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Country Summary

Zimbabwe

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This analytical profile on child and adolescent health is structured as follows:

4.5.1 Analytical summary
4.5.2 Disease burden
4.5.3 Nutrition
4.5.4 Intervention coverage
4.5.4.1 Immunization coverage
4.5.4.2 Prevention
4.5.4.3 Newborn health
4.5.4.4 Case management
4.5.5 Equity
4.5.6 Policies
4.5.7 Systems (financial flows and human resources)
4.5.8 State of surveillance

Namibia

O conteúdo em Portugês estará disponível em breve.

This analytical profile on child and adolescent health is structured as follows:

4.5.1 Analytical summary
4.5.2 Disease burden
4.5.3 Nutrition
4.5.4 Intervention coverage
4.5.4.1 Immunization coverage
4.5.4.2 Prevention
4.5.4.3 Newborn health
4.5.4.4 Case management
4.5.5 Equity
4.5.6 Policies
4.5.7 Systems (financial flows and human resources)
4.5.8 State of surveillance

Mozambique

Moçambique continua a ter uma das mais baixas taxas de melhoria da sobrevivência infantil, apesar das altas taxas de redução da mortalidade infantil e em menores de 5 anos. As principais causas de mortalidade em menores de 5 anos são: malária, SIDA, pneumonia, diarreia e malnutrição. (INCAM, 2000) As principais causas de mortes em crianças menores de 1 ano são: malária, sépsis bacteriana do recém-nascido, HIV/SIDA, pneumonia e Diarreia.

Os dados do IDS 2011 confirmam que a subnutrição crónica em crianças menores de 5 anos continua a ser um grande problema de saúde pública e a sua prevalência não regista melhoria significativa desde de 2003. Em 2008, o MICS estimou em 44% a prevalência de subnutrição crónica, contra 48% de 2003, uma redução de 4 pontos percentuais em 7 anos. A prevalência reduziu em um ponto percentual de 2008 a 2011 pós a prevalência passou de 44% para 43% (INE/MISAU, 2011).

Mauritius

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This analytical profile on child and adolescent health is structured as follows:

4.5.1 Analytical summary
4.5.2 Disease burden
4.5.3 Nutrition
4.5.4 Intervention coverage
4.5.4.1 Immunization coverage
4.5.4.2 Prevention
4.5.4.3 Newborn health
4.5.4.4 Case management
4.5.5 Equity
4.5.6 Policies
4.5.7 Systems (financial flows and human resources)
4.5.8 State of surveillance

Mauritania

O conteúdo em Portugês estará disponível em breve.

This analytical profile on child and adolescent health is structured as follows:

4.5.1 Analytical summary
4.5.2 Disease burden
4.5.3 Nutrition
4.5.4 Intervention coverage
4.5.4.1 Immunization coverage
4.5.4.2 Prevention
4.5.4.3 Newborn health
4.5.4.4 Case management
4.5.5 Equity
4.5.6 Policies
4.5.7 Systems (financial flows and human resources)
4.5.8 State of surveillance

Mali

O conteúdo em Portugês estará disponível em breve.

This analytical profile on child and adolescent health is structured as follows:

4.5.1 Analytical summary
4.5.2 Disease burden
4.5.3 Nutrition
4.5.4 Intervention coverage
4.5.4.1 Immunization coverage
4.5.4.2 Prevention
4.5.4.3 Newborn health
4.5.4.4 Case management
4.5.5 Equity
4.5.6 Policies
4.5.7 Systems (financial flows and human resources)
4.5.8 State of surveillance

Sierra_Leone

O conteúdo em Portugês estará disponível em breve.

This analytical profile on child and adolescent health is structured as follows:

4.5.1 Analytical summary
4.5.2 Disease burden
4.5.3 Nutrition
4.5.4 Intervention coverage
4.5.4.1 Immunization coverage
4.5.4.2 Prevention
4.5.4.3 Newborn health
4.5.4.4 Case management
4.5.5 Equity
4.5.6 Policies
4.5.7 Systems (financial flows and human resources)
4.5.8 State of surveillance

Ghana

Esta seção do perfil do sistema de saúde está estruturado da seguinte forma:

Analytical summary

O conteúdo em Portugês estará disponível em breve.

Percentage of infants exclusively breastfed for the first 6 months of life in Ghana and neighboring countries, 2000-2009
Percentage of infants exclusively breastfed for the first 6 months of life in Ghana and neighboring countries, 2000-2009.JPG

Disease burden

Nutrition

Intervention coverage

Equity

Policies

Systems

State of surveillance

Endnotes: sources, methods, abbreviations, etc.

Kenya

Esta seção do perfil do sistema de saúde está estruturado da seguinte forma:

Analytical summary

O conteúdo em Portugês estará disponível em breve.

Percentage of infants exclusively breastfed for the first 6 months of life in Kenya and neighboring countries, 2000-2009
Percentage of infants exclusively breastfed for the first 6 months of life in Kenya and neighboring countries, 2000-2009.JPG

Disease burden

Nutrition

Intervention coverage

Equity

Policies

Systems

State of surveillance

Endnotes: sources, methods, abbreviations, etc.

Guinea-Bissau

Esta seção do perfil do sistema de saúde está estruturado da seguinte forma:

Resumo analítico - Saúde infantil e dos adolescentes

O conteúdo em Portugês estará disponível em breve.

Nourrissons nourris exclusivement au sein dans les six premiers mois de vie en Guinée-Bissau et dans les pays limitrophes, en pourcentage, 2000-2009
Nourrissons nourris exclusivement au sein dans les six premiers mois de vie en Guinée-Bissau et dans les pays limitrophes, en pourcentage, 2000-2009.JPG

Fardo de doença

Nutrição

Cobertura das intervenções

Equidade (lacuna de cobertura por quintil de riqueza; média de 8 indicadores-chave)

Políticas

Sistemas (Fluxos financeiros e recursos humanos)

Estado da vigilância

Notas de fim: fontes, métodos, abreviaturas, etc.

Guinea

Esta seção do perfil do sistema de saúde está estruturado da seguinte forma:

Résumé analytique

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Nourrissons nourris exclusivement au sein dans les six premiers mois de vie en Guinée et dans les pays limitrophes, en pourcentage, 2000-2009
Nourrissons nourris exclusivement au sein dans les six premiers mois de vie en Guinée et dans les pays limitrophes, en pourcentage, 2000-2009.JPG

Charge de morbidité

Nutrition

Couverture des Activités de santé

Equité

Politiques

Systèmes (flux des financements et ressources humaines)

Etat de la surveillance

Notes de fin: sources, méthodes, abréviations, etc.

Niger

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This analytical profile on child and adolescent health is structured as follows:

4.5.1 Analytical summary
4.5.2 Disease burden
4.5.3 Nutrition
4.5.4 Intervention coverage
4.5.4.1 Immunization coverage
4.5.4.2 Prevention
4.5.4.3 Newborn health
4.5.4.4 Case management
4.5.5 Equity
4.5.6 Policies
4.5.7 Systems (financial flows and human resources)
4.5.8 State of surveillance

Nigeria

O conteúdo em Portugês estará disponível em breve.

This analytical profile on child and adolescent health is structured as follows:

4.5.1 Analytical summary
4.5.2 Disease burden
4.5.3 Nutrition
4.5.4 Intervention coverage
4.5.4.1 Immunization coverage
4.5.4.2 Prevention
4.5.4.3 Newborn health
4.5.4.4 Case management
4.5.5 Equity
4.5.6 Policies
4.5.7 Systems (financial flows and human resources)
4.5.8 State of surveillance

Seychelles

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This analytical profile on child and adolescent health is structured as follows:

4.5.1 Analytical summary
4.5.2 Disease burden
4.5.3 Nutrition
4.5.4 Intervention coverage
4.5.4.1 Immunization coverage
4.5.4.2 Prevention
4.5.4.3 Newborn health
4.5.4.4 Case management
4.5.5 Equity
4.5.6 Policies
4.5.7 Systems (financial flows and human resources)
4.5.8 State of surveillance

Zambia

O conteúdo em Portugês estará disponível em breve.


