Please click the following link in order to know the Trends in Maternal Mortality: 1990 to 2008 Estimates developed by WHO, UNICEF, UNFPA and The World Bank:
According to A Fair Chance at Life: Why Equity Matters for Children (2010), which has been prepared by Save the Children,
• In 2000, the world’s governments committed themselves to make a two-thirds reduction in the child mortality rate by 2015 – the fourth of eight United Nations Millennium Development Goals (MDGs). But with five years to go before the target date, the world is collectively off track to reach MDG 4. Just 40% of the necessary progress has been achieved so far, and in three-quarters of countries the goal will be missed on current trends.
• The child mortality rate at a global level has fallen by just 28% since the MDG baseline year of 1990, far short of the 67% reduction required to meet the goal. Less than 30% of countries are making equitable progress towards MDG 4.
• Ghana, Mozambique, Niger, Egypt, Indonesia, Bolivia and Zambia have made equitable progress in reducing child mortality. Chad, Congo, Kenya, South Africa and Zimbabwe have actually seen increases in their child mortality rates since 1990.
• In sub-Saharan Africa, close to one child in seven still dies before their fifth birthday. Although the mortality rate in sub-Saharan Africa has fallen, high fertility levels mean that the absolute number of child deaths in the region has increased since 1990, from 4.2 to 4.6 million.
• Almost all child deaths – 99% – happen in the developing world. A person born in sub-Saharan Africa can expect to live, on average, 52 years. In western Europe, life expectancy is 80 years. The life expectancy rates in sub-Saharan Africa today have not been seen in Europe since the beginning of the 20th century. In 40 developing countries, children have less chance of living to the age of five than a person in the UK has of living to the age of 65.
• Sri Lanka – with a per capita income of $1,790 – has a child mortality rate of 13, less than half the level in Guatemala, which has a per capita income of $2,680. Gabon has an equivalent per capita income to Argentina, but a child mortality rate of 57, almost four times higher.
• In India, high levels of selective abortion contribute to skewed male-to-female birth ratios. Son preference in India and China can result in high mortality among girls because they are not adequately breastfed or given the same access to medical treatment. A study of 4,000 children aged between one and two in India found that the likelihood of girls being fully vaccinated was five percentage points lower than that for boys. In Gujarat, India, 50% of women feel they need the permission of their husband or parent-in-law before taking their sick child to a doctor.
• High child mortality, illness and malnutrition can be a brake on economic and social development. Children who are sick and undernourished, especially in the first two years of life, often pay a life-long and irreversible price in terms of physical stunting and reduced cognitive ability.
• On the positive side, of the 68 ‘Countdown to 2015’ countries (which together account for 97% of maternal and child deaths worldwide), 60 have reduced child mortality since 1990. A recent study found that the rate of reduction has accelerated since 2000, compared with the period from 1990 to 2000.
• Of the 68 ‘Countdown to 2015’ priority countries, only 19 are on-track to reach MDG 4. Eleven more are making faster-than-average progress, but still not enough progress to achieve MDG 4 by 2015.
• It is estimated that children under five make up 85% of those who die as a result of climate change; 44% of child deaths happen in countries considered fragile; and nearly 70% of the countries with the highest child mortality burden are currently experiencing or have experienced armed violence in the last two decades.
• Inadequate care before birth and during delivery contributes to 40% of child deaths. Even babies who survive the neonatal period (up to 28 days) have greatly reduced chances of surviving beyond the age of five if their mothers die, in part because they are less likely to receive adequate nutrition and healthcare.
• Although the percentage of stunted children decreased globally from 40% to 27% between 1990 and 2010, the number of stunted children is projected to increase in many areas. In Africa, the number of stunted children is estimated to have increased from 45 million in 1990 to 60 million in 2010.
• Undernutrition among pregnant women in developing countries leads to one in six infants being born with low birth weight, which not only carries a high risk of neonatal death, but can also permanently damage long-term cognitive and physical development.
• Infectious diseases accounted for an estimated 68% of the 8.8 million child deaths in 2008, with pneumonia accounting for 18% and diarrhoea for 15% of the global total. More than 40% of deaths from pneumonia and diarrhoea take place in sub-Saharan Africa, where 42% of people lack access to an improved water source, and almost 70% are without adequate sanitation.
• Improved drinking water sources and proper sanitation are crucial to reducing child deaths from diarrhoea, while an estimated 45% of cases could be prevented by simple hand washing with soap.
