Child Health (A)

K. V. Ramani

doi:10.4135/9781473977280

Cases

By:
K. V. Ramani
Publisher: Indian Institute of Management, Ahmedabad
- Publication year: 2015
- Online pub date: March 06, 2016
Discipline: Health, Education & Welfare Economics, Strategic Management & Planning
DOI: https://doi.org/10.4135/9781473977280
Keywords:
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Contains: Content Partners | Teaching Notes
Length: 2,589 words
Region: Global
Originally Published In:
Ramani, K. V. ( 2015). Child Health (A). CMHS0033(A). Ahmedabad: Indian Institute of Management, Ahmedabad.
Industry: Human health activities
Type:
Indirect caseinfo
Organization: UNICEF
Organization Size:
Largeinfo
Online ISBN: 9781473977280
Copyright: Certain material used with permission of Indian Institute of Management, Ahmedabad. © 2015. All rights reserved.
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Case
Teaching Notes
Supplementary Resources

Abstract

The Executive Director, UNICEF was reviewing the UNICEF 2014 report on the progress made by the WHO countries towards achieving the fourth Millennium Development Goal MDG 4. MDG 4 called for reduction in U5 mortality (U5 represents children less than 5 years old) by a two-third between 1990 and 2015. The report mentioned 6.6 million children died in the year 2012. He realized that many countries were not likely to achieve MDG 4 and therefore called for a meeting to discuss the report in detail and evolve future strategies to improve child health.

This case was prepared for inclusion in Sage Business Cases primarily as a basis for classroom discussion or self-study, and is not meant to illustrate either effective or ineffective management styles. Nothing herein shall be deemed to be an endorsement of any kind. This case is for scholarly, educational, or personal use only within your university, and cannot be forwarded outside the university or used for other commercial purposes.

Resources

Exhibit 1: 10 Facts on Child Health1

Fact 1: A child's risk of dying is highest in the first month of life

In the first month of life safe childbirth and effective neonatal care are essential. Preterm birth, birth asphyxia and infections cause most newborn deaths. Once children have reached one month of age, and up until the age of five years, the main causes of loss of life are pneumonia, diarrhoea, and malaria. Malnutrition contributes to almost one half of all child deaths.

Fact 2: Nearly three million children died in 2011 within a month of their birth

Newborn life is fragile. Health risks to newborns are minimized by:

quality care during pregnancy;
safe delivery by a skilled birth attendant;
essential neonatal care after birth: immediate attention to breathing and warmth, hygienic cord and skin care, and exclusive breastfeeding.

Fact 3: Pneumonia is the largest single cause of death in children under five years of age

In 2011, it killed an estimated 1.2 million children under the age of five years, accounting for 17% of all deaths of children under five years old worldwide. Addressing the major risk factors for pneumonia through immunization, exclusive breastfeeding, reduction in household air pollution and adequate nutrition is essential for prevention. Antibiotics and oxygen are vital treatment tools.

Fact 4: Diarrhoeal diseases are a leading cause of sickness and death among children in developing countries

Exclusive breastfeeding and proper sanitation and hygiene, and immunization help prevent diarrhoea among young children. Treatment for sick children with Oral Rehydration Salts (ORS) and zinc supplements is safe, cost-effective and saves lives. The lives of more than 50 million children have been saved in the last 25 years as a result of ORS.

Fact 5: Every minute a child dies from malaria

It is one of the leading causes of death among children under-five. Sleeping under insecticide-treated nets prevents transmission and increase child survival. Early testing and treatment with effective anti-malarial medication saves lives.

Fact 6: Over 90% of children with HIV are infected through mother-to-child transmission

This is preventable with the use of antiretrovirals, as well as safer delivery and feeding practices. An estimated two million children under 15 years of age are living with HIV, and every day more than 1000 are newly infected. Without intervention, more than half of all HIV-infected children die before their second birthday. Early testing and treatment with antiretroviral therapy for all HIV-infected children greatly improves survival and quality of life.

