20641 - Child survival how many deaths can we prevent Dr SK...

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2004.6.5 Child survival – how many deaths can we prevent? Dr SK CHATURVEDI Dr KANURPIYA CHATURVEDI
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2004.6.5 Issue Worldwide over 10 million children under 5 years of age are dying each year. What interventions are appropriate for reducing these deaths, and what would their impact be if full coverage of the interventions were achieved? Child survival: focus India contributes nearly 25% to the worldwide total of under-5 deaths, so a major reduction by India will have a major worldwide impact.
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2004.6.5 Child survival – the Lancet approach Review the state of evidence for interventions to reduce mortality for each of the major direct and underlying causes of death in children under five. Determine their efficacy and apply to current situation to assess how many under-5 deaths could be prevented. 1 st alternative – apply at regional level 2 nd alternative – apply at country level Compromise – apply to each of 42 countries where 90% of worldwide under-5 deaths occur
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2004.6.5 Child survival - interventions Focus on interventions addressing proximal determinants of child mortality and those that can be delivered mainly through the health sector. Take each of the main causes* of under-5 deaths and examine the effectiveness of available interventions for each cause of death * diarrhoea, pneumonia, measles, malaria, HIV/AIDS, and the underlying causes of undernutrition for deaths among under-5s, and asphyxia, preterm delivery, sepsis, and tetanus for deaths among neonates
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2004.6.5 Intervention search strategy Estimates of effectiveness of interventions taken from: either – published articles that summarized earlier research results or – systematic reviews by the authors and participants in the Bellagio Child Survival Study Group, together with input from other experts Included search of MEDLINE, POPLINE, and other databases, including the Cochrane database of randomized controlled trials and the WHO Reproductive Health Library
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2004.6.5 Interventions – level of evidence Each potential intervention was assigned to one of three levels based on the strength of evidence for its effect on under-5 mortality: Feasibility for delivery at high coverage levels is a central criterion for any intervention intended to reduce child mortality. But what is feasible varies widely among countries. Therefore the approach focused on an essential set judged to be feasible for all countries.
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