This analytical profile on child and adolescent health is structured as follows:

4.5.1 Analytical summary
4.5.2 Disease burden
4.5.3 Nutrition
4.5.4 Intervention coverage
4.5.4.1 Immunization coverage
4.5.4.2 Prevention
4.5.4.3 Newborn health
4.5.4.4 Case management
4.5.5 Equity
4.5.6 Policies
4.5.7 Systems (financial flows and human resources)
4.5.8 State of surveillance

The country’s objectives for child and adolescent health are aligned to the MDGs and other relevant global strategies and targets.

Uganda

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This analytical profile on child and adolescent health is structured as follows:

4.5.1 Analytical summary
4.5.2 Disease burden
4.5.3 Nutrition
4.5.4 Intervention coverage
4.5.4.1 Immunization coverage
4.5.4.2 Prevention
4.5.4.3 Newborn health
4.5.4.4 Case management
4.5.5 Equity
4.5.6 Policies
4.5.7 Systems (financial flows and human resources)
4.5.8 State of surveillance

Togo

O conteúdo em Portugês estará disponível em breve.


This analytical profile on child and adolescent health is structured as follows:

4.5.1 Analytical summary
4.5.2 Disease burden
4.5.3 Nutrition
4.5.4 Intervention coverage
4.5.4.1 Immunization coverage
4.5.4.2 Prevention
4.5.4.3 Newborn health
4.5.4.4 Case management
4.5.5 Equity
4.5.6 Policies
4.5.7 Systems (financial flows and human resources)
4.5.8 State of surveillance

Tanzania

O conteúdo em Portugês estará disponível em breve.


This analytical profile on child and adolescent health is structured as follows:

4.5.1 Analytical summary
4.5.2 Disease burden
4.5.3 Nutrition
4.5.4 Intervention coverage
4.5.4.1 Immunization coverage
4.5.4.2 Prevention
4.5.4.3 Newborn health
4.5.4.4 Case management
4.5.5 Equity
4.5.6 Policies
4.5.7 Systems (financial flows and human resources)
4.5.8 State of surveillance

Swaziland

O conteúdo em Portugês estará disponível em breve.


This analytical profile on child and adolescent health is structured as follows:

4.5.1 Analytical summary
4.5.2 Disease burden
4.5.3 Nutrition
4.5.4 Intervention coverage
4.5.4.1 Immunization coverage
4.5.4.2 Prevention
4.5.4.3 Newborn health
4.5.4.4 Case management
4.5.5 Equity
4.5.6 Policies
4.5.7 Systems (financial flows and human resources)
4.5.8 State of surveillance

South_Sudan

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This analytical profile on child and adolescent health is structured as follows:

4.5.1 Analytical summary
4.5.2 Disease burden
4.5.3 Nutrition
4.5.4 Intervention coverage
4.5.4.1 Immunization coverage
4.5.4.2 Prevention
4.5.4.3 Newborn health
4.5.4.4 Case management
4.5.5 Equity
4.5.6 Policies
4.5.7 Systems (financial flows and human resources)
4.5.8 State of surveillance

South_Africa

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This analytical profile on child and adolescent health is structured as follows:

4.5.1 Analytical summary
4.5.2 Disease burden
4.5.3 Nutrition
4.5.4 Intervention coverage
4.5.4.1 Immunization coverage
4.5.4.2 Prevention
4.5.4.3 Newborn health
4.5.4.4 Case management
4.5.5 Equity
4.5.6 Policies
4.5.7 Systems (financial flows and human resources)
4.5.8 State of surveillance

Senegal

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This analytical profile on child and adolescent health is structured as follows:

4.5.1 Analytical summary
4.5.2 Disease burden
4.5.3 Nutrition
4.5.4 Intervention coverage
4.5.4.1 Immunization coverage
4.5.4.2 Prevention
4.5.4.3 Newborn health
4.5.4.4 Case management
4.5.5 Equity
4.5.6 Policies
4.5.7 Systems (financial flows and human resources)
4.5.8 State of surveillance

Rwanda

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This analytical profile on child and adolescent health is structured as follows:

4.5.1 Analytical summary
4.5.2 Disease burden
4.5.3 Nutrition
4.5.4 Intervention coverage
4.5.4.1 Immunization coverage
4.5.4.2 Prevention
4.5.4.3 Newborn health
4.5.4.4 Case management
4.5.5 Equity
4.5.6 Policies
4.5.7 Systems (financial flows and human resources)
4.5.8 State of surveillance

Sao_Tome_and_Principe

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This analytical profile on child and adolescent health is structured as follows:

Resumo analítico - Saúde infantil e dos adolescentes

O conteúdo em Portugês estará disponível em breve.


Nourrissons nourris exclusivement au sein dans les six premiers mois de vie au Sao Tomé-et-principe et dans les pays limitrophes, en pourcentage, 2000-2009
Nourrissons nourris exclusivement au sein dans les six premiers mois de vie au Sao Tome-et-principe et dans les pays limitrophes en pourcentage 2000-2009.JPG


Fardo de doença

Nutrição

Cobertura das intervenções

Equidade (lacuna de cobertura por quintil de riqueza; média de 8 indicadores-chave)

Políticas

Sistemas (Fluxos financeiros e recursos humanos)

Estado da vigilância

Notas de fim: fontes, métodos, abreviaturas, etc.

Gambia

Esta seção do perfil do sistema de saúde está estruturado da seguinte forma:

Analytical summary

O conteúdo em Portugês estará disponível em breve.

According to the Gambia Multiple Indicator Cluster Survey 2005–2006 (Round 3), the under-five mortality rate was 131 per 1000.[1] This figure represents a fall in mortality compared with the Gambia multiple indicator cluster survey 2000–2001 (Round 2), which reported a mortality rate of 141 per 1000.[2] Many factors related to the improvement in health services and social determinants of health have contributed to this success.

Malnutrition among children continues to be a major public health problem in the Gambia. Children aged under 5 years are vulnerable owing to poor feeding practices, inadequate care and increasing exposure to infection, with poor environmental sanitation being a major contributing factor. Although breastfeeding is a universal practice in the Gambia, exclusive breastfeeding practice stands at 41% and protein energy malnutrition is more prevalent among children aged under 5 years.[3]


Disease burden

Nutrition

Intervention coverage

Equity

Policies

Systems

State of surveillance

Endnotes: sources, methods, abbreviations, etc.

References

  1. Gambia Multiple Indicator Cluster Survey 2005–2006 (Round 3). Gambia Bureau of Statistics, Department of State for Finance and Economic Affairs
  2. Gambia Multiple Indicator Cluster Survey 2000–2001 (Round 2). Gambia Bureau of Statistics, Department of State for Finance and Economic Affairs
  3. National Nutrition Policy, 2000–2004. Banjul, Government of the Gambia

Gabon

Esta seção do perfil do sistema de saúde está estruturado da seguinte forma:

Résumé analytique

O conteúdo em Portugês estará disponível em breve.

Depuis 1990, les indicateurs en matière de mortalité des enfants de moins de 5 ans, tout comme celle de la mortalité infantile, sont orientés à la baisse. Entre 1990 et 2000, ces taux sont passés de 155‰ à 91,4‰ en ce qui concerne la mortalité des enfants de moins de 5 ans, et de 65,2‰ à 61,1‰ en 2000 pour la mortalité infantile.

L’embellie est nette, quoique légère. La couverture du pays en structures sanitaires pour la PEC des enfants et des adolescents est globalement satisfaisante, avec toutefois une offre de service beaucoup plus présente en milieu urbain qu’en milieu rural, et une persistance de dysfonctionnements qui obèrent la qualité de soins.

La mise en œuvre de la nouvelle Politique Nationale de Santé (2010-2016), validée en 2010, est attendue avec beaucoup d’espoir, de même que celle du Plan d’Accélération de la Survie de l’Enfant au Gabon (PASEG), pour améliorer les performances de la lutte contre la morbidité et la mortalité maternelle, néonatale, infanto juvénile et des adolescents.

Charge de morbidité

Nutrition

Couverture des Activités de santé

Equité

Politiques

Systèmes (flux des financements et ressources humaines)

Etat de la surveillance

Notes de fin: sources, méthodes, abréviations, etc.

