The document discusses strategies for improving child survival, with a focus on children under 5 years old. It defines key terms and outlines the Sustainable Development Goals' targets for reducing child mortality. The major causes of under-5 deaths are preventable conditions like pneumonia, diarrhea, and malaria. Interventions discussed include integrated management of childhood illness, immunization, breastfeeding promotion, vitamin A supplementation, insecticide-treated nets, skilled birth attendance, and growth monitoring. The document also provides country-specific child mortality data for Kenya and guidelines on pediatric HIV treatment.

1. CHILD SURVIVAL STRATEGIES
HABAKUK LARRY OMONDI

2. Definitions
• Child- Persons under the age of 18
• Survival - Ensuring the realization of the child’s inherent right to life
• Child survival: All children have the right to life and governments are
expected to protect this right, but the term child survival refers to the
survival of children aged 0-5 years, commonly called “Under-fives”.
• Child Survival Programmes: Child Survival programmes are those
that address the major causes of under-five mortality

3. POST 2015: SUSTAINABLE DEVELOPMENT GOALS(SDG)

4. …….
• Child survival strategies- interventions that lead to a childhood
mortality reduction in line with the SDG(in children under 5)
• The proposed SDG target for child mortality aims to end, by 2030,
preventable deaths of newborns and children under 5 years of age,
with all countries aiming to reduce neonatal mortality to at least as low
as 12 deaths per 1,000 live births and under-5 mortality to at least as
low as 25 deaths per 1,000 live births.

5. • Achieving the SDG target on under-five mortality on time would mean
averting 11 million under-five deaths compared with the current
situation. If current trends continue, roughly 52 million children under
5 years of age will die between 2019 and 2030, half of them newborns.
Urgent efforts are needed in the countries that are falling behind, many
of which are located in sub-Saharan Africa and South Asia

6. Why should child survival focus on under-
fives?
• Analyses of several child morbidity and mortality data from
community and facility based surveys in developed and developing
nations indicate that the under-fives constitute the most at-risk group.
• It is therefore sensible to focus on this group if development targets
are to be attained

7. Why are under 5 the most at risk group?
• immaturity of all the baby’s immune systems
• immature digestive system-cannot handle the usual adult foods-no
teeth for chewing and the skill for swallowing semisolids and solids
develops with time hence the need for appropriate Infant and Young
Child Feeding practices to protect them from malnutrition and related
nutritional deficiencies and diseases
• they can neither take themselves for preventive health interventions
nor give histories of their illnesses for appropriate therapeutic
interventions to be applied. Dependent on adults if intervention is
delayed they are at high risk.

8. Causes of under 5 death
The global under-five mortality rate declined by 59 per cent,
from 93 deaths per 1,000 live births in 1990 to 39 in 2018.
Despite this considerable progress, improving child survival
remains a matter of urgent concern. In 2018 alone, roughly
15,000 under-five deaths occurred every day, an intolerably
high number of largely preventable child deaths.
• More than half of these early child deaths are due to
conditions that could be prevented or treated with access to
simple, affordable interventions.

9. • Globally, pneumonia, diarrhoea and malaria remain among the leading
causes of death among children under age 5 – accounting for almost a
third of global under-five deaths. The leading causes of death among
children under age 5 in 2018 included preterm birth complications (18
per cent), pneumonia (15 per cent), intrapartum-related events (13 per
cent), congenital abnormalities (9 per cent), diarrhoea (8 per cent),
neonatal sepsis (7 per cent) and malaria (5 per cent). Nutrition-related
factors contribute to about 45% of deaths in children under-5 years of
age.

10. • Although the world as a whole has been accelerating progress in
reducing the under-5 mortality rate, disparities exist in under-5
mortality across regions and countries. Sub-Saharan Africa remains
the region with the highest under-5 mortality rate in the world, with 1
child in 13 dying before his or her fifth birthday, 15 times higher than
in high income countries. Two regions, Sub-Saharan Africa and
Central and Southern Asia, account for more than 80 per cent of the
5.3 million under-five deaths in 2018, while they only account for 52
per cent of the global under-five population. Half of all under-five
deaths in 2018 occurred in just five countries: India, Nigeria, Pakistan,
Ethiopia and the Democratic Republic of the Congo. India and Nigeria
alone account for about a third

12. • Children in sub-Saharan Africa are more than 14 times more likely to
die before the age of 5 than children in developed regions.
• 1 in every 19 babies born in Kenya this year will die before their first
birthday.
• 60% of these deaths will occur in the neonatal period.
• While poverty and high rates of HIV, TB, malaria and other infectious
diseases provide underlying substantial challenges, the appalling
mortality statistics implicate dysfunctional health systems as being the
principal obstacle for addressing these challenges and preventing pre-
mature mortality.

