Highlights
Progress Report 2010-2011
m ATERNAL
n EWBORN
c HILD AND
a DOLESCENT
h EALTH
WHO Library Cataloguing-in-Publication Data
Maternal, newborn, child and adolescent health: progress report 2010-2011: highlights.
1.Child welfare. 2.Child health services. 3.Adolescent health services. 4.Maternal welfare. 4.Infant welfare.
4.Program evaluation. 5.Program development. I.World Health Organization.
ISBN 978 92 4 150360 0 (NLM classication: WA 310)
© World Health Organization 2012
All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int)
or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
(tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: ).
Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial
distribution – should be addressed to WHO Press through the WHO web site ( />copyright_form/en/index.html).
The designations employed and the presentation of the material in this publication do not imply the expression of
any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country,
territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines
on maps represent approximate border lines for which there may not yet be full agreement.
The mention of specic companies or of certain manufacturers’ products does not imply that they are endorsed or
recommended by the World Health Organization in preference to others of a similar nature that are not mentioned.
Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.
All reasonable precautions have been taken by the World Health Organization to verify the information contained in
this publication. However, the published material is being distributed without warranty of any kind, either expressed
or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall
the World Health Organization be liable for damages arising from its use.
Printed in France
Design by paprika-annecy.com

increasing access to low-cost technologies and increasing nancial
support.
Commitments need to translate into action and action has to generate
results. The Commission on Information and Accountability for Women’s
and Children’s Health, established by our Director-General Dr Margaret
Chan in January 2011, came out with ten compelling recommendations
for tracking results and resources. Moreover,
the Commission called for a mechanism of
internal oversight and I am delighted that
an independent Expert Review Group was
appointed by the UN Secretary General in
September 2011, after a transparent and
open nomination process. The ERG will report
on progress every year and hold stakeholders
to account, in beneciary as well as donor
countries. WHO is privileged to host the
Secretariat of the ERG and to facilitate access to information through its
website at />It is now a time of unprecedented opportunity. Never before has the
global community rallied so strongly and uniformly around the cause of
reproductive, maternal, child and adolescent health. WHO is determined
to play its role and facilitate that indeed, investments will lead to improved
access and coverage of essential interventions. The Family, Women and
Children’s Health Cluster is uniquely positioned to take on the charge.
Its new structure permits us to act in a more coherent way and respond
efciently to the requirements for building the continuum of care. This
report highlights achievements of the Department of Maternal, Newborn,
Child and Adolescent Health. It pays testimony to a range of tools and
actions developed and supported by our extensive network of staff in
headquarter, regional and country ofces. WHO cannot do it alone, but
with so many committed stakeholders, I would like to convey the message

effective throughout its reorganisation.
Ultimately, it is the action and outcomes at country level measure the
success of the work of the Department. This report provides a good picture
of the depth and diversity of our work, and can serve as an inspiration for
renewed and strengthened action for the health of mothers, newborns,
children and adolescents.
Elizabeth Mason, Director, Department of Maternal,
Newborn, Child and Adolescent Health
Working
along the
continuum
of care
MATERNAL, NEWBORN, CHILD AND ADOLESCENT HEALTH PROGRESS REPORT 2010-2011
5
The UN Global Strategy for
Women’s and Children’s Health
In September 2010, the
UN Secretary-General
launched the Global
Strategy for Women’s
and Children’s Health as
a nal push towards the
attainment of Millennium
Development Goals
4 and 5. The Strategy
was developed with the
involvement of many
partners and stakeholders,
and generated commit-
ments in excess of US$ 40