Benin

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La réduction de la mortalité maternelle et néonatale constitue une préoccupation majeure pour le gouvernement du Bénin. En effet, les Objectifs du Millénaire pour le Développement (OMD) appellent à une réduction de la mortalité maternelle de trois-quarts entre 1990 et 2015 et de deux-tiers la mortalité infantile dans la même période. Au Bénin, le niveau et la tendance de la mortalité sont fonction des socio-économiques et culturelles, de l’environnement pathologique, des conditions sanitaires, des conditions politiques et des facteurs biogénétiques qui prévalent dans une population et dans les différentes couches sociales de cette population. Le Bénin présente encore un taux relativement élevé de mortalité chez les enfants même si l’on est sur une tendance baissière depuis 1996. En effet, selon les résultats de l’Enquête Démographique et de Santé et à indicateurs multiple du Bénin (EDS-MICS IV) 2011-2012 [1], le Taux de Mortalité Infanto-Juvénile (TMIJ) est passé de 166,5 pour mille naissances vivantes en 1996 à 160 en 2001, et à 125 en 2006 puis à 70 en 2011. La mortalité de 2011 révèle plusieurs disparités géographiques, de résidence et de niveau de vie. Les départements connaissent des niveaux très variés de mortalité. Six sur 12 départements présentent des niveaux de mortalité supérieurs à la moyenne nationale.

Botswana

Esta seção do perfil do sistema de saúde está estruturado da seguinte forma:

Analytical summary

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Besides programmes for pregnant women, neonates and children aged under 5 years, the Government of Botswana has established policies, programmes and procedures to protect the health of older children and adolescents. The Early Childhood Care and Education Policy of 2001 aims to provide preschool children with stimulation and play.

The School health policy and procedure manual[2] provides a guide for monitoring the growth and health status of schoolchildren. Some of the major services provided in the school health programme are feeding and immunization.


Disease burden

Nutrition

Intervention coverage

Equity

Policies

Systems

State of surveillance

Endnotes: sources, methods, abbreviations, etc.

References

  1. EDS-MICS 2011-2012. 464Ko
  2. Botswana national school health policy and procedure manual. Gaborone, Government of Botswana, Government printers, 1999

Angola

Esta seção do perfil do sistema de saúde está estruturado da seguinte forma:

Analytical summary

O conteúdo em Portugês estará disponível em breve.

Percentage of infants exclusively breastfed for the first 6 months of life in Angola and neighboring countries, 2000-2009
Percentage of infants exclusively breastfed for the first 6 months of life in Angola and neighboring countries 2000-2009.JPG

Disease burden

Nutrition

Intervention coverage

Equity

Policies

Systems

State of surveillance

Endnotes: sources, methods, abbreviations, etc.

Algeria

Résumé analytique

O conteúdo em Portugês estará disponível em breve.

Percentage of infants exclusively breastfed for the first 6 months of life in Algeria and neighboring countries, 2000-2009
Percentage of infants exclusively breastfed for the first 6 months of life in Algeria and neighboring countries 2000-2009.JPG

...: No data

Malawi

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This analytical profile on child and adolescent health is structured as follows:

4.5.1 Analytical summary
4.5.2 Disease burden
4.5.3 Nutrition
4.5.4 Intervention coverage
4.5.4.1 Immunization coverage
4.5.4.2 Prevention
4.5.4.3 Newborn health
4.5.4.4 Case management
4.5.5 Equity
4.5.6 Policies
4.5.7 Systems (financial flows and human resources)
4.5.8 State of surveillance

Madagascar

O conteúdo em Portugês estará disponível em breve.

This analytical profile on child and adolescent health is structured as follows:

4.5.1 Analytical summary
4.5.2 Disease burden
4.5.3 Nutrition
4.5.4 Intervention coverage
4.5.4.1 Immunization coverage
4.5.4.2 Prevention
4.5.4.3 Newborn health
4.5.4.4 Case management
4.5.5 Equity
4.5.6 Policies
4.5.7 Systems (financial flows and human resources)
4.5.8 State of surveillance

Liberia

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The Liberia demographic and health survey 2007[1] reported that the infant mortality rate in Liberia declined from 144 deaths per 1000 live births in 1986 to 71 deaths per 1000 live births in 2007, thus contributing toward achievement of Millennium Development Goal 4.

The under-five mortality rate followed the same trend, declining from 220 deaths per 1000 live births in 1986 to 110 deaths per 1000 live births in 2007. However, despite the progress that has been made, many health problems persist.

Lesotho

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This analytical profile on child and adolescent health is structured as follows:

4.5.1 Analytical summary
4.5.2 Disease burden
4.5.3 Nutrition
4.5.4 Intervention coverage
4.5.4.1 Immunization coverage
4.5.4.2 Prevention
4.5.4.3 Newborn health
4.5.4.4 Case management
4.5.5 Equity
4.5.6 Policies
4.5.7 Systems (financial flows and human resources)
4.5.8 State of surveillance

AFRO

Esta seção do perfil do sistema de saúde está estruturado da seguinte forma:

Analytical summary

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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.


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.


Disease burden

Although child survival has improved globally, sub-Saharan Africa has seen the smallest rate of improvement over the last 20 years. Deaths in children under five years of age have decreased globally from 12.5 million in 1990 to 8.8 million in 2008. However, sub-Sahara’s contribution to the global under-five mortality rate increased from 34% in 1990 to 50% in 2008. It is estimated that 4.2 million children under five years of age died in the African Region in 2008, mainly concentrated in sub-Saharan Africa and South Asia.

The fourth Millennium Development Goal (MDG 4) requires countries to reduce under-five mortality rate by two thirds by 2015. In the WHO African Region, under-five mortality rates have dropped from 180:1 000 live births in 1990 to 142:1 000 in 2008[2], the highest rate of any region in the world. Child mortality is currently decreasing at an average rate of 1.4% per year[3]. In order to meet the goal, countries need to reduce mortality by at least 8% each year until 2015.

Currently only six countries in the African Region are estimated to be on track to achieve MDG 4 (Botswana, Cape Verde, Eritrea, Malawi, Mauritius and Seychelles). Twenty-seven countries are estimated to be making insufficient progress, while the remaining 13 are making no progress[4],[5].


Most prevalent diseases and conditions

There are a small number of diseases and conditions that directly cause more than 80% of childhood deaths in Africa. These are neonatal conditions, diarrhoea, pneumonia, malaria, measles, and HIV/AIDS. Figure 1 shows the main causes of under-five mortality in the region.

Figure 1: Main causes of Neonatal and under-five mortality, African Region, 2008

Fig18section45CAHfig1.png

Source: WHO, World Health Statistics, 2010 and www.who.int/child_adolescent_health/media/CAH_death_u5_neonates_afro_2008.pdf

Diarrhoea

After neonatal conditions, diarrhoea is the leading cause of death in children under five in the WHO African Region, with 748 000 annual deaths. Nearly one in every five child deaths (17%) is due to diarrhoea. Only 37% of African children with diarrhoea receive the recommended treatment of low-osmolarity oral rehydration salts (ORS) and zinc, which would prevent most diarrhoea deaths. Limited trend data suggest that little progress has been made in this regard since the year 2000, and in some places the situation is worsening. Zinc supplements are largely unavailable in most African countries, while low-osmolarity ORS have been rolled out more slowly than expected, even five years after WHO and UNICEF recommended their use[6],[7].

Malaria

Malaria causes an estimated 16% of under-five deaths in the WHO African Region, or 704 000 deaths annually. At present, fewer than 20% of children in sub-Saharan Africa sleep under insecticide treated bednets (ITNs). Ethiopia, Mali, Niger, Rwanda, Sao Tome and Principe, and Zambia have distributed ITNs to between 68% and 100% of the vulnerable population, with recorded usage rates of between 44% and 63%.

In these six countries, only one third to two thirds of all fever cases are being treated. Although there has been dramatic improvement over the last six years, these countries still fall short of the agreed target of 80% coverage[8] Ten countries in the African Region, namely Botswana, Cape Verde, Eritrea, Namibia, Rwanda, Sao Tome and Principe, South Africa, Swaziland, United Republic of Tanzania (Zanzibar) and Zambia, have succeeded in reducing malaria cases by at least 50% between 2000 and 2008.

Pneumonia

Pneumonia causes an estimated 14% of deaths in children under five in the African Region, or 616 000 annual deaths[9]. Many countries are implementing innovative strategies to identify and manage pneumonia closer to home[10]. The antibiotics to treat pneumonia cost less than US $ 1 per child per treatment, and community health workers have been trained for as little as US$ 100 per trainee to diagnose and treat pneumonia. Malawi has begun to roll out community case management for pneumonia, soon to be followed by Rwanda, Uganda and Zambia.

