Millennium Development Goals and monitors progress towards the Millennium Development Goal targets. The 2007 report focuses on gender equality and the empowerment of women. State of the World Population Report is the United Nations Populations Fund flagship publication (http://www.unfpa.org/swp/2007/english/ introduction.html). Each year the report focuses on a key issue addressing population, reproductive and maternal health and development concerns and provides statistical tables on a range of key demographic, health and socioeconomic indicators. Past reports have addressed such topics as urbanization, adolescent health, poverty, the environment, international migration, gender equality and changing population age structures. The relation of the thematic focus to maternal and reproductive health is a feature of every report. Resources and monitoring activities Millennium Development Goal monitoring occurs within the United Nations system. The UN Statistics Division (UNSD) coordinates the preparation of the UN Secretary General’s report on progress towards the Millennium Development Goals and is responsible for maintaining the Millennium Indicators database. The UN Statistics Division also coordinates the Inter- Agency and Experts Group on Millennium Development Goal reporting (IAEG), which is responsible for the preparation of data and analysis to monitor progress towards the Millennium Development Goals. The Group also reviews and defines methodologies and technical issues in relation to the indicators, produces guidelines and helps define priorities and strategies to support countries in data collection, analysis and reporting on Millennium Development Goals. Lead agencies have been assigned to report on progress towards specific goals and targets. UNICEF and World Health Organization are the lead agencies for reporting on the health-related Millennium Development Goals. United Nations Population Fund is also involved in reporting on Millennium Development Goal 5. UNDP is responsible for providing support to countries in the preparation of country reports on progress towards the Millennium Development Goals. The Child Health Epidemiology Reference Group (CHERG) was established in 2001 and has worked since that time to improve the quality of global estimates on maternal and child mortality and morbidity, intervention coverage and the potential effects of health services and interventions. The coverage estimates reported through the Countdown process are reviewed by the Child Health Epidemiology Reference Group for consistency with mortality estimates. The Country Profiles on Maternal and Newborn Health produced in 2008 by the World Health Organization Department of Making Pregnancy Safer (MPS) complements the Countdown with country-specific reports focusing specifically on maternal and newborn health indicators, including subnational distributions and disaggregated reporting by measures of equity and location. In 2007 the Department initiated creation of a maternal and neonatal health epidemiology reference group (MNHERG) of global experts to catalyze improved capacity and use of country-level data to guide implementation and decisionmaking. The Partnership for Maternal, Newborn and Child Health has collaborated closely with the Countdown in its efforts to monitor progress and to promote the use of the monitoring results for political advocacy related to maternal, newborn and child health. Publicly accessible databases UNICEF maintains a series of publicly accessible databases for tracking the situation of children and women globally. These databases contain both the current (presented in The State of the World’s Children) and trend data for tracking progress on the situation of women and children. UNICEF’s global databases include only statistically sound and nationally representative data from household surveys and other sources. These databases are updated annually through a process that draws on the wealth of data maintained by UNICEF’s wide network of 140 field offices and other sources. All these data have undergone a rigorous data quality review based on a series of objective criteria. UNICEF includes survey data in global estimates after reviewing them for quality based on the following criteria: The survey is based on a nationally representative sampling frame. Standard protocols for collecting and analyzing data for the Countdown indicators were used in the survey. To the extent determinable, the survey was carried out using procedures to ensure data quality in the recruitment, training and supervision of data collection teams and in the transfer and management of the survey data. One of the databases maintained by UNICEF is DevInfo, a technical platform designed for use in monitoring progress towards the Millennium Development Goals. Nationally, 103 countries are now using DevInfo to develop national socioeconomic databases for Millennium Development • • • Goal monitoring. (More information is available at http://www.devinfo.org/.) The World Development Indicators Online (WDI) provide direct access to more than 700 development indicators, with time series for 208 countries and 18 country groups from 1960 to 2006, where data are available for interactive queries and can be downloaded by users (http://go.worldbank. org/6HAYAHG8H0). The website for the Millennium Development Goals Indicators is maintained by the United Nations Statistics Division. The home page states that the site presents the official data, definitions, methodologies and sources for the 48 indicators to measure progress