13. • Child survival- KENYA
• Under-five mortality rate (U5MR), deaths per 1,000 live births
• 46
• Number of under-five deaths
• 68,882
• Infant mortality rate (IMR), deaths per 1,000 live births
• 34
• Neonatal mortality rate (NMR), deaths per 1,000 live births
• 21
• Under-five mortality rate (U5MR), deaths per 1,000 live births (male)
• 50
• Under-five mortality rate (U5MR), deaths per 1,000 live births (female)
• 41

15. Child Survival Strategy for the African
Region
• WHO calls on Member States to address health equity through
universal health coverage so that all children are able to access
essential health services without undue financial hardship. Moving
from “business as usual” to innovative, multiple, and tailored
approaches to increase access, coverage, and quality of child health
services will require strategic direction and an optimal mix of
community and facility (based care. Health sector and multi-sectoral
efforts are also needed to overcome the inequalities and the social
determinants of health.

16. • Although the member States of the African Union committed
themselves to the attainment of MDG 4, the persisting poor child
survival indices in the region led the WHO, UNICEF and World Bank
to develop the Child Survival Strategy for the African Region. This
was adopted by the 56th WHO Regional Committee in 2006

17. INTERVENTIONS
• IMCI (Integrated Management of Childhood Illness)
• Immunization
• Early initiation of breastfeeding
• Exclusive breastfeeding
• Vitamin A Supplementation
• ITN
• Skilled birth attendants.
• Growth monitoring.
• Female education.
• Family planning.

18. Cont….
From conception to 5th birthday
• Antenatal intervention
• Early childhood intervention up to 5 years of age
- Prevention
- Care

19. Antenatal care
• Tetanus immunization
• Iron and folate Supplement
• Intermittent treatment against malaria - IPTp
• ITNS
• PMTCT / HIV AIDS

20. Preventive interventions
• IMMUNIZATION
• VIT A Supplementation
• Deworming

21. Female education
• studies have shown the benefits that education has for girls and women.
• The studies link education with:
 reduced child and maternal deaths
improved child health
lower fertility (contraception)
Proper nutrition
Vaccination
Income potential
Decreased HIV/AIDS transmission
Informed decision making

22. Growth monitoring & surveillance
Aims:
To identify children with growth deviation
To identify diseases and conditions that manifest thru abnormal
growth eg chronic illnesses, growth hormone deficiency
To detect feeding difficulties esp in neonates
To identify social deprivation (e.g poverty) whose outcome is poor
nutrition
Ultimately the goal of growth monitoring is to minimize
illness and avoid unnecessary child death

23. Cont…
Steps of growth monitoring
i. Determining correct age
ii. Accurate weighing and measurement of parameters
iii. Plotting data accurately in growth charts
iv. Interpreting direction of growth curve
v. Discussing the child's growth and follow-up with mother

24. Parameters…..
Data presentation on gender-specific charts
i. Weight/age
ii. Height/age
iii. HC/age
iv. Weight for height (infants)
v. BMI/age (children)
vi. MUAC

25. Integrated Management of Childhood Illness (IMCI)
Established by WHO (1992) to provide simple effective methods to prevent and
manage the leading causes of serious illness & mortality in young children.
Designed for use in OPC clinical settings w/ ltd diagnostic tools, ltd medications &
ltd opportunities to practice complicated clinical procedures.
7/10 deaths result from one of the following 5 causes or a combination there of :
ARI (pneumonia), diarrhea, measles, malaria or malnutrition.
IMCI strategy includes three main components:
1. Improving case management skills of health-care staff
2. Improving overall health systems
3. Improving family and community health practices.

