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Subject: The Drum Beat - 301 - MDG #4 - Reducing Child Mortality


The Drum Beat - Issue 301 - MDG #4 - Reducing Child Mortality
May 30 2005


from The Communication Initiative...global forces...local choices...critical
voices...telling
stories...


Partners: ANDI, BBC World Service Trust, Bernard van Leer Foundation,
Calandria, CFSC
Consortium, The CHANGE Project, CIDA, DFID, Exchange, FAO, Ford Foundation,
Fundacion Nuevo Periodismo, Johns Hopkins Bloomberg School of Public Health
Center for
Communication Programs, MISA, OneWorld, The Panos Institute, PCI, The
Rockefeller
Foundation, SAfAIDS, Soul City, UNAIDS, UNICEF, USAID, WHO.


Chair of the Partners Group: Garth Japhet, Soul City [log in to unmask]
Director: Warren Feek [log in to unmask]
http://www.comminit.com


Subscribe to The Drum Beat: http://www.comminit.com/subscribe_drumbeat.html
Access this issue online at http://www.comminit.com/drum_beat_301.html


***


Millennium Development Goal (MDG) #4 seeks to reduce by two-thirds (66%),
between 1990
and 2015, the probability of children dying between birth and 5 years of age.
This issue of
The Drum Beat highlights just a few of the ways in which communication
strategies are being
implemented - with direct impact on child survival rates - in communities
around the world. To
view additional materials, please use our Custom Search tool - http://
www.comminit.com/
search.html - and select the keyword for this MDG. For background on MDG #4 and
the other
goals, see http://www.comminit.com/mdgs/mdgs/mdgs-1.html

Please also visit our MDG Impact section for more examples of the impact of
communication
on meeting child survival goals - http://www.comminit.com/mdgs/mdgs/mdgs-5.html

To view previously published Drum Beats on related themes, please see issues
264, 251,
224, 180, 156, and 66 - http://www.comminit.com/drum_beat_archives.html


Next month we will focus on MDG #5: Improving Maternal Health. Please send your
projects,
articles, events, etc. to Deborah Heimann [log in to unmask]


***


CONTEXT


1.      The United Nations' Dept. of Economic and Social Affairs anticipates that
MDG #4 will be
met in Northern Africa, Latin America and the Caribbean, and South Eastern
Asia. Progress
has been less significant in Southern Asia and negligible in Western Asia,
Oceania, and sub-
Saharan Africa. The latter continues to have the highest level of under-5
mortality, with a rate
over 20 times that of developed countries. Further, "Despite the availability
of a safe, effective
and relatively inexpensive vaccine for over 40 years, measles remains a major
cause of
childhood mortality affecting nearly 30 million children and killing an
estimated
610,000....[S]ub-Saharan Africa, the region with the lowest coverage in 1990,
has
experienced the smallest progress - with immunization coverage improving only
from 57 to 61
per cent."
Source: "Progress towards the Millennium Development Goals, 1990-2004" [PDF]
http://www.comminit.com/redirect.cgi?r=http://millenniumindicators.un.org/unsd/
mi/techgroup/
goals_2004/Goal_4-web_2004FC2_rev%2027%20OCT.pdf


2.      Child Mortality
99% of the 10.9 million children under age 5 who died in 2000 were from
developing
countries; 36% died in Asia and 33% in Africa. More than 50% of all child
deaths are due to 5
preventable and treatable communicable diseases: pneumonia, diarrhoea, measles,
malaria,
and HIV/AIDS. Malnutrition is associated with half of all under-5 deaths.
http://www.comminit.com/baseline/baseline2003/baseline-62.html


3.      Goals for Children not Being Met
UNICEF projects that by 2015 the under-5 mortality rate will have only dropped
by 23%.
About 90 countries are on track to achieve the MDG goal, while 98 are
stagnating or going
backwards. The single most prominent cause of child deaths is poor neonatal
conditions.
http://www.comminit.com/baseline/baseline2004/baseline-406.html