towards the Millennium Development Goals. The data and analyses are the product of the work of the Inter-agency and Expert Group (IAEG) on Millennium Development Goal Indicators, coordinated by the United Nations Statistics Division (http://mdgs.un.org/unsd/mdg/Host.aspx?Content=Indicators/OfficialList. htm). Household survey protocols The Multiple Indicator Cluster Survey (MICS) is a household survey programme developed by UNICEF to assist countries in filling data gaps to monitor the situation of children and women. It is capable of producing statistically sound data that are internationally comparable. The Multiple Indicator Cluster Survey was developed after the World Summit for Children to measure progress towards an internationally agreed-upon set of mid-decade goals. The first round of Multiple Indicator Cluster Surveys was conducted around 1995 in more than 60 countries. A second round of about 65 surveys was conducted in 2000. The 2005–06 round of Multiple Indicator Cluster Surveys was planned to provide a monitoring tool for the Millennium Development Goals and other major international commitments including the publication of A World Fit for Children, the UN General Assembly Special Session on HIV/AIDS, and the Abuja targets for malaria. Multiple Indicator Cluster Surveys are usually carried out by government organisations, with the support and assistance of UNICEF and other partners. Results from the different rounds of surveys, as well as related technical background materials, are available at www.childinfo.org. The USAID-supported Demographic and Health Surveys (DHS) have been conducted in many countries over the last 20 years. They provide national and subnational data on family planning, maternal and child health, child survival, HIV/AIDS and sexually transmitted infections, infectious diseases and reproductive health and nutrition. More information is available at www.measuredhs.com. The MICS and DHS programmes have coordinated efforts both in terms of standardizing survey questions and methods for data analysis, as well as data collection on the ground. Coordinating both the countries surveyed and the questions included in the questionnaire modules ensures maximum coverage of countries and provides comparability across surveys. TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT ��� TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT ��� Annex B Indicators and data sources Indicators Data Source Global Database DEMOGRAPHICS Demographics Total population United Nations Population Division United Nations Population Division Total under-five population United Nations Population Division United Nations Population Division Total births United Nations Population Division United Nations Population Division Birth registration Multiple Indicator Cluster Survey, Demographic and Health Surveys United Nations Children’s Fund Child Mortality Under-five mortality rate United Nations Children’s Fund United Nations Children’s Fund/ World Health Organization/World Bank/United Nations Population Division Infant mortality rate United Nations Children’s Fund/ World Health Organization/World Bank/United Nations Population Division United Nations Children’s Fund/ World Health Organization/World Bank/United Nations Population Division Neonatal mortality rate World Health Organization World Health Organization Total children under five deaths United Nations Children’s Fund/ World Health Organization/World Bank /United Nations Population Division United Nations Children’s Fund Cause of death of children under five Child Health Epidemiology Reference Group World Health Organization Maternal Mortality Maternal mortality ratio United Nations Children’s Fund/World Health Organization/ United Nations Population Fund/ World Health Organization United Nations Children’s Fund/World Health Organization/ United Nations Population Fund/ World Bank Lifetime risk of maternal death United Nations Children’s Fund/World Health Organization/ United Nations Population Fund/ World Health Organization United Nations Children’s Fund/World Health Organization/ United Nations Population Fund/ World Bank Total maternal deaths United Nations Children’s Fund/World Health Organization/ United Nations Population Fund/ World Health Organization United Nations Children’s Fund/World Health Organization/ United Nations Population Fund/ World Bank Maternal deaths by cause (regional) World Health Organization World Health Organization NUTRITION Anthropometric Underweight prevalence Demographic and Health Surveys, Multiple Indicator Cluster Survey, National Survey United Nations Children’s Fund/ World Health Organization Stunting prevalence Demographic and Health Surveys, Multiple Indicator Cluster Survey, National Survey United Nations Children’s Fund/ World Health Organization Wasting prevalence Demographic and Health Surveys, Multiple Indicator Cluster Survey, National Survey United Nations Children’s Fund/ World Health Organization Infant feeding Exclusive breast-feeding rate (<6 months) Demographic and Health Surveys, Multiple Indicator Cluster Survey, National Survey United Nations Children’s Fund Complementary feeding rate (6-9 months) Demographic and Health Surveys, Multiple Indicator Cluster Survey, National Survey United Nations Children’s Fund Low birth weight Low birth weight incidence Demographic and Health Surveys, Multiple Indicator Cluster Survey, National Survey United Nations Children’s Fund Micronutrient supplementation Vitamin A supplementation (at least 1 dose & 2 doses) National Immunisation Days, Demographic and