State of the world's children 1986.

State of the World's Children 1986

The lives of well over a million children in the developing world are now being saved each year as a result of two simple, low-cost health techniques-- immunization and oral rehydration therapy. Those methods, according to the United Nations Children's Fund (UNICEF), are main components of UNICEF's "Child Survival Revolution' and focal points of its State of the World's Children 1986 report.

Immunization coverage has doubled in many countries during the last two years, preventing close to a million deaths annually among children under five. At the same time, the rapid spread of oral rehydration therapy is saving up to half a million children a year from death by diarrhoeal dehydration.

"Despite the continuing crisis of Africa, immunization and oral rehydration therapy are leading the way towards a revolution in child survival and development which could save the lives of half the 15 million under-fives who are now dying each year', affirms UNICEF Executive Director James Grant.

Other "child protectors' promoted by UNICEF to save lives and ensure children's development include breast-feeding, improved weaning, growth checking and adequate nutrition. Although such measures can exert powerful leverage on child health, their execution does not require medical professionals or sophisticated equipment.

Because the "Child Survival Revolution' depends on parents as front-line health workers, it is part of a wide shift in the concept of health care in both industrialized and developing countries, the report indicates. The next generation of advances in health, according to UNICEF, will come about not through more medical technology but through ordinary people knowing more--and doing more-- about their own and their families' health.

Immunization

Measles, tetanus, whooping cough, polio, diphtheria and tuberculosis together kill close to 4 million permanently disabled. In the past 18 months, however, a number of countries have doubled or even trebled immunization levels against these illnesses. World-wide demand for vaccines in 1985 reached approximately three times the 1983 total.

This sudden acceleration in immunization has been made possible in large part by new strategies for reaching a much greater proportion of the population than is normally touched by modern health services. The cost of immunizing all children, thereby saving more than 3 million lives a year, is approximately $5 per child, or a total of $500 million--slightly less than the cost of three fighter planes.

Universal vaccination, according to UNICEF Executive Director Grant, depends on parents knowing when, where and why they must take children to be innoculated, as well as on doctors and health services making the vaccines available. But above all, he stresses, "it depends on a nation's leaders seeing that it can now be done--that the goal of immunizing all children in the next five years is something which is both dramatically important and realistically achievable.'

The Secretary-General has asked heads of all 159 United Nations Member States to give personal support to the goal of immunization for all the world's children by 1990--a key element of the World Health Organization's overall target of "Health for All by the Year 2000'. As of mid-1985, more than 40 developing countries had accelerated their immunization programmes.

India's Prime Minister Rajiv Gandhi announced that immunization of every Indian child by 1990 was to be a "living monument' to his mother, former Prime Minister Indira Gandhi, assassinated in 1984.

A nationwide immunization drive launched by Turkey's President Kenan Evren in September 1985 resulted in the vaccination of more than 3 million children in the first eight days. Prime Minister Turgut Ozal called it "the most important programme started by this Government'.

Presidents Thomas Sankara of Burkina Faso, Belisario Betancur of Columbia, Salvador Jorge Blanco of the Dominican Republic and Jose Sarney of Brazil were among other national leaders who personally administered the first dose of vaccine to launch immunization campaigns in 1985.

On all continents, there are "success stories' of countries mobilizing resources to make immunization available on a grand scale.

Government and rebel troops in El Salvador observed three days of cease-fire during 1985 so that two thirds of the nation's 400,000 unimmunized children under age five could be innoculated against five major infectious diseases. At the end of the first National Vaccination Day, President Jose Napoleon Duarte announced: "We have had a day of peace, a day of life, a day of hope.'

Burkina Faso's "Vaccination Commando', during one three-week period in 1984, immunized almost two thirds of the country's children against its three main killer-diseases: measles, yellow fever and meningitis. Lines stretched for kilometres at vaccination posts as more than 1 million children awaited innoculation. Health workers are now building a system of regular immunization against the major vaccine-preventable diseases.

In Brazil, poliomyelitis has been virtually eliminated with the immunization of 20 million children on each of two National Vaccination Days held every year since 1980. Manning the 90,000 vaccination posts across the country is a network of 400,000 volunteers.

Nurses and students in Syria working on their vacations have raised immunization coverage from 13 per cent to 63 per cent in the Ragga area, one of the nation's most remote and inaccessible regions.

Since 1978, when Sri Lanka began its expanded immunization programme, the incidence of polio and whooping cough dropped by 65 per cent, of diphtheria and tetanus by 90 per cent.

In Kabul, Afghanistan, immunization of children rose from less than 20 per cent to more than 80 per cent in 1985 alone.

In Khartoum, capital of the Sudan, immunization of 200,000 children in autumn 1985 launched a campaign to reach 90 per cent of Sudanese children by 1990.

Like other powerful low-cost basic health strategies available to the developing world today, immunization could contribute to economic growth and comprehensive health care, rather than be an eventual effect, according to UNICEF. "It is clear', the report states, "that there is a long-term connection between the mental and physical development of children and the social and economic development of nations.'