Fact 7: In 2012, about 17 million children suffered from severe wasting

Almost half of the under-five child deaths are associated malnutrition. Severe acute malnutrition leaves children more vulnerable to serious illness and high probability of dying. Most children can be successfully treated at home with ready-to-use therapeutic foods (RUTF). Globally, in 2012, an estimated 162 million children below 5 years of age, were stunted and 99 million were underweight.

Fact 8: Some 80% of the world's under-five deaths in 2012 occurred in only 25 countries, and about half in only five countries

Under-five deaths are increasingly concentrated in sub-Saharan Africa and Southern Asia. Child survival rates differ significantly around the world. Within countries, child mortality is higher in rural areas, and among poorer and less educated families.

Fact 9: About two-thirds of child deaths are preventable

They are preventable through access to practical, low-cost interventions, and effective primary care up to five years of age. Child health is improving, but serious challenges remain to achieve global goals to reduce deaths. Stronger health systems are crucial for improving access to care and prevention.

Fact 10: Greater investment is key

Greater investment will help in reducing the under-five mortality rate by two-thirds by 2015 (Millennium Development Goal 4). Public and private partners must come together to fill the gap in order to meet this ambitious, but achievable goal. The launch of the Commission on Information and Accountability and of the Global Strategy for Women's and Children's Health and several large bilateral donor pledges in recent months are important steps in the right direction.

References

1. 10FACTSONCHILDHEALTH; http://www.who.int/features/factfiles/child_health2/photo_story/en/

Exhibit 2: Nutritional Status of Children: 2012


Countries and Areas	Low Birth Weight	Under-weight Moderate and severe	Under-weight Severe	Stunting Moderate & severe	Wasting Moderate and severe	Over-weight
Sub-Sahara Africa	13	21	7	38	9	6
Middle East and North Africa	-	7	-	18	8	11
South Asia	28	32	15	38	16	4
East Asia and Pacific	6	5	4	12	4	5
Latin America & Caribbean	9	3	-	11	1	7
CEE/CIS	-	2	-	11	1	7
Least Developed Countries	13	23	7	37	19	5
World	15	15	9	25	8	7

Source: UNICEF Report 2014

Exhibit 3: Immunization Coverage (%) Against Vaccine Preventable Diseases: 2012


Countries and areas	BCG	DPT1	DPT3	Polio	Measles	HepB3	Hob3
Sub-Sahara Africa	81	80	71	76	72	70	64
Middle East and North Africa	93	94	89	90	88	90	55
South Asia	88	89	76	74	77	74	24
East Asia and Pacific	95	97	92	93	94	89	11
Latin America & Caribbean	96	96	93	93	95	92	91
CEE/CIS	96	95	94	95	95	91	71
Least Developed Countries	86	90	80	82	80	76	75
World	89	91	83	84	84	79	45

Source: UNICEF Report 2014

BCG % of live births who received vaccine against TB
DPT1 % of surviving infants who received their first dose of DPT
DPT3 % of surviving infants who received three doses of DPT
Polio % of surviving infants who received three doses of polio vaccine
MCV % of surviving children who received first dose of Measles vaccine
HepB % of surviving infants who received three doses of hepatitis B vaccine
Hib3 % of surviving infants who received three doses of Haemophilus influenza type B vaccine

Note: Even though immunization coverage has improved over the years, an estimated 21.8 million infants worldwide were not reached with routine immunization services in 2013, of whom nearly half live in 3 countries: India, Nigeria and Pakistan1.

References

1. Immunization coverage; Fact sheet N°378, Reviewed November 2014 http://www.who.int/mediacentre/factsheets/fs378/en/

Exhibit 4: Treatment Taken for Pneumonia, Diarrhoea and Malaria: 2012


Countries and areas	Pneumonia Care seeking for children	Pneumonia % treated antibiotics	Diarrhoea % treated with ORS	Malaria % treated	% children sleeping under ITN
Sub-Sahara Africa	46	39	31	37	36
Middle East and North Africa	70	63	35	-	-
South Asia	65	20	33	7
East Asia and Pacific	60	45	44	1	-
Latin America & Caribbean	55	-	48	-	-
CEE/CIS	-	-	-	-	-
Least Developed Countries	49	41	41	3-	40
World	59	34	35	19	-

