Child Health (A)

Abstract

The Executive Director, UNICEF was reviewing the UNICEF 2014 report on the progress made by the WHO countries towards achieving the fourth Millennium Development Goal MDG 4. MDG 4 called for reduction in U5 mortality (U5 represents children less than 5 years old) by a two-third between 1990 and 2015. The report mentioned 6.6 million children died in the year 2012. He realized that many countries were not likely to achieve MDG 4 and therefore called for a meeting to discuss the report in detail and evolve future strategies to improve child health.

This case was prepared for inclusion in Sage Business Cases primarily as a basis for classroom discussion or self-study, and is not meant to illustrate either effective or ineffective management styles. Nothing herein shall be deemed to be an endorsement of any kind. This case is for scholarly, educational, or personal use only within your university, and cannot be forwarded outside the university or used for other commercial purposes.

2024 Sage Publications, Inc. All Rights Reserved

You are not authorized to view Teaching Notes. Please contact your librarian for instructor access or sign in to your existing instructor profile.

Resources

Exhibit 1: 10 Facts on Child Health 1

Fact 1: A child's risk of dying is highest in the first month of life

In the first month of life safe childbirth and effective neonatal care are essential. Preterm birth, birth asphyxia and infections cause most newborn deaths. Once children have reached one month of age, and up until the age of five years, the main causes of loss of life are pneumonia, diarrhoea, and malaria. Malnutrition contributes to almost one half of all child deaths.

Fact 2: Nearly three million children died in 2011 within a month of their birth

Newborn life is fragile. Health risks to newborns are minimized by:

  • quality care during pregnancy;
  • safe delivery by a skilled birth attendant;
  • essential neonatal care after birth: immediate attention to breathing and warmth, hygienic cord and skin care, and exclusive breastfeeding.
Fact 3: Pneumonia is the largest single cause of death in children under five years of age

In 2011, it killed an estimated 1.2 million children under the age of five years, accounting for 17% of all deaths of children under five years old worldwide. Addressing the major risk factors for pneumonia through immunization, exclusive breastfeeding, reduction in household air pollution and adequate nutrition is essential for prevention. Antibiotics and oxygen are vital treatment tools.

Fact 4: Diarrhoeal diseases are a leading cause of sickness and death among children in developing countries

Exclusive breastfeeding and proper sanitation and hygiene, and immunization help prevent diarrhoea among young children. Treatment for sick children with Oral Rehydration Salts (ORS) and zinc supplements is safe, cost-effective and saves lives. The lives of more than 50 million children have been saved in the last 25 years as a result of ORS.

Fact 5: Every minute a child dies from malaria

It is one of the leading causes of death among children under-five. Sleeping under insecticide-treated nets prevents transmission and increase child survival. Early testing and treatment with effective anti-malarial medication saves lives.

Fact 6: Over 90% of children with HIV are infected through mother-to-child transmission

This is preventable with the use of antiretrovirals, as well as safer delivery and feeding practices. An estimated two million children under 15 years of age are living with HIV, and every day more than 1000 are newly infected. Without intervention, more than half of all HIV-infected children die before their second birthday. Early testing and treatment with antiretroviral therapy for all HIV-infected children greatly improves survival and quality of life.

Fact 7: In 2012, about 17 million children suffered from severe wasting

Almost half of the under-five child deaths are associated malnutrition. Severe acute malnutrition leaves children more vulnerable to serious illness and high probability of dying. Most children can be successfully treated at home with ready-to-use therapeutic foods (RUTF). Globally, in 2012, an estimated 162 million children below 5 years of age, were stunted and 99 million were underweight.

Fact 8: Some 80% of the world's under-five deaths in 2012 occurred in only 25 countries, and about half in only five countries

Under-five deaths are increasingly concentrated in sub-Saharan Africa and Southern Asia. Child survival rates differ significantly around the world. Within countries, child mortality is higher in rural areas, and among poorer and less educated families.

