Save the Children Situational analysis of under five mortality across the East African Community, presented at the launch of the East Africa Paediatric Association, Kampala

1. State of Child Survival
in East Africa
Zaeem Ul Haq, MBBS, MPH

2. East Africa - demographics
total population - over 133 million
almost half are under 15; 64 million
children under 5; over 21 million
U5MR – 105 (2010); was 154 in 2000
LE at birth – 52 (2010); was 49 in 2000
Literacy rate – 60% (2006)
Source: EAC Facts & Figures, Oct 2011. www.eac.int

3. Child survival
• Despite a steady global decline in child mortality over the
past two decades, many countries remain far from
achieving MDG 4*
• Pneumonia, diarrhoea and malaria account for 36% of all
under five deaths**, yet these conditions can be easily
prevented and treated with existing interventions.
Source: * Countdown Report 2012
** Liu et al, May 2012

4. Causes of under five mortality - global
Source: Liu et all, 2012

5. Cause-specific u5 mortality

6. Challenges on child survival
• Less than half of children in East Africa have access to first
line treatment for pneumonia and ORS for diarrhoea
• Coverage is highly inequitable, determined largely by
household wealth. Wealthier households are up to 40
percentage points more likely to seek care for childhood
pneumonia than poor households.
Source: Countdown Report 2012

7. Access to treatment (%)

8. Access to prevention (%)

9. Equity in coverage
• Tanzania
– Care seeking for pneumonia – 40 % point
– Immunization coverage – 10 % point
• Kenya
– Immunization coverage – 20 % point
• Uganda
– Smaller gap but equally low coverage for all wealth quintiles
Source: Countdown Report 2012

10. Policies on child survival

11. SSA – regional comparison U5MR

12. Progress towards MDG 4
insufficient progress; indicates that the under-five mortality rate for 2010 is 40
deaths per 1,000 live births or more with an average annual rate of reduction of
1%–3.9% for 1990–2010;
no progress; indicates that the under-five mortality rate for 2010 is 40 deaths
per 1,000 live births or more with an average annual rate of reduction of less than
1% for 1990–2010

13. U5MR trends

14. Way forward…
• Prompt treatment of diarrhoea with ORS and Zinc can
reduce diarrhoeal deaths by over 70%
• Community delivery of oral antibiotics can reduce under-
five mortality from pneumonia by 35%*
• In Kenya and Tanzania alone, this could prevent an
additional 20,000 child deaths per year**
Source: * Theodoratou et al. (2010) ‘The effect of case management.’, IJE. 39:i155-i171
** based on LiST projection by Save the Children UK and JHSPH, USA

15. Child deaths averted

16. Way forward…
Strategies to promote child survival are well-known, evidence-based
and have huge potential impact. These must be adopted into national
policy with full resourcing and implementation;
• integrated management of childhood illnesses (IMCI) can improve
health-worker performance, quality of care and promote rational
drug use, and is considered an essential strategy for achieving MDG
4*
• integrated community case management (ICCM) of pneumonia,
diarrhoea and malaria, essentially a simplified adaptation of IMCI
which empowers community health workers to prevent and manage
childhood illnesses at the community level**
Source: * Mason E et al. WHO position statement on IMCI. Lancet 2009; 374: 782–3
** Jones et al. (2003) ‘How many child deaths can we prevent this year?’, the Lancet, vol. 362:65-71

17. Way forward…
We have a clearer idea today why and where children
are dying
We also know where they are dying within the countries
Combined with effective interventions such as vaccines
and breastfeeding, we have the potential to reach the
East African children in the most cost-effective manner
and avert thousands of child deaths

18. Comments, Questions ?
mail;
Save the Children
1 St Johns Lane
Farringdon
London EC1M 4AR
UK
email; z.haq@savethechildren.org.uk