the Global Strategy had made specic
commitments to accelerating action
towards the achievement of Millennium
Development Goals 4 and 5.
WHO together with its partners in the H4+ inter-agency mechanism facilitated the
development of national commitments. Now WHO is working with its H4+ partners
to support countries to turn these national commitments into action. In countries
with existing plans for maternal, newborn and child health interventions, the H4+
agencies are supporting faster implementation and linkages with national health
strategies and systems strengthening efforts, as well as with monitoring progress
in maternal, newborn, child and adolescent health.
In Burkina Faso, the Democratic Republic of the Congo, the Republic of Sierra
Leone, the Republic of Zambia and the Republic of Zimbabwe the H4+ agencies
have jointly supported the development of country plans with a specic focus
on accelerating progress in maternal and newborn health under the umbrella of
a grant from the Canadian International Development Agency. In addition, with
support of France, the H4+ agencies work in nine francophone countries in West
Africa and in Haiti to improve maternal and child health. This joint support will
continue over the next ve years to further reinforce the national scale-up of
integrated reproductive, maternal, newborn and child health interventions, and
national health systems strengthening and monitoring.
United Nations Secretary-General Ban Ki-moon
Global Strategy
for Women
,
s and
Children
,
s Health
6

A number of recommendations adopted at the consultation are now being
implemented, including providing assistance to the UN Committee on the Rights of
the Child in the development of a General Comment on children’s right to health.
The consultation also revealed that raising awareness of the CRC must go hand-in-
hand with demonstrating its practical added value in planning and programming
for child and adolescent health.
Planning informed
by evidence
Having a national strategy and plan of action to increase access and coverage
of effective interventions is a pre-requisite for countries to make steady progress
towards the attainment of improved health outcomes of the population, including the
targets of the health-related MDGS.
The Department is providing guidance on strategy development that involves
identication of high impact interventions to address the burden of disease according
to context, and costing of the resulting action plan. To this effect, a new tool is now
available to guide the national dialogue. The United Nations OneHealth Costing Tool
developed by UN agencies can be used to ensure that national strategies and plans
for maternal, newborn and child health are appropriately prioritized and realistically
costed. The tool covers multiple public health areas (such as immunization, HIV
and tuberculosis) as well as health system functions such as human resources and
medicines, supplies and equipment. It thus has potential to consider the health
sector’s absorptive capacity and simplify and harmonise national planning and
costing processes under one unied platform.
Experts in health systems and maternal and child health programmes from nine
countries in the Western Pacic Region attended a training workshop on using the
OneHealth tool. At the end of the workshop, participants were able to cost health-
related interventions in different country contexts and generate basic costing
projections for their maternal and child health programmes. They could also
perform a strategic assessment of a health system’s performance and capacity for
key maternal and child health interventions. Additionally they could use the tool to

44 times the average in more developed regions.
In three WHO regions—Western Pacic, South-East
Asia and Europe—the estimated maternal mortality
ratio has fallen by 50% or more. Several factors
may have contributed to the decline in estimated
maternal mortality rates, ranging from health systems
strengthening to increasing female literacy. Improved
vital registration and notication of maternal deaths
are urgently needed for better understanding of and
response to improve maternal health.
More than 60% of maternal deaths occur in the
postpartum period. The risk of death is highest
close to birth and then decreases over the
subsequent days and weeks. Delays in recognizing
and responding to life-threatening complications
at home are also important non-medical reasons
for maternal deaths. Globally, the proportion of
births attended by skilled health personnel has
increased (Figure 3) and many countries are actively
encouraging women to give birth in health facilities.
While the increasing in number of births in facilities
is encouraging, it is equally important to ensure
good quality of care there.
Figure 1 Trends in Maternal Mortality
Ratios 1990 - 2008*
0
100
200
300
400