ITN: Insecticide –treated mosquito nets. Source: UNICEF Report 2014

Exhibit 5: Progress of WHO countries towards MDG4: Ref: The State of the World's Children 2014 in Numbers: Every Child Counts; UNICEF, January 2014


SL no	Country	U5MR 1990	U5MR 2012	% reduction in U5MR in 2012	SL no	Country	U5MR 1990	U5MR 2012	% reduction in U5MR in 2012
1	Afghanistan	176	99	44	26	Bulgaria	22	12	45
2	Albania	43	17	60	27	Burkina Faso	202	102	50
3	Algeria	50	20	60	28	Burundi	164	104	37
4	Andorra	8	3	63	29	Cabo Verde	62	22	65
5	Angola	213	164	23	30	Cambodia	116	40	66
6	Antigua and Barbuda	24	10	58	31	Cameroon	135	95	30
7	Argentina	28	14	50	32	Canada	8	5	38
8	Armenia	49	16	67	33	Cape Verde
9	Australia	9	5	44	34	Central African Republic	171	129	25
10	Austria	10	4	60	35	Chad	209	150	28
11	Azerbaijan	93	35	62	36	Chile	19	9	53
12	Bahamas	23	17	26	37	China	54	14	74
13	Bahrain	23	10	57	38	Colombia	35	18	49
14	Bangladesh	144	41	72	39	Comoros	124	78	37
15	Barbados	18	18	0	40	Congo	100	96	4
16	Belarus	17	5	71	41	Cook Islands	25	11	56
17	Belgium	10	4	60	42	Costa Rica	17	10	41
18	Belize	43	18	58	43	Côte d'Ivoire	152	108	29
19	Benin	181	90	50	44	Croatia	13	5	62
20	Bhutan	131	45	66	45	Cuba	13	6	54
21	Bolivia	123	41	67	46	Cyprus	11	3	73
22	Bosnia and Herzegovina	18	7	61	47	Czech Republic	15	4	73
23	Botswana	48	53	−10	48	Democratic People's Republic of Korea	44	29	34
24	Brazil	62	14	77	49	Democratic Rep of the Congo	171	146	15
25	Brunei Darussalam	12	8	33	50	Denmark	9	4	56


SL no	Country	U5MR 1990	U5MR 2012	% reduction in U5MR in 2012	SL no	Country	U5MR 1990	U5MR 2012	% reduction in U5MR in 2012
51	Djibouti	119	81	32	76	Holy See	–	–	#######
52	Dominica	17	13	24	77	Honduras	59	23	61
53	Dominican Republic	60	27	55	78	Hungary	19	6	68
54	Ecuador	56	23	59	79	Iceland	6	2	67
55	Egypt	86	21	76	80	India	126	56	56
56	El Salvador	59	16	73	81	Indonesia	84	31	63
57	Equatorial Guinea	182	100	45	82	Iran (Islamic Republic of)	56	18	68
58	Eritrea	150	52	65	83	Iraq	53	34	36
59	Estonia	20	4	80	84	Ireland	9	4	56
60	Ethiopia	204	68	67	85	Israel	12	4	67
61	Fiji	31	22	29	86	Italy	10	4	60
62	Finland	7	3	57	87	Jamaica	30	17	43
63	France	9	4	56	88	Japan	6	3	50
64	Gabon	92	62	33	89	Jordan	37	19	49
65	Gambia	170	73	57	90	Kazakhstan	54	19	65
66	Georgia	35	20	43	91	Kenya	98	73	26
67	Germany	9	4	56	92	Kiribati	94	60	36
68	Ghana	128	72	44	93	Kuwait	16	11	31
69	Greece	13	5	62	94	Kyrgyzstan	71	27	62
70	Grenada	22	14	36	95	Lao People's Demo Rep	163	72	56
71	Guatemala	80	32	60	96	Latvia	20	9	55
72	Guinea	241	101	58	97	Lebanon	33	9	73
73	Guinea-Bissau	206	129	37	98	Lesotho	85	100	−18
74	Guyana	60	35	42	99	Liberia	248	75	70
75	Haiti	144	76	47	100	Libya	43	15	65