Basic steps towards protecting the health and normal growth of the young therefore constitute a "slowly maturing but exceptionally high-yielding investment in economic development itself', UNICEF, affirms.

Oral rehydration 

A second major force in the "Child Survival Revolution' is oral rehydration therapy (ORT). Parents cannot make their own vaccines for their children, but they can prevent dehydration by mixing up a packet of oral rehydration salts, or preparing a traditional home remedy such as rice conjee or carrot soup.

Dehydration from diarrhoea is a major cause of death and malnutrition among children in the developing world. In some countries, families now spend as much as 10 per cent of their income on anti-diarrhoeal drugs that are worthless. ORT is a simple, safe, effective method by which parents, no matter how poor, can protect the lives and growth of their offspring.

In Egypt, infant death rates from diarrhoea were reduced by 30 per cent in a pilot ORT project now extended to the whole country. As of mid-1985, 4,000 clinics had set up oral rehydration centres to teach mothers how to use the simple therapy.

In Bangladesh, oral rehydration workers go house-to-house giving 30-minute lessons in how to treat diarrhoea with molasses and salt. By the end of 1985, village teams were expected to have visited 5 million of the roughly 16 million households throughout the country.

Since ORT was introduced in Nicaragua in 1980, the death rate among children hospitalized with diarrhoea has fallen by 42 per cent, and diarrhoea has dropped from the first to the fifth cause of child death.

Other measures

Along with immunization and oral rehydration therapy, breast-feeding, improved weaning and regular monitoring of children's growth could save the lives of at least half the 40,000 children who die each day in the developing world, UNICEF estimates.

Although breast-feeding takes a considerable amount of the mother's time, it can save $200 to $300 a year in infant formula costs and provide important health benefits for both mother and child. Breast milk contains at least six anti-infective agents, offering a considerable degree of immunity to an infant. Breast-feeding can halve the number of illnesses, particularly diarrhoeal and respiratory infections, during a child's first year. It also tends to delay the return of menstruation, offering the mother protection against another pregnancy too soon.

Growth monitoring normally involves a monthly visit to a clinic or village weighing centre, but the effort is more than repaid: it gives the mother regular access to basic advice on child health and provides an early-warning system to spot irregularities in growth and development.

The most insidious aspect of child malnutrition is that in all but the most severe cases it is virtually invisible. However, since a regular monthly weight gain is considered the best single indicator of a child's normal growth, growth checking can be an effective way to prevent a child from slipping into a cycle of illness and malnutrition. It is estimated that growth monitoring could reduce by 50 per cent child malnutrition in the developing world.

One contributory factor to slowed growth, according to UNICEF, is lack of understanding about when to wean children and what foods to introduce. In some parts of the world, children are given nothing but breast-milk up to age one and even beyond, resulting in malnutrition. At the other extreme, solid foods--or inappropriate foods--are introduced too early, causing risk of diarrhoea or other digestive disorders. Improved knowledge about the energy needs of a weanling could help mothers provide an adequate diet to ensure child health.

Recent findings suggest that sufficient vitamin A levels may be another important determinant of a child's overall health. The link between vitamin A deficiency and xerophthalmia (drying of the eyes) has long been recognized; some 250,000 children a year are blinded as a result, and as many as 5 to 10 million are affected to some degree. But a major child health study in Indonesia has also reported a close association between vitamin A deficiency and the incidence of respiratory and diarrhoeal infections.

In a test of the practical significance of those findings, administration of a standard UNICEF vitamin A capsule every six months reduced death rates by approximately 30 per cent among a group of more than 15,000 Indonesian children aged one to three years.

"Should these findings be confirmed [in repeated studies]', the report states, "then the maintenance of an adequate level of vitamin A will join the range of low-cost, parent-based ways of protecting the health and lives of children in the poor communities of the world.'

Fewer deaths, fewer births

The breakthroughs described in the State of the World's Children report are making it possible to save millions of child lives each year. But a question frequently asked about the potential of UNICEF's "Child Survival Revolution' is: Won't it lead to even more rapid population growth?

Paradoxically, according to UNICEF, the answer is no. A sharp reduction in child deaths would lead instead to an eventual reduction in population growth.

The reasons?

If parents had more assurance their children would survive and be healthy, they would be likely to produce fewer of them.

Several of the low-cost strategies for reducing child deaths are also key strategies for reducing births. Among them: family spacing (infant mortality is twice as high when the interval between births is less than two years); female literacy (rising female literacy brings falling birth rates, according to the World Fertilty Study); and breast-feeding (a protection, to a great extent, against pregnancy).

Furthermore, UNICEF points out, the "Child Survival Revolution' increases parents' sense of control over their lives. "Probably the most important prerequisite for the acceptance of family planning', the report states, "is the growing confidence of parents that they can improve their lives by their own informed decisions and actions. Anything which helps to increase that confidence, as all parent-based child survival strategies do, is therefore also likely to lower birth rates.'

Countries which have already achieved a revolution in child survival are lending support to those arguments. China, Costa Rica, the Republic of Korea, Singapore and Sri Lanka--which have the lowest infant death rates in the developing world-- now also have the lowest birth rates.