CHILD SURVIVAL Reproductive Health School Of Public Health Jember University By Ni’mal Baroya, M. PH.

Siapa? Setiap manusia yang berusia di bawah 18 tahun, kecuali berdasarkan ketentuan yang berlaku bagi anak ditentukan bahwa usia dewasa dicapai lebih cepat (convention on the rights of the child)

Siapa? Seseorang yang belum berusia 18 tahun, termasuk anak yang masih dalam kandungan (UU 23 tahun 2002 ttg perlindungan anak)

Siapa? Seseorang yang berusia dibawah 5 tahun (Child Survival Study)

Ada Apa Dengan Anak? Manusia yang masih lemah (fisik, mental, sosial) Anak tidak bisa memperjuangkan nasib sendiri Menderita akibat distribusi sumber daya yang tdk merata Tergantung pada orang dewasa untuk memenuhi kebutuhannya

Current Situation Estimated that 3000 children under 5 years of age die every day from common preventable and treatable condition including diarrhoea, pneumonia, and perinatal events. Most childhood deaths occur in low-income countries or poor communities in middle-income countries where many deaths are unrecorded

WHAT CAUSES CHILD MORTALITY? In 1993, the number of under-five deaths attributable to malnutrition: 54% United Nations. 2010. The millennium development goals report. New York, NY: Inter-Agency and Expert Group on MDG Monitoring United States Agency for International Development. (2007, June). Diarrheal disease course guide. Retrieved from http://www.globalhealthlearning.org/page.cfm?course=22&topic=1&page=7

SO WHY IS THE MEASLES VACCINE INCLUDED? United Nations. 2010. The millennium development goals report. New York, NY: Inter-Agency and Expert Group on MDG Monitoring United States Agency for International Development. (2007, June).

THE MEASLES VACCINE IS INCLUDED BECAUSE… 2008: 164,000 measles deaths It costs less than $1 dollar to vaccinate a child against measles Most common in children in parts of Asia sub-Saharan Africa where child mortality is highest HIV/AIDS, Vit A deficiency, conflict zone co- morbidity WHO Africa region (10% world’s population) accounted for 58% of measles deaths in 2000. Access to measles vaccine varies across socio- economic, education, rural location and birth order demographics Source: World Health Organization. (2009). Measles. Retrieved from http://www.who.int/mediacentre/factsheets/fs286/en/

WHAT ISN’T INCLUDED? Advent of medical advances since 1990 Rotavirus vaccine improvement to prevent major cause of diarrheal illness Addressing root causes of childhood illness/death Malnutrition Access to healthcare services Sanitation: ACCESS TO CLEAN DRINKING WATER Example: Cholera outbreak in Haiti Homelessness led to “open defecation” No place in temporary camps to purify water ORT

DISPARITIES BETWEEN COUNTRIES Gap mirrors economic development between countries but there is no obvious correlation between changes in GDP and child mortality South Africa Egypt Policy choices Distribution of wealth and health resources Graph shows gap in life chances depending on where a child lives. Afghanistan vs. Guyana USA/Poland vs. Ethiopia, Rwanda What separates the countries on the left from those on the right? What are these disparities related to? South Africa has almost 3x the GDP per capita of Egypt and has experienced a lot of economic growth recently but it’s under-5 mortality rate has stayed steady, actually slight increase, 3x higher than that of Egypt. Egypt is one of the few countries that has actually achieved MDG 4 (2006). Government launched “Healthy Mother, Healthy Child” initiative in 1992 Political commitment & policy choices are important Save the Children. (2010). A Fair Chance at Life: Why Equity Matters for Child Mortality.

DISPARITIES WITHIN COUNTRIES Data from study 2003 -Brazil: 3x more likely -India: 3x more likely -Gradient based on SES Victoria, et al. Applying an equity lens to child health and mortality: more of the same is not enough. Lancet. 2003;362(9379):233-41.