HIV/AIDS

Four percent of child deaths in the Region are caused by HIV/AIDS, with 176 000 deaths annually. Antiretroviral drug therapy (ART) can greatly reduce mother-to-child transmission of HIV, and is essential for tackling AIDS-related child mortality in Africa. Kenya, Nigeria, South Africa and Zimbabwe account for nearly half (146 000) of all HIV-related deaths in children under five in the Region. For most African countries, access to ART for infants with HIV/AIDS remains a challenge. Opportunistic infections, including pneumonia, are the main cause of early death in HIV-infected infants. Cotrimoxazole prophylaxis coverage to prevent opportunistic infections among HIV-infected or exposed infants is low. In 2008, only 8% of HIV exposed infants are reported to have initiated this prophylaxis by two months of age.

Nutrition

Only nine countries on the continent are on track to reach MDG Target 1 of halving hunger and malnutrition by 2015. Africa has high levels of maternal and child undernutrition and poor feeding practices. Today, 25% of children under 5 years of age in Africa are underweight[11]. More than one third of children under five in Africa are stunted.1 And despite some recent progress, only 31% of infants in the Region are exclusively breastfed for their first six months. Complementary feeding frequently begins too early or too late, and foods are often nutritionally inadequate and unsafe.

A lack of certain key micronutrients can also damage the health of the mother and child, and increase the risk of maternal and child mortality. For example, anaemia affects 42% of pregnant women globally, ranging from 24% in the Americas to 57% in Africa, raising the risk of premature birth, low birth weight, haemorrhage and sepsis[12]. Zinc deficiency in children is associated with increased risk of pneumonia, diarrhoea and malaria. However, the national prevalence of zinc is high in most countries of sub-Saharan Africa[13]. Vitamin A supplementation to children is implemented by 72% of countries, while salt iodization is implemented by 61%.2

The nutritional challenges faced by most African countries are well known. They include meeting the energy needs and strengthening the immune systems of people with communicable diseases such as HIV/AIDS and tuberculosis; increasing household food security through improved food availability and affordability; increasing dietary intake across the life cycle through appropriate feeding practices and debunking of food taboos; and addressing the high consumption of sugars and fats that contribute to diet-related disorders.

WHO is currently collaborating with Member States on the development of a comprehensive plan on infant and young child nutrition. This is a critical component of a global multisectoral nutrition framework to address the challenges outlined above.

Intervention coverage

In nearly all cases, the diseases and conditions that cause child deaths are preventable, and are treatable with proven interventions. But these interventions remain unavailable or inaccessible to many children in the African region.

The 2010 report, "Countdown to 2015", shows data from the 68 countries where more than 95% of global maternal and child deaths occur. Of these, 39 countries are in the African region. The report indicates that most countries have high or increasing coverage for preventive interventions such as vaccinations, with measles immunization at 80%, and vitamin A supplementation (2 doses) at 73%[1]. However, it also shows that very few countries are making progress in reaching women and children with clinical care services such as skilled attendants at delivery (47%), treatment of pneumonia (43%), diarrhoea (37%) and malaria (35%)[2]. Implementation of interventions that require behavioural and social change, such as exclusive breastfeeding up to the age of six months (31%), is also low.

In sub-Saharan Africa, antiretroviral coverage for preventing mother-to-child transmission of HIV currently stands at 45%, while access to ART for children needing treatment is only 35%[14]. Postnatal care programmes are among the weakest of all interventions for maternal and child health in the African Region. Where there is least contact with the health system, 870 000 newborns die annually in their first week of life[15]. Figure 2 shows coverage rates of some key child survival interventions.

Figure 2: Coverage of Child Survival Interventions, AFRO 2008 Fig19section45CAHfig2.jpg

Source: WHO World Health Statistics 2010, UNICEF SOWC, 2011

Immunization coverage

Although overall progress on improving child survival in Africa has been inadequate, there have been some key successes. The adoption of effective measles mortality reduction strategies in Africa has resulted in a 92% reduction in the number of deaths of children under five years from this cause between 2000 and 2008 – a reduction from over 395 000 to less than 32 000 [3]. Botswana, Malawi, Namibia, and South Africa have reduced measles deaths to near zero. However, reduction in funding available for measles prevention activities in countries has led to recent outbreaks in several African countries that threaten the gains achieved.

Progress has also been made on preventive interventions such as vitamin A supplementation. But in other areas, much work remains. Rotavirus and pneumococcal vaccine for preventing diarrhoea and pneumonia respectively are not available in most African countries. Thirty-one percent of the people in sub-Saharan Africa lack access to improved sanitation facilities, and 28% still practise open defecation. Forty-two percent of people in sub-Saharan Africa lack access to improved drinking-water sources.

Newborn health

Deaths in the first month of life account for more than a quarter of child mortality in sub-Saharan Africa, taking an annual toll of 1.2 million cases. While a number of countries have seen recent gains in child survival, neonatal mortality has, for the most part, remained stagnant over the last decade. Deaths in the first month of life are primarily due to birth asphyxia (not breathing at birth), complications of preterm birth, and severe infections such as sepsis and pneumonia. Neonatal tetanus causes about 24 000 deaths annually, despite the availability of tetanus toxoid immunization during pregnancy that costs less than US $ 0.50 US cents[16].

Approximately one third of newborn deaths could be prevented through improved family and community care alone, such as better hygiene standards at birth, both in health facilities and in homes, early and exclusive breastfeeding, better recognition of signs that the child is seriously ill, timely and appropriate care-seeking, and treatment for newborn infections.7 A range of known and affordable interventions exists, which if implemented fully, could prevent 63% of current childhood mortality.

Case management

The Integrated Management of Childhood Illness strategy (IMCI) remains key to reducing child mortality. The strategy includes improving case management of sick children at first-level health facilities, strengthening health systems and improving family and community practices to promote child health. In the African Region, 22 countries are now implementing IMCI in over 75% of districts, compared with only 10 countries in 2007.

Equity

National data on coverage levels often hide important disparities among population subgroups. Equity analyses, including systematic breakdowns of key coverage indicators by wealth quintiles, have been done by the "Countdown to 2015" initiative, in which WHO plays a major role.

A mean coverage index, consisting of an unweighted average of four intervention areas across the continuum of care, has been developed. Each area includes selected indicators for eight reproductive, maternal, newborn and child interventions:

1. family planning: need for family planning satisfied;
2. maternal and newborn health: at least one antenatal visit and skilled attendant at delivery;
3. immunizations: measles, BCG and DPT3; and
4. curative child care: diarrhoea and pneumonia management (ORS + zinc and continued feeding, and care-seeking for pneumonia).

To give an example, according to the "Countdown to 2015" report, the mean coverage index of the eight interventions in Benin is 73% among children in the richest wealth quintile, compared with 41% in the poorest wealth quintile.

This report also indicates that countries in the African Region with the lowest gap in coverage for the eight interventions are Rwanda, South Africa, Swaziland and Zambia. Countries with the largest gap in coverage are Chad, Madagascar and Nigeria. Countries with the lowest coverage – below 25% in the poorest population groups – are Chad, Ethiopia and Nigeria.

In most countries with Demographic and Health Survey data, intervention coverage is substantially higher among mothers and children from better-off households than among those from poor households.

The equity analysis gaps are markedly larger for maternal and newborn interventions than interventions delivered to older children. Interventions that are most frequently delivered in fixed health facilities, for example antenatal, delivery, or postnatal care, tend to show greater disparities than those delivered at the community level, such as vaccinations, vitamin A supplementation or ITNs).

Policies

The year 2006 saw the development by WHO, UNICEF and the World Bank of a Regional Child Survival Strategy[17]. It aims to scale up a defined set of effective child survival interventions in African countries, including antenatal care, newborn care, appropriate infant feeding, immunization, management of common childhood illnesses and the use of ITNs. By the end 2009, 27 countries had developed or updated national child survival policies, strategies or plans, compared to only 11 in 2007.

Systems

Beyond the negative impact of HIV/AIDS and conflict, coverage of effective health and nutrition interventions and practices in many countries remains low and inequitable. Key obstacles are found in public policies regarding budget allocations, and the development, deployment and retention of human resources.

The majority of child mortality causes can be correlated with economic, social and environmental factors. Dramatic declines in child mortality are attributable both to control of communicable diseases, and to policies ensuring better nutrition, improved standards of living, and social protection.