26. Cont…..
• It consists of:
1. Emergency triage and assessment and diagnosis.
2. Assessment n diagnosis
3. Cough and difficulty in breathing
4. Diarrhea
5. Fever
6. Young infants
7. Severe malnutrition
8. Children with HIV/AIDs
9. Supportive care
10. Monitoring a child's progress
11. Counselling and discharge from hospital

30. October 2019 guidelines on paediatric Haart
Preferred first line ART for infants, children and
adolescents less than 15 years of age;
•Birth to 4 weeks: AZT +3TC+RAL or NVP
•<20Kgs (above 4 weeks old): ABC +3TC+LPV/r
•20kg-35kg: ABC +3TC+DTG
•≥35kg: TDF+3TC+DTG

31. Preferred Second-line ART Regimens for Children and Adolescents (4 weeks --Less
than 15Years of age), October 2019

32. Expanded programme on immunization-
currently Uvis
• Vaccines are one of the most cost-effective and popular preventive
interventions globally.
• From the beginning of the 20th century the extensive use of vaccines
has resulted in significant reductions in the prevalence of many
diseases and the eradication of smallpox.
• Goal: reduce morbidity, mortality & disability due to life threatening
infections of vaccine preventable diseases.

33. Types of Vaccines used in Kenya -UVIS
• There are three types of vaccine:
• Live attenuated vaccines
• Inactivated vaccines – either whole cell or cell fractions
• Genetically engineered ( recombinant) vaccines – which are similar to
inactivated vaccines
• Live attenuated vaccines are derived from disease-causing viruses or
bacteria that have been weakened under laboratory conditions. They
will multiply in a vaccinated individual, but because they are weak,
either cause no disease or only a mild form. Usually, only one dose of
this type of vaccine provides life-long immunity, with the exception of
oral polio vaccine, which requires multiple doses.

34. • Examples of live attenuated vaccines include: • Virus: oral polio
vaccine (OPV), measles, yellow fever • Bacteria: BCG, oral typhoid
(Salmonella typhi) and oral cholera
• Inactivated vaccines are produced by growing viruses or bacteria and
then inactivating them with heat or chemicals. Because they are not
alive, they cannot grow in a vaccinated individual and therefore cannot
cause the disease. Since they are not as effective as live vaccines,
multiple doses are required for full protection. Booster doses are
needed to maintain immunity because protection by these vaccines
diminishes over time.

35. • Examples of inactivated vaccines include: • Whole inactivated viral
vaccines, e.g. Smallpox, Injectable Polio Vaccine (IPV) (Salk),
hepatitis A, Influenza, rabies • Whole inactivated bacterial vaccines,
e.g. whole-cell pertussis, inactivated cholera, anthrax • Subunit and
fractional vaccine - These vaccine are composed of parts (i.e. subunits
or fractions) of the pathogen, instead of the whole pathogen, e.g. •
Fractional: Diphtheria and tetanus toxoids, Haemophilus influenza
type b conjugate vaccine (Hib), pneumococcal conjugate vaccine
(PCV) • Recombinant: Hepatitis B, HPV

36. • All the vaccines for which the child is eligible at an earlier age can be
given together anytime you come in first contact with the child
• There is an optimal age for each vaccine: BCG and OPV0 are given at
birth. DPT+HepB-Hib and pneumococcal vaccines should be
commenced at age 6 weeks. If given earlier, they will not provide
protection. Measles vaccine should not be given before nine months
because of the presence of significant blood levels of maternal
antibodies that lower its efficacy

37. • All series antigens, the three doses of OPV, DPT+HepB-Hib and PCV
should be given one month apart to let the child’s immune system
process the previous dose and produce the best antibody response
• DO not restart the schedule since there is no maximum interval
between doses and the vaccine will be as effective as if given after
four weeks
• Remember: Do not miss an opportunity to immunize when you see an
eligible