SL No	Country	U5 MR 1990	U5 MR 2012	% reduction in U5MR in 2012	SL No	Country	U5MR 1990	U5 MR 2012	% reduction in U5MR in 2012
101	Liechtenstein	–	–	#VALUE!	126	Nicaragua	66	24	64
102	Lithuania	17	5	71	127	Niger	326	114	65
103	Luxembourg	9	2	78	128	Nigeria	213	124	42
104	Madagascar	159	58	64	129	Niue	14	25	−79
105	Malawi	244	71	71	130	Norway	9	3	67
106	Malaysia	17	9	47	131	Oman	39	12	69
107	Maldives	94	11	88	132	Pakistan	138	86	38
108	Mali	253	128	49	133	Palau	34	21	38
109	Malta	11	7	36	134	Panama	32	19	41
110	Marshall Islands	49	38	22	135	Papua New Guinea	89	63	29
111	Mauritania	128	84	34	136	Paraguay	46	22	52
112	Mauritius	23	15	35	137	Peru	79	18	77
113	Mexico	46	16	65	138	Philippines	59	30	49
114	Micronesia	55	39	29	139	Poland	17	5	71
115	Monaco	8	4	50	140	Portugal	15	4	73
116	Mongolia	107	28	74	141	Qatar	21	7	67
117	Montenegro	17	6	65	142	Republic of Korea	7	4	43
118	Morocco	80	31	61	143	Republic of Moldova	32	18	44
119	Mozambique	233	90	61	144	Romania	38	12	68
120	Myanmar	106	52	51	145	Russian Federation	26	10	62
121	Namibia	73	39	47	146	Rwanda	151	55	64
122	Nauru	58	37	36	147	Saint Kitts and Nevis	29	9	69
123	Nepal	142	42	70	148	Saint Lucia	22	18	18
124	Netherlands	8	4	50	149	St Vincent and Grenadines	25	23	8
125	New Zealand	11	6	45	150	Samoa	30	18	40


SL No	Country	U5 MR 1990	U5 MR 2012	% reduction in U5MR in 2012	SL No	Country	U5 MR 1990	U5 MR 2012	% reduction in U5MR in 2012
151	San Marino	11	3	73	176	Former Yugoslav Rep Macedonia	37	7	81
152	Sao Tome & Principe	104	53	49	177	Timor-Leste	171	57	67
153	Saudi Arabia	47	9	81	178	Togo	143	96	33
154	Senegal	142	60	58	179	Tonga	23	13	43
155	Serbia	28	7	75	180	Trinidad and Tobago	33	21	36
156	Seychelles	17	13	24	181	Tunisia	51	16	69
157	Sierra Leone	257	182	29	182	Turkey	74	14	81
158	Singapore	8	3	63	183	Turkmenistan	90	53	41
159	Slovakia	18	8	56	184	Tuvalu	58	30	48
160	Slovenia	10	3	70	185	Uganda	178	69	61
161	Solomon Islands	39	31	21	186	Ukraine	20	11	45
162	Somalia	177	147	17	187	United Arab Emirates	17	8	53
163	South Africa	61	45	26	188	United Kingdom	9	5	44
164	South Sudan	251	104	59	189	United Republic of Tanzania	166	54	67
165	Spain	11	5	55	190	United States	11	7	36
166	Sri Lanka	21	10	52	191	Uruguay	23	7	70
167	State of Palestine	43	23	47	192	Uzbekistan	74	40	46
168	Sudan	128	73	43	193	Vanuatu	35	18	49
169	Suriname	51	21	59	194	Venezuela (Bolivarian Republic of)	30	15	50
170	Swaziland	71	80	−13	195	Viet Nam	51	23	55
171	Sweden	7	3	57	196	Yemen	125	60	52
172	Switzerland	8	4	50	197	Zambia	192	89	54
173	Syrian Arab Republic	38	15	61
174	Tajikistan	105	58	45
175	Thailand	38	13	66