Health Surveys, Multiple Indicator Cluster Survey United Nations Children’s Fund CHILD HEALTH Immunisation Measles immunisation coverage Routine, Multiple Indicator Cluster Survey, Demographic and Health Surveys United Nations Children’s Fund/ World Health Organization DPT3 immunisation coverage Routine, Multiple Indicator Cluster Survey, Demographic and Health Surveys United Nations Children’s Fund/ World Health Organization Hib3 immunisation coverage Routine, Multiple Indicator Cluster Survey, Demographic and Health Surveys United Nations Children’s Fund/ World Health Organization Malaria Under-fives sleeping under ITNs Demographic and Health Surveys, Multiple Indicator Cluster Survey, United Nations Children’s Fund Antimalarial treatment (under-fives) Demographic and Health Surveys, Multiple Indicator Cluster Survey, United Nations Children’s Fund Pneumonia Careseeking for pneumonia Demographic and Health Surveys, Multiple Indicator Cluster Survey United Nations Children’s Fund Antibiotic treatment for pneumonia Demographic and Health Surveys, Multiple Indicator Cluster Survey United Nations Children’s Fund Diarrhoeal diseases Oral rehydration and continued feeding Demographic and Health Surveys, Multiple Indicator Cluster Survey United Nations Children’s Fund AIDS HIV+ pregnant women receiving ARVs for PMTCT MOH, Joint United Nations Programme on HIV/AIDS United Nations Children’s Fund MATERNAL AND NEWBORN HEALTH Antenatal care Antenatal care (at least one visit) Demographic and Health Surveys, Multiple Indicator Cluster Survey, Reproductive Health Survey, Family Health Survey United Nations Children’s Fund Antenatal care (4 or more visits) Demographic and Health Surveys, Multiple Indicator Cluster Survey, Reproductive Health Survey, Family Health Survey United Nations Children’s Fund/ World Health Organization IPTp for malaria Intermittent preventive treatment for pregnant women Demographic and Health Surveys, Multiple Indicator Cluster Surveys United Nations Children’s Fund Neonatal tetanus protection Neonatal tetanus protection Demographic and Health Surveys, Multiple Indicator Cluster Survey United Nations Children’s Fund/ World Health Organization Delivery care Skilled attendant at birth Demographic and Health Surveys, Multiple Indicator Cluster Survey, Reproductive Health Survey, Family Health Survey United Nations Children’s Fund C-section C-section rate Demographic and Health Surveys, Multiple Indicator Cluster Survey, Reproductive Health Survey, Family Health Survey United Nations Children’s Fund Postnatal visit Postnatal visit for mother Demographic and Health Surveys, Multiple Indicator Cluster Survey, Reproductive Health Survey, Family Health Survey Special data analysis by SNL Postnatal visit for baby Demographic and Health Surveys, Multiple Indicator Cluster Survey, Reproductive Health Survey, Family Health Survey Special data analysis by SNL TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT ��� TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT ��� Breast-feeding Early initiation of breast-feeding Demographic and Health Surveys, Multiple Indicator Cluster Survey, NS United Nations Children’s Fund Contraceptive prevalence Contraceptive prevalence rate Demographic and Health Surveys, Multiple Indicator Cluster Survey, Reproductive Health Survey, Family Health Survey United Nations Children’s Fund Unmet need Unmet need for family planning Demographic and Health Surveys, National Survey United Nations Population Fund MATERNAL AND NEWBORN HEALTH Water Use of improved drinking water sources United Nations Children’s Fund/ World Health Organization United Nations Children’s Fund/ World Health Organization Sanitation Use of improved sanitation facilities United Nations Children’s Fund/ World Health Organization United Nations Children’s Fund/ World Health Organization POLICIES, SYSTEMS AND EQUITY Policies International code of marketing of breast milk substitutes United Nations Children’s Fund/ World Health Organization Special data compilation by World Health Organization New ORS formula and zinc for management of diarrhoea World Health Organization/ United Nations Children’s Fund/ Zinc task force Special data compilation by World Health Organization Community treatment of pneumonia with antibiotics United Nations Children’s Fund/ World Health Organization Special data compilation by World Health Organization IMCI adapted to cover newborns 0-1 week of age World Health Organization Special data compilation by World Health Organization Costed implementation plan for MNCH available World Health Organization Special data compilation by World Health Organization Midwives authorised to administer a core set of life saving interventions World Health Organization Special data compilation by World Health Organization Maternity protection in accordance with ILO convention 183 ILOLEX International Labor Organization Specific notification of maternal deaths World Health Organization Special data compilation by WHO Systems Per capita total expenditure on health World Health Stat 2007 World Health Organization General government expenditure on health as % of total government expenditure World Health Stat 2007 World Health Organization Out-of-pocket expenditure as % of total expenditure on health World Health Stat 2007 World Health Organization Density of health workers per 1000 population Global Atlas on Human Resources World Health Organization Official development assistance to child health per child Development Assistance Committee London School of Health and Tropical Medicine Official