Fact 9: About two-thirds of child deaths are preventable

They are preventable through access to practical, low-cost interventions, and effective primary care up to five years of age. Child health is improving, but serious challenges remain to achieve global goals to reduce deaths. Stronger health systems are crucial for improving access to care and prevention.

Fact 10: Greater investment is key

Greater investment will help in reducing the under-five mortality rate by two-thirds by 2015 (Millennium Development Goal 4). Public and private partners must come together to fill the gap in order to meet this ambitious, but achievable goal. The launch of the Commission on Information and Accountability and of the Global Strategy for Women's and Children's Health and several large bilateral donor pledges in recent months are important steps in the right direction.

Exhibit 2: Nutritional Status of Children: 2012

Countries and Areas

Low Birth Weight

Under-weight Moderate and severe

Under-weight Severe

Stunting Moderate & severe

Wasting Moderate and severe

Over-weight

Sub-Sahara Africa

13

21

7

38

9

6

Middle East and North Africa

-

7

-

18

8

11

South Asia

28

32

15

38

16

4

East Asia and Pacific

6

5

4

12

4

5

Latin America & Caribbean

9

3

-

11

1

7

CEE/CIS

-

2

-

11

1

7

Least Developed Countries

13

23

7

37

19

5

World

15

15

9

25

8

7

Source: UNICEF Report 2014

Exhibit 3: Immunization Coverage (%) Against Vaccine Preventable Diseases: 2012

Countries and areas

BCG

DPT1

DPT3

Polio

Measles

HepB3

Hob3

Sub-Sahara Africa

81

80

71

76

72

70

64

Middle East and North Africa

93

94

89

90

88

90

55

South Asia

88

89

76

74

77

74

24

East Asia and Pacific

95

97

92

93

94

89

11

Latin America & Caribbean

96

96

93

93

95

92

91

CEE/CIS

96

95

94

95

95

91

71

Least Developed Countries

86

90

80

82

80

76

75

World

89

91

83

84

84

79

45

Source: UNICEF Report 2014

  • BCG % of live births who received vaccine against TB
  • DPT1 % of surviving infants who received their first dose of DPT
  • DPT3 % of surviving infants who received three doses of DPT
  • Polio % of surviving infants who received three doses of polio vaccine
  • MCV % of surviving children who received first dose of Measles vaccine
  • HepB % of surviving infants who received three doses of hepatitis B vaccine
  • Hib3 % of surviving infants who received three doses of Haemophilus influenza type B vaccine

Note: Even though immunization coverage has improved over the years, an estimated 21.8 million infants worldwide were not reached with routine immunization services in 2013, of whom nearly half live in 3 countries: India, Nigeria and Pakistan 1 .

References

1. Immunization coverage; Fact sheet N°378, Reviewed November 2014 http://www.who.int/mediacentre/factsheets/fs378/en/

Exhibit 4: Treatment Taken for Pneumonia, Diarrhoea and Malaria: 2012

Countries and areas

Pneumonia Care seeking for children

Pneumonia % treated antibiotics

Diarrhoea % treated with ORS

Malaria % treated

% children sleeping under ITN

Sub-Sahara Africa

46

39

31

37

36

Middle East and North Africa

70

63

35

-

-

South Asia

65

20

33

7

East Asia and Pacific

60

45

44

1

-

Latin America & Caribbean

55

-

48

-

-

CEE/CIS

-

-

-

-

-

Least Developed Countries

49

41

41

3-

40

World

59

34

35

19

-

ITN: Insecticide –treated mosquito nets. Source: UNICEF Report 2014

Exhibit 5: Progress of WHO countries towards MDG4: Ref: The State of the World's Children 2014 in Numbers: Every Child Counts; UNICEF, January 2014