Exhibit 6: Best Performers: Countries who had already achieved the MDG4 target by 2012


Sl No.	Country	U5MR 1990	U5MR 2012	U5MR Target 2015	U5MR % decline 1990-2012
1	Maldives	94	11	31	88
2	The former Yugoslav Rep Macedonia	37	7	12	81
3	Turkey	74	14	25	81
4	Saudi Arabia	47	9	16	81
5	Brazil	62	14	21	77
6	Peru	79	18	26	77
7	Egypt	86	21	29	76
8	China	54	14	18	74
9	Mongolia	107	28	36	74
10	El Salvador	59	16	20	73
11	Lebanon	33	9	11	73
12	Bangladesh	144	41	48	72
13	Malawi	244	71	81	71
14	Nepal	142	42	47	70
15	Liberia	248	75	83	70
16	Oman	39	12	13	69
17	Tunisia	51	16	17	69
18	Romania	38	12	13	68
19	Iran (Islamic Republic of)	56	18	19	68
20	United Republic of Tanzania	166	54	55	67
21	Armenia	49	16	16	67
22	Bolivia (Plurinational State of)	123	41	41	67
23	Timor-Leste	171	57	57	67
24	Ethiopia	204	68	68	67

Exhibit 7: Countries making sufficient progress to meet the MDG4 2015 target


No	Country	U5 1990	U5 2012	Target 2015	U5MR % Decline 1990-2012
1	Thailand	38	14	13	66
2	Bhutan	131	45	44	66
3	Cambodia	116	40	39	66
4	Eritrea	150	52	50	65
5	Mexico	46	16	15	65
6	Libya	43	15	14	65
7	Niger	326	114	109	65
8	Kazakhstan	54	19	18	65
9	Cabo Verde	62	22	21	65

Exhibit 8: 10 Worst Performing countries: U5MR reduction less than 25%


SL No	Country	Region	U5MR 1990	U5MR 2012	% reduction in U5MR 1990-2012
1	Zimbabwe	Sub-Saharan Africa	74	90	−22
2	Lesotho	Sub-Saharan Africa	85	100	−18
3	Swaziland	Sub-Saharan Africa	71	80	−13
4	Botswana	Sub-Saharan Africa	48	53	−10
5	Congo	Sub-Saharan Africa	100	96	4
6	Democratic Rep of Congo	Sub-Saharan Africa	171	146	15
7	Somalia	Sub-Saharan Africa	177	147	17
8	Solomon Islands	Oceania	39	31	21
9	Marshall Islands	East Asia and Pacific	49	38	22
10	Angola	Sub-Saharan Africa	213	164	23

Exhibit 9: Countries with U5MR more than 100 in 2012


SL No	Country	Region	U5 MR 1990	U5 MR 2012	% reduction in U5MR by 2012
1	Sierra Leone	Sub-Saharan Africa	257	182	29
2	Angola	Sub-Saharan Africa	213	164	23
3	Chad	Sub-Saharan Africa	209	150	28
4	Somalia	Sub-Saharan Africa	177	147	17
5	Democratic Rep Congo	Sub-Saharan Africa	171	146	15
6	Central African Rep	Sub-Saharan Africa	171	129	25
7	Guinea-Bissau	Sub-Saharan Africa	206	129	37
8	Mali	Sub-Saharan Africa	253	128	49
9	Nigeria	Sub-Saharan Africa	213	124	42
10	Niger	Sub-Saharan Africa	326	114	65
11	Côte d'Ivoire	Sub-Saharan Africa	152	108	29
12	Burundi	Sub-Saharan Africa	164	104	37
13	South Sudan	Sub-Saharan Africa	251	104	59
14	Burkina Faso	Sub-Saharan Africa	202	102	50
15	Guinea	Sub-Saharan Africa	241	101	58
16	Lesotho	Sub-Saharan Africa	85	100	−18
17	Equatorial Guinea	Sub-Saharan Africa	182	100	45

Exhibit 10: MDG Grouping: Developing and Developed Regions

Developing Regions:


