Targets by 2015:
Halt and begin to reverse the spread of HIV/AIDS.
Halt and begin to reverse the incidence of malaria and other major diseases.
Millions of children are dying needlessly.
Malaria kills a child somewhere in the world every 30 seconds.
Disease is a cruelly potent child killer, especially when combined with the poverty in which much of the developing world lives. In the absence of good nutrition, sanitation and health care, HIV/AIDS, malaria, measles, polio and tuberculosis mean certain end to millions of children who would survive and flourish elsewhere.
AIDS alone has taken more than 20 million lives and may take millions more if trends continue. Roughly 500,000 children younger than 15 years died of the disease last year alone, and children accounted for 13 percent of new infections in 2004 (640,000 cases). And mothers and pregnant women are ill; as of November 2004, women accounted for nearly 50 per cent of the more than 37 million people living with HIV worldwide and for 60 per cent in sub-Saharan Africa.
The pandemic hits all sectors of society in a cycle of illness and wasted lives; ill parents are unable to work and support the family, children drop out of school to help, orphans fall prey to violence, disease and, perhaps later, HIV/AIDS; a poverty-stricken country is even less able to support its citizens.
Yet directly, malaria is proportionally an even more vicious killer of children under five, responsible for 10 per cent of child mortality in the developing world. Contracted during a pregnancy, it can seriously affect the size and development of a newborn. It keeps children from attending school and adults from working. It costs Africa some $10 billion to 12 billion every year in lost gross domestic product.
In urgent response to this grim situation, in the year 2000 African countries committed themselves to a series of malaria control targets to be reached by the end of 2005, chiefly protection through the use of insecticide-treated nets (ITNs) for 60 per cent of people at highest risk and intermittent preventive treatment for 60 per cent of pregnant women.
Other diseases claim large numbers of small victims. Malnutrition and AIDS are contributing to an increase in tuberculosis cases, which now affects some 250,000 children. Outbreaks of polio and cholera require fast, experienced action in some of the world’s most hard-to-reach areas.
Over the decades research and experience has clearly shown what needs to be done, what works and what doesn’t. There are measures that are proven to work and to be cost-effective, including micronutrient supplementation, insecticide-treated mosquito nets, breastfeeding and interventions to improve basic health care. These are the backbone of UNICEF’s advocacy and activities to help defeat disease and achieve Millennium Goal 6 – and Goal 4, child survival, as well.
UNICEF responds by:
Focusing on HIV/AIDS and children. UNICEF directs its efforts in several key areas to combat this pandemic, the first being prevention. More than 2 million children under 15 are infected with HIV, and 15 to 24-year-olds accounted for half of all new HIV infections in 2003. With government and civil partners, UNICEF helps reduce adolescent risks and vulnerability to HIV/AIDS by increasing access to and use of gender-sensitive sexual and reproductive health promotion and disease-prevention information, skills and services.
For example, UNICEF helps organize information campaigns on HIV/AIDS prevention and treatment, and helps increase young people’s access to youth-friendly, gender-sensitive health services that provide voluntary testing and counselling, especially in countries affected by emergencies.
UNICEF also supports actions of governments in preventing parent-to-child transmission of the virus. In 2004, 640,000 babies become infected with the HIV virus either during their mother's pregnancy, birth or through breastfeeding. Pregnant women with HIV can halve the chance of passing HIV on to their babies if they have access to antiretroviral drugs. UNICEF helps strengthen government capacities to ensure that both women and children receive an equitable share of ARV treatment.
As part of this effort, UNICEF, the World Health Organization (WHO) and UNAIDS launched the ‘3 by 5’ initiative in 2003, which aims to ensure that 3 million people have access to anti-retroviral treatment by the end of 2005. It complements the work of government donors, international agencies and pharmaceutical companies to reduce medicine prices and increase treatment access.
UNICEF also promotes counselling on best breast feeding practices so that every parent affected by HIV/AIDS knows how to help prevent its transmission to newborns.