SL no

Country

U5MR 1990

U5MR 2012

% reduction in U5MR in 2012

SL no

Country

U5MR 1990

U5MR 2012

% reduction in U5MR in 2012

1

Afghanistan

176

99

44

26

Bulgaria

22

12

45

2

Albania

43

17

60

27

Burkina Faso

202

102

50

3

Algeria

50

20

60

28

Burundi

164

104

37

4

Andorra

8

3

63

29

Cabo Verde

62

22

65

5

Angola

213

164

23

30

Cambodia

116

40

66

6

Antigua and Barbuda

24

10

58

31

Cameroon

135

95

30

7

Argentina

28

14

50

32

Canada

8

5

38

8

Armenia

49

16

67

33

Cape Verde

9

Australia

9

5

44

34

Central African Republic

171

129

25

10

Austria

10

4

60

35

Chad

209

150

28

11

Azerbaijan

93

35

62

36

Chile

19

9

53

12

Bahamas

23

17

26

37

China

54

14

74

13

Bahrain

23

10

57

38

Colombia

35

18

49

14

Bangladesh

144

41

72

39

Comoros

124

78

37

15

Barbados

18

18

0

40

Congo

100

96

4

16

Belarus

17

5

71

41

Cook Islands

25

11

56

17

Belgium

10

4

60

42

Costa Rica

17

10

41

18

Belize

43

18

58

43

Côte d'Ivoire

152

108

29

19

Benin

181

90

50

44

Croatia

13

5

62

20

Bhutan

131

45

66

45

Cuba

13

6

54

21

Bolivia

123

41

67

46

Cyprus

11

3

73

22

Bosnia and Herzegovina

18

7

61

47

Czech Republic

15

4

73

23

Botswana

48

53

−10

48

Democratic People's Republic of Korea

44

29

34

24

Brazil

62

14

77

49

Democratic Rep of the Congo

171

146

15

25

Brunei Darussalam

12

8

33

50

Denmark

9

4

56

SL no

Country

U5MR 1990

U5MR 2012

% reduction in U5MR in 2012

SL no

Country

U5MR 1990

U5MR 2012

% reduction in U5MR in 2012

51

Djibouti

119

81

32

76

Holy See

#######

52

Dominica

17

13

24

77

Honduras

59

23

61

53

Dominican Republic

60

27

55

78

Hungary

19

6

68

54

Ecuador

56

23

59

79

Iceland

6

2

67

55

Egypt

86

21

76

80

India

126

56

56

56

El Salvador

59

16

73

81

Indonesia

84

31

63

57

Equatorial Guinea

182

100

45

82

Iran (Islamic Republic of)

56

18

68

58

Eritrea

150

52

65

83

Iraq

53

34

36

59

Estonia

20

4

80

84

Ireland

9

4

56

60

Ethiopia

204

68

67

85

Israel

12

4

67

61

Fiji

31

22

29

86

Italy

10

4

60

62

Finland

7

3

57

87

Jamaica

30

17

43

63

France

9

4

56

88

Japan

6

3

50

64

Gabon

92

62

33

89

Jordan

37

19

49

65

Gambia

170

73

57

90

Kazakhstan

54

19

65

66

Georgia

35

20

43

91

Kenya

98

73

26

67

Germany

9

4

56

92

Kiribati

94

60

36

68

Ghana

128

72

44

93

Kuwait

16

11

31

69

Greece

13

5

62

94

Kyrgyzstan

71

27

62

70

Grenada

22

14

36

95

Lao People's Demo Rep

163

72

56

71

Guatemala

80

32

60

96

Latvia

20

9

55

72

Guinea

241

101

58

97

Lebanon

33

9

73

73

Guinea-Bissau

206

129

37

98

Lesotho

85

100

−18

74

Guyana

60

35

42

99

Liberia

248

75

70

75

Haiti

144

76

47

100

Libya

43

15

65

SL No

Country

U5 MR 1990

U5 MR 2012

% reduction in U5MR in 2012

SL No

Country

U5MR 1990

U5 MR 2012

% reduction in U5MR in 2012

101

Liechtenstein

#VALUE!