development assistance to maternal and neonatal health per live birth Development Assistance Committee London School of Health and Tropical Medicine Availability of emergency obstetric care services EMOC Assessments, Health Information System Averting maternal death and disability/United Nations Children’s Fund Equity Coverage gap by wealth quintile Multiple Indicator Cluster Survey/Demographic and Health Surveys Special data analysis by World Health Organization Coverage gap (%) Multiple Indicator Cluster Survey/Demographic and Health Surveys Special data analysis by World Health Organization Ratio poorest/wealthiest Multiple Indicator Cluster Survey/Demographic and Health Surveys Special data analysis by World Health Organization Difference poorest - wealthiest (%) Multiple Indicator Cluster Survey/Demographic and Health Surveys Special data analysis by World Health Organization NO. INDICATOR NAME INDICATOR DEFINITION NUMERATOR DENOMINATOR NUTRITION 1 Exclusive breast-feeding (<6 months) Percentage of infants aged 0-5 months who are exclusively breastfed Number of infants aged 0-5 months who are exclusively breastfed Total number of infants aged 0-5 months surveyed 2 Breast-feeding plus complementary food (6-9 months) Percentage of infants aged 6-9 months who are breastfed and receive complementary food Number of infants aged 6-9 months who are breastfed and receive complementary food Total number of infants aged 6-9 months surveyed 3 Vitamin A supplementation coverage Percentage of children aged 6-59 months who received at least one high done vitamin A supplement in the last six months (and at least two doses in the last 12 months). Number of children aged 6-59 months receiving at least one high dose vitamin A supplement in the 6 months prior to the survey (and at least two doses in the last 12 months). Total number of children aged 6-59 months CHILD HEALTH 4 Measles immunisation coverage Percentage of children aged 12-23 months who are immunized against measles Number of children aged 12-23 months who are immunized against measles Total number of children aged 12-23 months surveyed 5 DPT3 immunisation coverage Percentage of children aged 12-23 months who received 3 doses of DPT vaccine Number of children aged 12-23 months receiving 3 doses of DPT vaccine Total number of children aged 12-23 months surveyed 6 HiB3 immunisation coverage Percentage of children aged 12-23 months who received 3 doses of HiB vaccine. Number of children aged 12-23 months receiving 3 doses of Haemophilus influenzae type B (HiB) vaccine Total number of children aged 12-23 months surveyed 7 Oral rehydration and continued feeding Percentage of children aged 0-59 months with diarrhoea receiving oral rehydration and continued feeding Number of children aged 0-59 months with diarrhoea in the 2 weeks prior to the survey receiving oral rehydration therapy (oral rehydration solution and/or recommended homemade fluids or increased fluids) and continued Total number of children aged 0-59 months with diarrhoea in the 2 weeks prior to the survey 8 Insecticide-treated net coverage Percentage of children aged 0-59 months sleeping under an insecticide-treated mosquito net Number of children aged 0-59 months sleeping under an insecticide-treated mosquito net the night before the survey Total number of children aged 0-59 months surveyed 9 Antimalarial treatment Percentage of children aged 0-59 months with fever receiving appropriate antimalarial drugs Number of children aged 0-59 months reported to have fever in the 2 weeks prior to the survey who were treated with an appropriate antimalarial within 24 hours of the onset of symptoms Total number of children aged 0-59 months reported to have fever in the 2 weeks prior to the survey 10 Prevention of mother-to- child transmission of HIV transmission Percentage of all HIV-positive pregnant women who received a complete course of ART prophylaxis Number of HIV-positive pregnant women given ART prophylaxis in the preceding 12 months Estimated number of HIV-positive pregnant women giving birth in the preceding 12 monthsa Annex C Defining current Countdown indicators TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT ��� TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT ��� 11 Careseeking for pneumonia Percentage of children aged 0-59 months with suspected pneumonia taken to an appropriate health provider Number of children aged 0-59 months with suspected pneumonia in the 2 weeks prior to the survey who were taken to an appropriate health provider Total number of children aged 0-59 months with suspected pneumonia in the 2 weeks prior to the survey 12 Antibiotic treatment for pneumonia Percentage of children aged 0-59 months with suspected pneumonia receiving antibiotics Number of children aged 0-59 months with suspected pneumonia in the 2 weeks prior to the survey receiving antibiotics Total number of children aged 0-59 months with suspected pneumonia in the 2 weeks prior to the survey MATERNAL AND NEWBORN HEALTH 13 Contraceptive prevalence Proportion of women currently married or in union aged 15-49 that are using (or whose partner is using) a contraceptive method (either modern or traditional) Number of women currently married or in union aged 15-49 years that are using (or whose partner is using) a contraceptive method (either modern or traditional) Total number of women aged 15-49 years that are currently married or in union 14 Unmet need for family planning Proportion of women that are currently married/in union that have an unmet need for contraception Number of women that are currently