Addis Ababa, Ethiopia
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van den Ent M.M.V.X.,United Nations Childrens Fund UNICEF | Yameogo A.,UNICEF Madagascar | Ribaira E.,UNICEF East and Southern Africa Region | Hanson C.M.,United Nations Childrens Fund UNICEF | And 4 more authors.
Vaccine | Year: 2017

Vaccination rates have improved in many countries, yet immunization inequities persist within countries and the poorest communities often bear the largest burden of vaccine preventable disease. Madagascar has one of the world's largest equity gaps in immunization rates. Barriers to immunization include immunization supply chain, human resources, and service delivery to reflect the health system building blocks, which affect poor rural communities more than affluent communities. The Reaching Every District (RED) approach was revised to address barriers and bottlenecks. This approach focuses on the provision of regular services, including making cold chain functional. This report describes Madagascar's inequities in immunization, its programmatic causes and the country's plans to address barriers to immunization in the poorest regions in the country. Methods Two cross-sectional health facility surveys conducted in November and December 2013 and in March 2015 were performed in four regions of Madagascar to quantify immunization system barriers. Findings Of the four regions studied, 26–33% of the population live beyond 5 km (km) of a health center. By 2015, acceptable (fridges stopped working for less than 6 days) cold chains were found in 52–80% of health facilities. Only 10–57% of health centers had at least two qualified health workers. Between 65% and 95% of planned fixed vaccination sessions were conducted and 50–88% of planned outreach sessions were conducted. The proportion of planned outreach sessions that were conducted increased between the two surveys. Conclusion Madagascar's immunization program faces serious challenges and those affected most are the poorest populations. Major inequities in immunization were found at the subnational level and were mainly geographic in nature. Approaches to improve immunization systems need to be equitable. This may include the replacement of supply chain equipment with those powered by sustainable energy sources, monitoring its functionality at health facility level and vaccination services in all communities. © 2017 The Author(s)


Hanson C.M.,United Nations Childrens Fund UNICEF | George A.M.,United Nations Childrens Fund UNICEF | Sawadogo A.,United Nations Childrens Fund UNICEF | Schreiber B.,United Nations Childrens Fund UNICEF
Vaccine | Year: 2017

Vaccine exposure to temperatures below recommended ranges in the cold chain may decrease vaccine potency of freeze-sensitive vaccines leading to a loss of vaccine investments and potentially places children at risk of contracting vaccine preventable illnesses. This literature review is an update to one previously published in 2007 (Matthias et al., 2007), analyzing the prevalence of vaccine exposure to temperatures below recommendations throughout various segments of the cold chain. Overall, 45 studies included in this review assess temperature monitoring, of which 29 specifically assess ‘too cold’ temperatures. The storage segments alone were evaluated in 41 articles, 15 articles examined the transport segment and 4 studied outreach sessions. The sample size of the studies varied, ranging from one to 103 shipments and from three to 440 storage units. Among reviewed articles, the percentage of vaccine exposure to temperatures below recommended ranges during storage was 33% in wealthier countries and 37.1% in lower income countries. Vaccine exposure to temperatures below recommended ranges occurred during shipments in 38% of studies from higher income countries and 19.3% in lower income countries. This review highlights continuing issues of vaccine exposure to temperatures below recommended ranges during various segments of the cold chain. Studies monitoring the number of events vaccines are exposed to ‘too cold’ temperatures as well as the duration of these events are needed. Many reviewed studies emphasize the lack of knowledge of health workers regarding freeze damage of vaccines and how this has an effect on temperature monitoring. It is important to address this issue by educating vaccinators and cold chain staff to improve temperature maintenance and supply chain management, which will facilitate the distribution of potent vaccines to children. © 2017 The Authors


Nisar Y.B.,United Nations Office for Project Services UNOPS | Dibley M.J.,University of Sydney | Aguayo V.M.,United Nations Children's Fund UNICEF
Nutrients | Year: 2016

