Child Survival Strategies

• Child Survival is a global imperative.
• Parents desire to see their offspring succeed them in all spheres of life;
• Nations want young ones to grow and take over from the adults.
• Therefore, various policies and services are established.

However...

• More than ten million children die each year, of this number four million are in the first four weeks of lives.
• 1,200 deaths every hour mostly from preventable or treatable causes.
• Almost all these deaths occur in poor countries.

• Globally, the four major killers of children under age 5 are pneumonia (18%), diarrheal diseases (15%), preterm birth complications (12%) and birth asphyxia (9%).
• Under nutrition is an underlying cause in more than a third of under-five deaths.
• Malaria is still a major killer in Sub-Saharan Africa, causing about 16% of under-five deaths.
• In Nigeria, malaria is still a ‘BIG’ cause of morbidity and mortality.

The Current Neonatal, Infant and Under-Five Mortality Rates In Nigeria (2016)

	Rate	Ranking
Infant Mortality	67	NA
Under-Five Mortality	104	9
Neonatal Mortality	34	NA

Source: data.worldbank.org

Intervention

During the last two decades, child survival in developing countries has been given a prominent place in the world agenda. The realization that of 20 million children born each year in Africa, 4 million will die before their 5th birthday has led to the child survival initiative project.

Child Survival Strategies (CSS) was a brain child of the United Nations Children's Fund (UNICEF) following the Alma-Ata declaration in 1978.

These strategies comprise low-cost technologies believed to be affordable to nations, communities, and individuals.

The primary aim of these technologies is to reduce childhood mortalities, which are most prevalent in the developing world.

CSS was established as a means of promoting accelerated and sustained action towards achieving Millennium Development Goal 4 (MDG4).

CSS followed a process…

Core versus Non-Core

1st Strategy: Growth Monitoring, Oral Rehydration, Breastfeeding, and Immunization (GOBI)

2nd Strategy: GOBI plus Female Education, Family Planning, Food Supplementation, and Follow-up (GOBI plus FFFF)

3rd Strategy: GOBIFFFF plus Essential Care for Every Newborn, Training in Home Management of Fever, and Hygiene (GOBIFFFF plus EETH)

With time, other low-cost technologies were added. These components are:

• Female education
• Family planning
• Food supplementation
• Follow-up

The acronym then became GOBIFFF.

These strategies have further been enlarged to include several other Primary Health Care (PHC) activities such as:

• Environmental Protection and Adequate Sanitation
• Essential Drugs Programme
• Treatment of Common Diseases
• Health Education

The acronym now stands as GOBIFFFFEETH.

Growth Monitoring involves regularly measuring a child's size to document their growth.

The child's measurements are then plotted on a growth chart, which is crucial for detecting early changes in their growth patterns.

Abnormal growth rates—either too slow or too fast—may indicate underlying nutritional or health issues.

Growth Monitoring is an integral component of primary health care.

It serves as an early warning mechanism, as the detection of growth faltering allows for timely and appropriate nutritional intervention.

Encouraging mothers' participation in weighing their children and offering rewards to mothers of children on the path to health can further enhance the effectiveness of growth monitoring efforts.

Approximately Weight

• At birth: 3 kg
• Double birth weight by 6 months: 6 kg
• Infants weight: (n + 8) / 2
• Post-infancy weight: 2n + 8

Head Circumference

• At birth: 35 ± 5 cm
• 1st 2 months: +4 cm
• 2nd 2 months: +3 cm
• 3rd 2 months: +2 cm
• 4th 2 months: +1 cm
• 5th 2 months: +1 cm
• 6th 2 months: +1 cm

• Oral Rehydration Salt (ORS)
• A cheap, cost-effective, and easy-to-use remedy for home and institutional use.
• ORS reduces dehydration due to diarrhea (and/or vomiting), preventing child deaths.
• Universal use; alternatives developed in most countries.
• In Nigeria, mothers/caregivers are taught to use salt sugar solution (SSS) where pre-packaged ORS is unavailable.
• 50 – 60% of diarrheal deaths are acute and often due to dehydration.
• Early treatment of acute watery diarrhea significantly reduces dehydration, mortality, and costs.

• In order to promote breastfeeding, WHO and UNICEF have come up with 10 steps to successful breastfeeding policy, which is promoted through the Baby Friendly Hospital Initiative (BFHI).
• Many tertiary health facilities in Nigeria and other countries are already implementing this breastfeeding policy.
• Breast milk, especially colostrum, has important immunological properties that help the child fight infection.
• Prolonged breastfeeding also reduces the probability of conception, significantly affecting children's survival chances.
• Infants completely weaned at birth have 14.2 times the risk of death from diarrhea and 3.6 times the risk of death from respiratory infection compared to breastfed infants.

10 Steps to Successful Breastfeeding

1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
2. Train all health care staff in skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding within one hour of birth.
5. Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants.
6. Give newborn infants no other food or drink other than breast milk unless medically indicated.
7. Practice rooming-in, allow mother and infant to remain together 24 hours a day.
8. Encourage breastfeeding on demand.
9. Give no artificial teats or pacifiers to breastfeeding infants.
10. Foster the development of breastfeeding support groups and refer mothers to them after discharge from the hospital or clinic.