126

Nicaragua

66

24

64

102

Lithuania

17

5

71

127

Niger

326

114

65

103

Luxembourg

9

2

78

128

Nigeria

213

124

42

104

Madagascar

159

58

64

129

Niue

14

25

−79

105

Malawi

244

71

71

130

Norway

9

3

67

106

Malaysia

17

9

47

131

Oman

39

12

69

107

Maldives

94

11

88

132

Pakistan

138

86

38

108

Mali

253

128

49

133

Palau

34

21

38

109

Malta

11

7

36

134

Panama

32

19

41

110

Marshall Islands

49

38

22

135

Papua New Guinea

89

63

29

111

Mauritania

128

84

34

136

Paraguay

46

22

52

112

Mauritius

23

15

35

137

Peru

79

18

77

113

Mexico

46

16

65

138

Philippines

59

30

49

114

Micronesia

55

39

29

139

Poland

17

5

71

115

Monaco

8

4

50

140

Portugal

15

4

73

116

Mongolia

107

28

74

141

Qatar

21

7

67

117

Montenegro

17

6

65

142

Republic of Korea

7

4

43

118

Morocco

80

31

61

143

Republic of Moldova

32

18

44

119

Mozambique

233

90

61

144

Romania

38

12

68

120

Myanmar

106

52

51

145

Russian Federation

26

10

62

121

Namibia

73

39

47

146

Rwanda

151

55

64

122

Nauru

58

37

36

147

Saint Kitts and Nevis

29

9

69

123

Nepal

142

42

70

148

Saint Lucia

22

18

18

124

Netherlands

8

4

50

149

St Vincent and Grenadines

25

23

8

125

New Zealand

11

6

45

150

Samoa

30

18

40

SL No

Country

U5 MR 1990

U5 MR 2012

% reduction in U5MR in 2012

SL No

Country

U5 MR 1990

U5 MR 2012

% reduction in U5MR in 2012

151

San Marino

11

3

73

176

Former Yugoslav Rep Macedonia

37

7

81

152

Sao Tome & Principe

104

53

49

177

Timor-Leste

171

57

67

153

Saudi Arabia

47

9

81

178

Togo

143

96

33

154

Senegal

142

60

58

179

Tonga

23

13

43

155

Serbia

28

7

75

180

Trinidad and Tobago

33

21

36

156

Seychelles

17

13

24

181

Tunisia

51

16

69

157

Sierra Leone

257

182

29

182

Turkey

74

14

81

158

Singapore

8

3

63

183

Turkmenistan

90

53

41

159

Slovakia

18

8

56

184

Tuvalu

58

30

48

160

Slovenia

10

3

70

185

Uganda

178

69

61

161

Solomon Islands

39

31

21

186

Ukraine

20

11

45

162

Somalia

177

147

17

187

United Arab Emirates

17

8

53

163

South Africa

61

45

26

188

United Kingdom

9

5

44

164

South Sudan

251

104

59

189

United Republic of Tanzania

166

54

67

165

Spain

11

5

55

190

United States

11

7

36

166

Sri Lanka

21

10

52

191

Uruguay

23

7

70

167

State of Palestine

43

23

47

192

Uzbekistan

74

40

46

168

Sudan

128

73

43

193

Vanuatu

35

18

49

169

Suriname

51

21

59

194

Venezuela (Bolivarian Republic of)

30

15

50

170

Swaziland

71

80

−13

195

Viet Nam

51

23

55

171

Sweden

7

3

57

196

Yemen

125

60

52

172

Switzerland

8

4

50

197

Zambia

192

89

54

173

Syrian Arab Republic

38

15

61

174

Tajikistan

105

58

45

175

Thailand

38

13

66

Exhibit 6: Best Performers: Countries who had already achieved the MDG4 target by 2012

Sl No.