4.      Women's Reproductive Health & Armed Conflict
During the siege of Sarajevo, perinatal mortality increased from 15 deaths per
1,000 live births
before the war to 39 deaths per 1,000 afterward. More than 20% of births at a
Burundi refugee
camp in Tanzania in 1998 were below average weight, and infant deaths rose
sharply from
prewar levels.
http://www.comminit.com/baseline/baseline2001/baseline-323.html


5.      India & Hunger
In India, nearly 9 out of 10 pregnant women suffer from malnutrition and
anaemia; the latter
condition causes 20% of infant mortality. More than 50% of children under 5 are
moderately or
severely malnourished, or suffer from stunting.
http://www.comminit.com/baseline/baseline2002/baseline-196.html


6.      Distribution of Inappropriate Malaria Drugs Increasing Child Mortality
"[A] new, highly effective treatment known as artemisinin-class combination
therapy (ACT)
offers more hope for treating malaria in countries where drug resistance to
conventional drugs
has become widespread." But, "despite a policy that names ACT as the gold
standard of
treatment, WHO signs its approval when GFATM [Global Fund for AIDS Tuberculosis
and
Malaria] funds cheap but ineffective chloroquine or sulfadoxine-pyrimethamine
to treat P
falciparum malaria." The authors claim that this unwillingness to fund ACT
results in the
deaths of "tens of thousands of children".
http://www.comminit.com/baseline/baseline2004/baseline-25.html


STRATEGIES: ADDRESSING VACCINE-PREVENTABLE DISEASES


7.      Africa's 2005 Polio Eradication Strategy
In 2004, the number of African children who contracted polio doubled to 1037
(85% of the
global total); the Sudan went from 0 to 112 cases in a 9-month period. Worried
by these
trends, health ministers gathered in January 2005 to embark on a "massive
series of
immunization campaigns across 25 countries". The meeting signaled a recognition
of the
importance of using community mobilisation to motivate behaviour change in the
area of polio
vaccination. Following resumption of synchronised social mobilisation
activities, 80 million
children were reached and the epidemic was reined in.
http://www.comminit.com/strategicthinking/st2005/thinking-991.html


8.      Social Mobilisation/Communication Polio Eradication Partnership - Pakistan
Prior to the National Immunisation Days (NIDs) and Sub-National Immunisation
Days (SNIDs),
a variety of communication tools were used to encourage Pakistanis to
participate by getting
their children vaccinated. Television (national, regional and cable) is
commonly cited as the
most effective medium in Pakistan for delivery of these messages. The popular
singer Jawad
collaborated in promoting the campaign and in the production of a broadcast
song.
Information, education, and communication (IEC) materials were designed for
selected social
groups such as Nazims and teachers. Posters provided basic vaccination pictures
and dates,
while brochures gave more detailed campaign information.
http://www.comminit.com/experiences/pds112004/experiences-2810.html
Contact Sebastian Taylor [log in to unmask]


9.      Vaccination Week in the Americas (VWA) - The Americas
Headed by the Pan American Health Organization (PAHO), VWA highlights the need
for
routine childhood vaccinations, especially in rural and border areas. Each
year, a week of
intensive mobilisation efforts constitutes part of a broader, year-long
awareness raising effort.
Organisers conclude that, among the keys to the 2003 week's successes were
communication campaigns set up in each of the countries. PAHO sent out radio
and
television spots, posters, and news releases to promote the week, whose theme
was
"Vaccination: An Act of Love". In the Caribbean, radio spots were produced in
indigenous
languages and dialects for several countries. On-site evaluations indicated
that most parents
heard about the week on radio or TV.
http://www.comminit.com/experiences/pds22004/experiences-520.html
Contact Daniel Epstein [log in to unmask] OR Piedad Huerta [log in to unmask]
OR
Bryna Brennan [log in to unmask]