married or in union that are fecund and want to space their births or limit the number of children they have and that are not currently using contraception Total number of women interviewed that are currently married or in union 15 Antenatal care (at least one visit) Percent of women attended at least once during pregnancy by skilled health personnel for reasons related to the pregnancy in the X years prior to the survey Number of women attended at least once during pregnancy by skilled health personnel for reasons related to the pregnancy in the X years prior to the survey Total number of women who had a live birth occurring in the same period 16 Antenatal care (4 or more visits) Percent of women attended at least four times during pregnancy by any provider (skilled or unskilled) for reasons related to the pregnancy in the X years prior to the survey Number of women attended at least four times during pregnancy by any provider (skilled or unskilled) for reasons related to the pregnancy in the X years prior to the survey Total number of women who had a live birth occurring in the same period 17 Neonatal tetanus protection Percentage of newborns protected against tetanus Number of mothers with a live birth in the year prior to the survey who received 2 does of TT within the appropriate interval prior to the infant’s birth Total number of women aged 15-49 with a live birth in the year prior to the survey 18 Intermittent preventive treatment Proportion of women who received intermittent preventive treatment for malaria during their last pregnancy Number of women at risk for malaria who received two or more doses of a recommended antimalarial drug treatment to prevent malaria during their last pregnancy that led to a live birth Total number of women surveyed at risk for malaria who delivered a live baby within the last two years. 19 Skilled attendant at delivery Percentage of live births attended by skilled health personnel (doctor, nurse, midwife or auxiliary midwife) Number of live births to women aged 15-49 years in the X years prior to the survey attended during delivery by skilled health personnel (doctor, nurse, midwife or auxiliary midwife) Total number of live births to women aged 15-49 years in the X years prior to the surveyb 20 C-section rate Percentage of live births delivered by Caesarean section Number of live births to women aged 15-49 years in the X years prior to the survey delivered by Caesarean section Total number of live births to women aged 15-49 years in the X years prior to the survey 21 Early initiation of breast- feeding Percentage of newborns put to the breast within one hour of birth Number of women with a live birth in the X years prior to the survey who put the newborn infant to the breast within 1 hour of birth Total number of women with a live birth in the X years prior to the surveyc 22 Postnatal care for mothersd Percentage of mothers who received postnatal care visit within two days of childbirth Number of women who received a postnatal care visit within two days of childbirth (regardless of place of delivery) Total number of women aged 15-49 years with a last live birth in the x years prior to the survey (regardless of place of delivery) 23 Postnatal care for babies who were born at home Percentage of babies born outside a facility who received a postnatal care visit within two days of birth. Number of babies born outside of a health facility who received a postnatal care visit within two days of birthe Total number of last-born babies born outside of a health facility in the x years prior to the surveyf WATER AND SANITATION 24 Use of improved drinking water sources Percentage of the population using improved drinking water sources Number of household members living in households using improved drinking water sources (including household connections, public standpipe, borehole, protected dug well, protected spring, rainwater collection) Total number of household members in households surveyed 25 Use of improved sanitation facilities Percentage of the population using improved sanitation facilities Number of household members using improved sanitation facilities (including connection to a public sewer, connection to a septic system, pour- flush latrine, simple pit latrine, or a ventilated improved pit latrine) Total number of household members in households surveyed Notes a. More details on the HIV estimates methodology can be found at www.unaids.org. b. This reference period may differ between surveys. c. This reference period may differ between surveys. d. As used for postnatal care in the continuum of care figure. e. Information on postnatal care for babies who were born in health facilities is not collected because it is assumed by DHS that mothers would not know whether or not their newborn received specific aspects of immediate care, for example early bathing. f. This denominator differs from the all births denominator used for the indicator for postnatal care for mother. Therefore, the coverage for mother and baby cannot be compared. Data for both mothers and babies that is comparable (home birth denominator) is available for only four countries. TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �00 TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �0� Annex D Definitions of policy and health systems indicators NO. POLICY INDICATOR DEFINITION CRITERIA FOR RANKING 2007 RESULTS (68 Countries) 2005 RESULTS (60 Countries) POLICIES 1 Midwives authorized to administer a core set of life saving interventions National policy adopted authorizing midwives to administer