Mediterranean
Europe South-East
Asia
Weatern
Pacic
Percentage
1990
2008
>20
20 - 99
100 - 299
300 - 549
550 - 999
≥1000
Not applicable
Data not available
MATERNAL, NEWBORN, CHILD AND ADOLESCENT HEALTH PROGRESS REPORT 2010-2011
9
Road Map for reduction
of maternal mortality in Africa
By the end of 2011, 44
countries in sub-Saharan
Africa had developed national
Road Maps for accelerating the
attainment of the Millennium
Development Goals 4 and 5.
As part of the implementation
process, countries review their
progress towards set objectives
and adjust their strategies

monitoring of maternal mortality, allowing
more accurate identication of maternal
deaths than in previous years.
The majority of maternal deaths are
due to avoidable causes and are more
frequent among vulnerable groups: poor
adolescents, rural residents, indigenous
women and those of African descent. The
gains made so far are insufcient if the
region is to reach Millennium Development
Goal 5 by 2015.
The Plan of Action to Accelerate the
Reduction of Maternal Mortality and Severe Maternal Morbidity was developed
by the Latin-American Center for Perinatology/Women and Reproductive Health,
a WHO Regional Ofce of the Americas technical centre responsible for maternal
and perinatal health.
The plan focuses on four strategic areas: prevention of unwanted pregnancies
and resulting complications; universal access to affordable, high-quality maternity
services within a coordinated health care system; increasing the number of
skilled personnel in health facilities for preconception, antenatal, childbirth, and
postpartum care; and strategic information for action and accountability.
IMPLEMENTING
NATIONAL
STRATEGIES
m ATERNAL HEALTH
10
A better system for maternal and
neonatal health surveillance in the
Eastern Mediterranean Region
The vast majority of maternal

There are also large discrepancies both between and
within countries. Even in countries where resources are
limited, most maternal and perinatal complications and
deaths can be averted with basic and effective low-cost
interventions. WHO in the European Region shows how
this can be accomplished, using tools such as Beyond
the Numbers.
The Beyond the Numbers tool was introduced in the European Region in 2004
and since then many countries have implemented it under the leadership of
Ministries of Health. In June 2010, 90 representatives from 16 countries gathered
in Charvak, the Republic of Uzbekistan to share experiences and lessons learned
using the tool, in order to further improve the quality of care for mothers and
babies in their countries.
There were a number of important lessons learned. The principles and practices
of WHO/Europe Effective Perinatal Care as well as national clinical guidelines on
major obstetric complications must be implemented for successful introduction
of the Beyond the Numbers tool. For appropriate implementation of Beyond the
Numbers, the support of ministries of health, together with external support from
experts, is crucial. Case reviews at the meeting also showed that many of the
recommendations were related to organizational issues.
STRENGHTENING
THE SURVEILLANCE
SYSTEM
MATERNAL, NEWBORN, CHILD AND ADOLESCENT HEALTH PROGRESS REPORT 2010-2011
11
DOCUMENTING
SUCCESS AND
CHALLENGES
Documenting lessons
learned

to take part in an inter-country workshop on
maternal death review in the Western Pacic
Region. At the meeting, hosted by the WHO Western
Pacic Regional Ofce and held in Kuala Lumpur,
Malaysia in November 2011, participants from the
Kingdom of Cambodia, the Republic of Korea, Lao
People’s Democratic Republic, Malaysia, Papua
New Guinea, the Republic of the Philippines
and the Socialist Republic of Viet Nam shared
processes and tools for maternal death reviews
and learned from the Malaysian experience.
Malaysian experts explained the history of reducing maternal mortality and the
implementation of the country’s condential enquiry into maternal death. The
group also made a eld visit to observe a district facility-based maternal death
review. Country participants then evaluated maternal death review processes and
tools from various countries, identied the next steps to strengthen countries’
review processes and developed realistic action plans.
Several important messages emerged from the workshop. Firstly, maternal death
reviews do not need to cover all deaths to be useful. The most important step
is to carefully analyse cases to guide local action and stimulate national level
policy change. Secondly, it took time for Malaysia to have the maternal deaths
reported through the health system match the Bureau of Statistics’ data and
this was only possible once the country’s vital registration system was well-
established. Thirdly, Malaysia’s success story can be achieved in an environment
with a high commitment, supportive policies, a well-functioning health system and
adequate monitoring of processes and outcomes. Finally, maternal death review
implementation must be tailored to each country’s situation using the most
suitable methodology.
m ATERNAL HEALTH
12

