World Vision’s Little Book of Maternal and Child Health in the Asia Pacific docx

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World Vision’s Little Book ofMaternal and Child Health in the Asia PacicStatistics and strategies to help bring Millennium Development Goals Four and Five within reachMOTHER&CHILDHEALTH2© World Vision Asia-Pacic 2009Stories researched and contributed by World Vision communicators, 2008/2009Editing and design: Katie ChalkReview: Laurence Gray, Dr Sri ChanderTo nd out more about World Vision’s work with maternal and child health in Asia and the Pacic:www.wvasiapacic.orgapro@wvi.org 3Left: Doctor GoatThameesha has always suffered from wheezing and breathing difculties. Since he started drinking goat milk, he is stronger and his lungs less prone to asthma or infections. “A villager told me that goat milk is good medicine,” says Thameesha’s father. “So with World Vision’s help I went out and got a male and four female goats.”While the “medicinal” properties of goat milk are unconrmed, its nutritional value for children is very high. Thameesha’s father says since the goat’s milk was introduced to his children’s diets, their wheezing has all but disappeared.Photo: Hasanthi Jayamaha/World Vision LankaContents:Why health, why now? 4Who is this book for? 6Maternal and child health 8terms and denitions Part 1: Statistics 10Part 2: Strategies 18Part 3: Recommendations 40References and reading 444An introduction by Watt Santatiwat, Vice President, World Vision Asia Pacic regionMaternal and child health and nutrition interventions are complex issues for the Asia Pacic region. As statistical indicators they measure the health of a nation and the level of its development. But behind those statistics are the shadows of many other urgent development issues - gender inequality, massive wealth discrepancies, inadequate education or public health spending, and the tragedy of avoidable deaths through under-prioritisation of women, children and the poor.The Asia Pacic region has made some progress in changing the health of mothers and children for the better. But we still seriously lag behind in our efforts. The region still makes up 43% of the world’s total maternal deaths, and well over 40% of our children are malnourished.In our region, 18 of the 29 developing countries are currently off-track to achieve Goal 4 – to reduce child deaths by two-thirds, and 23 are off-track to achieve Goal 5 – to reduce maternal deaths by three-quarters.In 2010, World Vision will commence advocacy efforts across the region to encourage solutions at national Why health, why now?level on maternal and child health. Each country faces a different set of challenges, and no country can rest just yet.My home country of Thailand, for instance, has shown what can be possible with appropriate investment of government funds in its people. Yet even here, in a country that is often held up as a development model for others, there is room for improvement. We still see unacceptable levels of preventable illness and deaths in marginalised communities, and malnutrition still exists in our children in both rural and urban areas.Fighting malnutrition needs to be a priority in all Asia Pacic countries, not just for children at different stages of their growth, but also for mothers. Over 30% of women are malnourished in this region, harming expectant mothers and reducing the chances of survival for their children before they are even born.Spending on health and nutrition needs to be increased and improved. The Asia Pacic region spends well below the world average of 5.1% of GDP. In South Asia only 1.9% is currently spent on healthand one in every ve children that dies worldwide is an Indian child. 5The ADB estimates that additional government investment of only around $3 per person per year, spent carefully to target specic healthcare gaps, could bring the MDGs within reach.Private sector contribution to health coverage is a vital component of strategies for meeting MDGs Four and Five. However, this should not detract from or replace government responsibility for public health care. This region is calling out for private and public collaboration on research, improvement and promotion of healthier living, in tandem with facilities and resources to improve the health of mothers and children in the Asia Pacic’s most vulnerable communities. I urge governments and donors in the Asia Pacic to recognise the way forward on sustainable, equitable health solutions to protect mothers and their children. It is at once a humanitarian duty and an investment in the future resilience of every nation in the region.Watt SantatiwatAugust 2009 This book is for anyone with an interest in maternal and child health, but in particular for people who can play a role in strengthening it.The Asia Pacic has some of the biggest health challenges of any region. Here, health is a complex issue, at the heart of community development and wellbeing and yet held back by resources, attitudes and traditions. These aspects come together as barriers to deny fair access