Child Survival Programmes Research Articles

Comparison of door-to-door and fixed-point delivery of azithromycin distribution for child survival in Niger: A cluster-randomized trial.

Recent evidence indicates mass azithromycin distribution reduces under-5 mortality. This intervention is being considered for child survival programs in high mortality sub-Saharan African settings. The delivery approach used in prior studies required a full-time census and distribution team, which is not feasible for most programs. To determine the optimal programmatic approach to delivery, this study aimed to compare treatment coverage, costs, and acceptability of different delivery approaches with existing community health workers (CHWs). This cluster-randomized trial included rural and peri-urban communities in Dosso, Niger (clinicaltrials.gov, NCT04774991). A random sample of 80 eligible communities was randomized 1:1 to biannual door-to-door or fixed-point delivery of oral azithromycin to children 1-59 months old over 1 year. Data analysts alone were masked given the nature of the intervention. The primary outcome was community-level treatment coverage defined as the number of children treated recorded by CHWs divided by the number of eligible children determined using a post-distribution census. Costs were monitored through routine administrative data collection and micro-costing. The census included survey questions on intervention acceptability among caregivers, community leaders, and CHWs. After randomization, 1 community was excluded due to inaccuracies in available administrative data, resulting in 39 communities receiving door-to-door delivery. At the second distribution, community-level mean treatment coverage was 105% (SD 44%) in the door-to-door arm and 92% (SD 20%) in the fixed-point arm (Mean difference 13%, 95% CI -2% to 28%, P-value = 0.08). The total cost per dose delivered was $1.91 in the door-to-door arm and $2.51 in the fixed-point arm. Indicators of acceptability were similar across stakeholder groups in both arms, with most respondents in each group indicating a preference for door-to-door. Overall, door-to-door delivery is the preferred approach to azithromycin distribution in this setting and might reach more children at a lower cost per dose delivered than fixed-point. Trial Registration: clinicaltrials.gov NCT04774991.

Case Studies on Maternal & Newborn Care among Recently Delivered Women of Scheduled Caste Community through the Role of ASHA in Banda District of Uttar Pradesh, India

Case Studies on Maternal & Newborn Care among Recently Delivered Women of Scheduled Caste Community through the Role of ASHA in Banda District of Uttar Pradesh, India

Case Studies on Maternal & Newborn Care among Recently Delivered Women of Scheduled Caste Community through the Role of ASHA in Saharanpur District of Uttar Pradesh, India

Case Studies on Maternal & Newborn Care among Recently Delivered Women of Scheduled Caste Community through the Role of ASHA in Saharanpur District of Uttar Pradesh, India

Case Studies on State and District Level Stakeholders Perspective on Home Based Newborn Care Program in Uttar Pradesh, India

Case Studies on State and District Level Stakeholders Perspective on Home Based Newborn Care Program in Uttar Pradesh, India

Case Studies on Maternal & Newborn Care among Recently Delivered Women of Scheduled Caste Community through the Role of ASHA in Gonda District of Uttar Pradesh, India

When ASHAs were introduced in NRHM in 2005, their primary aim was to visit homes of newborns as the first program in UP operated through the ASHAs was the Comprehensive Child Survival Program in 2008. Since then, tracking of all deliveries and all the newborns are an integral part of the work of ASHAs in all the primary health care programs operated by the NHM in UP. Evaluation studies on the performance of ASHAs was done since 2011 as by then ASHAs had actually worked in the field for a minimum period of 5 years. It is to be noted that National Rural Health Mission was rolled out in April 2005 but it took about one to two years for the states to hire ASHAs and put things in place right from the state to the village level. In this article, a comprehensive feedback is elicited from the mothers of Scheduled Caste (SC) community from the last visit of ASHAs to their homes to visits during pregnancy & newborn care in Gonda district of UP. The current study explores some of the crucial variables through five case studies on the performance of ASHAs through their message delivery & visits during natal, newborn care of mothers of Scheduled Caste (SC) community. The article also includes the feedback of the SC community mothers on the work & approach of ASHAs. That’s how the perception of the Recently Delivered Women of SC community in the state of UP is included in this article. The mothers of SC community responded about the performance based upon their experience in visits & messaging by ASHAs on Janani Surakhya Yojana (JSY), New Born Care (NBC) & Routine Immunization (RI) as these were the frontline programs for the states. The responses of these mothers or Recently Delivered Women (RDW) (as named for the current study) had a 3 to 6 months old child during the time of survey. They were selected as respondents as they were from SC community & were in a position to recollect the health care events of their children. The relevance of the study assumes significance as .....

Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ approach of Curamericas: 2. Study site, design, and methods

BackgroundThe Curamericas/Guatemala Maternal and Child Health Project, 2011–2015, included implementation research designed to assess the effectiveness of an approach referred to as CBIO+ , composed of: (1) the Census-Based, Impact-Oriented (CBIO) Approach, (2) the Care Group Approach, and (3) the Community Birthing Center Approach. This is the second paper in a supplement of 10 articles describing the implementation research and its findings. Paper 1 describes CBIO+ , the Project Area, and how the Project was implemented.ObjectiveThis paper describes the implementation research design and details of how it was carried out.MethodsWe reviewed the original implementation research protocol and the methods used for all data collection related to this Project. The protocol and methods used for the implementation research related to this Project were all standard approaches to the monitoring and evaluation of child survival projects as developed by the United States Agency for International Development Child Survival and Health Grants Program (CSHGP) and the CORE Group. They underwent independent peer review supervised by the CSHGP before the implementation research began.ResultsThe study area was divided into two sets of communities with a total population of 98,000 people. Project interventions were implemented in Area A from 2011 until the end of the project in 2015 (44 months) and in Area B from late 2013 until 2015 (20 months). Thus, Area B served as a quasi-comparison area during the first two years of Project implementation. The overarching study question was whether the CBIO+ Approach improved the health and well-being of children and mothers. The outcome indicators included (1) changes in population coverage of evidence-based interventions, (2) changes in childhood nutritional status, (3) changes in the mortality of children and mothers, (4) quality of care provided at Community Birthing Centers, (5) the impact of the Project on women’s empowerment and social capital, (6) stakeholder assessment of the effectiveness of the CBIO+ Approach, and (7) the potential of wider adoption of the CBIO+ Approach.ConclusionThe implementation research protocol guided the assessment of the effectiveness of the CBIO+ Approach in improving the health and well-being of children, mothers, and their communities.

Maternal autonomy but not social support is a predictor of child feeding indicators in the Northern Region, Ghana

BackgroundChild malnutrition may be mediated by poor infant and young child feeding (IYCF) practices. This study sought to explore if maternal social support or autonomy was related to IYCF indicators in Northern Region, Ghana.MethodsAn analytical cross-sectional study was conducted with 395 randomly sampled mother–child pairs from 8 health facilities. Data were collected on socio-demographic characteristics, social support and autonomy statuses of mothers, and dietary intake and anthropometry of children. Maternal social support and autonomy statuses were derived and classified into tertiles and IYCF and child growth indicators were derived based on WHO protocol. Logistic regression analysis was used to explore the association of maternal social support and autonomy statuses to IYCF indicators and child nutritional status.ResultsThe mean age of the women was 27 (± 5.10) years and most belonged to the lowest tertile of social support (52.4%), and autonomy (44.1%). About half of the children, 53.2% and 44.6%, received Minimum Dietary Diversity (MDD) and Minimum Acceptable Diet (MAD) respectively but the majority (72.9%) received Minimum Meal Frequency (MMF). About a fifth of the children, 21.0%, 24.1%, and 20.5%, were wasted, stunted, and underweight respectively. Maternal autonomy was associated with IYCF but not growth indicators of young children. Compared to children of mothers of richest autonomy tertile, children of women of middle autonomy tertile were 67% less likely to receive MDD [Adjusted Odds Ratio (AOR): 0.33; 95% Confidence Interval (CI): 0.18–0.59], and 56% less likely to receive MAD (AOR: 0.44; 95% CI: 0.24–0.77). Also, children belonging to mothers of poorest autonomy tertile were 56% less likely to receive MMF compared to children of richest maternal autonomy tertile (AOR: 0.44; 95% CI: 0.23–0.84).ConclusionMaternal autonomy and not social support is associated with IYCF indicators of children in Northern Ghana; child survival programmes should incorporate or strengthen women empowerment interventions to improve child nutrition.

Simplified dosing of oral azithromycin for children 1–11 months old in child survival programmes: age-based and height-based dosing protocols

BackgroundTo facilitate mass distribution of azithromycin, trachoma control programmes use height instead of weight to determine dose for children 6 months to 15 years old. WHO has recommended azithromycin distribution...