While macroeconomic policies and poverty reduction strategies address the underlying causes of high child mortality, they do not affect the supply, demand and access to health care among families and communities. Policies and action in the water and sanitation, education, and transport sectors — and in the national legal framework — need to be combined with scaling up effective health interventions to ensure sustained improvements in child health and survival, and equitable access to services.


Health Financing

Maternal, newborn and child health services should be available, of good quality, and free at the point of delivery in order to remove financial barriers to access and utilization.

An important obstacle to the uptake of services is the expected cost of care. To reach universal coverage, financial barriers to service utilization need to be removed, and families protected against catastrophic expenditures on health care. Therefore, user fees need to be phased out and replaced by policies that promote a shift from out-of-pocket payments to pre-payment and pooling.

Catastrophic payments and fairness in financial contributions for health care are of increasing concern to many governments[18]. Out-of-pocket financing for health care is common in many African countries. It is generally agreed that above 15% out-of-pocket financing for health care makes households more vulnerable to catastrophic payments[19].

A key step towards universal coverage is therefore to move away from out-of-pocket payments through prepayment and risk-pooling schemes. Several countries are moving in this direction. In Mali and Rwanda, social health insurance schemes are achieving high coverage and showing a positive effect on access to priority health services, including maternal, newborn and child health. Uganda has succeeded in increasing essential health service coverage, particularly among the poor, by removing user fees.

Median per capita government expenditure on health in the African Region is US$ 34 (in 2007 international dollars), with only six countries devoting the recommended level of at least 15% of their national budgets to health. However, these six still have low indicators in one or more MDG categories, principally due to low per capita investment in health and social determinants[20]. Commitment by African countries to increasing government expenditure on health to at least 15% therefore remains a challenge.

Access to maternal and child care

A series of intermediate factors makes some children more likely to fall prey to disease or medical conditions, limiting their chances of recovery. These factors include the absence of essential health care or the inability of mothers and their children to access it. At minimum, health systems should be equipped, staffed and organized to deliver proven interventions, effectively and equitably, to those mothers, newborns and children who need them, particularly those from the poorest and most marginalized communities.

These systems need to operate across the ‘continuum of care’. Services must be provided to women of reproductive age, through pregnancy, birth, and the early days and years of a child’s life. There must also be links between care provided in the home, locally in the community, and in hospitals and other health facilities.

Yet in many poor countries and communities, strong health systems operating across the continuum of care simply do not exist. Health facilities are often too far away or too expensive to access. In many cases, those that do exist are inadequately staffed and lack essential medicines and equipment. Poor people are therefore reluctant to invest precious time, effort and money in seeking care that may be unavailable or of poor quality.

Human Resources

Among the 39 African countries monitored by the ‘Countdown process’, only four (10%) meet the critical threshold of 23 doctors, nurses and midwives per 10 000 people generally considered necessary to deliver essential health services. The shortage is compounded by uneven geographic distribution within countries. Increased investment in education of health workers, strategies for motivating health workers to remain in underserved areas, and effective regulatory frameworks (including those for skills substitution) are among the effective policy options for addressing critical workforce shortages and maldistribution.

Ethiopia, Ghana, Malawi and Rwanda are among the countries addressing workforce shortages and maldistribution challenges through comprehensive strategies, including deployment of health service providers at the community level. The United Republic of Tanzania and Zambia have authorized non-physician clinicians to carry out certain specialized tasks. More than 90% of caesarean sections in rural areas of Malawi and Mozambique are successfully performed by surgical technicians, with low rates of morbidity and mortality.

State of surveillance

Monitoring and evaluation in relation to child survival in the African Region is mainly based on indicators to assess inputs such as implementation of appropriate policies and strategies, and the availability of human resources. It also relies on output and outcome indicators such as the number of health workers trained in IMCI, supervisory visits completed as planned, the availability of drugs, supplies and equipment, the quality of case-management of sick children, caretaker knowledge and practices, and the level of coverage of key interventions. It relies, finally, on health status indicators such as mortality and nutritional status. Disease surveillance is well developed for malaria, HIV/AIDS and vaccine-preventable diseases, but much less so for diarrhoea and pneumonia.

Endnotes: sources, methods, abbreviations, etc.

List of Tables/Figures

Atlas Figure 84: Under 5 mortality rate per 1 000 live births in the African Region by country, 2009 and 1990.

Figure 1: Main causes of Neonatal and under-five mortality, African Region, 2008 Figure 2: Coverage of Child Survival Interventions, AFRO 2008

References

1. World Health Statistics 2009. WHO, Geneva.

2. The State of Africa’s Children 2010. UNICEF, New York.

3. Countdown Coverage Writing Group on behalf of the Countdown to 2015 Core Group: Countdown to 2015 for maternal, newborn and child survival: the 2008 report on tracking coverage of interventions, Lancet 317:1247-58.

4. The State of Africa’s Children, 2010. Celebrating 20 Years of the Convention on the Rights of the Child. UNICEF, New York (Table 10. The rate of progress).

5. Joint statement: clinical management of acute diarrhoea. WHO and UNICEF, 2004. http://www.who.int/child_adolescent_health/documents/who_fch_cah_04_7/en/index.html (accessed April 2, 2010).

6. World Malaria Report 2008. WHO, Geneva. available at http://malaria.who.int/wmr2008/malaria2008.pdf

7. World Health Statistics 2009. WHO, Geneva.

8. Marsh, DR et al., 2008. Community case management of pneumonia: at a tipping point? Bull. World Health Org., 86 (5):381-9.

9. Briefing for the Day of the African Child Reaching Millennium Development Goal 4: What progress has Africa made and what more needs to be done? UNICEF, New York 2009

10. de Benoist B, McLean E, Egli I, and Cogswell M (eds), 2008. Worldwide prevalence of anaemia 1993–2005: WHO global database on anaemia, World Health Organization and the Centers for Disease Control and Prevention. Accessed 06 April 2010 http://whqlibdoc.who.int/publications/2008/9789241596657_eng.pdf

11. Black, RE et al., 2008. Maternal and child undernutrition: Global and regional exposures and health consequences. Lancet, 371:243-260

12. Towards Universal Access: Scaling up priority HIV and AIDS interventions in the health sector, progress report 2009. WHO, UNAIDS, and UNICEF.

13. Lawn J, Kerber K, and Eds, Opportunities for Africa’s Newborns: practical data, policy and programmatic support for newborn care in Africa. 2006, Cape Town: PMNCH, Save the Children, UNFPA, UNICEF, USAID, WHO.

14. WHO/IVB estimates, October 2009, based on Wolfson et al, Lancet 2007:369: 191-200

15. Africa Public Health Alliance and 15%+ Campaign, 2010 Africa Health Financing Scorecard, URL:http://www.hoffmanpr.com/world/PMNCH/InvestmentinAfrica/A3 MDGs%20Health%20Financing%20Scorecard-First%20Quarter%202010..pdf

16. Child Survival: A Strategy for the African Region, 2006. WHO Regional Office for Africa (AFR/RC56/13), World Health Organization.

17. Manzi F, Schellenberg JA, Adam T, Mshinda H, Victoria CG, Bryce J, 2005. Out-of-pocket payments for under-five health care in rural southern Tanzania. Health Policy and Planning. Vol. 20 Supp. 1:185-193

18. Countdown Coverage Writing Group on behalf of the Countdown to 2015 Core Group: Countdown to 2015 for maternal, newborn and child survival: the 2008 report on tracking coverage of interventions, Lancet 317:1247-58.