10.     Measles Initiative - Global
This collaborative global effort uses mass media, community mobilisation, and
other
communication strategies to control measles. Weeks prior to any vaccination
weekend,
trained local volunteers go door-to-door and distribute banners, brochures, and
posters to
encourage participation. They put on plays in the centre of the village that
emulate the
vaccination process, the harm of not vaccinating the child, and the folly of
believing that "witch
doctors" have the cure. "It is important for people to hear these messages from
their friends.
They internalize the information and are convinced. They figure 'how can a
friend do anything
bad to us?'. We partner with the leaders in a certain village who have the ear
of the people -
religious leaders, tribal chief, teachers, drummers, clan leaders. It is
important to speak their
language." WHO and UNICEF claim that, since 2001, the Initiative has vaccinated
more than
150 million children against measles. Deaths fell globally by 39% bet!
ween 1999 and 2003 from 873,000 to 530,000; Africa experienced a 46% reduction
in
deaths.
http://www.comminit.com/experiences/pds2005/experiences-3145.html
Contact Julie Irby [log in to unmask] OR Jessica Sapalio
[log in to unmask] OR
Amy Weiss [log in to unmask] OR Steven Stewart [log in to unmask] OR Erica Kochi
[log in to unmask] OR Hayatee Hasan [log in to unmask]


11.     Marklate ('Vaccinate') - Sierra Leone
From 1988 to 1990, religious leaders, alongside the UNICEF national social
mobilisation team
and the Ministry of Health, worked to educate and motivate Sierra Leone's
people to
immunise their children. Developed through partnership and participation,
Marklate's
strategies included training health workers, expanding the number of
vaccination sites, and
encouraging outreach services. When UNICEF met resistance among those who
considered
vaccination anti-Islamic or suspected a secret family planning agenda, the
social mobilisation
team organised a series of national and district-level workshops. In 1990,
Marklate reached
its goal, moving from 6% to 75% coverage of Sierra Leone's 135,000 children
under age one.
http://www.comminit.com/experiences/pds112004/experiences-2804.html
Contact Mohammad Jalloh [log in to unmask] OR Judith Graeff [log in to unmask]
OR
Salieu Jalloh [log in to unmask]


***


PULSE Poll
http://www.comminit.com/pulse.html

Rather than getting back into the trenches of the 1990ies, the challenge today
- in times of a
strong treatment agenda -  is to reassess our communication science, models and
practice
when putting HIV/AIDS prevention on the agenda.

[For context, please see http://www.comminit.com/drum_beat_297.html]

Do you agree or disagree?


VOTE and COMMENT - http://www.comminit.com/pulse.html


***


STRATEGIES: ADDRESSING OTHER CAUSES OF DEATH


12.     Millions Saved - Case 7: Preventing Diarrhoeal Deaths in Egypt
by Ruth Levine et al.
In 1977, diarrhoeal diseases were identified as a major cause of infant deaths
in Egypt. This
finding led to the creation of a national project to promote the use of locally
manufactured oral
rehydration salts (ORS). More than 63 television spots were aired between 1984
and 1990;
billboards, magazine ads, and posters were also used. The language was simple,
employing
expressions commonly used by mothers, with a theme of maternal love. By 1985
and 1986,
ORS distribution was 4 times the level at the start of the programme. By 1986,
nearly 99% of
mothers were aware of ORS, use of the solution was common, and a majority of
women could
correctly mix the solution. The number of children with diarrhoea attending a
public clinic rose
from 630,000 in 1983 to 1.4 million in 1985, indicating increased parental
awareness. The
campaign helped avert about 300,000 childhood deaths between 1982 and 1989.
http://www.comminit.com/strategicthinking/steval/evaluations-31.html


13.     Control of Diarrhoeal Diseases (CDD) Programme - Bangladesh
Thanks to door-to-door contact made in the 1980s with over 13 million rural
households,
today there is a 90% knowledge of oral rehydration therapy (ORT) in Bangladesh.
CDD aimed
to convert this knowledge into life-saving action by increasing ORT usage from
60% (up from
24% in 1990) to the mid-decade goal of 80%. The campaign addressed ground-level
"influencers" or spokespeople who would create an environment of acceptance and
support
for caretakers, the primary audience being addressed. Specific packages were
developed for
schoolteachers, development and health workers, maulvis or Islamic religious
leaders, urban
medical professionals, and rural health functionaries/village doctors. One
package featured
an inflatable plastic doll. When filled with water, the doll depicts a healthy
child; when drained,
it becomes shriveled to depict a dehydrated child. Merely replacing the stopper
in the outlet
doesn't restore the doll; it has to be refilled to look healthy, demonstrating
tha!
t it is crucial to replenish the body with fluids rather than to merely stop
the diarrhoea.
http://www.comminit.com/experiences/pdsaug/experiences-669.html
Contact Professor Dr. Md. Shahadat Hossain [log in to unmask] OR Shivaji
Bhattacharya [log in to unmask]