The aim of the study was to investigate the effect of antenatal iron-folic acid (IFA) supplementation on child stunting in Nepalese children age <2 years. A retrospective cohort study design was used, in which a pooled cohort of 5235 most recent live births 2 years prior to interview from three Nepal Demographic and Health Surveys (2001, 2006 and 2011) was analysed. The primary outcome was stunting in children age <2 years. The main exposure variable was antenatal IFA supplementation. Multivariate Poisson regression analysis was performed. In our sample, 31% and 10% of Nepalese children age <2 years were stunted and severely stunted, respectively. The adjusted relative risk of being stunted was 14% lower in children whose mothers used IFA supplements compared to those whose mothers did not use (aRR = 0.86, 95% CI = 0.77–0.97). Additionally, the adjusted relative risk of being stunted was significantly reduced by 23% when antenatal IFA supplementation was started ≤6 months with ≥90 IFA supplements used during pregnancy (aRR = 0.77, 95% CI = 0.64–0.92). Antenatal IFA supplementation significantly reduced the risk of stunting in Nepalese children age <2 years. The greatest impact on the risk reduction of child stunting was when IFA supplements were started ≤6 months with ≥90 supplements were used. © 2016 by the authors; licensee MDPI, Basel, Switzerland.


Gandhi G.,United Nations Childrens Fund UNICEF | Lydon P.,World Health Organization | Cornejo S.,GAVI Alliance Secretariat | Brenzel L.,Bill and Melinda Gates Foundation | And 2 more authors.
Vaccine | Year: 2013

The Decade of Vaccines Global Vaccine Action Plan has outlined a set of ambitious goals to broaden the impact and reach of immunization across the globe. A projections exercise has been undertaken to assess the costs, financing availability, and additional resource requirements to achieve these goals through the delivery of vaccines against 19 diseases across 94 low- and middle-income countries for the period 2011-2020. The exercise draws upon data from existing published and unpublished global forecasts, country immunization plans, and costing studies. A combination of an ingredients-based approach and use of approximations based on past spending has been used to generate vaccine and non-vaccine delivery costs for routine programs, as well as supplementary immunization activities (SIAs). Financing projections focused primarily on support from governments and the GAVI Alliance. Cost and financing projections are presented in constant 2010 US dollars (US$;). Cumulative total costs for the decade are projected to be US$;57.5 billion, with 85% for routine programs and the remaining 15% for SIAs. Delivery costs account for 54% of total cumulative costs, and vaccine costs make up the remainder. A conservative estimate of total financing for immunization programs is projected to be $;34.3 billion over the decade, with country governments financing 65%. These projections imply a cumulative funding gap of $;23.2 billion. About 57% of the total resources required to close the funding gap are needed just to maintain existing programs and scale up other currently available vaccines (i.e., before adding in the additional costs of vaccines still in development). Efforts to mobilize additional resources, manage program costs, and establish mutual accountability between countries and development partners will all be necessary to ensure the goals of the Decade of Vaccines are achieved. Establishing or building on existing mechanisms to more comprehensively track resources and commitments for immunization will help facilitate these efforts. © 2013 Elsevier Ltd.


Bornstein M.H.,Eunice Kennedy Shriver National Institute of Child Health and Human Development | Britto P.R.,Yale University | Nonoyama-Tarumi Y.,Ochanomizu University | Ota Y.,United Nations Childrens Fund UNICEF | And 2 more authors.
Child Development | Year: 2012

The Multiple Indicator Cluster Survey (MICS) is a nationally representative, internationally comparable household survey implemented to examine protective and risk factors of child development in developing countries around the world. This introduction describes the conceptual framework, nature of the MICS3, and general analytic plan of articles in this Special Section. The articles that follow describe the situations of children with successive foci on nutrition, parenting, discipline and violence, and the home environment. They address 2 common questions: How do developing and underresearched countries in the world vary with respect to these central indicators of children's development? How do key indicators of national development relate to child development in each of these substantive areas? The Special Section concludes with policy implications from the international findings. © 2012 The Authors. Child Development © 2012 Society for Research in Child Development, Inc.


