MDG Progress Towards MDG 4 and 5

7/30/2019 MDG Progress Towards MDG 4 and 5

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Progress towards MDG 4 and 5

MDG4 and Kenyas position,

where are we?-


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Outline

MDG 4

Status of child health

High impact interventions

Progress

Challenges

opportunities


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MDG 4&5

GOAL 4:REDUCE CHILD MORTALITY

Target 4.A:Reduce by two thirds, between 1990 and 2015, theunder-five mortality rate

GOAL 5:IMPROVE MATERNAL HEALTH

Target 5.A:Reduce by three quarters the maternal mortality ratio

Target 5.B:Achieve universal access to reproductive health
http://www.un.org/millenniumgoals/pdf/MDG%20Report%202010%20En%20r15%20-low%20res%2020100615%20-.pdfhttp://www.un.org/millenniumgoals/pdf/MDG%20Report%202010%20En%20r15%20-low%20res%2020100615%20-.pdfhttp://www.un.org/millenniumgoals/pdf/MDG%20Report%202010%20En%20r15%20-low%20res%2020100615%20-.pdfhttp://www.un.org/millenniumgoals/pdf/MDG%20Report%202010%20En%20r15%20-low%20res%2020100615%20-.pdfhttp://www.un.org/millenniumgoals/pdf/MDG%20Report%202010%20En%20r15%20-low%20res%2020100615%20-.pdfhttp://www.un.org/millenniumgoals/pdf/MDG%20Report%202010%20En%20r15%20-low%20res%2020100615%20-.pdfhttp://www.un.org/millenniumgoals/pdf/MDG%20Report%202010%20En%20r15%20-low%20res%2020100615%20-.pdfhttp://www.un.org/millenniumgoals/pdf/MDG%20Report%202010%20En%20r15%20-low%20res%2020100615%20-.pdfhttp://www.un.org/millenniumgoals/pdf/MDG%20Report%202010%20En%20r15%20-low%20res%2020100615%20-.pdfhttp://www.un.org/millenniumgoals/pdf/MDG%20Report%202010%20En%20r15%20-low%20res%2020100615%20-.pdf


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Global status of child mortality

Globally 8.8 million children under five die

every year.

4.4 million are from the Sub-Saharan Africa

About 96,200 are from Kenya (birth cohort of1.2 million)


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Status in the African Region: Progress towards MDG4 in

Africa 2008

According to the

latest evidence

Kenya is one of the

high burden

disease countrywith high under five

mortality rates that

is not on track to

attain the MDG 4

targets.


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Current Child Health Status in Kenya

Under 5 mortality rate: 74/1000 live births

Under 1 mortality rate: 52/1000 live births

Newborn mortality rate: 31/1000 live births

60% of infants deaths occur during the first month oflife

Prevalence of Low-birth weight:10%

Prevalence of stunting: 35%


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Infant and Under-five Mortality Rates,

Kenya 1990/2009 (KDHS and KIHBS)


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Causes of under-five child deaths in Kenya *

Black RE, Cousens S, Johnson HL, et al. Global, regional, and national causes of child mortality in 2008 :

a systematic analysis. Lancet : 12 May 2010 ; 375 : 1969-87.


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Global Evidence Based Cost Effective Interventions

Table 2a: Cost Effective Preventive Interventions: Lancet 2003

0% 5% 10% 15%

Antimalarial for IPT in pregnancy

Antibiotics for premature rupture of membranes

Nevirapine and replacement feeding

Tetanus Toxoid

New born Temperature Management

Water Sanitation Hygiene

Antenatal steroids

Hib Vaccine

Clean delivery

Zinc

Complementary feeding

ITM

Breastfeeding


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10

Universal coverage with a few interventions can prevent

over 6 million deaths in a year

Prevention

Intervention

Deaths

Prevented as

proportion of

All child deaths

Treatment

Intervention

Deaths

Prevented as

proportion of

All child deaths

Breastfeeding 13% Oral rehydration 15%

Insecticide-treated materials 7% Antibiotics forpneumonia

6%

Complimentary feeding 6% Antimalarials 5%

Zinc 5% Zinc 4%

Hib vaccine 4% Antibiotics for

dysentery

3%

Water, sanitation, hygiene 3%

Vitamin A 2%


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Sou rce: KDHS 2009, UNGASS 2009


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Priority High Impact Interventions by Level of Care, Cohort and

Intervention Area

Community- L1 Facility level- L2, L3, L4Demand creation for early initiation of

ANCIndividualised birth plan and Emergency

preparedness

Four timely focused ANC visits with a focus on:

Individualised Birth Plan and Emergency PreparednessPrevention and management of pregnancy complications

