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Child Health

Multiple Indicator Cluster Surveys Data Interpretation, Further Analysis and Dissemination Workshop. Child Health. Overview of presentation. Two Modules Immunization (3 tables) Care of illness: Disease episodes (1 table) Diarrhoea (5 tables) ARI (4 tables) Malaria/fever (12 tables).

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Child Health

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  1. Multiple Indicator Cluster SurveysData Interpretation, Further Analysis and Dissemination Workshop Child Health

  2. Overview of presentation • TwoModules • Immunization (3 tables) • Care of illness: • Disease episodes (1 table) • Diarrhoea (5 tables) • ARI (4 tables) • Malaria/fever (12 tables)

  3. Cause of death distribution for children under 52012 estimates UNICEF analysis based on IGME 2013, WHO and CHERG 2103; as published in ‘Committing to child survival: A promised renewed UNICEF Progress Report 2013

  4. Overview of MICS5 contents • Two Modules • Immunization (3 tables) • Care of illness: • Disease episodes (1 table) • Diarrhoea (5 tables) • ARI (4 tables) • Malaria/Fever (12 tables)

  5. Background Up-to-date information on recommended vaccines can be obtained from www.who.int/immunization/documents/positionpapers/en/index.html It is recommended that all children receive the following immunizations: • At birth BCG (Tuberculosis) • At 6 weeks Polio 1 and DPT 1 (Diphtheria, Pertussis, Tetanus) • At 10 weeks Polio 2 and DPT 2 • At 14 weeks Polio 3 and DPT 3 • At 9* months Measles and Rubella • Hepatitis B (HepB), Haemophilusinfluenzae type B (Hib), Rotavirus, and Pneumococcal have same schedules as Polio and DPT

  6. Indicators • BCG, • DPT 1-3, • Polio 1-3 • HepB • Hib • Measles (MMR) • Yellow fever In MICS5, immunization indicators are calculated as: Percentage of children age 12-23 months vaccinated against vaccine preventable childhood diseases 1) at any time before the survey and 2) by their first birthday.

  7. Indicators • BCG, • DPT 1-3, • Polio 1-3 • HepB • Hib • Measles (MMR) • Yellow fever Depending on measles schedule, need to look at vaccinations by second birthday. In MICS5, immunization indicators are calculated as: Percentage of children age 12-23 months vaccinated against vaccine preventable childhood diseases 1) at any time before the survey and 2) by their first birthday.

  8. Methodological issues • The model schedule is adapted by most countries. • The survey questions should reflect the national immunization schedule and take into account recent changes or vaccine introductions (if any)

  9. Methodological issues Coverage estimates obtained from 1) observed child health cards* and 2) maternal recall of specific immunizations. Child health cards are not subject to recall bias, but are not always accurate.

  10. Calculation For children without cards (or who have cards with missing or incomplete dates), how do we compute the percentage of children vaccinated by 12 months of age? Assume the proportion vaccinated by 12 months of age is the same as for children who have cards. Children vaccinated according to card data + Children vaccinated according to mother’s recall = Total number of children vaccinated

  11. Example: BCG

  12. MICS4 MICS5 2 panels: 12-23 and 24-35

  13. Neonatal Tetanus Protection Found in women’s questionnaire Proportion of women age 15-49 years with a live birth in the 2 years preceding the survey who were given at least two doses of tetanus toxoid vaccine within the appropriate interval prior to giving birth Complex calculation: women can be protected from neonatal tetanus in a variety of circumstances based on the receipt of vaccinations in the previous years

  14. The information contained in the first five columns of this table are calculated in a hierarchical fashion Women who fall into one of these 5 categories are considered ‘protected against tetanus’ and are included in the MICS indicator

  15. Overview of MICS5 contents • Two Modules • Immunization (3 tables) • Care of illness: • Disease episodes (1 table) • Diarrhoea (5 tables) • ARI (4 tables) • Malaria/Fever (12 tables)

  16. NEW! This table establishes the denominators for all of the following care-seeking behaviour and treatment tables related to diarrhoea, suspected ARI, and fever (malaria). Prevalence varies by season and caretaker reporting Symptoms of ARI versus suspected pneumonia

  17. Overview of MICS5 contents • Two Modules • Immunization (3 tables) • Care of illness: • Disease episodes (1 table) • Diarrhoea (5 tables) • ARI (4 tables) • Malaria/Fever (12 tables)

  18. The case for pneumonia and diarrhoea Pneumonia & diarrhoea are leading Infectious killers of the world’s youngest children This toll is highly concentrated in the poorest regions and countries and among the most disadvantaged children within these societies. But coverage of low-cost curative interventions against pneumonia and diarrhoearemains low, particularly among the most vulnerable.

  19. Diarrhoeatreatment • 2004 joint UNICEF/WHO recommendation for diarrhoea treatment: • Oral rehydration therapy with solutions made of low-osmolarity oral rehydration salts (ORS) • Continued feeding • Zinc treatment • Preventing dehydration is key to child survival • However, only about a third of children with diarrhoea in the developing world receive ORS

  20. NEW! Percentages of children for whom advice or treatment was sought will not add to 100 since for some advice or treatment may have been sought from more than one type of provider. Note that community health provider includes categories from both public and private facilities or providers Note that “A health facility or provider” is used for all three diseases and for both advice/treatment and source of drug and changes according to disease.