the following: a. perenteral antibiotics b. perenteral oxytocics c. perenteral anticonvulsants d. manual removal of placenta e. removal of retained products of conception f. assisted vaginal delivery g. newborn resuscitation Yes: midwives authorized for all tasks Partial: midwives authorized for some tasks No: midwives not authorized for any of these tasks Yes: 27 Partial: 25 No: 5 No data: 11 Specific notification of maternal deaths National policy adopted requiring health professionals to notify any maternal death Yes: national policy adopted and implemented Partial: national policy adopted but no systematic implementation No: no national policy Yes: 23 Partial: 14 No: 18 No data: 13 IMCI adapted to cover newborns 0-1 week of age National IMCI guidelines adapted to cover major conditions affecting newborn survival in the first week of life generic guidelines 2006 Yes: National IMCI guidelines adapted and in line with WHO generic guidelines 2006 Partial: National IMCI guidelines adapted but not fully in line with WHO generic guidelines 2006 No: National IMCI guidelines not adapted Yes: 39 Partial: 3 No: 21 No data: 5 New ORS formula and zinc for management of diarrhoea National policy guidelines adopted on management of diarrhoea with low osmolarity ORS and zinc supplements Yes: low osmolarity ORS and zinc supplements in national policy Partial: low osmolarity ORS or zinc supplements in national policy No: low osmolarity ORS and zinc supplements not promoted in national policy Yes: 34 Partial: 17 No: 10 No data: 7 Yes: 6 Partial: 17 No: 36 No data: 1 Community management of pneumonia with antibiotics National policy adopted authorizing community health workers to identify and manage pneumonia with antibiotics Yes: community health workers authorized to give antibiotics for pneumonia Partial: no national policy but some implementation of community-based management of pneumonia No: no national policy and no implementation Yes: 18 Partial: 11 No: 31 No data: 8 Yes: 16 Partial: 2 No: 41 No data: 1 Maternity protection in accordance with ILO Convention 183 ILO Convention 183 ratified by the country Yes: ILO Convention 183 ratified Partial: ILO Convention 183 not ratified but previous maternity convention ratified No: No ratification of any maternity protection convention Yes: 10 Partial: 21 No: 47 No data: 0 International Code of Marketing of Breast milk Substitutes National policy adopted on all provisions stipulated in the International Code of Marketing of Breast milk Substitutes Yes: all provisions of the International Code adopted in legislation Partial: voluntary agreements or some provisions of the international Code adopted in legislation No: no legislation and no voluntary agreements adopted in relation to the International Code Yes: 25 Partial: 28 No: 13 No data: 2 Yes: 15 Partial: 39 No: 3 No data: 3 FINANCIAL FLOWS AND HUMAN RESOURCES Costed implementation on plan for maternal, newborn and child health National plan or plans for scaling up maternal, newborn and child health interventions available and costed Yes: costed plan or plans to scale up maternal, newborn and child health interventions available at national level Partial: costed plan available for either maternal and newborn health or child health No: no costed implementation plan for MNCH available Yes: 31 Partial: 18 No: 14 No data: 5 Data obtained from expert opinion in countries Variability between countries in interpretation of the indicator with respect to the scope of costing (programme costs versus programme and recurrent costs) and the time period covered by the plan Per capita total expenditure on health (at international US$ rate) Numerical World Health Statistics 2007 Per capita expenditure on health as % of total government expenditure Numerical World Health Statistics 2007 TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �0� TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �0� Out-of-pocket expenditure as % of total expenditure on health Numerical World Health Statistics 2007 Density of health workers per 1000 population Total number of physicians, nurses and midwives relative to the overall population Numerical Minimum Standard: 2.5 health workers per 1000 people needed to deliver basic maternal and child health services Above minimum standard: 14 Below minimum standard: 54 WHO Global atlas of the health work force (http://www. who.int/globalatlas/ default.asp) HEALTH SYSTEM Availability of Emergency Obstetric Care (EmOC) Services % of recommended minimum Minimum recommended is five EmOC facilities per 500,000 people. This should include 1 Comprehensive and 4 Basic Emergency Obstetric Care facilities. The breakdown of Comprehensive and Basic by population and geographic area is available in country Assessment Reports, but not included in the Countdown. Availability is expressed as a percentage of the minimum acceptable number of EmOC facilities. The minimum acceptable number of EmOC facilities (C-EmOC and B- EmOC) is calculated by dividing the population by 500,000 and multiplying by 5. The percentage of recommended minimum number of EmOC facilities is calculated by dividing the number of functioning EmOC facilities by the recommended number and multiplying by 100. To qualify as fully functioning Basic or Comprehensive EmOC a facility must provide a standard set of signal functions. 27 countries had comparable data from EmOC Assessments. 