to health for more than half the people living in the Asia Pacic.As an international NGO with a strong grassroots approach, World Vision is ideally placed both to deliver health strategies in under-resourced communities, and to recognise gaps that cannot be lled without the support and mobilisation of others.This book explores some of these gaps, as well as potential solutions to ll them, by sharing stories from World Vision’s eld experiences. A single story may not constitute “evidence” but it can bring unique insight into challenges, and how current health practices are missing the mark when it comes to pro-poor, child-focused protection of lives.Who is this book for?Born in a remote village in the district of Xieng Nguen, Baby Anoi has had his weight and height measured since birth, and passes the test each time. Despite its relative poverty, Lao PDR is one of the Asian countries on track to achieve MDG Four. The Laos government has announced its commitment to opening community health centres, providing better delivery care, immunisations and micro-nutrient supplements for infants and mobilizing resources to improve mother and child health. World Vision currently partners with the government in rural areas to monitor child health through mobile clinics. Photo: Albert Yu/World Vision Lao PDR6On track: Bangladesh, China, Indonesia, Lao PDR, Solomon Isl.,Timor-Leste, Nepal, Sri Lanka, Thailand, Vietnam Off track: Cambodia, India, Myanmar, Papua New Guinea, Philippines, VanuatuOn track: China, Philippines, Solomon Isl., Sri Lanka, Thailand,VietnamOff track: Bangladesh, Cambodia, India, Indonesia, Lao PDR, Myanmar, Nepal, Papua New Guinea, Timor-Leste 7MDG Four: Reduce child deaths (under ve) by two thirds by 2015MDG Five: Reduce maternal deaths by three quarters by 2015Statistics and case studies in this book include only countries where World Vision is working in the Asia Pacic. The summary above is based on World Vision’s 2009 report “Strategies that Work”: http://wvasiapacic.org/downloads/publications/StrategiesThatWork.pdf 8Under ve mortality rate The probability (expressed as a rate per 1,000 live births) of a child dying before reaching the age of ve.Infant mortality rateThe probability (expressed as a rate per 1,000 live births) of a child dying before reaching the age of one year.Maternal mortality ratioThe probability (expressed as a rate per 100,000 pregnancies) of a woman dying during pregnancy, childbirth or the rst 42 days after delivery.Low birth weightA birth weight of under 2,500 grams. Babies born with a low birth rate are twenty times more likely to die than babies born above the minimum weight of 2,500 grams. StuntingMeasures height against age: usually caused by long-term insufcient nutrient intake or frequent infections. Stunting generally occurs before the age of two; effects are largely irreversible. WastingMeasures weight against height in all ages: usually an indicator of acute food shortage and/or disease. A high prevalence of wasting usually correlates with a high under-ve mortality rate.UnderweightMeasures weight against age: the indicator used to determine malnutrition in children under ve. Micro-nutrient deciencyEven in a diet where macro-nutrients (carbohydrate, protein and fat) are provided, a lack of micro-nutrients can lead to lasting and life-threatening malnutrition. Common deciencies include iron, vitamin A and iodine. VaccinationMany childhood diseases including measles, polio, diptheria, tetanus and whooping cough are preventable through early vaccines. However the measure of vaccination in statistical terms usually refers to immunisation against measles by the age of one year.Improved waterAccess to uncontaminated, contained water sources. Improved sanitationSafe disposal of excrement whereby it is separated from the possibility of human contact (usually means a toilet).Maternal and child health terms and denitions9Across Asia and the Pacic, World Vision’s child-focused programmes are partnering at house-hold, community and national level to:• Improve standards and increase action around maternal and child health• Empower girls and women with the knowledge to take good care of themselves and their children, including nutrition, vaccinations, rst aid and family health responses, and birth spacing• Encourage governments and international donors to nd ways to provide affordable, equal access for all to healthcare, in particular services for mothers and children under veWorld Vision is working in nearly 90 countries worldwide with health interventions to support the achievement of Millennium Goals Four and Five.BangladeshCambodiaChinaDPRK (North Korea)IndiaIndonesiaLao PDRMongoliaMyanmarNepalPapua New GuineaPhilippinesSolomon IslandsSri LankaThailandTimor-LesteVanuatuVietnamWorld Vision Asia Pacic region encompasses:10Bangladesh % children underweight: 41%Under 5 mortality (per 1000): 61Living with improved water: 80%Living with improved sanitation: 36%Maternal mortality (per 100,000): 320Bangladesh’s poverty, and the constant setbacks of natural disasters, challenge its ability to remain food-secure. In addition, gender inequality, including a lack of priority for girls’ education, means many mothers lack nutritional knowledge for themselves or their children.In Bangladesh today, 500,000 children are diagnosed with severe acute malnutrition. The maternal mortality ratio is also high, ranging from 320-380 per every 100,000 live births. As only around 7% of births are registered, this gure is an estimate and could easily be higher.Part 1: StatisticsAll statistics in this section are taken from UNICEF’s State of the World’s Children 2009 unless otherwise noted.