References

  1. Liberia demographic and health survey 2007 (2.5Mb). Monrovia, Liberia Institute of Statistics and Geo-Information Services, Ministry of Health and Social Welfare National AIDS Control Program and Macro International, 2008
  2. World Health Statistics 2009. WHO, Geneva.
  3. The State of Africa’s Children 2010. UNICEF, New York.
  4. Countdown Coverage Writing Group on behalf of the Countdown to 2015 Core Group: Countdown to 2015 for maternal, newborn and child survival: the 2008 report on tracking coverage of interventions, Lancet 317:1247-58.
  5. The State of Africa’s Children, 2010. Celebrating 20 Years of the Convention on the Rights of the Child. UNICEF, New York (Table 10. The rate of progress).
  6. Joint statement: clinical management of acute diarrhoea. WHO and UNICEF, 2004. http://www.who.int/child_adolescent_health/documents/who_fch_cah_04_7/en/index.html (accessed April 2, 2010).
  7. WHO/IVB estimates, October 2009, based on Wolfson et al, Lancet 2007:369: 191-200
  8. World Malaria Report 2008. WHO, Geneva. Available at http://malaria.who.int/wmr2008/malaria2008.pdf
  9. World Health Statistics 2009. WHO, Geneva.
  10. Marsh, DR et al., 2008. Community case management of pneumonia: at a tipping point? Bull. World Health Org., 86 (5):381-9.
  11. Briefing for the Day of the African Child Reaching Millennium Development Goal 4: What progress has Africa made and what more needs to be done? UNICEF, New York 2009
  12. de Benoist B, McLean E, Egli I, and Cogswell M (eds), 2008. Worldwide prevalence of anaemia 1993–2005: WHO global database on anaemia, World Health Organization and the Centers for Disease Control and Prevention. Accessed 06 April 2010 http://whqlibdoc.who.int/publications/2008/9789241596657_eng.pdf
  13. Black, RE et al., 2008. Maternal and child undernutrition: Global and regional exposures and health consequences. Lancet, 371:243-260
  14. Towards Universal Access: Scaling up priority HIV and AIDS interventions in the health sector, progress report 2009. WHO, UNAIDS, and UNICEF.
  15. Lawn J, Kerber K, and Eds, Opportunities for Africa’s Newborns: practical data, policy and programmatic support for newborn care in Africa. 2006, Cape Town: PMNCH, Save the Children, UNFPA, UNICEF, USAID, WHO.
  16. World Health Statistics 2009. WHO, Geneva.
  17. Africa Public Health Alliance and 15%+ Campaign, 2010 Africa Health Financing Scorecard, URL:http://www.hoffmanpr.com/world/PMNCH/InvestmentinAfrica/A3MDGs%20Health%20Financing%20Scorecard-First%20Quarter%202010.pdf
  18. Child Survival: A Strategy for the African Region, 2006. WHO Regional Office for Africa (AFR/RC56/13), World Health Organization.
  19. Manzi F, Schellenberg JA, Adam T, Mshinda H, Victoria CG, Bryce J, 2005. Out-of-pocket payments for under-five health care in rural southern Tanzania. Health Policy and Planning. Vol. 20 Supp. 1:185-193
  20. Countdown Coverage Writing Group on behalf of the Countdown to 2015 Core Group: Countdown to 2015 for maternal, newborn and child survival: the 2008 report on tracking coverage of interventions, Lancet 317:1247-58.

Title

Saúde infantil e dos adolescentes

Burkina_Faso

O conteúdo em Portugês estará disponível em breve.

20. santé infantile.jpg

De façon générale, quoique encore élevés, les niveaux de mortalité infantile et juvénile sont en baisse par rapport à leurs niveaux antérieurs. En effet, en 2006, selon les données du RGPH, un enfant de moins d'un an court un risque de décéder de 92 pour mille et un enfant de la tranche d'âge 1-4 ans, un risque de 55 pour mille. Les enfants du milieu rural courent quelque soit l'année considérée plus de risque de décéder que ceux du milieu urbain.

Cameroon

Esta seção do perfil do sistema de saúde está estruturado da seguinte forma:

Résumé analytique

O conteúdo em Portugês estará disponível em breve.

Nourrissons nourris exclusivement au sein dans les six premiers mois de vie au Cameroun et dans les pays limitrophes, en pourcentage, 2000-2009
Nourrissons nourris exclusivement au sein dans les six premiers mois de vie au Cameroun et dans les pays limitrophes, en pourcentage, 2000-2009.JPG

...: Données indisponibles

Charge de morbidité

Nutrition

Couverture des Activités de santé

Equité

Politiques

Systèmes (flux des financements et ressources humaines)

Etat de la surveillance

Notes de fin: sources, méthodes, abréviations, etc.

Burundi

Esta seção do perfil do sistema de saúde está estruturado da seguinte forma:

Résumé analytique

O conteúdo em Portugês estará disponível em breve.

La Santé des enfants reste au cœur des préoccupations du pays. Les résultats préliminaires de l’EDS [1] réalisée en 2010 rapportent un taux de mortalité infantile et juvénile respectivement de 59% et de 96%. Les progrès enregistrés sont liés à plusieurs facteurs notamment la gratuité des soins des enfants de moins de cinq ans, le renforcement de la vaccination de routine, la prise en charge intégrée des maladies de l’enfant, au renforcement des activités de prise en charge des cas de malnutrition , la motivation des prestataires de soins et la prise en charge des indigents.

Les données 2009 de l’EPISTAT (Service d’Epidémiologie et des Statistiques ) montrent que la morbidité et la mortalité enregistrées dans les structures de santé restent élevées chez les enfants et les jeunes. Parmi tous les nouveaux cas de maladies enregistrés, 70% sont des enfants de moins de 15 ans dont 59% de moins de 5 ans.


Charge de morbidité

Nutrition

Couverture des Activités de santé

Equité

Politiques

Systèmes (flux des financements et ressources humaines)

Etat de la surveillance

Notes de fin: sources, méthodes, abréviations, etc.

Référence

  1. Résultats préliminaires EDS 2010. 840Ko

Equatorial_Guinea

O conteúdo em Portugês estará disponível em breve.

Santé des enfants:

La santé des enfants de moins de 5 ans c’est un problème considérable où il ya une incidence plus élevée de morbidité et de mortalité influencée par plusieurs facteurs, notamment l'état de pauvreté des familles, accompagnés par la faible accessibilité aux services de santé et de difficultés dans l'approvisionnement de médicaments essentiels; avec faible niveau d'instruction des mères qui ont conduit à l'état de malnutrition des enfants.

Malgré tout l’effort du gouvernement le taux de mortalité infantile reste encore de 93 pour 1000 avec une forte incidence des maladies transmissibles; où la necécité de renforcer la stratégie de PCME.

Ethiopia

O conteúdo em Portugês estará disponível em breve.

Improving child health is one of the priorities of the Health Sector Development Programme IV[1] covering the period 2010–2015. The infant mortality rate is 59 deaths per 1000 live births. The estimate of child mortality is 31 deaths per 1000 children surviving to 12 months of age, while the overall under-five mortality rate is 88 deaths per 1000 live births. In addition, 67% of all deaths in children aged under 5 years in Ethiopia take place before the child’s first birthday.[2] Malaria, pneumonia, diarrhoea and nutrition deficiencies are among the major causes of child mortality. A high mortality and disease burden from nutrition-related factors is also prominent among children aged under 5 years.[3]

Malnutrition is widespread across the country. Overall, 29% of all children are underweight and 9% of children are severely underweight. Also, 31% of male children are underweight compared with 27% of female children. The percentage of children who are underweight is eight times higher in children with mothers with no education compared with children whose mothers have more than secondary education.[2]

Eritrea

Esta seção do perfil do sistema de saúde está estruturado da seguinte forma:

Analytical summary

O conteúdo em Portugês estará disponível em breve.

Percentage of infants exclusively breastfed for the first 6 months of life in Eritrea and neighboring countries, 2000-2009
Percentage of infants exclusively breastfed for the first 6 months of life in Eritrea and neighboring countries, 2000-2009.JPG

Disease burden

Nutrition

Intervention coverage

Equity

Policies

Systems

State of surveillance

Endnotes: sources, methods, abbreviations, etc.

Democratic_Republic_of_the_Congo

Esta seção do perfil do sistema de saúde está estruturado da seguinte forma:

Résumé analytique

Charge de morbidité

Nutrition

Couverture des Activités de santé

Equité

Politiques

Systèmes (flux des financements et ressources humaines)

Etat de la surveillance

Notes de fin: sources, méthodes, abréviations, etc.

Côte_d'Ivoire

Esta seção do perfil do sistema de saúde está estruturado da seguinte forma:

Résumé analytique

Charge de morbidité

Nutrition

Couverture des Activités de santé

Equité

Politiques

Systèmes (flux des financements et ressources humaines)

Etat de la surveillance

Notes de fin: sources, méthodes, abréviations, etc.

Congo

Les adolescents représentent près d’un tiers de la population avec une forte concentration en milieu urbain (56,6%). On note une précocité des rapports sexuels souvent non protégés (âge moyen 14 ans).

