Child survival and Development

Program: Child Survival and Development

 

Program: Child Survival and Development

© UNICEF/Djibouti/Rabemiafara/

Context

In Djibouti, the situation of children under 5 years is alarming. The MICS/EDIM-2006 survey results show higher rates of infant and child mortality, respectively 67 and 94 deaths per 1 000 live births. The main causes of death among children are neonatal ones (infections, prematurity, and asphyxia), acute respiratory infections (ARI), diarrhea, malaria and malnutrition.

Malnutrition affects several children in the Republic of Djibouti. The EDIM survey conducted in 2006 shows a prevalence of 28.9% of underweight rate in children under 5 years with 10.3% of severe underweight cases. There is stunting rate of 32.6% with 19.7% rate of severe stunting. Acute malnutrition rate is 20.7% with 7.5% of severe acute malnutrition.

Compared with PAPFAM 2002 survey data, the nutritional situation among children under 5 years has deteriorated. The main causes of malnutrition are linked to inadequate dietary intake, insufficient care for children, poor hygiene and inadequate access to heath care. Poverty remains the bedrock for food and nutritional problems.

Progress is being observed in maternal health care, although many efforts are still to be made to achieve Goal 5 of the Millennium Development. From 1996 to 2002, the maternal mortality ratio has decreased from 740 to 546 deaths per 100 000 live births (Source: Djibouti survey on family health, 2002). However, despite encouraging progress, the maternal mortality rate of 546 deaths per 100,000 live births ranks Djibouti among countries with the highest maternal deaths rates in Africa.

As for the situation of HIV / AIDS in Djibouti, the proportion of women aged 15-49 with enough knowledge (able to identify two prevention methods and three prejudices about HIV transmission) remains low (18% in 2006). Since 2003, tremendous efforts have been made to scaling up the PMTCT program. More than 50% of health facilities in the country provide health care to prevent mother to child transmission of HIV, while plans to generalize the programme within prenatal consultation services are underway.

Although nearly 80% of women accept HIV / AIDS screening, part of them does not collect their results. Among those who don’t return, nearly 30% do not show up after delivery. Even when continuing with the PMTCT program, the majority of HIV-positive mothers dare not declare their status to their spouses for fear of being rejected. Rejection and stigma are evidence that there is a lot of work to be done in terms of community mobilization and change behaviour as regards AIDS disease.

There is an increase access to drinking water but major efforts are required to reduce disparities between urban and rural areas and about sanitation. Percentage of households with access to a source of improved potable water rose from 92% in 2002 to 93.5% in 2006 (EDIM). However, only 52.5% of rural households have access to an improved drinking water source. 69% of urban population use sanitary facilities to remove excrement against 17% in rural areas. The persistence of cholera and other oral- faecal transmitted diseases shows that sanitation and hygiene practices still need to be improved.

Action

A range of interventions is being implemented to reduce the incidence of neonatal, infant and maternal mortality, especially through:
(i) promoting the use of insecticide-treated nets among children under five years;
(ii) Provision of exclusive breastfeeding from 0 to 6 months and adequate complementary feeding;
(iii) Adequate case management of diarrhea, IRA (by antibiotics), as well as moderate and acute severe malnutrition;
(iv) Hands washing with soap and proper management of water and sanitation;
(v) Improvement of routine EPI immunization, prenatal consultation and family planning;
(vi) Prevention and treatment of iron deficiency anemia during pregnancy;
(vii) Implementation of PMTCT program at health posts and cotrimoxazole prophylaxis for HIV + women;
(viii) Strengthening case management of severe malnutrition in hospitals as well as supplementation with vitamin A;
(ix) Advocacy, social mobilization and communication for behavior change;

Impact

• The infant mortality rate fell from 67 to 55 per 1,000 live births and the mortality rate among children under 5 years (U5MR) from 94 to 85 per 1000 live births.
• The maternal mortality rate fell from 546 to 400 per 100,000 live births
• Mother to child HIV transmission is reduced by 50%

 

 

 
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