[...]... that the children are healthier “When the clinic was first started two years ago, we found a lot of children who had not received a single vaccination since their birth So we had to start right from the beginning.” “Since then, we have seen a positive increase in the interest of the mothers in their children’s health Every month the clinic is packed with over 50 mothers.” Strategy: Strengthen childcare... knowledge about nutrition They get through the day on plain tea and roti And now through the clinic we have made them aware of their conditions and taught them what could be done.” Local women working as World Vision mobilisers are very involved in the clinic arrangements every month They visit every house in the area and inform them beforehand of the clinic day They also come on the day in case language becomes... underweight, a key indicator for chronic malnutrition and nearly 10 percentage points higher than the country average of 34% Apart from weakening the immune system of the child and lowering defences against preventable diseases such as malaria and diarrhea, chronic childhood malnutrition impairs the development of the child s brain, resulting in challenges in schooling Interestingly, the percentage of children... at the slightest change of climate and bouts of diarrhoea left him weak Amit’s village of Bhujubita in West Bengal, India, has 25 households, all of them facing regular food shortages in their families Their children have been malnourished since birth Malnutrition is one of the major crises facing children in India Close to 50% of children suffer from some form of malnutrition Over 43% of children in. .. works for World Vision’s maternal and child clinic, as part of World Vision’s Early Childhood Health Promotion initiatives in Baucau district Without this clinic, mothers would have to catch a public bus into Baucau town to the local hospital The distance, and the cost, is a strong deterrent – and if anything goes wrong, it is life-threatening Alexandrina has just had a baby herself, her fourth, and is... accidents and neglect Child health is not always linked to clinics, vaccinations, medicines or diet Nearly 10% of child deaths in the Asia Pacific occur as a result of accidents Left alone at home while their labourer parents work all day, these girls and millions like them are extremely vulnerable to accidental injuries and limited in their knowledge or ability to seek treatment Photo: Alina Shrestha /World. .. of the population In 82% of cases women do not have skilled professionals attending the delivery of children Timor-Leste’s birth rate of over seven children per family contributes further to the problem; mothers are often malnourished themselves and family incomes cannot meet their children’s health needs Vanuatu % children underweight: Under 5 mortality (per 1000): Living with improved water: Living... together and measure their children’s progress 34 The PD Hearth process provides 12 sessions, including demonstration of cooking and feeding, to the group After that they take on the responsibility themselves, cooking khichuri in their own houses and starting new groups of their own Sorufa says “Previously we used to cut the vegetables before washing, but now we cut the vegetables after washing When we cook... provide a balanced diet, including exclusive breastfeeding Children who know the basics of nutrition can share this information and even start to make choices themselves for a lifetime of healthier eating Photo: Mathira Sutiwananiti /World Vision Thailand 36 Right :World Vision’s handwashing campaign reached children in schools throughout Jakarta to teach them about the importance of good hygiene Photo:... Lanka, World Vision has helped the Ministry of Health go mobile By providing transport to isolated areas and negotiating for use of community or estate buildings, they have made it possible for a monthly government clinic to provide preand ante-natal checkups, monitoring of children’s weight and health and general medical advice Patients are checked by Dr Ragunath from Jaffna who has been working in the . improvement and promotion of healthier living, in tandem with facilities and resources to improve the health of mothers and children in the Asia Pacic’s. changing the health of mothers and children for the better. But we still seriously lag behind in our efforts. The region still makes up 43% of the world s
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