Based on current trends, the number of children orphaned by AIDS in sub-Saharan Africa will exceed 18 million by 2010. As well as being more vulnerable to malnutrition and disease, orphans are more likely to fall behind or drop out of school. UNICEF promotes and supports family, community and national programs that help families and children who have lost one or both parents to HIV/AIDS. These include schooling, health services, psychosocial support, and health services.
Working with partners to Roll Back Malaria. Malaria afflicts primarily the poor, who tend to live in malaria-prone areas in dwellings that offer few, if any, barriers against mosquitoes. Household use of insecticide treated nets is currently low, averaging only 1 per cent, as the nets are still too expensive or unavailable in some areas.
Pregnant women are particularly vulnerable to malaria as pregnancy reduces a woman’s immunity, making her more susceptible to infection and increasing the risk of illness, severe anaemia and death. For the unborn child, maternal malaria increases the risk of spontaneous abortion, stillbirth, premature delivery and low birth weight - a leading cause of child mortality.
UNICEF, along with the United Nations Development Programme and the World Bank, joined with the WHO in 1998 to found the global partnership Roll Back Malaria, with the goal of halving the burden of malaria by 2010. With UNICEF heading activities in East and West Africa, the group of some 90 global partners – including governments of malaria-endemic countries, donor governments, international organizations, private foundations and academic institutions – works together on a range of interventions to control malaria.
Foremost among these is mass-purchasing ITNs, the most effective prevention against malaria, and developing local distribution systems for them. If every African child under five years slept under an ITN, costing only $4, nearly 500,000 child deaths could be prevented every year.
For example, in 2002 RBM working with the government of Malawi on a dramatic scale-up in distribution of ITNs, with the objective of widespread and equitable access to the nets. Heavily subsidized ITNs were given out through maternal and child health clinics; others were distributed through community networks and sold through the private sector. Today Malawi has one of the largest ITN distribution programmes in Africa and has shown that net distribution can work nationwide.
The RBM partners are also working to encourage companies, especially in Africa, to manufacture the nets themselves. A factory in Tanzania was the first ever to product a net with long-lasting insecticides woven into the fabric.
Pregnant women, especially those who are pregnant for the first time, can take medicines to prevent and treat malaria. Home management of the disease – which involves educating and training families and providing pre-packaged high-quality medicines – allows families to care for their own children effectively and quickly, an important asset as malaria can kill within hours.
The RBM group partners with pharmaceuticals to purchase and deploy new, effective antimalarial drugs called artemisinin-based combination therapies (ACTs), and to research diagnostic tests. Along with its partners, UNICEF mobilizes communities, particularly via prenatal clinics, to provide preventive drug treatment against the disease, and advocates teaching mothers, shopkeepers and other local people to recognize the symptoms of malaria and treat the disease at home.
The world is seriously off track for meeting its health goals. HIV prevalence is rising in many countries, particularly in Europe and Asia. Absolute numbers are large in China and India, and the rate of prevalence in southern Africa, above 17 per cent for all seven countries, is highest of all. Although global spending on AIDS has increased 15-fold since 1996, it is less than half of what will be needed by 2005 in developing countries. Only 7 per cent of the people who needed antiretroviral treatment in developing countries had access to the drugs at the end of 2003. The incidence of tuberculosis, the leading AIDS-related killer, has tripled in Africa since 1990. In some parts, 75 per cent of people with HIV also have TB.
Malaria is a persistent killer, but some inroads are seen, especially in monitoring. In mid-2005 the WHO and UNICEF launched World Malaria Report, a status of the disease’s prevalence and progress against it. A snapshot: Some countries have been able to reach or even exceed some of the Abuja targets. Most remaining countries are now poised to begin scaling up antimalarial efforts. A total of 23 African countries are now using the new and effective drugs (ACTs) and 22 have adopted the RBM-recommended strategy of home management of malaria for children under 5 years of age.
The number of ITNs distributed has increased 10-fold during the past 3 years in over 14 African countries. And surveys have shown remarkable increases in ITN coverage for children in countries such as Eritrea and Malawi. But death rates are still high among those who fall ill and the vast majority of the death toll is among children under the age of 5.