DETERMINAN KELANGSUNGAN HIDUP ANAK (CHILD SURVIVAL) MENURUT MOSLEY DAN CHEN (1988) DETERMINAN SOSIAL-EKONOMI Faktor ibu Pencemaran Lingkungan Kekurangan Gizi Kecelakaan Kesehatan Sakit Pencegahan Pengobatan Gangguan Pertumbuhan MATI Pengendalian Penyakit Perorangan

Menurut Katrina Galway dkk (1987) dalam buku “Child Survival : Risk and the Road to Health”, menyatakan bahwa yang mempengaruhi kelangsungan hidup anak : Faktor kesehatan yang berpengaruh langsung Faktor sosial ekonomi yang berpengaruh tidak langsung

Penyakit yang dapat dicegah dengan imunisasi ISPA Malaria & DHF Faktor kesehatan yang berpengaruh langsung pada kelangsungan hidup anak : Penyakit diare Penyakit yang dapat dicegah dengan imunisasi ISPA Malaria & DHF Malnutrisi Fertilitas beresiko tinggi

Edukasi dan pemberantasan buta huruf Faktor sosial ekonomi yang berpengaruh tidak langsung pada kelangsungan hidup anak : Edukasi dan pemberantasan buta huruf Tersedianya fasilitas yankes modern Pendapatan perkapita dan belanja negara Ketersediaan makanan Penyediaan air dan sarana sanitasi

a. Terapi rehidrasi oral : - pemberian larutan rehidrasi oral Langkah terpilih menuju sehat untuk mengatasi faktor kesehatan yang berpengaruh langsung pada child survival : Penyakit diare Langkah terpilih : a. Terapi rehidrasi oral : - pemberian larutan rehidrasi oral - melanjutkan pemberian makanan - aturan pemberian tepat b. Pemberian ASI c. Perilaku sehat di rumah (Higiene perorangan, air dan makanan)

d. Memperbaiki penyediaan air dan sarana sanitasi lingkungan e d. Memperbaiki penyediaan air dan sarana sanitasi lingkungan e.Imunisasi 2. Penyakit yang dpt dicegah dg imunisasi a. Dipteri,pertusis, polio, TB - imunisasi menjelang 1 th - nutrisi yang mencukupi - mengurangi kepadatan t4 tinggal dan kepadatan penghuni rumah

b. Tetanus - imunisasi menjelang 1 th - perawatan higienis thd luka c b. Tetanus - imunisasi menjelang 1 th - perawatan higienis thd luka c. Tetanus Neonatorum - imunisasi WUS - praktek persalinan higienis (t.u.tali pusat) - pertolongan persalinan oleh tenaga medis

Interventions by cause - diarrhoea Prevention Treatment Breastfeeding Exposure to diarrhoea Water/San/Hygiene Complementary feeding Oral rehydration therapy Zinc Vitamin A Diarrhoea Antibiotics for dysentry Zinc The United Nations Millennium Declaration, was adopted on 8 September 2000 by all 189 Member States of the United Nations (147 of them represented directly by their head of State or Government). This Declaration embodies a large number of specific commitments aimed at improving the lot of humanity in the new century. The Declaration is divided into eight sections as listed in the slide. Sections 3 and 4 are highlighted since these are the only sections within the Declaration from which the Millennium Development goals have grown. Die Survive 2004.6.5 Future: rotavirus vaccine

Interventions by cause - pneumonia Treatment Prevention Exposure to pneumonia Breastfeeding Complementary feeding Zinc Hib vaccine Pneumonia Antibiotics The United Nations Millennium Declaration, was adopted on 8 September 2000 by all 189 Member States of the United Nations (147 of them represented directly by their head of State or Government). This Declaration embodies a large number of specific commitments aimed at improving the lot of humanity in the new century. The Declaration is divided into eight sections as listed in the slide. Sections 3 and 4 are highlighted since these are the only sections within the Declaration from which the Millennium Development goals have grown. Die Survive Future: Pneumococcal vaccine, zinc for therapy, reduction of indoor air pollution 2004.6.5

