Comparison of child health and immunization in Afghanistan with global estimates and neighboring countries

1. Child Health and Immunization:
Global versus Afghanistan prospect
International Conference of Religious Scholars on Immunization
22 – 23 Feb, 2016
Najibullah Safi, MD, MSc. HPM
Director General of Preventive Medicines and Primary Health Care
MoPH – Afghanistan

2. Presentation outline
• Overview of child health
• Immunization coverage in Afghanistan
• Overview of global/country burden of Polio

3. Introduction
• The under-five mortality rate is a key indicator of
child well-being, including:
• Health and nutrition status
• Coverage of child survival interventions
• And, more broadly, of socio-economic development

4. Under-five mortality
• Substantial global progress has been made in
reducing child deaths since 1990
•Under-five deaths worldwide has declined from 12.7
million in 1990 to 6.3 million in 2013
•Despite these gains, progress remains insufficient to
reach MDG 4, particularly in sub-Saharan Africa
central and southern Asia

5. Under-five mortality cont.
• About 50% of under-five deaths occur in five countries
• India, Nigeria, Pakistan, Democratic Republic of the Congo
and China
•The deaths are not distributed evenly over 0-5 year age
•More than 70% of all child deaths occur in the first year
of life
•Around 40% of them occur in the first month of life

6. Global trend of under 5 mortality rate
15
11 10 8 7 6 5
100
94
83
69
57
50
33
90
85
76
63
51
46
30
1990 1995 2000 2005 2010 2013 MDG TARGET
2015
Developed regions Developing regions World

7. Risk of under 5 mortality

8. Under 5 mortality rate in selected countries, 2013
97
86
17
48
43
55 53
13
46

9. Trend of Under 5 mortality in Afghanistan
Indicator Current average Annual
rate of reduction
Expected average annual
rate of reduction
Under 5 Mortality Rate 2.7% 6.5%
Neonatal Mortality Rate 0.1% 5.2%
257
161
97
65
BASELINE 2008 2012 2020
Under 5 Mortality (per 1000 live births)

10. •More than 50% of deaths occur due to:
• Preterm birth complications (17%)
• Complication during labour (11%)
• Pneumonia (15%)
• Diarrhoea (9%)
• Malaria (7%)
• Measles
•Malnutrition contributes to more than half of all
under-five deaths
Causes of child mortality

11. Progress in achieving the MDG 4 and 5
•57 countries: likely to reduce child mortality by 2/3
(1990-2015)
• Intra-country disparities exist
•16 countries: significant increase in child mortality
•Progress slow/stagnating in Sub-Saharan Africa and
South Asia
•42 countries account for 90% of all child deaths
•Over 1 billion children severely deprived of basic
health and other social services

12. Immunization coverage in Afghanistan

13. Fully immunized children aged 12-23 months
2.5%
86.8%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
13

14. 34% 33%
21%
0%
5%
10%
15%
20%
25%
30%
35%
40%
No faith in vaccine Unaware of need Security concern
Main reasons for no immunization

15. Polio cases in 2014 - 2015
28
306
20
54
0
50
100
150
200
250
300
350
Afghanistan Pakistan
2014
2015
• Since August 2014, no WPV outside of Afghanistan & Pakistan

16. Wild Poliovirus cases in last months
Endemic country
Wild poliovirus type 1
1Excludes viruses detected from environmental surveillance.
2Onset of paralysis 10 August 2015 – 09 February 2016
Country
Onset of most
recent case
Number of
infected districts
Total WPV
(All type1)
Pakistan 17-Jan-16 12 26
Afghanistan 20-Dec-15 10 11
EMR 17-Jan-16 22 37
Global 17-Jan-16 22 37
Data in WHO HQ as of 09 February 2016

17. Trend of WPV in Afghanistan 1999-2015
150
118
11 10 8
4
9
31
17
31
38
25
80
37
14
28
20
0
20
40
60
80
100
120
140
160
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Poio Cases

18. Simple intervention for improving child health
•Skilled care during pregnancy, childbirth and in the
post-natal period
•Immunization
•Infant feeding: exclusive breastfeeding,
complementary feeding and micronutrients
•Combating diarrhoea (e.g. ORS, Zinc)
•Treating pneumonia, diarrhoea and new-born sepsis
•Combating malaria
Religious scholars can play critical role in social
mobilization, raising awareness and improving child health

19. Polio and Immunization
Maternal and
New born Health
Nutrition
ACT NOW FOR THE
LONG TERM
Children are the future of Afghanistan, we need
to work today to secure the future for tomorrow