advocacy to support national efforts to improve women’s and children’s health.
An updated approach to
prevention and treatment of
pre-eclampsia and eclampsia
Hypertensive disorders of pregnancy are a signicant
cause of severe morbidity, long-term disability and
death among both mothers and their babies. There are
a number of hypertensive disorders that complicate
pregnancy, but pre-eclampsia and eclampsia stand out
as major causes of maternal and perinatal mortality and
morbidity. The majority of these deaths are avoidable if
women who present with these complications are given
timely and effective care. Thus, optimizing health care
to prevent and treat women with hypertensive disorders
is a necessary step towards achieving the Millennium
Development Goals.
In 2011, the WHO’s guidelines for the prevention and treatment of pre-
eclampsia and eclampsia were updated using the Grading of Recommendations,
Assessment, Development and Evaluation (GRADE) process. In all, 23
recommendations covering various aspects of prevention and treatment
of pre-eclampsia and eclampsia resulted from a technical consultation in
Geneva in April. The new recommendations [ />publications/2011/9789241548335_eng.pdf and evidence tables (http://
whqlibdoc.who.int/hq/2011/WHO_RHR_11.25_eng.pdf) are being disseminated
and will be used in updates of the WHO Integrated Management of Pregnancy
and Childbirth clinical guidelines.
WHO recommendations for
Prevention and treatment of
pre-eclampsia and eclampsia
MATERNAL, NEWBORN, CHILD AND ADOLESCENT HEALTH PROGRESS REPORT 2010-2011
13

reduce maternal and perinatal morbidity and
mortality. WHO recognizes that effective and
sustainable reductions in mortality, for both
mothers and newborn infants, require the presence
of health care personnel equipped with a full range
of midwifery skills. Without competent personnel,
international goals for maternal and newborn
health cannot be reached.
In 2010, WHO published the Strengthening
Midwifery Toolkit. This toolkit comprises nine
modules and focuses on the central role and
function of the professional midwife in the
provision of quality reproductive and sexual health services. Guidelines have
been prepared to assist Member States as they consider strategies to strengthen
midwifery services.
These guidelines have been developed by experts drawing on lessons learned
from countries where quality midwifery services have been successfully made
accessible to all women. The toolkit can be used for establishing or reviewing
midwifery programmes according to a country’s needs and priorities.
/>midwifery_toolkit/en/index.html
Supported by:
Coordinated by UNFPA
605 Third Avenue
New York, NY 10016
www.stateoftheworldsmidwifery.com
AFRICAN DEVELOPMENT
BANK GROUP
THE STATE OF THE
WORLD’S MIDWIFERY
2011

identify priority areas, gaps,
and constraints of national
programmes. The Regional
Ofce also developed tools
and standards for monitoring,
programme evaluation and maternal and newborn health impact assessment
in Member States. At the same time, it launched an online reproductive health
research directory, an evidence-based tool that supports strategic planning for
maternal and newborn health promotion in the Region.
An inter-country meeting to promote maternal and neonatal health in the Region
held in Dubai, the United Arab Emirates, in April 2011, enabled countries to
develop work plans for the implementation of national programmes on maternal
and newborn health in 2012-13.
Although the region is broadly on track to reach the Millennium Development Goals,
some Member States will struggle to meet the targets of Goal 5. They continue
to need support in a number of priority areas, including medical education on
maternal and neonatal health; promotion of universal provision of skilled health
care for all women and newborns; promotion of good reproductive health practices
such as birth spacing and prevention of sexually transmitted infections; and better
maternal and neonatal health surveillance systems.
Making progress in Albania
For the past three years, the WHO Regional
Ofce for Europe has been providing
technical assistance to the Ministry of Health
of the Republic of Albania as it reforms its
maternal and child health services under
a project supported by the Spanish Agency
for International Development Cooperation.
The objectives of the project are to improve
capacity in regional hospitals; assure

