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Analytical summary - Child and adolescent health

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Sub-Saharan Africa has the lowest rate of improvement in child survival in the past 20 years, despite the highest rate of reduction in under-five mortality. To meet Millennium Development Goal 4, child mortality must be reduced by 8% per year, whereas the present rate is 1.4%. The leading causes of childhood deaths, in order, are neonatal conditions, diarrhoea, pneumonia, malaria, measles and HIV/AIDS. A total of 25% of under-fives are underweight and one third are stunted.

Percentage of infants exclusively breastfed for the first 6 months of life in the WHO African Region, 2000–2010

The challenges in nutrition faced by most African countries include:

  • the need to meet the energy needs and strengthen the immune systems of people with infectious diseases such as HIV/AIDS and tuberculosis;
  • increasing household food security and increasing dietary intake across the life cycle;
  • addressing the high consumption of sugars and fats that contribute to diet-related disorders.

Insufficient countries are making adequate progress on services such as skilled birth attendance, exclusive breastfeeding, and treatment of pneumonia, diarrhoea, and malaria.

However, good progress has been made on immunization and vitamin A supplementation. Measles vaccination has been successful, although recent gains are threatened by funding shortages.

Antiretroviral therapy access for children is low at only 35%. Postnatal care programmes are the weakest intervention of all, reflected in the high neonatal mortality rates.

All interventions need to be understood in the context of persistently poor environmental health conditions, with lack of drinking water and sanitation, and high rates of open defecation, occurring throughout sub-Saharan Africa. These represent particular threats to infants and young children and negate the benefits of many medical interventions.

The number of countries with child survival strategies has increased rapidly from only 11 in 2007 to 27 in 2009. However, the distribution of interventions remains low and inequitable, and does not operate across a continuum of care. Policies and action in the water and sanitation, education and transport sectors and revisions in national legal frameworks need to be combined with effective health interventions coverage to ensure sustained improvements in child health and survival and equitable access to services.

More attention is needed to putting in place health social insurance schemes to facilitate and encourage attendance at health services. It is clearly a disincentive for those in poor communities to make an effort to reach health facilities that cost them significant out-of-pocket sums, while these services are frequently inadequately staffed and poorly supplied.