"It might be a statistic to me, but every death matters.": An assessment of facility-level maternal and perinatal death surveillance and response systems in four sub-Saharan African countries.

Maternal and perinatal death surveillance and response (MPDSR) systems aim to understand and address key contributors to maternal and perinatal deaths to prevent future deaths. From 2016-2017, the US Agency for International Development's Maternal and Child Survival Program conducted an assessment of MPDSR implementation in Nigeria, Rwanda, Tanzania, and Zimbabwe. A cross-sectional, mixed-methods research design was used to assess MPDSR implementation. The study included a desk review, policy mapping, semistructured interviews with 41 subnational stakeholders, observations, and interviews with key informants at 55 purposefully selected facilities. Using a standardised tool with progress markers defined for six stages of implementation, each facility was assigned a score from 0-30. Quantitative and qualitative data were analysed from the 47 facilities with a score above 10 ('evidence of MPDSR practice'). The mean calculated MPDSR implementation progress score across 47 facilities was 18.98 out of 30 (range: 11.75-27.38). The team observed variation across the national MPDSR guidelines and tools, and inconsistent implementation of MPDSR at subnational and facility levels. Nearly all facilities had a designated MPDSR coordinator, but varied in their availability and use of standardised forms and the frequency of mortality audit meetings. Few facilities (9%) had mechanisms in place to promote a no-blame environment. Some facilities (44%) could demonstrate evidence that a change occurred due to MPDSR. Factors enabling implementation included clear support from leadership, commitment from staff, and regular occurrence of meetings. Barriers included lack of health worker capacity, limited staff time, and limited staff motivation. This study was the first to apply a standardised scoring methodology to assess subnational- and facility-level MPDSR implementation progress. Structures and processes for implementing MPDSR existed in all four countries. Many implementation gaps were identified that can inform priorities and future research for strengthening MPDSR in low-capacity settings.

Quality of labour and uncomplicated delivery care: a formative assessment of selected health facilities in Ebonyi and Kogi States, Nigeria.

Maternal Child Survival Program (MCSP) worked in Ebonyi and Kogi States between 2014 to 2018 to improve quality of maternal, child and newborn health care. A formative assessment was conducted in selected health facilities to examine the quality of care received by mothers and their newborns at all stages of normal birth on the day of birth. Health providers attending deliveries at 13 facilities in the two states were observed by trained health professionals. Forty health facilities with a high volume of at least 50 Antenatal Care visits per month and deliveries were purposively selected from 120 quality improvement health facilities. Screening for danger signs at admission was conducted for only 10.5% cases in labor and providers adhered to most recommended infection prevention standards but only washed hands before birth in 19.5% of cases. Chlorhexidine gel was applied to the newborn's umbilical stump in only 2% cases while partograph was used in 32% of the cases. No newborns received the full package of essential care. Potentially harmful practices were observed especially holding newborn babies upside down in 32% cases. Improved provider training and mentoring in high-quality care on the day of birth and strengthened supportive supervision may help to reduce maternal and newborn morbidity and mortality.

High fertility level in Sub-Saharan Africa: implication for reaping and optimizing demographic dividend

Africa region remains the continent with the highest total fertility rate among other major regions of the world such as Europe, North America, Asia and Latin America and Oceania. This paper examines the determinants of high fertility in sub-Saharan Africa; it also determines the policy implication for reaping and optimizing demographic dividend. Secondary data sources were employed in achieving the set objectives. This paper submitted that determinants such as age at first marriage; high child mortality; low female education; gender preference; and limited birth spacing were the determinants of high fertility in Africa. For Africa to harness the demographic dividend, certain policy implications such as investment in child survival and health programmes; investment in quantity and quality of education; multi-sectoral approaches and meeting infrastructural development; enhance job market and enact and enforce laws to prevent early marriage among other policy programmes must be embraced. The paper concludes that there is high fertility in sub-Saharan Africa because of the in-built population momentum of the populace. Also, fertility must be reduced significantly if sub-Saharan Africa must reap and optimize the promising dividend. This paper, therefore, recommends that all government in Africa continent should come up with and implement effective population policy that will help to reduce high fertility level.