• If women and men had equal status, it is estimated that the proportion of underweight children below the age of three years would fall by 13 percentage points globally.
According to Women on the Front Lines of Health Care, State of the World's Mothers 2010, http://www.savethechildren.in/files/SOWM2010_FullReport_email.pdf:
• Every year, 50 million women in the developing world give birth with no professional help and 8.8 million children and newborns die from easily preventable or treatable causes.
• Worldwide, there are 57 countries with critical health workforce shortages, meaning that they have fewer than 23 doctors, nurses and midwives per 10,000 people. Thirty-six of these countries are in sub-Saharan Africa. Making up for these shortages would require an additional 2.4 million doctors, nurses and midwives.
• Thirty-six of the countries with critical health worker shortages are in sub-Saharan Africa, which has 12 percent of the world’s population, 25 percent of the global burden of disease, and only 3 percent of the world’s health workers. South and East Asia have 29 percent of the disease burden and only 12 percent of the health workers.
• 41 percent of the child deaths occur among newborn babies in the first month of life.
• 99 percent of child and maternal deaths occur in developing countries where mothers and children lack access to basic health-care services.
• 250,000 women’s lives and 5.5 million children’s lives could be saved each year if all women and children had access to a full package of essential health care.
• Every year 8.8 million children die before reaching age 5.
• Every year 343,000 women lose their lives due to pregnancy or childbirth complications.
• An additional 4.3 million health workers are needed in developing countries to help save lives and meet the health-related Millennium Development Goals.
• The eleventh annual Mothers’ Index helps document conditions for mothers and children in 160 countries – 43 developed nations and 117 in the developing world – and shows where mothers fare best and where they face the greatest hardships.
• European countries – along with New Zealand and Australia – dominate the top positions while countries in sub-Saharan Africa dominate the lowest tier.
According to Performance Audit-Report No. 8 of 2009-10,
• This is the latest and an extremely significant report on the status and performance of the National Rural Health Mission (NRHM) all over India providing clues for areas of concern and immediate action. Some of the salient features are as follows:
• The performance audit on implementation of the NRHM was conducted during April-December 2008 in the Ministry of Health and Family Welfare, State Health Societies (SHS) of 33 States/UTs, District Health Societies (DHS) of 129 districts and 2369 health centres at block and village levels covering the period from 2005-06 to 2007-08.
• The NRHM initiated decentralised bottom-up planning. This, however, had been hindered by non-completion of household and facility surveys and State specific perspective plans. In nine States, district level annual plans were not prepared during 2005-08 and in 24 States/UTs block and village level annual plans had not been prepared at all.
• Village level health and sanitation committees were still to be constituted in nine States. The Rogi Kalyan Samitis (RKS) formed at many health centres, aiming at community ownership of healthcare delivery systems, were characterised by weak or absent grievance redressal mechanisms, outreach and awareness generation efforts.
• No RKS in any State/UT received all the stipulated central grants. In 13 States/UTs, the Samiti failed to generate internal resources, while in the remaining States no mechanism existed to monitor the generation of a third of the RKS funds from internal resources as prescribed.
• The participation of Non-Governmental Organisations (NGOs) in the Mission’s activities had not been facilitated and their contribution towards capacity building and service delivery was not effectively monitored. 71 per cent of the districts countrywide were yet to be covered under the Mother NGO scheme.
• During the period 2005-06 to 2007-08, the total outlay/expenditure on the NRHM was Rs. 24,151.45 crore. During the first two years the Centre was contributing 100 per cent of the funds. Thereafter, the States were to contribute 15 per cent of funds during the 11th Five Year Plan (2007-12). However, many of the States were yet to contribute their share to the Mission and this issue needs to be addressed.
• Many high focus States where diseases are endemic and health indicators poor, were however, receiving relatively lesser central grants, as high unspent balances of previous years remained, indicating that capacity building needs to be focused on.
• Basic facilities (proper buildings, hygienic environment, electricity and water supply etc.) were still absent in many existing health centres with many Primary Health Centres (PHCs) and Community Health Centres (CHCs) being unable to provide guaranteed services such as inpatient services, operation theatres, labour rooms, pathological tests, X-ray facilities and emergency care etc.
• While contract workers have been engaged to fill vacancies, there are still shortages of specialist doctors at CHCs, adequate staff nurses at CHCs/PHCs and Auxiliary Nursing Midwife (ANMs)/ Multi-purpose Worker (MPWs) at Sub Centres.