The possibility that children will become seriously ill or die depends largely on whether their immune systems can fight off infections. Malnutrition, combined with unsanitary or crowded conditions, makes them extremely vulnerable. For instance, measles rarely kills in industrialized countries but can cause up to 40% mortality among infected children in dire and overcrowded situations.

• A two-way relationship between health and nutrition is recognized. Sicknesses increase the possibility of malnutrition and vice-versa.
• Exclusive breastfeeding must be followed by appropriate and adequate complementary diet. Complementary foods that are locally produced can be conveniently and hygienically prepared and at the same time provide optimal nutrient content.
• Prevention of food-borne diarrhea by promoting proper feeding practices, food hygiene, and selection of nutrient-dense locally available foods will facilitate the control of the problem of malnutrition.

“Vaccination is widely recognized as one of the most powerful and cost-effective public health tools. Often immunization is a child’s first – sometimes only – contact with the health system.” – Carol Bellamy, Former Executive Director UNICEF.

• Immunization is essential to save children’s lives.
• It is also an affordable means of protecting whole communities (herd immunity).
• Immunization has saved over 20 million lives in the last two decades.
• Immunization rate for major vaccine preventable diseases (VPD) has risen from 10% in 1970 to > 80% today. Deaths from measles have declined by over 2/3 in the last decade.
• Immunization aims at reducing morbidity and mortality from VPD.
• Every contact a child has with a health facility should be used as an opportunity for vaccination.

Importance of Education:

"Educate a woman and you educate a nation." This statement underscores the significant role of female education in ensuring child survival.

Empowerment:

Education empowers women and mothers to make informed decisions that can directly contribute to saving the lives of their children.

Population Control and Beyond:

In many developing countries, family planning programs have primarily focused on controlling population growth. However, family planning can also serve as an indirect intervention to promote child survival.

Maternal Mortality:

One important aspect is that maternal mortality risks increase with higher birth orders. By providing family planning options, the risk of maternal mortality can be reduced, benefiting both mothers and children.

Micronutrient Deficiencies:

Micronutrient deficiencies, along with macronutrient deficiencies, often in combination with infections, contribute to high under-5 mortality rates.

Vitamin A Deficiency:

Approximately 40% of children under 5 experience compromised immune systems due to Vitamin A deficiency, resulting in about 1 million child deaths annually.

Iodine Deficiency:

Previously, approximately 18 million babies used to be born mentally impaired due to iodine deficiency, emphasizing the importance of proper nutrition.

Iron Deficiency:

Iron deficiency affects mental development in children aged 6 to 24 months, impacting 40–60% of children in this age group.

Importance of Vitamin A:

Vitamin A is essential for immune system functioning, making it crucial for child health.

Impact of Vitamin A Supplements:

Taking Vitamin A supplements every 4–6 months can reduce child mortality by 23% from all causes. It also reduces mortality from diarrhea by about 33–40% and from measles by 50%.

Food Fortification:

Various supplements, like iodine and iron, are used to fortify foods and prevent deficiencies in populations.

Environmental Management for Vector Control:

"Environmental management for vector control" refers to the planning, organizing, execution, and monitoring of activities that modify environmental factors to prevent or minimize vector propagation and reduce contact between humans, vectors, and pathogens (WHO, 1980).

Elements of Environmental Management:

• Basic Sanitation Measures: Implementing sanitation measures to ensure a clean and hygienic environment.
• House Screening and Bed Nets: Using methods like house screening and bed nets to prevent vectors from entering living spaces.
• Personal Protection: Using protective clothing and repellents to reduce the risk of vector-borne diseases.
• Filling, Grading, and Drainage: Modifying landscapes to prevent water accumulation and reduce vector breeding sites.
• Zooprophylaxis: Utilizing animals to divert vectors away from humans.
• Marsh Alteration: Modifying marshlands through actions like ditching and impoundments to reduce vector habitats.
• Barrier Planting: Planting certain vegetation to act as barriers against vectors.
• Others: Additional methods and strategies that contribute to vector control.

The Essential Drugs Programme involves the use of simple drugs to treat common illnesses.

• Anti-pyretics: Drugs like aspirin and paracetamol (PCM) used to reduce fever.
• Antimalarials: Medications for treating and preventing malaria.
• Antibiotics: Medicines like penicillin and co-trimoxazole used to treat bacterial infections.
• Oral Rehydration Salts: Solutions used to treat dehydration caused by diarrhea.
• Anti-convulsants: Drugs used to control and prevent seizures.
• Haematinics: Medications to treat anemia and improve blood hemoglobin levels.
• Anthelminthics: Medicines to treat parasitic worm infections.

Control of Malaria

Malaria is a major cause of morbidity and mortality.

Decreased drug sensitivity and presence of fake drug preparations in some countries have contributed to the increased malaria morbidity mortality and case fatality rate.