15
Supporting integrated maternal,
neonatal and child health
services in Lao PDR
The Government of Lao People’s
Democratic Republic has developed
a Strategy and Planning Framework
for the Integrated Package of
Maternal Neonatal and Child
Health Services 2009-2015. With
Millennium Development Goals
4 and 5 in mind, the framework
has three strategic objectives:
improving leadership, governance
and management capacity for
programme implementation; strengthening efciency and quality of health service
provision; and mobilizing individuals, families and communities for maternal,
newborn and child health.
Since 2009, with funding from the Korea Foundation for International Healthcare,
the Ministry of Health supported by WHO (in collaboration with the Asian
Development Bank, UNICEF, UNFPA, the World Bank and other partners) has given
intensive support in selected districts to gain practical experience with delivery of
the integrated maternal, neonatal and child health service package.
In these districts, the focus has been on improving maternal, neonatal and child
health programme management, such as strengthening primary health care and
improving the capacity of district hospitals, health centres and village health
volunteers. The support has also enhanced coordination among development
partners to ensure that various partners align their activities to the strategy and
its implementation plan.
In some districts, coverage of antenatal care went from 16% to 2009 to 35% a

Increased awareness of donors and other stakeholders on women’s and
children’s health issues has allowed for more funding secured in most countries
to accelerate progress towards health MDGs. The nal external evaluation of the
project is planned for 2012.
NATIONAL
CAPACITY
STRENGHTENING
PLANNING AND
MANAGEMENT
N EWBORN HEALTH
16
Neonatal mortality declines
across all regions
Deaths among newborns declined worldwide from 4.4 million in 1990 to 3.1 million
in 2010 and this decline has occurred in every region of the world.
1
This represents
a decline in the rate of neonatal mortality by 28% between 1990 and 2010 with an
annual reduction of 1.7%. The European Region, the Region of the Americas and
the Western Pacic Region experienced the steepest decline, at 50%, followed by
the South-East Asia Region at 36% and the Eastern Mediterranean Region at 26%.
The slowest reduction, of 19%, was seen in the African Region.
Neonatal mortality is an increasingly signicant proportion of child mortality. Due
to the declining post neonatal mortality, globally the proportion of child deaths
that occurred among newborns increased from 37% in 1990 to 40% in 2010. The
South-East Asia Region at 27% and the Eastern Mediterranean Region at 23%

are
the regions with the largest proportional increases. In the Western Pacic Region,
the region with the largest decline in under-ve mortality, neonatal deaths now

perinatal care
Co-operation between
countries in the Region of
the Americas and beyond
has helped promote the
Perinatal Information
System as an invaluable tool
for improving the quality of
maternal and newborn care.
The system can be used to
streamline patient record-
keeping and also to monitor
and evaluate efforts to
reduce maternal mortality.
The system is in use in hundreds of public and private health institutions, social
security and university hospitals across the region. To enable countries to share
their knowledge and expertise in using the system, in 2010 and 2011 the WHO
Regional Ofce for the Americas together with country ofces and ministries of
health launched a technical cooperation among countries project, ‘Strengthening
Perinatal Information Systems’, in four Latin American countries.
Under the project, the Republic of El Salvador, the Republic of Honduras, the
Republic of Nicaragua and the Republic of Panama agreed their work plans and
reached a consensus on using the Perinatal Information System for analysis
and follow-up of eight selected maternal and perinatal health indicators. These
are: maternal mortality ratio, access to contraception, four or more antenatal
visits, skilled birth attendant at delivery, corticosteroids prior to preterm delivery,
coverage of screening test for syphilis, timing of umbilical cord clamping and
neonatal resuscitation. Their experience in using this tool has been shared with
other countries in the region, and also beyond the Americas, in the Republic of
Equatorial Guinea, the Republic of Mozambique, the Republic of Namibia and