Aguayo V.M.,United Nations Childrens Fund UNICEF | Menon P.,International Food Policy Research Institute
Maternal and Child Nutrition | Year: 2016

The latest available data indicate that 38% of South Asia's children aged 0-59months are stunted. Such high prevalence combined with the region's large child population explain why South Asia bears about 40% of the global burden of stunting. Recent analyses indicate that the poor diets of children in the first years of life, the poor nutrition of women before and during pregnancy and the prevailing poor sanitation practices in households and communities are important drivers of stunting, most likely because of underlying conditions of women's status, food insecurity, poverty, and social inequalities. With this evidence in mind, UNICEF Regional Office for South Asia convened the Regional Conference: Stop Stunting: Improving Child Feeding, Women's Nutrition, and Household Sanitation in South Asia (New Delhi, November 10-12, 2014). The Conference provided a knowledge-for-action platform with three objectives: (1) share state-of-the-art research findings on the causes of child stunting and its consequences for child growth and development and the sustainable growth and development of nations; (2) discuss better practices and the cost and benefits of scaling up programmes to improve child feeding, women's nutrition, and household sanitation in South Asia; and (3) identify implications for sectoral and cross-sectoral policy, programme, advocacy and research to accelerate progress in reducing child stunting in South Asia. This overview paper summarizes the rationale for the focus on improving child feeding, women's nutrition, and household sanitation as priority areas for investment to prevent child stunting in South Asia. It builds on the invited papers presented at or developed as a follow on to the Stop Stunting Conference. © 2016 John Wiley & Sons Ltd.


Bagriansky J.,United Nations Childrens Fund UNICEF | Champa N.,United Nations Childrens Fund UNICEF | Pak K.,United Nations Childrens Fund UNICEF | Whitney S.,United Nations Childrens Fund UNICEF | Laillou A.,United Nations Childrens Fund UNICEF
Asia Pacific journal of clinical nutrition | Year: 2014

Abstract available from the publisher.BACKGROUND: Cambodia is among the 28 worst countries globally with the highest rates of childhood malnutrition. The aim of the assessment was to apply published evidence associating malnutrition and a variety of functional consequences to project economic implications of this high rate of childhood malnutrition. Such information is vital to advocate for appropriate programs and action plan to reduce malnutrition (from severe stunting to micronutrient deficiencies).METHODS: This exercise used a "consequence model" to apply these "coefficients of loss" established in the global scientific literature to Cambodia health, demographic and economic data to develop a national estimation of the economic losses link to malnutrition.RESULTS: The impact of the indicators of malnutrition analysed represent a burden to the national economy of Cambodia estimated at more than $400 million annually -2.5% of GDP. Micronutrient deficiencies suggest deficits in the quality of the diet - representing a national burden of more than $200 million annually while breastfeeding behaviours account for 6% of the burden. 57% of the losses emerge from indicators measured in children, while 43% of losses are from indicators independent of childhood measurements - indicators of maternal behaviour along with maternal and adult nutrition.CONCLUSIONS: Given the low cost of interventions and the high baseline losses, investment in nutrition programs in Cambodia is likely to offer high returns and attractive benefit cost ratios. Since nearly half the losses are determined prior to the birth of the child, this has implications for targeting and timing of programs.