Valuation of Satisfaction Level among Patients Attending the Indoor Clients of First Referral Units in Lahore

Objective: Internal customer satisfaction is a breakthrough parameter for assessing the functioning of the First Command Unit established by the government. Pakistan, as part of the Child Survival and Safe Motherhood (CSSM) Program in 1992. It is currently expected that CSSM, as part of the flagship National Health Mission (NHM), will reduce the burden of high maternal mortality in Pakistan and the extent of further reductions from current levels to ensure safe motherhood and then childhood to achieve the Health for All goal. In this context, some primary and most community health centers have been upgraded to the first referral unit (FRU), which has been specifically prepared to handle obstetric emergencies. Intensive efforts continue to strengthen these FRUs under the National Health Mission Program by addressing the needs of patients particularly staying in rooms participating in the FRU.
 Methods: Data was collected from outpatient ward of the Jinnah Hospital Lahore for one year from November 2017 to October 2018. Patients / clients using internal services; a sample of 60 customers was selected for the survey. They were asked questions to assess the level of satisfaction with the use of various internal services, and their answers were rated as poor-1, fair-2 and good-3.
 Results: An evaluation of the functioning of some FRUs showed that the overall level of internal customer satisfaction is around 50%, which can be further improved by improving service delivery.
 Conclusions: We conclude that in order for FRU to operate smoothly, the health needs of clients should be a priority.

Exclusive Breast Feeding of Infants of Recently Delivered Women of Uttar Pradesh, India

When ASHAs were introduced in NRHM in 2005, their primary aim was to visit homes of newborns as the first program in Uttar Pradesh (UP) operated through the ASHAs was the Comprehensive Child Survival Program in 2008. Since then, tracking of all deliveries and all the newborns are an integral part of the work of ASHAs in all the primary health care programs operated by the NHM in UP (GoI,2005, GoUP, 2013). The current article examines the role & work of ASHAs through the responses of the mothers of newborns & infants at district level. Evaluation studies on the performance of ASHAs was done since 2011 as by then ASHAs had actually worked in the field for a minimum period of 5 years. It is to be noted that National Rural Health Mission was rolled out in April 2005 but it took about one to two years for the states to hire ASHAs and put things in place right from the state to the village level (GOUP, 2013). In this article, a comprehensive feedback is elicited from the Recently Delivered Women on the Exclusive Breast Feeding (EBF) practices of their infants as part of newborn & infant care program at the district level. The current study explores some of the crucial variables on the home-based newborn care activities like the ideal practice of EBF of the newborn & infants through the response of mothers of newborns & infants on newborn care. The ideal practice of EBF in newborn & infants in child health programs is a critical facilitator in breastfeeding practices. The current article follows up the role of ASHAs in Home Based Newborn Care & child care program through the response of the mothers on EBF & the type of fluids they gave to their children on the day prior to the survey. The mothers were selected as respondents as they were the selected mothers from the list of mothers available with their ASHAs at the time of survey.

Does choice of health care facility matter? Assessing out-of-pocket expenditure and catastrophic spending on emergency obstetric care in India.

The key recommendation of the Child Survival and Safe Motherhood programme was the provision of Emergency Obstetric Care (EmOC) for the prevention of maternal mortality, especially in developing countries like India. The objectives of this paper were three-fold: to examine the socioeconomic differentials in mean out-of-pocket expenditure on EmOC in public and private health care facilities in India; to evaluate the catastrophic health expenditure of households at the threshold levels of 5% and 10%; and finally, to assess the effects of various socioeconomic and demographic covariates on the levels of catastrophic health expenditure on EmOC. Data were extracted from the 71st round of the National Sample Survey Office (NSSO) survey conducted in India between January and June 2014. A stratified multi-stage sampling design was followed to conduct the survey. The information was collected from 65,932 households (rural: 36,480; urban: 29,452) and 33,104 individuals across various states and union territories in India. However, the present study had taken only 1653 sample women who availed EmOC care during the last one year preceding the survey date. Binary logistic regression was applied. Large differences in out-of-pocket expenditure on EmOC were found between private and public health care facilities. Mean annual out-of-pocket expenditure by women in private hospitals was INR 23,309 (US$367), which was about 6 times higher than in public hospitals, where mean spending was INR 3651 (US$58). Furthermore, logistic regression analysis showed a significant association between household socioeconomic status and level of catastrophic health expenditure on EmOC. The odds of catastrophic health expenditure in public health facilities among women from the North region were higher than among those from the Central, South and West regions. Age and level of education significantly influenced the mean level of catastrophic health expenditure. Access to good-quality obstetric care is key to reducing the maternal mortality rate and child deaths, and thus achieving Sustainable Development Goal 3. There is an urgent need for policy interventions to reduce the financial burden of households in accessing obstetric care in India.