Guidelines on hospital care for newborns were also updated. Early identication
of infections in newborns and prompt and appropriate antibiotic treatment will
substantially reduce mortality due to sepsis and pneumonia. Newborns with
serious infections need intramuscular or intravenous antibiotics and supportive
care in hospitals. WHO is working with ministries of health and partners to
implement these guidelines.
Progress in assuring essential
care for newborns
There has been substantial
progress in implementing
a package of essential
care for newborns in the
African Region. Decision-
makers from the Republic
of Angola, the Republic of
Burundi, the Central African
Republic, the Republic of
Chad, the Republic of the
Congo, the Democratic
Republic of the Congo and
the Gabonese Republic,
underwent training at two
inter-country workshops
held in Gabon and the
Congo.
Following these workshops,
Gabon went on to organize
its own national training
sessions for health care
professionals in charge of

IMNCI-trained health worker, while only 23% had two or more IMNCI-trained health
workers. Most health facilities had the crucial IMNCI job aids, i.e., registration
books and chart booklets. At facility level, availability of oral medicines was good
but parenteral pre-referral medicine supplies were very low except for gentamicin.
There was high availability of oral rehydration salts in the facilities but availability
of oral rehydration therapy materials and service provision was markedly low.
The relatively low IMNCI coverage in the two most populous regions of Oromiya
(45%) and Amhara (49%) as well as the two pastoralist regions of Somali (26%)
and Afar (47%) is of serious concern. The results of this survey will serve as a
baseline for future planning and resource allocation for scaling up IMNCI services
and for objective monitoring of the progress of implementation of the strategy in
the country.
Integrated management of
neonatal and childhood
illness in India saves lives
Infant mortality dropped by 15% in a district in the
Republic of India using the Integrated Management
of Neonatal and Childhood Illness strategy,
according to ndings from a cluster-randomized
trial. The strategy combines improved treatment of
illness in newborns and children with home visits
for newborn care. To evaluate its impact on infant
mortality, a trial was conducted in a total population
of 1.1 million in Faridabad district, Haryana, India.
In clusters where the strategy was implemented,
community health workers were trained to
conduct postnatal home visits and women’s group
meetings, and together with nurses and physicians
were also trained to treat or refer sick newborns
and children according to the specic guidelines. Under the strategy, medical

Ofce for South-East Asia and the WHO Regional Ofce for the Western Pacic.
The Task Force developed the Asia Pacic Conceptual Framework on elimination of
mother-to-child transmission. This is an excellent example of integration between
programmes addressing HIV/sexually transmitted infections and maternal and
neonatal health. It received an enthusiastic response when launched at the 10th
International Conference on AIDS in the Asia Pacic in September 2011 and has
highlighted the importance of appropriate maternal health services to prevent
onward transmission of HIV and syphilis.
Much work needs to be done to take this ambitious agenda forward, including
proles of HIV/sexually transmitted infections and maternal and neonatal health
programmes. These have already been developed for high-burden countries. An
advocacy document to translate the conceptual framework into messages for
garnering support and commitment is being nalized. An implementation guide
is underway, to make the framework customized and operational according to the
situation in different countries. In addition, a pilot project on stillbirth surveillance
has been initiated in India to address the paucity of information on the congenital
syphilis disease burden.

E-learning and telemedicine
reach the Maldives
Because newborn
health is inextricably
linked to maternal
health, it is dependent
on universal access to
essential services like
family planning, skilled
care during pregnancy,
childbirth and, in
the postpartum and