  21. Preventing dehydration is key to child survival • Feeding should continue during the diarrhoea episode

  22. Zinc treatment – key recommended intervention ORS (Oral Rehydration Salts) – recent push to scale up – ‘Gold standard’ of oral rehydration therapy Recommended home fluids – varyaccording to country eg. Sugar salt solutions or cereal based drink – although not as effective

  23. NEW!

  24. Overview of MICS5 contents • Two Modules • Immunization (3 tables) • Care of illness: • Disease episodes (1 table) • Diarrhoea (5 tables) • ARI (4 tables) • Malaria/Fever (12 tables)

  25. Symptoms of ARI = cough + rapid/ difficult breathing + problem in the chest New MICS5 terminology Interpret with caution due to denominator! All public and private health facilities and providers BUT not private pharmacy All public and private health facilities and providers

  26. The two danger signs are fast breathing and difficult breathing Table is based on who are mothers/ caretakers of children under age five Warning: Open-ended questions can lead to challenges during data collection

  27. Essential steps for reducing pneumonia deaths among children MICS5 tables cover threeessential steps needed to reduce deaths among children under five with pneumonia: 1. Recognize a child is sick 2. Seek appropriate care 3. Treat appropriately with antibiotics

  28. Essential steps for reducing pneumonia deaths among children 1 2 3 Example from MICS4

  29. Pneumonia 3 billion people use solid fuels as main cooking fuel Household air pollution, a well known risk factor for childhood pneumonia – Mainly caused by solid fuels (wood, crop waste, animal dung and coal) for cooking or heating in poorly ventilated open fires and stoves.

  30. Pneumonia

  31. Take advantage of increasing focus on health for dissemination, advocacy and analysis! Further use of data

  32. Health interventions across the continuum of care Source: Countdown to 2015 Decade Report (2012 report)

  33. A second look at diarrhoea- pneumonia related data? Pneumonia and Diarrhoea: Tackling the deadliest diseases for the world’s poorest children, UNICEF 2012

  34. Overview of MICS5 contents • Two Modules • Immunization (3 tables) • Care of illness: • Disease episodes (1 table) • Diarrhoea (5 tables) • ARI (4 tables) • Malaria/Fever (12 tables) MICS4 – 6 Tables

  35. Standard MICS5 malaria tables Prevention • Household availabilityof ITNs & protection by a vector control Method (ITN & IRS) • Access to an ITN - # of household members • Access to an ITN - background characteristics • Use of ITNs – number of ITNs • Use of mosquito nets by the household population • Children sleepingunder mosquito nets

  36. Standard MICS5 malaria tables Prevention – Malaria during pregnancy • Pregnant women sleepingunder mosquito nets • Intermittent preventive treatment – for pregnant women Case management • Care-seeking during malaria • Treatment of children with fever • Diagnostics and anti-malarial treatment of children • Source of anti-malarial

  37. Global and African malaria-mortality burden among children under five The WHO estimates that approximately 216 million malaria episodes occurred in 2010 -- leading to approximately 655,000 deaths. While malaria accounts for 7% of global deaths in children... The majority of those deaths occur in Africa.... Where approximately 1 in every 7 child deaths (15%) is due to malaria. Global cause of death among children under five, 2010 Global distribution of malaria deaths among children under five, 2010 African cause of death among children under five, 2010

  38. NEW! Household protection IRS - increasing importance in some countries, but many countries do not have IRS programmes

  39. NEW! The denominator is number of usual (de jure) household members and does not take into account whether household members stayed in the household last night. Percentage of household population who could sleep under an ITN if each ITN in the household were used by up to two people

  40. NEW!

  41. NEW!

  42. Potential seasonal effect in these indicators This new indicator tells us about utilization in HHs with ITNs. Note different denominator

  43. Intermittent Preventive Treatment (IPT) - pregnant women who received at least 3 doses of SP/Fansidar (and once at any antenatal care visit during pregnancy).

  44. Sub-Saharan Africa- Trends in ITN use Note: Dates of national surveys are indicated next to the country. Lighter shade of colour refers to ‘earlier survey’ while darker shade refers to ‘later survey’. Source: UNICEF global malaria databases 2011, from MICS, DHS and MIS, published in A Decade of Partnership and Results, RBM Progress & Impact Series, Report No. 7, 2011.

  45. Case management – new recommendation MDG, but Interpret with caution Diagnosis Proportion of children under five years old with fever in the last two weeks who had a finger or heel stick Treatment Proportion of children under five years old with fever receiving anti-malarial medicines Proportion of children under five years old with fever receiving anti-malarial medicines by drug type Proportion receiving any ACT (or other first-line treatment), among children under five years old with fever in the last two weeks who received any antimalarial drugs

  46. NEW! Percentages will not add to 100 since for some advice or treatment may have been sought from more than one type of provider. Includes all public and private health facilities and providers as well as shops

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