2 of these countries had additional updates from national inventory or health system reports Of the 27 countries with data: • 4 had over 80% of the recommended minimum number of EmOC facilities. • 7 countries had 50-79% • 14 countries had 25-49% • 2 countries had 14-21% 18 additional countries have data from EmOC Assessments for specific geographic regions or using different criteria. 23 countries had no data UNICEF/AMDD data base of Emergency Obstetric Care Assessments, Bangladesh National EmOC Inventory, HIS for Nepal and Bangladesh for updates Annex E Countdown to 2015 measuring equity in maternal, newborn and child health through the coverage gap index: technical notes 1. Coverage indicators The measure of equity constructed for this report is called the ‘coverage gap index’. For guidance on interpreting the coverage gap graphs in the country profiles, please see section 4 below. The coverage gap index combines information on four intervention areas across the Continuum of Care: family planning, maternal and newborn care, immunisation and treatment of sick children. Data from Demographic and Health Surveys and Multiple Indicator Cluster Survey on eight coverage indicators in these four intervention areas was used to construct the coverage gap index. Table E1 defines the indicators. Table E1. Coverage gap index indicator definitions No. Indicator Definition 1a. Need for family planning satisfied (FP) Percentage of currently married women who say that they do not want any more children or that they want to wait two or more years before having another child, and are using contraception 1b. Contraceptive prevalence rate (CPR) Percentage of women currently married or in union aged 15–49 that are using (or whose partner is using) a modern contraceptive method 2. Antenatal care (ANC) Percentage of women attended at least once during pregnancy by skilled health personnel for reasons related to the pregnancy in the three years prior to the survey 3. Skilled birth attendance (SBA) Percentage of live births in the three years prior to the survey attended by skilled health personnel (doctor, nurse, midwife or auxiliary midwife) 4. Measles vaccination (MSL) Percentage of children aged 12–23 months who are immunized against measles 5. Diphtheria, pertussis and tetanus vaccination (three doses of combined diphtheria/pertussis/tetanus vaccine) Percentage of children aged 12–23 months who received three doses of DPT vaccine 6. BCG vaccination Percentage of children age 1–23 months currently vaccinated against BCG 7. Oral rehydration therapy (ORT) Percentage of under-five children with diarrhoea in the last two weeks who received ORT (ORS packets, recommended home solution or increased fluids) and continued feeding 8. Treatment of acute respiratory infection (ARI) Percentage of children aged 0–59 months with suspected pneumonia (cough and dyspnoea) who sought care from a health provider 2. Calculation of the coverage gap index The coverage gap index was calculated using the formula: 100 per cent – ([ORT+ARI]/2 + FP +[SBA+ANC]/2 +[MSL+2*DPT3+BCG]/4)/4 Each of the four intervention areas is given equal weight. Note: If need satisfied for family planning (FP) was not available, the contraceptive prevalence rate (CPR) among married women 15–49 years was used to estimate the need satisfied according to the following formula: FP = CPR*1.07 +27. This formula was derived from analysis of more than 100 Demographic and Health Surveys with data on both unmet need and contraceptive prevalence rate. 3. Wealth index The coverage gap index was calculated for the total sample for each country and data point. To measure equity, one needs to divide the total sample into groups by socioeconomic status. The Demographic and Health Surveys and Multiple Indicator Cluster Survey do not collect information on income and expenditure, which could be used to divide the sample into socioeconomic groups. However, the Demographic and Health Surveys and Multiple Indicator Cluster Survey do collect information on asset ownership and availability of basic household services. For the purposes of analyzing socioeconomic inequalities in health, it has been shown that using such variables to develop an index of socioeconomic status leads to similar results as using income and/or expenditure data.1 For coverage of health interventions in the Demographic and Health Surveys, we used data from an analysis conducted by Gwatkin and colleagues (2005). They used information in Demographic and Health Surveys on household assets and access to basic household services to construct a wealth index.2 The index was used to TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �0� TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �0� rank households and then divide the household population into quintiles. Results from recent Demographic and Health Surveys results were also included. For Multiple Indicator Cluster Surveys, we used data provided by UNICEF through the MICS website (http://childinfo.org) for those countries and data points for which a wealth index had been constructed.3 4. Explanation and interpretation of coverage gap graph The x-axis shows the wealth quintiles; from the poorest 20 per cent to the best-off 20 per cent. The y-axis shows the coverage gap, which is measured as a percentage as explained in section 2. No percentage gap implies maximum coverage for all interventions. A 20 per cent gap means that the coverage as calculated in the index is 80 per cent. Given that the gap is measured as maximum coverage minus actual coverage, a low figure is preferable to a high figure. The difference between the poorest and richest quintiles and shape of the line show the patterns of inequality within a country. First, the