Progress in Implementing the Child Survival Strategy in the African Region

Under-five mortality rate in the African Region was estimated at 145/1;000 live births in 2007. These deaths were the result mainly of preventable or treatable conditions. A child survival strategy for the African Region was developed by WHO; UNICEF and World Bank and adopted by the fifty-sixth WHO Regional Committee in 2006 to address this high mortality rate.1 This report; which is a review made using reports and the results of a questionnaire sent to countries; summarizes progress in implementing the strategy as at December 2009 and proposes next steps for action. Significant achievement has been made in the areas of policy; strategy and plandevelopment; capacity building; partnerships and communication strategies; operations research; documentation and monitoring and evaluation. Also in scalingup of child survival interventions such as measles vaccination coverage; insecticidetreated nets use in children and provision of antiretroviral drugs to prevent motherto-child transmission of HIV. Currently; 21 countries are implementing the Integrated Management of Childhood Illness strategy in more than 75of the districts. Despite the achievements in some areas; coverage of some eff ective interventions remains low. Various health system challenges hamper the progress of child survival. These include inadequate country-level funding for scaling-up effective interventions; inadequate monitoring of coverage of interventions and human resource limitations. In order to increase coverage of eff ective child survival interventions and accelerate progress in implementation of the regional child survival strategy; the paper recommends several actions including the improvement of coverage of key child survival interventions and mobilization and allocation of resources to implement national child survival scale-up strategies and plans

What can be Done to Improve Women's Health Region?

Women constitute a key link in the chain of development actions worldwide. For women to be able to fulfi ll their role in society; however; they need to be in a state of adequate physical; mental and social well-being. Unfortunately; the huge majority of African women are still unaware of their fundamental rights to health; education and life; and suffer from ill-health and sub-standard living condition. Global leaders; including African ministers of health; have adopted a number of resolutions to improve women's health. However; the health situation of women in Africa continues to be poor; with 57of women in the African Region lacking access to assistance by qualified staff during childbirth; one out of twenty-six women being at risk of dying from birth-related complications; to mention a couple of significant indicators. Given that the issues of women's health are complex; this paper calls for multisectoral and concerted action involving the public and private sectors; nongovernmental organizations; communities and families. For this; it proposes that countries set up a multidisciplinary technical team composed of experts in health; gender and human rights to identify priority interventions for eff ective scaling up and resource mobilization for women's health at national level. Among the ways forward proposed in the paper are scaling up women's health-related interventions; using the primary health care approach in line with the Ouagadougou Declaration to effectively deliver women's health interventions; strengthening the capacity of women; families and communities to prevent diseases; and empowering them economically to enable them to take appropriate decisions related to their health and sexuality

Physical punishment of elementary school children in urban and rural communities in Ethiopia.

Severe corporeal punishment is known to hamper the physical, emotional and psychosocial development of children. This cross-sectional study was, thus, undertaken to make a quantified preliminary investigation on the occurrence of the problem. Six hundred and forty nine elementary schools' students were interviewed in selected urban and rural schools in Ethiopia. Eighty percent and 76% of the urban and rural children, respectively, admitted being subjected to physical punishment. Almost 21% of the urban and 64% of the rural children had skin bruises or body swelling as a result of the punishment. Only six children (three in each group) visited health facilities for the injury. Among urban students the proportion of those who had physical punishment increased with increasing paternal education and also with increasing maternal education. Among the rural students, on the other hand, physical punishment decreased with increasing age and grade. The public needs to be aware of the rights of children and every possibility should be worked out to secure their utmost emotional and physical development.

Suicide attempts in Ethiopian adolescents in Addis Abeba high schools.

Suicide is currently recognized as one of the leading causes of death of adolescents and young adults worldwide. A representative sample of all high-school students in Addis Abeba in 1989/90 academic calendar was surveyed to estimate life-time prevalence and risk factors of suicide attempts. 14.3% of the adolescents reported having attempted suicide. 17.5% usually felt hopeless. Suicide attempts were strongly and linearly associated with hopelessness, grade, and heavy alcohol intake. No significant associations were observed between attempts and age, sex, family history of suicide or parental educational level. It is concluded that a substantial proportion of adolescents attempt suicide and also exhibit the risk factors.

Precursors of atherosclerotic and hypertensive diseases among adolescents in Addis Ababa, Ethiopia.

The present study measured the prevalence of the precursors of atherosclerosis among 519 adolescents selected from high-school students in Addis Ababa. Also assessed was their knowledge about these precursors and about the hazards of smoking and of heavy alcohol consumption. A total of 13.8% of the adolescents smoked, 11.6% had a sedentary lifestyle, 9.2% consumed alcohol heavily, 14.1% were obese, 30.3% had one risk factor, and 4.4% had two risk factors for atherosclerosis. Altogether, 58% had inadequate knowledge about the precursors of atherosclerosis, and 62% and 51.4%, respectively, had inadequate knowledge about the hazards of smoking and of consuming alcohol. High-risk behaviours were positively associated with upper-income families and inadequate knowledge about the precursors of atherosclerosis. A substantial proportion of adolescents in Addis Ababa therefore exhibit the precursors of atherosclerotic and hypertensive diseases. Further, similar studies should be carried out in other Ethiopian cities, and the Ministries of Health and Education should give due attention to the primary prevention of these diseases and formulate plans for appropriate actions.