38. Cold chain system
• Cold chain is a process of maintaining vaccines in a potent state from
the manufacturer to the recipient (child and woman of child bearing
age). Vaccines lose their potency when exposed to high temperature,
sunlight or freezing conditions depending on type.
• The equipment used in maintaining cold chain must meet standards set
by WHO and UNICEF for safe vaccine storage. They vary depending
on the level of use. Below is a list of the equipment currently used in
Kenya. 1. Cold rooms and freezer rooms 2. Freezers and Ice-lined
refrigerators 3. Gas electric refrigerators 4. Solar Refrigerators 5.
Vaccine carriers 6. Cold boxes 7. Icepacks 8. Thermometers

39. Vaccine Age N/B
BCG At birth
OPV At birth, 6 wk, 10 wk, 14 wk IPV introduced
Pentavalent
(DPT,HepB,Hib)
6 wk, 10 wk, 14 wk
Pneumococcal (PCV-10) 6 wk, 10 wk, 14 wk Intro 2011 Jan
Measles 9 months Measles 2 @ 18 mths
Yellow fever 9 mths Baringo, Keiyo, Koibatek &
Marakwet
TT Pg women, WCBA & sch girls age 7-14
Vit A 6m, 12m, 18m….. 54m, 60m <6m -50000u
6-12m – 100000u
>12m – 200000u
Rotavirus 6 wk, 10 wk Intro’ 2014

40. BCG -BacilliCalmette-Guerin vaccine
BCG is a freeze-dried live attenuated vaccine prepared from Mycobacterium Bovis.
It has a lifespan of up to 12 months from the date of preparation, when kept under
the right temperature of +20 C to +80 C
BCG immunization protects against tuberculosis
BCG immunity is estimated to last between 7-15 years. BCG vaccine should be
given at birth or at first contact.

41. BCG vaccine is usually given to children up to the age of 5
years, if no BCG scar is present There are no absolute
contraindications besides symptomatic HIV/AIDS and other
known immune-suppression diseases e.g. cancers
those with suspected TB infection at birth
• BCG is given through intradermal route, dose is 0.05 ml
for children less than 1 year or 0.1 ml for children above 1
year
It produces a lasting scar as an indicator for immunization

42. Oral Polio Vaccine (OPV) is a live attenuated vaccine made from the three types of polio virus:
type I, II and III.
Injectable Polio Vaccine (IPV) is given by subcutaneous injection
Given as two drops
The birth dose is counted as a Zero dose since the uptake of vaccine to the infants has not
develop adequately
At birth or at first contact with the child up to 2 weeks. No contraindication to oral polio
vaccine

43. DPT/HepB+Hib Vaccine (PENTAVALENT) DPT/HepB+Hib
vaccine is called Pentavalent vaccine because it protects
against five diseases namely diphtheria, pertusis, tetanus,
hepatitis B, and Haemophilus influenza type B (Pneumonia,
meningitis and epiglotitis) Do not give it to a child reported
with convulsions after the previous dose.
The “P” component is likely to cause convulsion.
The dose is 0.5 ml intramuscularly in the upper outer aspect of
the thigh . There is often fever within 48 hours. Give
antipyretic drug,

44. Measles vaccine is a freeze dried live attenuated vaccine that has to
be reconstituted with a cold diluent that is provided with the
vaccine. Maternal antibodies seem to remain in most children until
the age of 6 to 9 months. If children are immunized before the age
of 9 months, most of them might not be protected

45. • Immunization against measles with the present vaccine should not
start earlier than 9 months
• give measles vaccine at 9 months or at first contact with the child after
that age
• The dose is 0.5 ml. Give measles vaccine subcutaneous in the outer
side of the right upper arm, in the deltoid muscle a

46. • possible reactions after measles vaccine, e.g. slight fever, running nose
occurring 5 to 10 days after immunization, slight rash.
• Yellow Fever Vaccine a) Yellow fever is a live attenuated freeze-dried,
vaccine that must be reconstituted with the diluent provided. The
vaccine must be discarded six hours after reconstitution or at the end
of the immunization session, whichever comes first

47. • One dose should be given to children at nine months of age or at first
contact, at the same time as measles vaccine
• There are no contraindications for giving yellow fever to children
older than nine months of age.
• The 0.5 ml dose is given subcutaneously in the upper left arm
• Pneumococcal vaccine given as 0.5ml intramuscularly or
subcutaneously into deltoid muscle or lateral mid thigh.
• Rotavirus vaccine given 1ml (rotarix) orally ,two doses atleast 4 weeks
apart. It can be given with oral polio vaccine

48. Tetanus Toxoid Vaccine (TT)
• It is a relatively heat stable vaccine prepared by formalin treatment of
the toxin produced by Clostridium Tetani (mainly the Harvard strain).
• give it to prevent tetanus disease, because there is no natural
immunity to tetanus
• TT is given regardless of age
• 0.5 ml given through intra-muscular injection into the left upper arm
into the deltoid muscle.
• For focused antenatal care ;girls and women of child bearing age; for
trauma and occupational prophylaxis .