greater the inequality between the poorest and richest quintiles, the steeper the downward slope. With a few exceptions, the coverage gap line declines as one moves from the poorest quintile to the best-off quintile in the country profiles. A horizontal line indicates relative equity, which was observed in some of the surveys in Central Asian Republics. The shape is equally important.4 The way the lines are curved can illustrate where inequities are concentrated. There are three main patterns. First, bottom inequity occurs when the poorest lag behind. Second, top inequity occurs when the richest do substantially better than the other quintiles. The intermediate pattern is more or less linear. The coverage gap increases by a similar fraction as one goes from the richest to the poorest quintile. The shape of the coverage gap line can inform policies to address inequities. Many country graphs have relatively straight downward-sloping lines from the poorest to the best-off quintile, which would suggest that efforts should be made to increase the overall coverage of interventions, but with special attention paid to the poor. A top inequity pattern, as illustrated in the Burkina Faso and Niger country profiles, with a relatively small coverage gap among the best off 20 per cent, suggests that inequities would be reduced by raising the overall population coverage of interventions. A downward slope from the poorest quintile to the second-poorest quintile and then a more or less straight line (or at least less steep) to the best-off quintile would be an example of bottom inequity, as shown in the Brazil country profile. Such a pattern indicates that inequities are concentrated among the poorest and that the most appropriate policy response would be to target that particular group. For coverage gap graphs with data from two or more surveys, it can also be used to analyze trends, both by overall levels by wealth quintile and patterns between quintiles. A good example of the change from top inequity to linear pattern to bottom inequity as the overall coverage gap is reduced over time is Nepal between 1996 and 2006. 5. Explanation and interpretation of coverage gap ratio The ‘coverage gap ratio’ was derived by dividing the coverage gap for the poorest quintile with that of the best- off quintile. A ratio of 1 indicates equity in coverage in terms of comparing those two quintiles (there could still be inequities with regards to the three middle quintiles). A ratio of less than 1 indicates a lower coverage gap (higher coverage of interventions) among the poor, while a ratio of more than 1 indicates a lower coverage gap among the best-off. The higher the ratio, the more inequity there is in coverage of interventions. 6. Explanation and interpretation of coverage gap difference The difference is derived by subtracting the coverage gap of the best-off quintile from that of the poorest quintile. A positive difference implies that the coverage gap is larger among the poor; that is, coverage of interventions is lower among the poor. A relatively large poorest–best-off difference can occur in all patterns: top or bottom inequality or linear patterns. A small difference tends to occur in countries with smaller coverage gaps. Notes: 1 Wagstaff and Watanabe 2003. 2 Gwatkin, Rutstein, Johnson, and others 2005. 3 For more information on the calculation of the wealth index from DHS and MICS data, please refer to Rutstein and Johnson 2004. 4 Victora, Fenn, Bryce and Kirkwood 2005. Annex F Countdown priority countries considered to be malaria endemic Table F1. Plasmodium falciparum transmission risk in Countdown priority countries. This table indicates which of the Countdown priority countries are malaria endemic – defined as having a documented risk of Plasmodium falciparum transmission nationwide and throughout the year – and, of the remainder, which countries have subnational risk, mostly p. vivax, no risk or very limited risk. Malaria endemic countries (n=45) Countries with subnational risk of Plasmodium falciparum transmission (n=14) Countries with mostly p. vivax, no Plasmodium falciparum or very limited risk (n=9) Afghanistan Angola Bangladesh Benin Botswana Burkina Faso Burundi Cambodiaa Cameroon Central African Republic Chad Congo Congo Democratic Republic of the Cote d’Ivoire Djibouti Equatorial Guinea Eritrea Ethiopiaa Gabon Gambia, The Ghana Guinea Guinea-Bissau Kenyaa Lao People’s Democratic Republic Liberia Madagascar Malawi Mali Mozambique Myanmara Niger Nigeria Pakistana Papua New Guineaa Rwanda Senegala Sierra Leone Somalia Sudana Tanzania, United Republic of Togo Uganda Zambia Zimbabwe Bolivia Brazil China Haiti India Indonesia Mauritania Nepal Peru Philippines South Africa Swaziland Tajikistan Yemen Azerbaijan Egypt Guatemala Iraq Korea Democratic Republic of Lesotho Mexico Morocco Turkmenistan Note: a. Countries having lower risk of Plasmodium falciparum transmission in identifiable areas (such as certain urban centres), but with highest prevention strategy still recommended nationwide. Source: World Health Organization International Travel and Health Report TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �0� TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �0� TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT �0� FAMILY CARE I N T E R N A T I O N A L pantone 322 C 321 U pantone 382 C 381 U CMYK (process) DS 302-3 C C 25, Y 95 DS 302-5 U C 20, Y 65 CMYK (process) DS 249-3 C C 95, Y 25, K 35 DS 248-2 U C 100, Y 30, K 30 www.countdown2015mnch.org

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