PRELACTEAL FEEDING OF NEONANTS & DISCARDATION OF FIRST BREAST MILK AMONG RECENTLY DELIVERED WOMEN OF UTTAR PRADESH, INDIA

When ASHAs were introduced in NRHM in 2005, their primary aim was to visit homes of newborns as the first program in UP operated through the ASHAs was the Comprehensive Child Survival Program in 2008. Since then, tracking of all deliveries and all the newborns are an integral part of the work of ASHAs in all the primary health care programs operated by the NHM in UP (GOI, 2005, GOUP, 2013). The current article examines the role & work of ASHAs through the responses of the mothers of newborns at district level. Evaluation studies on the performance of ASHAs was done since 2011 as by then ASHAs had actually worked in the field for a minimum period of 5 years. It is to be noted that National Rural Health Mission was rolled out in April 2005 but it took about one to two years for the states to hire ASHAs and put things in place right from the state to the village level (GOUP, 2013). In this article, a comprehensive feedback is elicited from the Recently Delivered Women on the pre-lacteal feeding of their newborns as part of newborn care program at the district level. 
 
 The current study explores some of the crucial variables on the home-based newborn care activities like the poor practice of pre-lacteal feeding of the newborn through the response of mothers of newborns on newborn care. The poor practice of pre-lacteal feeding of newborn in child health programs is a critical barrier in breastfeeding practices. The current article follows up the role of ASHAs in Home Based Newborn Care program through the response of the mothers on the type of pre-lacteals & discarding of milk before breastfeeding the child. The mothers were selected as respondents as they were the selected mothers from the list of mothers available with their ASHAs at the time of survey. 
 
 The relevance of the study assumes significance as data on the details of the type of pre-lacteal feeding of newborn as a barrier component of child health & newborn programs are not included in many surveys. Further, response details from the mothers on these options on pre-lacteals where their types are discussed are usually not collected in many studies/surveys. Such responses that collect actual actions on the pre-lacteal feeding & milk discarding before breastfeeding are not collected in many surveys. Such information collection there by indirectly assess the work & approach of ASHAs including the awareness of ASHAs & mothers on the programs related to Early Initiation of Breastfeeding (EIBF) are not the focus in very large-scale health surveys. Similarly, such response on these two barriers on EIBF related activities of newborn care through the work of ASHAs in the current implemented programs do not come under the ambit of many social studies or surveys. The surveys gain more valency when the response is solicited from the horse’s mouth like the current article.
 
 A total of four districts of Uttar Pradesh were selected purposively for the study and the data collection was conducted among the mothers in the respective districts. A pre-tested structured & in-depth interview schedule was used with close-ended questions. These in-depth interview schedule collected descriptive details as responded by mothers. The quantitative data were conducted amongst the mothers and a total of 500 respondents participated in the study.
 
 The results reflected that majority of the RDWs in Banda, Barabanki and Saharanpur district and about 94% in Gonda had given milk other than breast milk to their newborn as pre-lacteal feed. Next barrier as an activity was discarding of milk before breastfeeding the child. About 10% in Banda, more than 5% in Barabanki 7 less than 5% of RDWs in the rest two districts replied that they discarded the first milk from their breast before the newborn is put to the breast for the first time.

Pneumonia-related ideations, care-seeking, and treatment behaviors among children under 2 years with pneumonia symptoms in northwestern Nigeria.

