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Britto P.R.,Yale University | Ulkuer N.,UNICEF
Child Development | Year: 2012

The Multiple Indicator Cluster Survey was used to provide information on feeding practices, caregiving, discipline and violence, and the home environment for young children across 28 countries. The findings from the series of studies in this Special Section are the first of their kind because they provide information on the most proximal context for development of the youngest children in the majority world using one of the only data sets to study these contexts across countries. Using the framework of the Convention on the Rights of the Child, in particular the Rights to Survival, Development and Protection, findings are explained with implications for international and national-level social policies. Implications are also discussed, with respect to policy makers and the larger international community, who have the obligation to uphold these rights. © 2012 The Authors. Child Development © 2012 Society for Research in Child Development, Inc. Source

Greenberg A.L.,UNICEF
Infant Mental Health Journal | Year: 2014

Countries throughout Eastern Europe and Central Asia struggle to change their childcare systems from one that is predominantly based on large-institution care to one that has a continuum of services and is family-focused. Georgia has shown, in large part, that the laudable goal of ending large-scale institutions for children is possible, including for children under the age of 6 years. Between 2005 and 2013, the Government in the Republic of Georgia closed 32 large, state-run institutions housing children without adequate family care. Social work was strengthened, a robust program was created to reunite children with their families, a foster care system was put into place and scaled up, and small group homes housing 8 to 10 children were established. What happened in Georgia is unique in the region. The Ukraine, which by many accounts has 100,000 children living in large, Soviet-style orphanages, has struggled to reform its childcare system. It has been estimated by childcare professionals in the Ukraine that institutional care for children accounts for over 1% of the gross domestic product. Romania, which has made considerable progress over the past 10 years, still has over 40,000 children in large-institution care. This article aims to tell how this transformation was accomplished, the conditions in Georgia that made the reform possible, how the institutions were closed, how the alternatives were established, and how sustainable the progress has been. © 2014 Michigan Association for Infant Mental Health. Source

Ravenscroft P.,UNICEF | McArthur J.M.,University College London | Hoque M.A.,University College London
Science of the Total Environment | Year: 2013

In forty six wells >. 150. m deep, from across the arsenic-polluted area of south-central Bangladesh, groundwater composition remained unchanged between 1998 and 2011. No evidence of deteriorating water quality was found in terms of arsenic, iron, manganese, boron, barium or salinity over this period of 13. years. These deep tubewells have achieved operating lives of more than 20. years with minimal institutional support. These findings confirm that tubewells tapping the deep aquifers in the Bengal Basin provide a safe, popular, and economic, means of arsenic mitigation and are likely to do so for decades to come. Nevertheless, concerns remain about the sustainability of a resource that could serve as a source of As-safe water to mitigate As-pollution in shallower aquifers in an area where tens of millions of people are exposed to dangerous levels of arsenic in well water. The conjunction of the stable composition in deep groundwater and the severe adverse health effects of arsenic in shallow groundwater lead us to challenge the notion that strong sustainability principles should be applied to the management of deep aquifer abstraction in Bangladesh is, the notion that the deep groundwater resource should be preserved for future generations by protecting it from adverse impacts, probably of a minor nature, that could occur after a long time and might not happen at all. Instead, we advocate an ethical approach to development of the deep aquifer, based on adaptive abstraction management, which allows possibly unsustainable exploitation now in order to alleviate crippling disease and death from arsenic today while also benefiting future generations by improving the health, education and economy of living children. © 2013 Elsevier B.V. Source

Binagwaho A.,Ministry of Health | Pegurri E.,UNAIDS | Muita J.,UNICEF | Bertozzi S.,Instituto Nacional Of Salud Publica
PLoS Medicine | Year: 2010

Background: There is strong evidence showing that male circumcision (MC) reduces HIV infection and other sexually transmitted infections (STIs). In Rwanda, where adult HIV prevalence is 3%, MC is not a traditional practice. The Rwanda National AIDS Commission modelled cost and effects of MC at different ages to inform policy and programmatic decisions in relation to introducing MC. This study was necessary because the MC debate in Southern Africa has focused primarily on MC for adults. Further, this is the first time, to our knowledge, that a cost-effectiveness study on MC has been carried out in a country where HIV prevalence is below 5%. Methods and Findings:A cost-effectiveness model was developed and applied to three hypothetical cohorts in Rwanda: newborns, adolescents, and adult men. Effectiveness was defined as the number of HIV infections averted, and was calculated as the product of the number of people susceptible to HIV infection in the cohort, the HIV incidence rate at different ages, and the protective effect of MC; discounted back to the year of circumcision and summed over the life expectancy of the circumcised person. Direct costs were based on interviews with experienced health care providers to determine inputs involved in the procedure (from consumables to staff time) and related prices. Other costs included training, patient counselling, treatment of adverse events, and promotion campaigns, and they were adjusted for the averted lifetime cost of health care (antiretroviral therapy [ART], opportunistic infection [OI], laboratory tests). One-way sensitivity analysis was performed by varying the main inputs of the model, and thresholds were calculated at which each intervention is no longer cost-saving and at which an intervention costs more than one gross domestic product (GDP) per capita per life-year gained. Results: Neonatal MC is less expensive than adolescent and adult MC (US$15 instead of US$59 per procedure) and is cost-saving (the cost-effectiveness ratio is negative), even though savings from infant circumcision will be realized later in time. The cost per infection averted is US$3,932 for adolescent MC and US$4,949 for adult MC. Results for infant MC appear robust. Infant MC remains highly cost-effective across a reasonable range of variation in the base case scenario. Adolescent MC is highly cost-effective for the base case scenario but this high cost-effectiveness is not robust to small changes in the input variables. Adult MC is neither cost-saving nor highly cost-effective when considering only the direct benefit for the circumcised man. Conclusions:The study suggests that Rwanda should be simultaneously scaling up circumcision across a broad range of age groups, with high priority to the very young. Infant MC can be integrated into existing health services (i.e., neonatal visits and vaccination sessions) and over time has better potential than adolescent and adult circumcision to achieve the very high coverage of the population required for maximal reduction of HIV incidence. In the presence of infant MC, adolescent and adult MC would evolve into a "catch-up" campaign that would be needed at the start of the program but would eventually become superfluous. © 2010 Binagwaho et al. Source

Anthony D.,Policy | Binkin N.,UNICEF | Binkin N.,San Diego State University
The Lancet | Year: 2012

Implementation of innovative strategies to improve coverage of evidence-based interventions, especially in the most marginalised populations, is a key focus of policy makers and planners aiming to improve child survival, health, and nutrition. We present a three-step approach to improvement of the effective coverage of essential interventions. First, we identify four different intervention delivery channels - ie, clinical or curative, outreach, community-based preventive or promotional, and legislative or mass media. Second, we classify which interventions' deliveries can be improved or changed within their channel or by switching to another channel. Finally, we do a meta-review of both published and unpublished reviews to examine the evidence for a range of strategies designed to overcome supply and demand bottlenecks to effective coverage of interventions that improve child survival, health, and nutrition. Although knowledge gaps exist, several strategies show promise for improving coverage of effective interventions - and, in some cases, health outcomes in children - including expanded roles for lay health workers, task shifting, reduction of financial barriers, increases in human-resource availability and geographical access, and use of the private sector. Policy makers and planners should be informed of this evidence as they choose strategies in which to invest their scarce resources. Source

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