( IPT, iron and folate, TT, PMTCT, MgSO4, micronutrients

Community actions to promote skilled

care

Emergency Obstetric Care- Administer IV oxytocin, IV antibiotics, Magnesium

sulphate, Manual removal of placenta, removal of retained POCs, Assisted

delivery, Blood transfusion, and caesarean section

Active management of third stage labour

Monitoring labour using partogram

BCC for FP, PNC, Newborn and child care

practicesBCC to promote skilled attendance with

first 24-48 hours after delivery

Hygienic cord care

Skilled attendance within first 24-48 hours after delivery

PNCLong acting and permanent FP methods

Conduct maternal and perinatal death reviews

Newborn temperature management

Hand washing with soap by caregiver

Hand washing with soap by caregiver

Temperature management

Antibiotics for neonatal infections

Newborn resuscitation

ARV prophylaxis

Early initiation and EBFComplementary

fee

ding

Vitamin A

Early initiation and EBF

Complementary feeding

Vitamin A

Immunization

LLITN

ORT and Zinc

Safe drinking water

ACT

Antibiotics for childhood pneumonia

Immunization

LLITN

ORT and Zinc

ACT

Antibiotics for childhood pneumonia

Early Infant Diagnosis of HIV

ART


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Progress has been made..

Some of these interventions are already at

over 50% coverage and this needs to be

sustained and increased.

Coverage of LLITNs,

Water and sanitation and hygiene

Hib and measles immunization

New vaccines: Pneumococcal vaccine this year

and Rotavirus in 2013


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What can be done to Accelerate child

Survival

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Focus on:

Commonest Killers

HIIs to address these killers

Urgency to scale up these interventions

Continuum of care and responsibility from

family, community level to HF level


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Status of Maternal Health

Population: Estimated at 40m

Women of childbearing age: 9.6m

MMR: 488/100,000 live births (2008-09)

Skilled birth attendance: 44%

? Quality

ANC 92%- once, 47%- 4 times

Unmet need for FP: 26%

Adolescents and youth: 30%

18% of young women age 15-19 have begun childbearing

21% of women have suffered sexual violence

Provision of youth-friendly services still a great challenge


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With less than 5 years to 2015, Kenya is

far from achieving MDG 5 targets:

Indicator KDHS 08 MDG 15

MMR 488 147

SBA 44% 90%

BEOC 15% 100%


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Trends in Maternal care indicators in Kenya (KDHS

2008-09)


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Family PlanningTrends


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Availability of Delivery Services:All Health Care Facilities

(Table 6.5)

Percent of all facilities (N=690)


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Safe Motherhood Ideal vs Real

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Ideal World

All deliveries have a skilledattendant.

Increasing the access of womento EmOC Facilities. Hospital basedEmOC is the foundation of theSMI.

Mortality rates will be decreasedby reducing the 3 delays.

Reality in Kenya

53% delivers at home (decline by 2%in five years).

Non-skilled attendants at thecommunity level.

Institutions with maternity do notmeet standards for safe delivery andnewborn care (KSPA).


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EAvailability of Services in Facilities

Offering Deliveries ncyEquipment and

Services

(Table A-6.36)

Percentage of facilities offering delivery services where specific services, equipment,and supplies

are available (N=207)

Assistlabour

Remove retainedproducts


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Challenges in Scaling up Health Systems Challenges

Human resources- numbers, skills, attitude,

Health Financing(current expenditure/woman is 2USD, recommended is

40USD)

Reliable Data

Referrals

Commodity security

Governance

Policy gaps at community level service delivery

Access

Geographic, Financial, socio-cultural

Multi-sectoral challenges

Infrastructure, safe water, status of women, education


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Opportunities

Current Constitution Devolution of resources & health Rights Increased GOK budget allocation to FP and Output Based

Approach (OBA)

Community Strategy

Economic stimulus program: More HWs and health facilities Increased Global interest in Maternal Health - Global Health

Initiative

Other funding modalities (HSSF,CDF)

Free Primary & Highly subsidized Secondary Education Increasing public private partnerships

Mobile Technology


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Conclusion

17 Jan 2011 24

No/Slow progress in indicators related to maternal and

newborn health in Kenya

We continue to work on improving institutional

deliveries and care at health facilities. In the meantime, we need to focus on

The major killers of mothers, newborns and children

HIIs to address these killers

Identify the barriers in scaling up these interventions

Address these barriers incl. mobilize sectors outside health

to address these


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Goal: Ensuring, availability accessibility and

acceptability of services even for this woman and

her baby

Documents

MDG Progress Towards MDG 4 and 5