Policy-makers and
programme managers
have a crucial role to play
in setting implementation
research priorities that
can help countries scale
up maternal, newborn,
child and adolescent
health care. During 2011,
national implementation
research priority setting
exercises were conducted
by the Department in the
Republic of Cameroon,
the Arab Republic of Egypt, India, the Republic of Kenya, the Islamic Republic of
Pakistan and the Republic of Rwanda, and by the Department of Reproductive
Heath and Research in the Democratic Republic of Congo, Ethiopia, the Republic
of Guinea, the Republic of Mozambique and the Federal Republic of Nigeria. An
adapted Child Health and Nutrition Research Initiative methodology was used to
identify, score and rank potential research issues.
The exercise identied up to 10 research priorities for each country. While many
of the priorities were specic to the issues and context within the country, many
common themes emerged. These included provision of maternal, newborn, child
and adolescent health services in remote areas and improving motivation and
supervision of health workers. Use of telecommunications to improve maternal,
newborn, child and adolescent health services was another common priority, as
was community-based provision of care and improving quality of care in rst level
health facilities. National institutions in many of these countries have already
issued a call for letters of intent to conduct research studies to address the
priorities, and those in the remaining countries are in the process of doing so.

The Regional Ofce has followed up with WHO country ofces to support
development of national networks for newborn health. The People’s Republic
of Bangladesh, the Republic of the Union of Myanmar, the Federal Democratic
Republic of Nepal and the Democratic Socialist Republic of Sri Lanka have already
taken appropriate steps.
PRIORITY
RESEARCH

qUESTIONS
MATERNAL, NEWBORN, CHILD AND ADOLESCENT HEALTH PROGRESS REPORT 2010-2011
21
Improved care in the community
for newborns and children
Lay community health
workers will be better able
to care for newborns and
children thanks to newly
published materials from
WHO. The training materials
consist of a community
health workers’ manual,
facilitator notes, photograph
book, chart booklet, and
training videos and DVDs.
They are part of three-part
package that can be used
independently or sequentially (see box). Caring for the sick child in the community
was published in 2011. Caring for the newborn at home, and caring for the healthy
child’s growth and development will be published in early 2012.
Evidence that community health workers can play a key role in caring for newborns

• Child development
• Infant and young child feeding
• Family’s response to a child’s illness
• Prevention of illness
NEW
TRAINING
MATERIAL
C HILD HEALTH
22
NEW
EVIDENCE
Progress in reducing
childhood mortality
Globally, the leading causes of morbidity and
mortality in children under the age of ve are
pneumonia, diarrhoea, prematurity, birth asphyxia
and malaria. The number of under-ve deaths
worldwide has declined from more than 12 million
in 1990 to 7.6 million in 2010, a 37% decrease.
Although the rate of decline in under-ve mortality
has accelerated in the past 10 years (2000-2010)
as compared to the previous decade (1990-
2000), it remains insufcient to reach Millennium
Development Goal 4 to reduce child mortality by
two thirds.
Of the 7.6 million child deaths, 40% occurred in the
neonatal period (0 to 28 days of life), 31% of occurred
between one and 11 months, and the remaining
29% occurred in children aged one to four years. As
under-ve mortality declines, the relative contribution

88
97
111
0
50
100
150
200
250
1980 1985 1990 1995 2000 2005 2010
Africa Eastern
Mediterranean
South-East Asia
Western Pacic
Americas
Europe
World
Under-ve Mortality Rate per 1000 live births
Figure 7 Under-ve mortality - global distribution
Better evidence to
tackle pneumonia
Twelve systematic reviews were completed on
aspects of clinical management of pneumonia and
oxygen use. The synthesized evidence was used to
revise pneumonia case management guidelines at
various levels of the health system. Several research
studies addressing various aspects of pneumonia in
newborns and children are ongoing, including large
multi-centre trials in Africa (Democratic Republic of
the Congo, Kenya and Nigeria) and Asia (Bangladesh