Ceci corrobore la forte prévalence des grossesses chez les adolescentes (8,5%). le déficit des connaissances en santé de la reproduction, l’absence des services adaptés et la faible utilisation des services en la matière exposent de plus en plus les adolescents à des comportements néfastes pour leur santé génésique : tabagisme, violence, consommation abusive d’alcool, des drogues et autres substances hallucinogènes.

Comoros

Esta seção do perfil do sistema de saúde está estruturado da seguinte forma:

Résumé analytique

O conteúdo em Portugês estará disponível em breve.

Campagne de vaccination à Anjouan

Selon une enquête sur la santé on note que sur 2227 jeunes et adolescents âgés de 10 à 24 ans réalisée en 2006 a relevé les informations suivantes : la majorité des adolescents (89%) a fréquenté un établissement scolaire, les principales causes de morbidité chez les adolescents sont le paludisme (22%) et les caries dentaires (15%), plus d’un adolescent sur deux (55%) fréquente une structure sanitaire en cas de maladie et 45% d’entre eux consultent les médecins publics et(39%) des adolescents qui adoptent comme démarche l’automédication.

En matière de connaissance de santé sexuelle et reproductive, l’étude révèle que 41% des adolescents sont sexuellement actifs. L’âge minimum au premier rapport sexuel est de 7 ans, pendant que l’âge moyen est évalué à 16 ans. Environ 32% des adolescents sexuellement actifs utilisent toujours le préservatif, 29% d’entre eux l’utilise rarement pendant qu’une importante proportion (39%) pratique des rapports sexuels non protégés.


Charge de morbidité

Nutrition

Couverture des Activités de santé

Equité

Politiques

Systèmes (flux des financements et ressources humaines)

Etat de la surveillance

Notes de fin: sources, méthodes, abréviations, etc.

Chad

Esta seção do perfil do sistema de saúde está estruturado da seguinte forma:

Résumé analytique

Charge de morbidité

Nutrition

Couverture des Activités de santé

Equité

Politiques

Systèmes (flux des financements et ressources humaines)

Etat de la surveillance

Notes de fin: sources, méthodes, abréviations, etc.

Central_African_Republic

Esta seção do perfil do sistema de saúde está estruturado da seguinte forma:

Résumé analytique

Charge de morbidité

Nutrition

Couverture des Activités de santé

Equité

Politiques

Systèmes (flux des financements et ressources humaines)

Etat de la surveillance

Notes de fin: sources, méthodes, abréviations, etc.

Cape_Verde

Esta seção do perfil do sistema de saúde está estruturado da seguinte forma:

Resumo analítico - Saúde infantil e dos adolescentes

As doenças respiratórias agudas, diarreicas e as afecções perinatais constituem as principais causas de morbi-mortalidade infantil, embora não seja possível fazer uma análise comparativa da evolução.

Criancas.jpg

A mortalidade de menores de cinco anos e a juvenil tem melhorado de forma continuada e sustentada nas últimas décadas[4].

A incidência das doenças alvo do PAV (Tuberculose, Hepatite B, Polio, Difteria, Tosse Convulsa, Tétano, Sarampo) tem diminuído significativamente, não se registando surtos desde as últimas epidemias de Sarampo em 1997 e de Poliomielite em 2000.

Considera- se que o Tétano neonatal está eliminado em Cabo Verde com 2 casos notificados nos últimos 6 anos, sendo um em 2000 e outro em 2002.

Fardo de doença

Verifica-se uma diminuição tendencial da mortalidade infantil no país que passou de 57/1000 nascidos vivos em 1995 para 26,8 no ano 2000 e para 21,5 por mil em 2006[5], tendo diminuído para 20,1 em 2009, o que significa uma redução em 35,3% dos casos.

A mortalidade de crianças menores de 5 anos segue a mesma disposição reduziu-se de 76,8 por mil em 1995 para 32,6 em 2000, este reduziu-se para 24,8 em 2006 e finalmente para 23,7 em 2009[6], traduzindo numa redução de 30,9% dos casos.


Nutrição

A situação actual da nutrição em Cabo Verde é caracterizada por uma fase de transição epidemiológica denominada como “o duplo fardo da malnutrição”, onde se encontram doenças de malnutrição por carência e por excesso.

Vários estudos relativos à prevalência da malnutrição, realizados no país revelaram uma predominância da malnutrição crónica, e um aumento de frequência da forma aguda. A malnutrição crónica em menores de 5 anos evoluiu de 16,2% em 1994 para 15% em 2006. A malnutrição aguda aumentou de 5,6% em 1994 para 7% em 2006.

Não existindo estudos recentes, apresenta-se os disponíveis, nomeadamente o realizado em 1996, referente à carência de iodo em crianças de idade entre 6 e 12 anos revelou uma deficiência ligeira em todo o país e uma prevalência de bócio endémico da ordem dos 25,5%.

Outro estudo transversal em menores de 5 anos de idade, no mesmo ano, apontou para uma hipovitaminose A de cerca de 2%. De acordo com os estudos realizados a anemia ferripriva em menores de 5 anos evoluiu de 70% em 1996 para 52,1% em 2005, que enquanto nas grávidas passou de 42% para 43,2% no mesmo período.

Em relação ao aleitamento materno exclusivo (AME), até à idade de 6 meses, os estudos mostram uma evolução significativa tendo passado de 38,9% e em1998 para 59,6% em 2005 (IDSR II). É promovido em todas as estruturas de saúde e sobretudo através da Iniciativa «Hospital Amigo da Criança», em 5 estruturas de saúde, com dois hospitais certificados amigos da criança no país.

Falando da malnutrição por excesso dados de 2004 apontam uma prevalência de sobrepeso de 24% e de obesidade de 7% nos meios urbanos, com especial incidência na Praia Urbana.

Não existe um plano estratégico sobre alimentação e nutrição da criança e as actividades no domínio da nutrição, aconselhamento e de recuperação nutricional são incipientes nos serviços de Saúde Reprodutiva.

No quadro do atendimento global da criança, as mães recebem uma educação alimentar e nutricional, com vista a desmistificar determinadas crenças tradicionais e adequar os recursos disponíveis a uma alimentação mais equilibrada e racional. É necessário re-dinamizar os espaços de orientação e recuperação nutricional nos centros de SR.


Cobertura das intervenções

Cobertura de vacinação

O Programa Alargado de Vacinação (PAV), cobre actualmente oito doenças (Tuberculose, Hepatite B, Poliomielite, Difteria, Tosse Convulsa, Tétano e Sarampo).

Cabo Verde aderiu às orientações para erradicação da poliomielite instituindo as normas internacionalmente exigidas em particular, a vigilância activa das PFA e a criação do Comité de Erradicação da Poliomielite e do Comité de Peritos desde o ano 2002.

Medidas estão também em curso para o controlo acelerado do sarampo tendo em vista a sua eliminação, que consistem na vigilância, campanhas de vacinação cada 4 anos e no aumento da cobertura vacinal de rotina, de 74,3% em 2007 no entanto ainda inferior à meta preconizada, superior a 90%.

A Estratégia de AIDI, adoptada em 2004 começou a ser implementada a partir de 2007 com a formação de formadores e dos primeiros prestadores de cuidados, estando na fase piloto de implementação, pelo que tem ainda uma abrangência limitada aos concelhos de Praia, Ribeira Grande, Paúl e Porto Novo. Contudo, constata-se que a oferta de cuidados em neonatologia é possível apenas nos hospitais centrais e regionais.

Segundo os dados disponíveis dos relatórios de inquérito de cobertura vacinal realizados em 2010 e 2011, dão conta de uma cobertura vacinal realizados em 2009 e 2010, com taxas de cobertura entre os 93,9 e 99,9% (valores em percentagem, respectivamente)[7];


Tabela 4 5 4 1 1 Cobertura Vacinal do PAV.png


Prevenção

A nível da prevenção da Saúde infantil e dos adolescentes, várias actividades são levadas a cabo, nomeadamente:

  • Atendimento infantil e vacinação;
  • Consultas pré-natais e pós partos;
  • Vacinação das grávidas;
  • Atendimento ao parto e ao aborto;
  • Prevenção e tratamento do cancro do colo do útero e da mama;
  • Cuidados de saúde reprodutiva aos adolescentes e jovens;
  • Cuidados de saúde reprodutiva para os homens;
  • Planeamento familiar/consulta de infertilidade;
  • Prevenção e tratamento das IST/VIH/SIDA;
  • Nutrição;
  • Promoção da Saúde/Comunicação para mudança de comportamento[8].