Interventions, neonatal - infections Prevention Treatment Clean delivery Exposure to infections Antibiotics for premature rupture of membranes Breastfeeding Severe bacterial infection Antibiotics for sepsis The United Nations Millennium Declaration, was adopted on 8 September 2000 by all 189 Member States of the United Nations (147 of them represented directly by their head of State or Government). This Declaration embodies a large number of specific commitments aimed at improving the lot of humanity in the new century. The Declaration is divided into eight sections as listed in the slide. Sections 3 and 4 are highlighted since these are the only sections within the Declaration from which the Millennium Development goals have grown. Die Survive 2004.6.5

Interventions, neonatal - prematurity Prevention Treatment Antibiotics for premature rupture of membranes Pregnant Treated bednets &materials* Intermittent preventive therapy Antinatal steroids Premature Newborn temperature management The United Nations Millennium Declaration, was adopted on 8 September 2000 by all 189 Member States of the United Nations (147 of them represented directly by their head of State or Government). This Declaration embodies a large number of specific commitments aimed at improving the lot of humanity in the new century. The Declaration is divided into eight sections as listed in the slide. Sections 3 and 4 are highlighted since these are the only sections within the Declaration from which the Millennium Development goals have grown. Die Survive * Indoor residual spraying may be used as an alternative 2004.6.5

KOMITMEN DUNIA TERHADAP ANAK 1977 Resolusi PBB “Health for all by the year 2000” 1978 Deklarasi Alma Ata (12 September) “Primary Health Care” sbg kunci mencapai “Health for all by the year 2000” 1984 Unicef mencanangkan GOBI-FFF (Growth monitoring, Oral rehydration, Breast feeding, Immunization, Food supplementation, Family Planning & Female education)

KOMITMEN DUNIA TERHADAP ANAK 13-15 Maret 1984, Konferensi Internasional Bellagio I di Italia membahas cakupan imunisasi di negara berkembang yang masih rendah), dibentuk Task force for child survival 14-16 Oktober 1985, Konferensi Bellagio II di Cartagena Kolumbia membahas imunisasi, KB dan rehidrasi oral), tema “Protecting the World’s Children” 10-12 Maret 1988 konferensi di Taloires Perancis dengan tema “A Child Survival Summit” membahas malnutrisi, penyakit,BBLR, IMR dan fertilitas

KOMITMEN DUNIA TERHADAP ANAK 20 November 1989 Sidang Umum PBB ke-44 menyetujui Konvensi Hak-Hak Anak (54 pasal) 30 September 1990 PBB mengadakan “World Summit for Children” membahas kesejahteraan anak dunia yang menghasilkan “World Declaration on the Child Survival, Protection and Development” sekaligus ditetapkan 10 pokok rencana kegiatan

3 KEGIATAN MENINGKATKAN KUALITAS HIDUP ANAK (BY UNICEF) Child survival revolution Child development promotion Child protection

SATUAN TUGAS KELANGSUNGAN HIDUP ANAK BERTUGAS : Mengembangkan vaksin baru yg lebih baik Memilih teknologi yang tepat untuk vaksinasi Menerapkan kedua hal tsb scr efisien melalui pelayanan kesehatan dasar

TALOIRES DECLARATION Immunization programme Diarrhoeal disease control programme Initiatives to control respiratory infections Safe motherhood and familiy planning programme

4 HAK DASAR ANAK (KONVENSI PBB) Hak atas kelangsungan hidup Hak atas perlindungan Hak untuk tumbuh kembang optimal Hak untuk berpartisipasi (dengan catatan bukan untuk berpartisipasi secara legal dalam dunia kerja sebelum waktunya)