IMPLEMENTING
REGIONAL
STRATEGIES
Coordinated approaches for
diarrhoea and pneumonia control
Diarrhoea and pneumonia remain
major causes of mortality and morbidity
in children under ve years of age. Of
the estimated 7.6 million child deaths
in the world in 2010, 18% were due to
pneumonia and 15% due to diarrhoea.
Both diseases are caused by multiple
pathogens and require concurrent,
complementary solutions. There
is a good deal of overlap between
pneumonia and diarrhoea prevention and treatment, and multiple interventions of
proven effectiveness exist. However, they are often not implemented in a coordinated
fashion. The WHO/UNICEF Global Action Plan for Prevention and Control of Pneumonia
aims to increase the coverage of evidence-based interventions and improve existing
case management guidelines. The WHO/UNICEF report on "Diarrhoea: Why children
are still dying and what can be done" contains two essential packages of prevention
and treatment. GAPP and diarrhoea reports were used to develop the coordinated
action plan for control of pneumonia and diarrhoea.
In collaboration with health ministries, UNICEF and other partners, WHO conducted
four regional workshops to facilitate the implementation of coordinated and
expanded interventions for the control of pneumonia and diarrhoea among under-
ves living in developing countries. Using the GAPP framework, workshops in the
WHO African Region covered 22 countries while all 11 countries in the WHO South-
East Asia Region participated in a workshop there. The workshops reinforced the
importance of a focused and coordinated approach to pneumonia and diarrhoea

A guide to the management of pneumonia and diarrhoea in HIV-infected
infants and children was published, and the Department also developed
advice on management of cryptococcal infections in children and adults. The
new recommendations include diagnosis of cryptococcal infections with new
rapid lateral ow assays using serum, cerebrospinal uid and urine, as well as
standardized dosing schedules for treatment of cryptococcal meningitis. In
2012, the Department will address skin and oral opportunistic infections. The
opportunistic infections guidelines target programme managers and HIV and
maternal and child health focal persons at health ministries, as well as senior
health care professionals engaged in patient care. The key recommendations will
also be used to update other WHO tools such as those for IMCI.
NEW
GUIDELINES
C HILD HEALTH
24
IMCI computerised training
course (ICATT) goes online
Since 1996, integrated
management of childhood
illness (IMCI) has been
one of the key strategies
for reducing childhood
mortality. In an effort to
provide alternative training
methods on IMCI clinical
guidelines, the IMCI
Computerised Adaptation
and Training Tool (ICATT)
has been developed and is
available in four languages

launched the tool in October 2011. Kenya and Uganda have planned national
ICATT orientation and capacity building courses for early 2012.
The training conducted in Mali was in collaboration with the Novartis Foundation
and was the rst training event using the French translation of the tools.
Figure 7 Introduction and Early Implementation of ICATT in Countries, June 2011

0
2
4
6
8
10
12
14
16
18
20
AFRO AMRO EURO EMRO SEARO WPRO Total
No. of countries
WHO Regions

UPDATING AND
EXPANDING
IMCI
IMPLEMENTING
ICATT/UPDATING
AND EXPANDING
IMCI
MATERNAL, NEWBORN, CHILD AND ADOLESCENT HEALTH PROGRESS REPORT 2010-2011
25

Distance learning can
signicantly reduce the
cost of running IMCI
courses and reach
health workers who
are unable to leave the
workplace for outside
training. It also enables
them to combine
learning with hands-on
practice as they progress
through the course at
their own pace.
The rst cohort of 24 nurses who completed two distance learning IMCI courses
offered in the Eastern Cape, South Africa, were evaluated in 2011 using standard
WHO follow-up tools to assess their performance in implementing IMCI. Most
of the nurses followed IMCI steps in assessing and managing sick children with
general danger signs, main symptoms, immunization, vitamin A supplementation
and deworming. The Road to Health Card is regularly used, the weight of children
plotted and interpreted and almost all caregivers reported being satised or very
satised with the care provided by nurses. Facilities, including equipment, oral
rehydration therapy provision, and storage of medicines and supplies were found
to be adequate. Medicines and other supplies for HIV diagnosis and paediatric HIV
treatment were also surprisingly available in almost all facilities visited.
UPDATING AND
EXPANDING
IMCI
UPDATING AND
EXPANDING
IMCI