Country

U5MR 1990

U5MR 2012

U5MR Target 2015

U5MR % decline 1990-2012

1

Maldives

94

11

31

88

2

The former Yugoslav Rep Macedonia

37

7

12

81

3

Turkey

74

14

25

81

4

Saudi Arabia

47

9

16

81

5

Brazil

62

14

21

77

6

Peru

79

18

26

77

7

Egypt

86

21

29

76

8

China

54

14

18

74

9

Mongolia

107

28

36

74

10

El Salvador

59

16

20

73

11

Lebanon

33

9

11

73

12

Bangladesh

144

41

48

72

13

Malawi

244

71

81

71

14

Nepal

142

42

47

70

15

Liberia

248

75

83

70

16

Oman

39

12

13

69

17

Tunisia

51

16

17

69

18

Romania

38

12

13

68

19

Iran (Islamic Republic of)

56

18

19

68

20

United Republic of Tanzania

166

54

55

67

21

Armenia

49

16

16

67

22

Bolivia (Plurinational State of)

123

41

41

67

23

Timor-Leste

171

57

57

67

24

Ethiopia

204

68

68

67

Exhibit 7: Countries making sufficient progress to meet the MDG4 2015 target

No

Country

U5 1990

U5 2012

Target 2015

U5MR % Decline 1990-2012

1

Thailand

38

14

13

66

2

Bhutan

131

45

44

66

3

Cambodia

116

40

39

66

4

Eritrea

150

52

50

65

5

Mexico

46

16

15

65

6

Libya

43

15

14

65

7

Niger

326

114

109

65

8

Kazakhstan

54

19

18

65

9

Cabo Verde

62

22

21

65

Exhibit 8: 10 Worst Performing countries: U5MR reduction less than 25%

SL No

Country

Region

U5MR 1990

U5MR 2012

% reduction in U5MR 1990-2012

1

Zimbabwe

Sub-Saharan Africa

74

90

−22

2

Lesotho

Sub-Saharan Africa

85

100

−18

3

Swaziland

Sub-Saharan Africa

71

80

−13

4

Botswana

Sub-Saharan Africa

48

53

−10

5

Congo

Sub-Saharan Africa

100

96

4

6

Democratic Rep of Congo

Sub-Saharan Africa

171

146

15

7

Somalia

Sub-Saharan Africa

177

147

17

8

Solomon Islands

Oceania

39

31

21

9

Marshall Islands

East Asia and Pacific

49

38

22

10

Angola

Sub-Saharan Africa

213

164

23

Exhibit 9: Countries with U5MR more than 100 in 2012

SL No

Country

Region

U5 MR 1990

U5 MR 2012

% reduction in U5MR by 2012

1

Sierra Leone

Sub-Saharan Africa

257

182

29

2

Angola

Sub-Saharan Africa

213

164

23

3

Chad

Sub-Saharan Africa

209

150

28

4

Somalia

Sub-Saharan Africa

177

147

17

5

Democratic Rep Congo

Sub-Saharan Africa

171

146

15

6

Central African Rep

Sub-Saharan Africa

171

129

25

7

Guinea-Bissau

Sub-Saharan Africa

206

129

37

8

Mali

Sub-Saharan Africa

253

128

49

9

Nigeria

Sub-Saharan Africa

213

124

42

10

Niger

Sub-Saharan Africa

326

114

65

11

Côte d'Ivoire

Sub-Saharan Africa

152

108

29

12

Burundi

Sub-Saharan Africa

164

104

37

13

South Sudan

Sub-Saharan Africa

251

104

59

14

Burkina Faso

Sub-Saharan Africa

202

102

50

15

Guinea

Sub-Saharan Africa

241

101

58

16

Lesotho

Sub-Saharan Africa

85

100

−18

17

Equatorial Guinea

Sub-Saharan Africa

182

100

45

Exhibit 10: MDG Grouping: Developing and Developed Regions

Developing Regions:

Northern Africa

Sub-Sahara Africa (Continued)