• In nine States, the stock of essential drugs, contraceptives and vaccines adequate for two months consumption as required under norms were not available in any of the test checked PHCs and CHCs.
• Despite holding two National Immunisation Days, six Special National Immunisation Days (and additional rounds in selected districts of Bihar and Uttar Pradesh), 1640 new polio cases had been detected in 17 States/UTs during 2005-08.
According to ‘Diarrhoea: Why children are still dying and what can be done?’ (2009),
• Diarrhoea is defined as having loose or watery stools at least three times per day, or more frequently than normal for an individual. Though most episodes of childhood diarrhoea are mild, acute cases can lead to death and other complications.
• The leading cause of diarrhea is lack of sanitation and safe drinking water and the life threatening disease is very easily curable with simple tablets and rehydration. (An estimated 88 per cent of diarrhoeal deaths worldwide are attributable to unsafe water, inadequate sanitation and poor hygiene.)
• Most pathogens that cause diarrhoea share a similar mode of transmission – from the stool of one person to the mouth of another.
• In India, under-five mortality rate (per 1000 live births) was 69 during 2008. The number of under-five deaths was 18,30,000 during 2008. The percentage of children under-five with diarrhoea receiving ORS packet during 2005-2008 was 26%.
• Nearly, nine million children under five years of age die each year. Diarrhoea is second only to pneumonia as the cause of these deaths.
• Reducing these deaths depends largely on delivering life-saving treatment of low-osmolarity oral rehydration salts (ORS) and zinc tablets to all children in need.
• Examples of rehydrating fluids include cereal-based drinks made from a thin gruel of rice, maize, potato or other readily available low-cost grain or root crop the family has at home. Breastmilk is also an excellent drink for fluid replacement and should continue to be given to infants with diarrhoea simultaneously with other oral rehydration solutions.
• According to the latest available figures, an estimated 2.5 billion people lack improved sanitation facilities, and nearly one billion people do not have access to safe drinking water. These unsanitary environments allow diarrhoea-causing pathogens to spread more easily.
• Globally, 1.2 billion people practise open defecation, 83 per cent of whom live in 13 countries
• Together, pneumonia and diarrhoea are responsible for an estimated 40 per cent of all child deaths around the world each year.
• Nearly 1 in 4 people in developing countries were practising indiscriminate or open defecation in 2006.
• Nearly one in five child deaths – about 1.5 million each year – is due to diarrhoea. It kills more young children than AIDS, malaria and measles combined.
• Between 1990 and 2006, the proportion of the developing world’s population using an improved drinking water source rose from 71 per cent to 84 per cent. Still, almost 1 billion people lack access to improved drinking water sources, and many households do not treat or safely store their household water supplies.
• The prevention package highlights five main elements that require a concerted approach in their implementation. The package includes: a) rotavirus and measles vaccinations, b) promotion of early and exclusive breastfeeding and vitamin A supplementation, c) promotion of handwashing with soap, d) improved water supply quantity and quality, including treatment and safe storage of household water, and e) community-wide sanitation promotion.
• Mortality from diarrhoea has declined over the past two decades from an estimated 5 million deaths among children under five to 1.5 million deaths in 2004
• Africa and South Asia are home to more than 80 per cent of child deaths due to diarrhoea
• Improving sanitation facilities has been associated with an estimated median reduction in diarrhoea incidence of 36 per cent across reviewed studies.
• Interventions to improve water quality at the source, along with treatment of household water and safe storage systems, have been shown to reduce diarrhoea incidence by as much as 47 per cent.
• Diarrhoea often leads to stunting in children due to its association with poor nutrient absorption and appetite loss.
• Breastmilk contains the nutrients, antioxidants, hormones and antibodies needed by a child to survive and develop.
• Undernourished children are more likely to suffer from diarrhoea and its consequences, which, in turn, increases their chances of worsening nutritional status. Today, 129 million children under the age of five in the developing world are underweight for their age. Together, Africa and South Asia account for more than 80 per cent of total underweight children (25 per cent and 57 per cent, respectively). About 40 per cent of children under five years of age are stunted in Africa, and nearly half in South Asia.
• Only 37 per cent of infants in developing countries are exclusively breastfed for the first six months of life.
• Boys and girls are equally likely to receive ORS to treat diarrhoea. Children in urban areas (39 percent) are more likely to receive ORS than those living in rural areas (31 per cent). Similarly, children from the wealthiest families are 1.5 times as likely to receive ORS to treat their diarrhoea as the poorest children