Saúde dos recém-nascidos

Cabo Verde é o segundo país africano onde numa lista de entre 11 Países Africanos onde os recém-nascidos correm menor risco de morte[9].

Os dados de 2010 revelaram um total de 232 óbitos infantis registados durante o ano, dos quais 48,7%, ou seja, 113 óbitos neonatal precoce, 13,8% do valor total, 32 óbitos neonatal tardia, e 37,5, isto é, 87 óbitos pós-neonatal[10].

Quando se fala de óbitos perinatais, a mesma fonte revela um total de 274 mortos perinatais, dos quais 58,4%, isto é, 160 foram nados-mortos, e os restantes 41,6%, 114 óbitos entre os 0-6 dia, sendo destes 65 de sexo masculino e 49 feminino.


Gestão de casos

A monitorização do crescimento e do desenvolvimento da criança é bem desempenhada pelo programa de SR.

A PNS[11] preconiza-se a efectivação duma estratégia de AIDI, incluído no pacote de cuidados essenciais, em todas as estruturas de saúde.

Não está estabelecido um programa integrado de actividades promocionais, preventivas, curativas ou de outra natureza para com as crianças de 5 anos ou mais, para além do Programa de Saúde escolar implementado pelo Ministério da Educação.

No entanto, esforços no sentido de melhorar o acompanhamento da gravidez, da assistência ao parto e pós-parto, com vista a:

  • reduzir o peso das afecções perinatais na mortalidade infantil;
  • reforçar o PAV para melhorar os níveis de cobertura;
  • generalizar a estratégia de AIDI; e
  • dinamizar a parceria com o Ministério da Educação no tocante à implementação do Programa de Saúde escolar.


A nível operacional várias outras acções são desenvolvidas, desde:

  • a criação de condições humanas, técnicas e materiais, em cada estrutura de saúde, para a prática duma "atenção integrada às doenças da infância", AIDI adoptada pelo país, incluindo os cuidados neonatais;
  • o reforço da capacidade de resposta do PAV incluindo a introdução de novas vacinas;
  • a garantia dum mecanismo eficaz de vigilância e resposta das doenças preveníveis por vacina, no quadro da vigilância integrada das doenças com potencial epidémico;
  • o reforço das actividades de IEC orientadas para a sobrevivência da criança;
  • a participação activa no programa de saúde escolar em parceria com o Ministério da Educação[12].


Equidade (lacuna de cobertura por quintil de riqueza; média de 8 indicadores-chave)

Entre outros problemas que afectam a prestação de cuidados de saúde às crianças e que podem ter algum peso na mortalidade infantil[13], destacam-se:

  • Fraca qualidade dos cuidados
  • Fraca comunicação com a comunidade
  • Deficiências na organização das estratégias de vacinação
  • Deficiências no registo dos dados de vacinação
  • Gestão dos dados de vacinação
  • Recursos humanos mal distribuídos
  • Insuficiência dos recursos humanos
  • Insuficiente acessibilidade física a centros de cuidados de urgência



Políticas

A política Nacional de atendimento às crianças e adolescentes, encontra-se incluída em vários planos e programas nacionais, nomeadamente:

  • Política Nacional de População e Planos Nacionais de Desenvolvimento;
  • Estratégia de crescimento e redução da Pobreza;
  • Política Nacional de Saúde;
  • Plano Nacional de Desenvolvimento Sanitário;
  • Programa de Luta contra SIDA;
  • Programa Nacional de Nutrição;
  • Programa de Saúde Escolar;
  • Programa Nacional para a Igualdade e Equidade de Género;
  • Programa Nacional de Luta contra a Pobreza, entre outras.


Sistemas (Fluxos financeiros e recursos humanos)

Os custos com a vacinação (vacinas e consumíveis) são suportados desde 1998 pelo orçamento do Ministério da Saúde, à excepção da vacina contra Hepatite B que tem sido apoiada pela cooperação bilateral (Itália, Luxemburgo e UNICEF).

A vacinação é oferecida à população gratuitamente.

O atendimento infantil nos serviços de SR inclui ainda rastreio precoce e atendimento especial de crianças dos 0 aos 5 anos portadoras de deficiência psico-motora[14].


Estado da vigilância

O Programa Nacional de Saúde Reprodutiva, que desde 2001 substitui o da Protecção Materno infantil/ Planeamento familiar [PMI/PF] implantado desde 1977, constitui o suporte organizacional para a prestação de cuidados de saúde, sobretudo preventivos, às crianças e às mulheres em idade fértil e timidamente aos adolescentes e adultos masculinos.

A ligação com as estruturas prestadoras de cuidados curativos e reabilitativos não é, contudo, suficiente para garantir a coordenação, a qualidade e a continuidade dos cuidados, apesar dos esforços envidados para se regulamentar as competências nessa matéria, e utiliza-las nos diferentes níveis de prestação de cuidados.

A nível da atenção primária, dos Centros de saúde em particular, é evidente a integração dos cuidados assumidos anteriormente, em exclusividade, pelos antigos serviços de PMI/PF. Já a nível do atendimento secundário a situação é mais problemática na medida em que persiste uma separação nítida entre os Centros regionais da Saúde Reprodutiva e os Hospitais regionais.

Se as questões relativas às crianças menores de 5 anos estão cobertas para as crianças em idade escolar e antes da adolescência resta um hiato de cuidados específicos por preencher. Quanto aos adolescentes contudo é necessário definir uma estratégia mais abrangente, certamente ligada ao processo de formação, de transição e de afirmação a que estão sujeitos (PNDS).


Notas de fim: fontes, métodos, abreviaturas, etc.

Bibliografia

  1. 1. Programa Nacional de Saúde Reprodutiva, 2008-2012. MS, 2008
  2. 2. Oportunidades para os recém-nascidos em África. Dados práticos, políticas e apoios programáticos para a prestação de cuidados de saúde aos recém-nascidos em África. 2006
  3. 3. Relatório Estatístico 2010. MS, 2011
  4. 4. Política Nacional da Saúde, MS, 2007
  5. 5. Inquérito Demográfico de Saúde Reprodutiva II. MS/INE. 2005

Abreviaturas

  • AIDI – Atenção Integrada às Doenças da Infância
  • AME – Aleitamento materno exclusivo
  • ISDR – Inquérito Demográfico da Saúde Reprodutiva
  • IST – Infecções Sexualmente Transmissíveis
  • PAV – Programa alargado de Vacinação
  • PNS – Política Nacional da saúde
  • PNSR – Programa Nacional de Saúde Reprodutiva
  • SIDA – Síndrome da Imunodeficiência Adquirida
  • SR – Saúde Reprodutiva
  • VIH – Vírus da Imunodeficiência Humana


Referências

  1. Health Sector Development Program IV, 2010/11–2014/15. Final draft (pdf 780.81kb). Addis Ababa, Government of Ethiopia, Ministry of Health, 2010
  2. 2.0 2.1 Ethiopian demographic and health survey 2011 (pdf 683.08kb). Addis Ababa, Central Statistics Agency; Calverton Maryland, ICF Macro, 2011
  3. World health statistics. Geneva, World Health Organization, 2010
  4. Programa Nacional de Saúde Reprodutiva, 2008-2012. MS, 2008
  5. Oportunidades para os recém-nascidos em África. Dados práticos, políticas e apoios programáticos para a prestação de cuidados de saúde aos recém-nascidos em África. 2006
  6. Relatório Estatístico 2010. MS, 2011
  7. Relatório Estatístico 2010. MS, 2011
  8. Programa Nacional de Saúde Reprodutiva, 2008-2012. MS, 2008
  9. Oportunidades para os recém-nascidos em África. Dados práticos, políticas e apoios programáticos para a prestação de cuidados de saúde aos recém-nascidos em África. 2006
  10. Relatório Estatístico 2010. MS, 2011
  11. Política Nacional da Saúde, MS, 2007
  12. Programa Nacional de Saúde Reprodutiva, 2008-2012. MS, 2008
  13. Programa Nacional de Saúde Reprodutiva, 2008-2012. MS, 2008
  14. Programa Nacional de Saúde Reprodutiva, 2008-2012. MS, 2008