14.     Impact Data - Mass Media & Health Practices Project - Honduras & Africa
The programme provided 900 health care workers with 4 to 8 hours of oral
rehydration
therapy (ORT) training; accompanying print materials and radio ads issued basic
messages
related to ORT. After one year, 93% of the mothers surveyed in rural Honduras
knew that the
radio campaign was promoting Litrosol, the brand name of the locally packaged
oral
rehydration salts (ORS) used to treat diarrhoea; 49% had used Litrosol. Of
these women, 94%
accurately described the correct mixing volume and 96% knew that the entire
package of
ORS was to be used in treatment. Between 1981 and 1982 mortality rates for
children under 5
decreased from 47.5% to 25%.
http://www.comminit.com/evaluations/idkdv2002/sld-2372.html


15.     Impact Data - Back to Sleep Campaign - Canada
This Health Canada project used mass media messaging strategies - e.g.,
magazines
shipped to healthcare professionals, TV public service announcements, and the
instructive
message "Back to Sleep" printed in English, French, and Spanish on the
waistband of
Pampers' 2 smallest-sized diapers - to teach parents and other caregivers how
to avoid the
risk factors associated with Sudden Infant Death Syndrome (SIDS). In 1999, 61%
of health
professionals claimed to have given advice to place a child on its side to
sleep; only 21%
advised the placing of the child on its back. In contrast, in 2001, 21% claimed
to have advised
a side position, while 67% of advised a back position. Among caregivers who
have taken
action to reduce the risk of SIDS, 69% said they lay their babies on their
backs to sleep, up
from 41% in 1999.
http://www.comminit.com/evaluations/idkdv2002/sld-2361.html


16.     Africa Malaria Day - Burkina Faso
Launched by the Maternal & Neonatal Health (MNH) Program, this one-week
programme
promoted use of Insecticide-Treated bed Nets (ITNs) and effective antimalarial
treatments on
the part of women and young children. Among the activities were screenings of
an information
film in Kouritenga province, followed by sessions in which community members
discussed the
effects of malaria and learned about the use and benefits of ITNs; more than
3,000 people
participated. As part of a contest based on a 10-question survey on key malaria
messages,
2000 questionnaires were distributed; 53 contestants achieved a perfect score.
http://www.comminit.com/experiences/pds12004/experiences-422.html
Contact Jeremie Zoungrana [log in to unmask]


MEASURING PROGESS


17.     The Child Survival Sustainability Assessment (CSSA): For a Shared
Sustainability
Evaluation Methodology in Child Survival Interventions
"The CSSA is presented as a tool helping CS [child survival] interventions,
notably PVO
[private voluntary organisation] CS interventions, better integrate their plans
and monitoring
and evaluation (M&E) systems under the overarching purpose of achieving
sustainable child
health gains. It seeks to do so through a realistic and contextually relevant
systematic
approach, yet expecting to increase the ability of the CS community as a whole
to be
accountable, to learn about and to communicate our common responsibility to the
children
today and tomorrow."
http://www.comminit.com/strategicthinking/steval/sld-2148.html