49. Complications
• Anaphylactic shock 2. Injection site abscesses. 3. Cases of BCG
lymphadenitis 4. Cases requiring hospitalizations that are thought by
health workers, or the public, to be related to immunization 5. Unusual
medical incidents that are thought by health workers, or the public, to
be related to immunization. 6. Deaths that are thought by health
workers, or the public, to be related to immunization

51. Breast feeding
• saves infant’s lives
• Contains balanced proportions and sufficient quantities of all needed
nutrients for the first 6 months (whole food)
• Prevents stunting
• Protects against diseases (esp. diarrhea and respiratory infections)
• Easy to digest
• At the right temperature and ready always, all time
• Protect against allergies
• Increased I.Q scores
• Suckling helps develop facial muscles
• Better psychomotor, affective and social development of the infant

52. Food supplementation
• Supplementary feeding = refers to giving other foods and liquids in
addition to breastmilk or commercial infant formula milk starting at 6
months of age.
Standard Infant formula
Soy based formulas
Hypoallergenic formulas (protein hydrosylate formulas)

54. Zn….
• Helps curb diarrhea and fluid loss
• <6 mths Zn tabs 10 mg O.D 10 days
• >6 mths 20 mg O.D 10 days
• ORS + Zinc can reduce diarrhoeal deaths by over 70%

55. Family planning
-Hormonal
Oral contraceptives
Injectable hormonal contaceptives
Hormonal delivery systems
Transdermal routes
-Non-hormonal
Barrier method(condoms, vaginal diaphragm, cervical cap)
IUCDs
Withdrawal
Calendar
-Sterilization (vasectomy, BTL)

56. Post-partum Infants – neonatal Infants - 6 week Infants- 1st year of life/ up
to 5 years
All women should be
educated and encouraged
to attend a Health Fascility
for any post-partum
complication and 6 week
evaluation; need to
encourage early
identification of infection
Safe water should be
ensured for all mothers
and infants; smokeless
stoves should be
implemented
All women should be
educated and encouraged
to come to a HF for any
post-partum complication,
especially in the first 28
days (neonatal period)
Encourage immediate and
exclusive breastfeeding for
all children
Ensure infant sleeping
under a bed net
Infants should receive
HIV PCR test if known
HIV exposed; antibody
to determine exposure
if mother status
unknown
o Follow new Kenya
National Guidelines for
testing and treating- all
babies HIV+ or HIV
exposed should receive
cotrimoxazole from 6
weeks of age
Malnutrition/ anemia
should be assessed
throughout and managed;
vitamin A supplementation
ORS/zinc: mothers should
be educated and ORS/zinc
made available in all health
facilities
Full uptake of
immunization series,
including new vaccines

57. Post-partum Infants – neonatal Infants - 6 week Infants- 1st year of life/
up to 5 years
Increase home visits by
community health workers during
the early hours of birth to
complement facility-based post-
natal care and improve neonatal
survival
Train community health workers
to use the algorithms to identify
acutely infected neonates
Use surveillance platform to
identify the principal bacterial and
viral agents of neonatal infections
and their drug resistance profiles,
and assessment of the
consequences of sexually
transmitted diseases to fetuses
and newborns
Ensure BCG vaccination
Infants should start
immunizations series-
6/10/14 weeks; 9
months. New vaccines
should be targeted to
these areas:
pneumococcal vaccine,
rotavirus vaccine, other
new vaccines
General health
management should
occur- mothers should be
educated about danger
signs (severe
diarrhea/dehydration,
etc) and encouraged to
bring their children in to
health facilities for
management

58. THANK YOU