PIP: Extensive research in developed countries on atherosclerotic and hypertensive diseases has shown that the major, but preventable precursors of such disease are smoking, obesity, a sedentary lifestyle, heavy alcohol consumption, diabetes, and hypertension. Since the behavioral risk factors for these diseases are initiated in childhood and adolescence, preventive activities should target people early in their lives. Adolescents comprise approximately 25% of the population of Addis Ababa, Ethiopia. The authors present findings from their assessment of the proportion of adolescents in the city who smoked, were obese, had a sedentary lifestyle, drank alcohol heavily, had diabetes, and were hypertensive. The study also set out to identify social factors associated with these risk factors, as well as to determine the level of participants' knowledge about the precursors and the hazards of smoking and of heavy alcohol consumption. 519 ninth, tenth, and eleventh grade students in government-owned high schools during the 1989-90 academic year participated. 72.3% were aged 15-19, while the rest were aged 10-14. 13.8% of the students smoked, 11.6% had a sedentary lifestyle, 9.2% consumed alcohol heavily, 14.1% were obese, 30.3% had one risk factor, and 4.4% had two risk factors for atherosclerosis. 58% had inadequate knowledge about the precursors of atherosclerosis. More specifically, 62% and 51.4%, respectively, had inadequate knowledge about the hazards of smoking and of consuming alcohol. High-risk behaviors were positively associated with upper-income families and inadequate knowledge about the precursors of atherosclerosis. The authors conclude on the basis of these findings that a substantial proportion of adolescents in Addis Ababa have the precursors of atherosclerotic and hypertensive diseases. Similar studies should be conducted in other Ethiopian cities and the Ministries of Health and Education should pay attention to the primary prevention of the diseases and develop plans for appropriate action.

Knowledge and practice of mothers/care-takers towards diarrhoea and its treatment in rural communities in Ethiopia.

Diarrhoeal diseases are major causes of childhood morbidity and mortality in developing countries. Knowledge and practices of mothers or other care-takers of children are important determinants of the occurrence or outcome of diarrhoeal diseases. Base-line information on these variables is also needed for developing health education programmes and for formulating national policy on home fluid therapy. This study was conducted with the objectives of assessing the knowledge and practice of mothers and other caretakers of children towards diarrhoeal diseases and the sociodemographic correlates of adequate knowledge and practice. A study was conducted in the rural North, South, East and West Shewa Administrative Regions in April, 1990. A two-stage cluster sampling proportionate to size was used to select a total of 750 mothers or other caretakers. These were interviewed by trained and supervised health workers who used a pretested questionnaire. The three major ethnic groups were Oromo, Guragie and Hadya. Of the total respondents, 79.3% were illiterate, 78.5% got their water from unprotected sources, 88.9% had no latrines, 80.4% had no access to mass media and 7.1% spent more than 2 hours to reach to the nearest health facilities. Only 2.6% and 5.7% of mothers had adequate knowledge and practice on diarrhoea or its treatment, respectively. Age and educational level of mothers or other caretakers were found to be positively associated with adequate knowledge and practice towards diarrhoea and its treatment. The study clearly indicated that health education messages have not been effectively disseminated to the rural population. It is, therefore, strongly recommended that the Diarrhoeal Diseases Control Programme strengthens its communication activities through increasing persuasion of health workers who could serve as effective means of reaching the population who have access to health services.

Patterns of breast feeding in western Ethiopia and their relationship to acute diarrhoea in infants.

To determine the extent of protection from breast feeding against acute diarrhoea, a cross-sectional study was conducted in rural areas in a western region of Ethiopia, Gamo-Gofa. The standard cluster sampling technique promoted by WHO/CDD Program was used. We employed trained and supervised health workers (physicians nurses, and sanitarians) as interviewers, and a pretested questionnaire was utilized for the purpose. Among a total of 3002 children under the age of 5 years surveyed for diarrhoeal disease morbidity, mortality, and treatment rates, all those 6 months of age and less (n = 331) were taken as subjects to examine the trends of breast feeding and their association with the occurrence of acute diarrhoeal diseases. It was found that out of these 331 infants, 217 (66 per cent) were exclusively breast-fed and 114 (34 per cent) were partially breast-fed. No one in the study group was fully weaned. Out of those who were exclusively breast-fed (n = 217), 25 (12 per cent) had diarrhoea which started within the past 2 weeks of the survey. Among those partially breast-fed (n = 114), 46 (40 per cent) had diarrhoea. The difference in the occurrence of diarrhoea among exclusively and partially breast-fed infants was statistically significant (P less than 0.0001). When infants with partial breast feeding were contrasted with those on exclusive breast feeding, a relative risk of developing diarrhoea of 5.2 (95 per cent confidence interval 3.00, 9.10) was obtained. It is recommended that breast feeding which tends to diminish with urbanization be promoted as one important intervention of the control of diarrhoeal diseases.