Prompt treatment of pediatric pneumonia symptoms is a cornerstone of child survival programs but remains a challenge in Nigeria. Psychosocial influences, or ideations, directly influence pathways to care but have not been previously measured or examined for pediatric pneumonia. A two-stage cluster-sample cross-sectional population-based survey was conducted in Kebbi, Sokoto, and Zamfara States in September 2019. Across 108 enumeration areas, all households were enumerated to census pregnant women and randomly sample women with children under 2 years ("under-twos") for inclusion. Respondents were asked about pediatric pneumonia and other health-related behaviors and ideations developed using the Ideation Model of Strategic Communication and Behavior Change. Prevalence ratios for predictors of care-seeking from formal medical sources and antibiotic treatment for pneumonia symptoms among under-twos were calculated using mixed-effects Poisson regression models with robust error variance. Among 350 under-twos with pneumonia symptoms, 33.8% were taken to formal medical care and 38.0% used antibiotics. Women who positively viewed treatment efficacy and those who positively viewed health services quality had 1.35 (95% CI: 1.00-1.82; P = .050) and 2.13 (95% CI: 1.35-3.35; P = .001) times higher likelihood of attending formal medical sources, while women viewing peers as mostly attending drug shops had 29% lower likelihood. Perceived treatment efficacy and illness susceptibility were also significant predictors for antibiotic use. Program interventions focusing on increasing pneumonia knowledge alone may not be sufficient to improve care-seeking and treatment rates and should expand to address perceived and actual poor-quality health services and maternal beliefs about treatment efficacy, social norms, illness severity, and susceptibility.

Male-Focused Breast-Feeding Promotion Programs: A New Route for Child Survival Programming Worldwide

Male-Focused Breast-Feeding Promotion Programs: A New Route for Child Survival Programming Worldwide

The Role of Maternal Intimate Partner Violence Victimization on Neonatal Mortality in Ethiopia.

Previous studies have suggested that when intimate partner violence (IPV) tends to be persistent across a woman's life span, her newborn offspring have a higher risk of ill health and mortality. There is a high prevalence of both IPV and neonatal mortality in Ethiopia, but the issue of IPV has remained largely outside the focus of child survival programs in this country. One of the noticeable reasons is a lack of evidence regarding the effect of IPV on neonatal mortality. Therefore, this study investigated the effect of maternal IPV on neonatal mortality in Ethiopia. This study used nationally representative data from the 2016 Ethiopian Demographic and Health Survey. A total of 2,863 currently married women of reproductive age who gave birth in the preceding 5 years were included in analysis. Regression models using propensity scores were used. The prevalence of physical, emotional, and sexual IPV were 24.5%, 22.9%, and 12.0%, respectively. About 56% of women had also experienced at least one act of partner controlling behavior. Maternal IPV experience (a composite measure of physical, sexual, and emotional abuse) was associated with increased neonatal mortality (adjusted odds ratio [AOR] = 2.58, 95% confidence interval [CI] = [1.03, 6.45]). In addition, the odds of neonatal mortality were 2.75 times (AOR = 2.75; 95% CI = [1.05, 7.2]) higher among women who had experienced three or more partner controlling behaviors than women who had experienced less than three or none. Maternal IPV is significantly associated with risk of neonatal mortality in Ethiopia. There is a clear need for IPV interventions in child survival programs. Therefore, existing neonatal survival strategies should focus beyond the direct causes of neonatal mortality, and they need to target IPV as an underlying factor to neonatal morbidities and mortality.

Knowledge in Tracking Danger Signs in Newborns and their Referrals by ASHA in Uttar Pradesh, India

When ASHAs were introduced in NRHM in 2005, their primary aim was to visit homes of newborns as the first program in UP operated through the ASHAs was the Comprehensive Child Survival Program in 2008. Since then, tracking of all deliveries and all the newborns are an integral part of the work of ASHAs in all the primary health care programs operated by the NHM in UP.
 The current study explores some of the crucial variables of the danger signs in newborns and their subsequent referrals by the ASHAs in four districts of UP. Through this profile, the knowledge of ASHAs on these danger signs and the action that they take after identification is detailed out. 
 The relevance of the study assumes significance as data on the details of targeted activities on high risk newborns done by ASHAs in comparison to their performance are usually not available in various studies.
 A total of four districts of Uttar Pradesh were selected purposively for the study and the data collection was conducted in the villages of the respective districts with the help of a pre-tested structured interview schedule with both close-ended and open-ended questions. In addition, in-depth interviews were also conducted amongst the ASHAs and a total 250 respondents had participated in the study.

Household Integration Could Potentially Improve the Integrated Community Case Management Strategy for Childhood Illnesses

Malaria, pneumonia and diarrhoea have together caused most childhood deaths particularly in resource poor underserved areas, though they are preventable and curable. The Integrated Community Case Management strategy building on previous child survival programmes has been adopted to improve access to treatment of children at risk of these diseases.