10 POKOK RENCANA KEGIATAN UNTUK KELANGSUNGAN HIDUP, PERLINDUNGAN DAN PERKEMBANGAN ANAK Konvensi hak anak Kesehatan anak Pangan dan gizi Peranan wanita, kesehatan ibu dan KB Peranan keluarga Pendidikan dasar dan melek huruf Anak-anak dalam keadaan yang sangat sulit Perlindungan anak dalam masa peperangan Anak-anak dan lingkungan Pengurangan kemiskinan dan membangkitkan kembali pertumbuhan ekonomi

Essential Package for Child Survival Skilled attendance during pregnancy, delivery and the immediate postpartum Care of the newborn Breastfeeding and complementary feeding Micronutrient supplementation Immunization of children and mothers Integrated management of pneumonia, diarrhoea and malaria Use of insecticide-treated bednets Source : A series in The Lancet 2005

Contributing Actions For Child Survival That Strengthen The Impact Of The Essential Package Improvements in water, sanitation and environment Birth spacing Promoting gender equality, empowerment of women and women’s education Prevention of mother-to-child transmission of HIV

STRATEGIC APPROACHES FOR CHILD SURVIVAL Improving leadership and governance Consolidating partnerships Improving efficiency and quality of service delivery Delivering essential interventions at the community level Service delivery at the health facility level Engaging and empowering families and communities Ensuring health care financing support for child survival

TEN CORE INDICATORS FOR CHILD SURVIVAL Components of essential package Core indicators Skilled attendance during pregnancy, delivery and the immediate postpartum 1 Proportion of deliveries assisted by skilled birth attendant Care of the newborn 2 Proportion of infants with breastfeeding initiated within one hour of birth Breastfeeding and complementary feeding 3 4 Proportion of infants exclusively breastfed for the first 6 month Proportion of infants 6-9 months old receiving breastmilk and semi-solid foods in the past 24 hours Micronutrient supplementation 5 Proportion of children 12-59 moths old who have received vitamin A in the past 6 months

TEN CORE INDICATORS FOR CHILD SURVIVAL Components of essential package Core indicators Immunization of children and mothers 6 7 Proportion of children 12-23 months old immunized against measles before reaching 12 months of age Proportion of pregnant women who have received 2 doses of tetanus toxoid during their most recent pregnancy or 5 doses in their lifetime Integrated management of diarrhoea, pneumonia and malaria 8 9 Proportion of children with diarrhoea in the past 2 weeks that received ORT Proportion of children with cough and fast or difficult breathing in the past 2 weeks who received treatment Use insecticide-treated bednets 10 Proportion of children less than 5 years who slept under an insecticide-treated bednet the previous night

MDG 4: REDUCE CHILD MORTALITY The Noun Project

THE GOAL Target 5: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate Indicators: 13. Under-five mortality rate 14. Infant mortality rate 15. Proportion of 1 yr-old children immunized against measles WHO via The global health nonprofit PATH, flickr

WHERE ARE WE NOW? Progress in MDG 4 1990 1995 2000 2005 2008 Mortality rate, under-5 (per 1,000) 92 88 79 68 63 Mortality rate, infant (per 1,000 live births) 64 61 55 48 44 Immunization, measles (% of children ages 12-23 months) 73 74 78 83 World Development Indicators database, http://data.worldbank.org/data-catalog/world-development-indicators Looking at data from the World Bank, there has been progress on all of the indicators for MDG 4 from 1990 to 2008. Explain infant mortality= under age one Other positive news: There is also an increase in the rate of decline in the last decade. The average rate of decline from 2000 to 2008 is 2.3%, compared to a 1.4% average decline from 1990 to 2000.   Source: United Nations Childrens Fund. (2009, September 10). Global child mortality continues to drop. Retrieved from http://www.unicef.org/media/media_51087.html

Terima kasih atas partisipasi anda! Semoga bisa menjadi inspirasi untuk berkarya! Bangsa ini menunggu tangan-tangan anda untuk bergerak mengambil peran! “Segala untuk semua tidak ada yang untuk kami sendiri “ Adopted by Elsup Comandante Marcos from Ciapas Mexico