Child Health & Nutrition

Despite major gains in child survival in the last 25 years, the average under-five mortality rate in 2001 was 121 deaths per 1,000 live births in low-income countries, 41 in lower-middle-income countries, and 27 in upper-middle-income countries. Child mortality is highly linked to poverty: in high-income countries, the rate was less than seven.

Child Survival: A Millennium Development Goal

Declared one of the Millennium Development Goals, the reduction of the under-five mortality rate by two thirds, between 1990 and 2015, continues to be a high priority for the development community. No region, however, except possibly Latin America and the Caribbean, is on track to achieve the target of reducing, by 2015, the under-five mortality rates by two thirds of their 1990 levels. Progress has been particularly slow in Sub-Saharan Africa, where civil disturbances and the HIV/AIDS epidemic have driven up rates of infant and child mortality in several countries.

Integrated Management of Child Illnesses - IMCI

Five common illnesses are responsible for the majority of child deaths in developing countries: diarrhea, acute respiratory infections, malaria, measles, and malnutrition or a combination of several of the above. While these conditions would be easily preventable and treatable in developed countries, they are often fatal in the developing world. The Integrated Management of Child Illnesses (IMCI) strategy, developed since 1995 by the WHO in cooperation with UNICEF, aims at adopting an integrated approach to child health and development of national health policies, focusing on the improvement of health-care staff’s case management skills, the improvement of the overall health system and of family and community health practices.

Importance of Nutrition

Nutrition is equally critical for child health and survival. According to the WHO, the proportion of children under five in the developing world who are malnourished to the point of stunting fell from 39% in 1990 to 30% in 2000. By 2005, this figure is projected to fall below 26%. And the UN's Food and Agriculture Organization (FAO) estimates that 17% of people in the developing world were undernourished in 1999-2001, a slight drop from 18% in the mid-1990s. The absolute number of undernourished people, however, rose slightly over that period, however, from 780 to 798 Million. Moreover, inadequate nutrition of mother and child accounts for 9.5% of the global burden of disease.

IMCI in World Bank Policies

IMCI includes preventive and curative interventions, such as improved infant and child nutrition, breastfeeding promotion, immunization, and use of bed nets in areas with malaria. It responds to the needs of caretakers and seeks to improve their satisfaction with child health services. IMCI has three main components:

1. To improve family and community practices related to child health and nutrition;
2. To strengthen the health system for effective management of childhood illness;
3. To improve health workers' skills.

Moreover, it has also been proven to be one of the most cost effective ways to prevent childhood illness – in other words, one of the “best buys” in public health for developing countries.

IMCI in World Bank Operations

While at least some aspects of IMCI have been supported by an estimated 35 Bank projects over the past decade, many have just been pilot efforts and there is considerable room for scaling up, given the ample evidence of its cost-effectivness in reducing child mortality and the worrisome lack of progress toward reaching the MDGs related to child health.

In Brazil, after receiving IMCI nutrition counseling, mothers were able to recall feeding recommendations, modified their feeding practices and as a result their children had significantly better nutritional status than control groups. In Tanzania, in districts where IMCI is in place, health worker performance has improved and caretakers are more satisfied with the care their children receive. In rural Kenya, IMCI led to savings of at least 50% in the cost of drugs per child treated.

Issues for Scaling Up

A recent multi-country evaluation of IMCI suggests that:

• IMCI training for health workers managing children in first-level health facilities can lead to rapid and sustained improvement in health workers’ performance.
• Ministries of health and their partners find it difficult to maintain and expand training coverage beyond a few pilot districts.
• Scaling up IMCI to national scale will require stronger management structures at central and district levels,; increased funding; coordination with other child health programs and elimination of conflicting regulations; improvement of supervision at the health-facility level, and reduction of staff turnover rates.
• Implementation of IMCI at the household and community levels is essential for improving care-seeking practices health services utilization.

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