Northern Africa	Sub-Sahara Africa (Continued)	South-East Asia	Oceania
Algeria	Mali	Brunei Darussalam	American Samoa
Egypt	Mauritania	Cambodia	Cook Islands
Libya	Mauritius	Indonesia	Fiji
Morocco	Mayotte	Lao Demo Rep	French Polynesia
Tunisia	Mozambique	Malaysia	Guam
Western Sahara	Namibia	Myanmar	Kiribati
Sub-Sahara Africa	Niger	Philippines	Marshall Islands
Angola	Nigeria	Singapore	Micronesia
Benin	Réunion	Thailand	Nauru
Botswana	Rwanda	Timor-Leste	Niue
Burkina Faso	San Tome & Principe	Viet Nam	New Caledonia
Burundi	Senegal	East Asia	North Maria Island
Cameroon	Seychelles	China	Palau
Cape Verde	Sierra Leone	Hong Kong	Papua New Guinea
Central Africa Rep	Somalia	Macau	Samoa
Chad	South Africa	Korea Demo People	Solomon Islands
Comoros	Sudan	Korea Rep of	Tokelau
Congo	Swaziland	Mongolia	Tonga
Cote d'Ivoire	Togo	Western Asia	Tuvalu
Demo Rep Congo	Uganda	Bahrain	Vanuatu
Djibouti	United Rep Tanzania	Cyprus	Eurasia
Equatorial Guinea	Zambia	Iraq	Armenia
Eritrea	Zimbabwe	Israel	Azerbaijan
Ethiopia	Southern Asia	Jordan	Belarus
Gabon	Afghanistan	Kuwait	Georgia
Gambia	Bangladesh	Lebanon	Kazakhstan
Ghana	Bhutan	Palestine	Kyrgyzstan
Guinea	India	Oman	Rep of Moldova
Guinea-Bissau	Iran	Qatar	Russian Federation
Kenya	Maldives	Saudi Arabia	Tajikistan
Lesotho	Nepal	Syrian Arab Rep	Turkmenistan
Liberia	Pakistan	Turkey	Ukraine
Madagascar	Sri Lanka	Utd Arab Emirates	Uzbekistan
Malawi		Yemen

MDG Groups: Developing and Developed Regions:
Developing Regions (Cont) Latin America & Caribbean		Developed Regions
Anguilla		Albania	Japan
Antigua and Barbuda	Haiti	Andorra	Latvia
Argentina	Honduras	Australia	Liechtenstein
Aruba	Jamaica	Austria	Lithuania
Bahamas	Martinique	Belgium	Luxembourg
Barbados	Mexico	Bermuda	Malta
Belize	Montserrat	Bosnia & Herzegovina	Monaco
Bolivia	Netherlands Antilles	Bulgaria	Netherlands
Brazil	Nicaragua	Canada	New Zealand
British Virgin Islands	Panama	Channel Islands	Norway
Cayman Islands	Paraguay	Croatia	Poland
Chile	Peru	Czech Republic	Portugal
Columbia	Puerto Rico	Denmark	Romania
Costa Rica	St Kitts & Nevis	Estonia	San Marino
Cuba	Saint Lucia	Faeroe Islands	Serbia & Montenegro
Dominica	St Vincent Grenadine	Finland	Slovakia
Dominican Rep	Suriname	France	Slovenia
Ecuador	Trinidad & Tobago	Germany	Spain
El Salvador	Turks & Caicos Islands	Greece	Sweden
Falklands	Uruguay	Hungary	Switzerland
French Guiana	US Virgin Islands	Iceland	Rep Macedonia
Grenada		Ireland	Ukraine
Guadeloupe		Isle of Man	United Kingdom
Guatemala		Italy	US of America
Guyana

This case was prepared for inclusion in Sage Business Cases primarily as a basis for classroom discussion or self-study, and is not meant to illustrate either effective or ineffective management styles. Nothing herein shall be deemed to be an endorsement of any kind. This case is for scholarly, educational, or personal use only within your university, and cannot be forwarded outside the university or used for other commercial purposes.

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