18.     Immunization Promotion Activities: Are They Effective in Encouraging
Mothers to
Immunize Their Children?
by Ricardo Perez-Cuevas, Hortensia Reyes, Ulises Pego, Patricia Tome, Karla
Ceja, Sergio
Flores & Gonzalez Gutierrez
This study evaluated the Mexican National Vaccination Council's communication
activities for
the Second National Health Week in Mexico City. Mass media promotion and
popular
campaigns were found to be effective: 83% of mothers were aware of the campaign
and 63%
were impacted by its messages, and the net increase in immunisation between the
"aware"
and "unaware" groups was 14.8%. The authors stress that the design of health
promotion
messages must be incorporated into local cultural patterns, and must be based
on formative
research and focus-group activities. These messages must provide full
information, and must
also be tailored to continue the trend toward proactive approaches to
preventive health care.
In short, programmes should create "active demand" for services.
http://www.comminit.com/evaluations/st2004/thinking-589.html


19.     Reaching Communities for Child Health & Nutrition: A Framework for
Household &
Community IMCI
by Peter Winch, Karen LeBan & Barmak Kusha
"While NGOs [non-government organisations] clearly have much to offer in terms
of
experiences with community approaches to child health and nutrition, the
sharing of these
experiences with other partners has at times been hampered by uncertainty about
what
exactly is meant by Household and Community IMCI [Integrated Management of
Childhood
Illness], and by the tremendous diversity of NGO activities in the field. It is
hoped that the
framework as it is discussed here can be used as a tool to help NGOs organize
and present
lessons learned based on their child survival and HH/C IMCI programs, both to
each other
and to other public health agencies. NGOs have proven experience in reducing
mortality and
morbidity and in improving child health and nutrition at the community level."
http://www.comminit.com/materials/ma2004/materials-1418.html


***


HealtheComm News #5
Resources, opportunities, and perspectives on health communication - supported
by the
Health Communication Partnership (HCP) and coordinated by The Communication
Initiative.
http://www.comminit.com/healthecomm/newsletter.php?id=6


***


RESOURCES FOR AWARENESS, ADVOCACY & ACTION


20.     Why Invest in Newborn Health?
by Nancy V. Yinger & Elizabeth I. Ransom
Newborns are "15 times more likely to die during the first month of life than
at any other time
during their first year." This policy brief (and the series it is a part of)
shows how incorporating
newborn care into existing safe motherhood and child survival programmes can
ensure
newborn survival.
http://www.comminit.com/materials/ma2003/materials-419.html


21.     Neonatal Survival Series
"Eight million children are either stillborn or die each year within the first
month of life. This
figure never makes news." The Lancet has launched a series of papers in an
effort "to erase
the excuse of ignorance for public and political inaction once and for all".
The special issue
provides new epidemiological evidence detailing the time, place, and causes of
neonatal
deaths worldwide - and the low-tech, low-cost interventions that are available
to prevent them.
http://www.comminit.com/materials/ma2005/materials-2196.html


22.     Saving Newborn Lives - Tools for Newborn Health: Qualitative Research to
Improve
Newborn Care Practices
by Ronald P. Parlato, Gary L. Darmstadt & Anne Tinker
Published by Save the Children as a reference tool for conducting qualitative
research, this
guide focuses on evidence-based practices, data collection techniques, data
analysis, and
behaviour change communication (BCC) planning and programming. It highlights
evidence-
based practices that have been shown to have the most significant and direct
implications for
newborn health, mortality, and morbidity.
http://www.comminit.com/materials/ma2004/materials-1521.html


23.     Questioning the Solution: The Politics of Primary Health Care & Child
Survival
by David Werner & David Sanders
This book explores the problem of primary health care and child survival in
underprivileged
countries and communities. Examples from all over the world illustrate
approaches to health
and development that put children's needs before top-heavy economic growth.
http://www.comminit.com/materials/ma2005/materials-2191.html


24.     Shaping Policy for Maternal & Newborn Health: A Compendium of Case Studies
JHPIEGO, Save the Children/Saving Newborn Lives, and Family Care International
compiled
this collection of case studies highlighting the strategies and processes
involved in securing
national policy commitments to improve healthcare for mothers and newborns.
Together
these 12 case studies show how civil society and nongovernmental organisations
can
contribute to positive change for safe motherhood and newborn health.
http://www.comminit.com/materials/ma2003/materials-366.html


***


This issue was written by Kier Olsen DeVries.


***


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