Aguayo V.M.,United Nations Childrens Fund UNICEF | Aneja S.,Lady Hardinge Medical College | Badgaiyan N.,United Nations Childrens Fund UNICEF | Singh K.,Child Development and Nutrition Programme
Public Health Nutrition | Year: 2015

Objective To assess the appropriateness of current mid upper-arm circumference (MUAC) cut-offs to identify children with severe acute malnutrition in India. Design The analysis concerned 6307 children admitted to nutrition rehabilitation centres (2009-2011) where they received therapeutic care as per guidelines by WHO and the Indian Academy of Pediatrics. Setting States of Jharkhand, Madhya Pradesh and Uttar Pradesh, India. Subjects Children aged 6-59 months with bilateral pitting oedema or weight-for-height Z-score (WHZ)<-3 or MUAC<115 mm at admission. Results Children aged 6-23 months represented ~80 % of the admissions. Among them, the proportion with WHZ<-3 was similar to that with MUAC<115 mm (85·7 % v. 81·8 %); the proportion with MUAC<115 mm whose WHZ was <-3 was 82·6 %; and the proportion with WHZ<-3 whose MUAC<115 mm was 78·8 %. MUAC<115 mm was as effective as WHZ<-3 in identifying 6-59-month-old children with medical complications (32·2 % v. 31·6 %, respectively), the most important risk factor of death among oedema-free children. Furthermore, death rates in children with MUAC<115 mm were higher than in children with WHZ<-3 (0·61 % v. 0·58 %, respectively) and 91 % of the deaths among oedema-free children were deaths of children with MUAC<115 mm. Conclusions In populations similar to those included in our analysis, MUAC<115 mm appears to be an appropriate criterion to identify children with severe acute malnutrition who are at a greater risk of medical complications and death, particularly among children 6-23 months old. © The Authors 2015.


Ejigui J.,United Nations Childrens Fund UNICEF | Desrosiers T.,Laval University
International Journal of Food Sciences and Nutrition | Year: 2011

The objective of the present study was to use lemon and selected foods to improve the nutritional characteristics, quality and the nutrient content of a traditional complementary porridge made of lactic acid fermented yellow maize. Boiled egg yolk, roasted peanut paste, dry crayfish flour, roasted soybean flour and lemon juice were used as food additions. Amounts of food added were calculated on the basis of World Health Organization estimated energy needs from complementary foods of well-nourished children in developing countries, aged 911 months, at four servings per day and a low amount of breast milk energy. The pH and viscosity increased in porridges with food addition, but lemon juice contributed to lowering them. Energy and nutrient densities/100 Â g porridge improved with food addition regardless of the use of lemon juice. An increase in iron, zinc and calcium in vitro availability was observed (P < 0.05) with the addition of lemon juice. © 2011 Informa UK, Ltd.


Admasu K.,Federal Ministry of Health | Haile-Mariam A.,United Nations Childrens Fund UNICEF | Bailey P.,Family Health International FHI 360
International Journal of Gynecology and Obstetrics | Year: 2011

Objective: To report on the availability and quality of emergency obstetric and newborn care (EmONC) in Ethiopia. Methods: All licensed hospitals and health centers were visited and standard questionnaires were administered. In addition, a nonrandom systematic sample was taken of recent cesarean deliveries, partographs, and maternal deaths-and these cases were systematically reviewed. Health facilities were geocoded using geographic positioning system devices. Results: Too few facilities provided EmONC to meet the UN standards of 5 per 500 000 population, both nationally and in all but 2 regions. Only 7% of deliveries took place in institutions of any type, and only 3% in facilities that routinely provided all the signal functions. Only 6% of women with obstetric complications were treated in any health facility, half of whom were treated in fully functional EmONC facilities. Nationwide, 0.6% of expected deliveries were by cesarean. The mortality rate for women with serious obstetric complications (case fatality rate) was 2%. The cause of death was unknown in 10% of cases, and 21% were due to indirect causes (primarily malaria, anemia, and HIV-related). Conclusion: None of the indicators met UN standards. Ethiopia faces many challenges-not least geography-with regard to improving EmONC. Nevertheless, the government places high priority on improvement and has taken (and will continue to take) action to achieve Millennium Development Goals 4 and 5. This comprehensive survey serves both as a road map for planning strategies for improvement and as a baseline for measuring the impact of interventions. © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

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