South-East Asia

Oceania

Algeria

Mali

Brunei Darussalam

American Samoa

Egypt

Mauritania

Cambodia

Cook Islands

Libya

Mauritius

Indonesia

Fiji

Morocco

Mayotte

Lao Demo Rep

French Polynesia

Tunisia

Mozambique

Malaysia

Guam

Western Sahara

Namibia

Myanmar

Kiribati

Sub-Sahara Africa

Niger

Philippines

Marshall Islands

Angola

Nigeria

Singapore

Micronesia

Benin

Réunion

Thailand

Nauru

Botswana

Rwanda

Timor-Leste

Niue

Burkina Faso

San Tome & Principe

Viet Nam

New Caledonia

Burundi

Senegal

East Asia

North Maria Island

Cameroon

Seychelles

China

Palau

Cape Verde

Sierra Leone

Hong Kong

Papua New Guinea

Central Africa Rep

Somalia

Macau

Samoa

Chad

South Africa

Korea Demo People

Solomon Islands

Comoros

Sudan

Korea Rep of

Tokelau

Congo

Swaziland

Mongolia

Tonga

Cote d'Ivoire

Togo

Western Asia

Tuvalu

Demo Rep Congo

Uganda

Bahrain

Vanuatu

Djibouti

United Rep Tanzania

Cyprus

Eurasia

Equatorial Guinea

Zambia

Iraq

Armenia

Eritrea

Zimbabwe

Israel

Azerbaijan

Ethiopia

Southern Asia

Jordan

Belarus

Gabon

Afghanistan

Kuwait

Georgia

Gambia

Bangladesh

Lebanon

Kazakhstan

Ghana

Bhutan

Palestine

Kyrgyzstan

Guinea

India

Oman

Rep of Moldova

Guinea-Bissau

Iran

Qatar

Russian Federation

Kenya

Maldives

Saudi Arabia

Tajikistan

Lesotho

Nepal

Syrian Arab Rep

Turkmenistan

Liberia

Pakistan

Turkey

Ukraine

Madagascar

Sri Lanka

Utd Arab Emirates

Uzbekistan

Malawi

Yemen

MDG Groups: Developing and Developed Regions:

Developing Regions (Cont)

Latin America & Caribbean

Developed Regions

Anguilla

Albania

Japan

Antigua and Barbuda

Haiti

Andorra

Latvia

Argentina

Honduras

Australia

Liechtenstein

Aruba

Jamaica

Austria

Lithuania

Bahamas

Martinique

Belgium

Luxembourg

Barbados

Mexico

Bermuda

Malta

Belize

Montserrat

Bosnia & Herzegovina

Monaco

Bolivia

Netherlands Antilles

Bulgaria

Netherlands

Brazil

Nicaragua

Canada

New Zealand

British Virgin Islands

Panama

Channel Islands

Norway

Cayman Islands

Paraguay

Croatia

Poland

Chile

Peru

Czech Republic

Portugal

Columbia

Puerto Rico

Denmark

Romania

Costa Rica

St Kitts & Nevis

Estonia

San Marino

Cuba

Saint Lucia

Faeroe Islands

Serbia & Montenegro

Dominica

St Vincent Grenadine

Finland

Slovakia

Dominican Rep

Suriname

France

Slovenia

Ecuador

Trinidad & Tobago

Germany

Spain

El Salvador

Turks & Caicos Islands

Greece

Sweden

Falklands

Uruguay

Hungary

Switzerland

French Guiana

US Virgin Islands

Iceland

Rep Macedonia

Grenada

Ireland

Ukraine

Guadeloupe

Isle of Man

United Kingdom

Guatemala

Italy

US of America

Guyana

This case was prepared for inclusion in Sage Business Cases primarily as a basis for classroom discussion or self-study, and is not meant to illustrate either effective or ineffective management styles. Nothing herein shall be deemed to be an endorsement of any kind. This case is for scholarly, educational, or personal use only within your university, and cannot be forwarded outside the university or used for other commercial purposes.

2024 Sage Publications, Inc. All Rights Reserved

locked icon

Sign in to access this content

Get a 30 day FREE TRIAL

  • Watch videos from a variety of sources bringing classroom topics to life
  • Read modern, diverse business cases
  • Explore hundreds of books and reference titles