A healthy generation of children

A healthy generation of children

 

A healthy generation of children

© UNICEF Uzbekistan/2005/Matteo Mode

A newly born child receives maximum attention in a new hospital in Khorezm

Issue

Infant Mortality
Although, the rate of infant mortality is improving, the official figure of 16.5 per thousand (source: Ministry of Health/Uzbekistan CCA 2003) remains high, compared to other CEE/CIS countries (and even more so compared to the EU average). Moreover, if internationally-accepted definitions of live births were used, the figure would be higher.  Within this figure there are too many children dying from respiratory infections and diarrhoeal diseases.

Feeding practices and micronutrient deficiency are a major public health concern. Infant and child health is threatened by malnutrition, reflecting the mother’s health status, micronutrient intake and child feeding habits. The rate of anemia due to iron deficiency in children (at over 60% for the 6-59 months age group. source: Uzbekistan CCA 2003) is high, reflecting poor nutrition and diet with consequences on children’s cognitive development. Vitamin A and iodine deficiencies are also prevalent (both between 50-60%. source: DHS 2002/ SOWC 2005), the latter resulting from only 19% of households using iodized salt (source: SOWC 2005). Although the rate of exclusive breastfeeding, during the first four months of a child’s life, has increased, the figure is still only 22%. The nutritional status of children between the ages of 0-3 included 1% emaciated, 8.8% underweight and 22.8% stunted (source: UHES 2002). Rates of malnutrition differ between rural and urban areas and there has been significant increase in number of emaciated children in rural areas to 7.2%, compared to 3.7% for urban areas.

Although immunization coverage is high (over 95%. source: SOWC 2005) and polio-free certification awarded, there are still lethal cases resulting from vaccination against measles. There have been 23 cases since 1997 including 4 in 2003.

The 2003 USAID study, ‘Primary Health Care Needs Assessment 2003’, revealed that only 35% of mothers with children under two knew two or more signs of pregnancy complications, 90% among them incorrectly stated danger signs of labor complications and only 11% women correctly described signs of possible postpartum complication.

There have been 40 cases of HIV/AIDS infection registered, where the disease was transmitted from mother to child. Despite the fact that HIV-testing is widely available for pregnant women, lack of treatment guidelines and supplies of anti-retroviral drugs hinder the opportunity to adequately address the problem.

Decline in pre-school education
There has also been a dramatic reduction in pre-schooling, with only 20% of children aged 3 to 6 enrolled in any kind of pre-school programme in 2002, compared with 37% in 1989 (sources: Social Monitor 2004). Pre-school education is essential to prepare a child for full-time schooling.  However, government efforts to establish and maintain both traditional and non-traditional Makhalla and private kindergarten pre-schools, resulted in increased coverage to 27% in 2002.
Most families lack appropriate knowledge and skills for bringing up children, which affects the child’s development and readiness for school. Child rearing studies show that 88% of parents use physical punishment and 65% do not give importance to interactive games with children (allocating only 30% of their time).

© UNICEF Uzbekistan/2005/Matteo Mode

Children and parents attending a Makhalla kindergarten, in Khorezm

Action

Health programmes promote and support health reform, safe motherhood, the integrated management of childhood illnesses, immunization, and the prevention of micronutrient deficiencies. The Government of Uzbekistan and UNICEF have developed an integrated programme that aims to improve early childhood and reduce infant mortality. The following measures have been taken:

• A National Policy and strategy on Safe Motherhood introduced;
• Clinical protocols are being introduced into peri-natal care services;
• A policy framework to introduce the International Live Birth Definition was established and is being implemented in one pilot region in Fergana, with future plans for nationwide replication;
• A State Policy on Safe Motherhood was developed under the leadership of the government, resulting from the experience of a successful pilot project on Safe Motherhood and Baby Friendly Hospitals in Fergana Valley;
• A state policy providing standards for ante-natal, peri-natal and neo-natal care has been adopted and is being implemented nationwide by the government; 
• Enhancement in levels of protection from diseases,  such as Initiation of a measles elimination programme;
• Achievement of Polio-free certification;
• Increased vaccination coverage for children under one year old (from the current coverage of over 95%. source: SOWC 2005) and better management of childhood illnesses such as respiratory infections and diarrhoeal diseases;
• A National Programme for iodine deficiency diseases (IDD) elimination has been developed: a Salt Producers Association was created and a nationwide campaign on the use of iodized salt launched in over 10,000 schools;
• A national programme of iron supplementation has been introduced, followed by the commencement of a national flour fortification programme, funded by GAIN;
• Nationwide vitamin A supplementation is ongoing and covers approximately 80% of all children aged 6-59 months (source: SOWC 2005);
• Exclusive breastfeeding increased from 4% in 2000 to 19% in 2003 (source: SOWC 2005)
• Advocacy for and assistance in the incorporation of HIV Prevention for Mother to Child Transmission into the maternal and child health system;
• Continuous capacity building of key health authorities and health professionals;
• The number of Baby-friendly Hospitals will be increased from 3 to 16, to ensure that 50% of babies are born in hospitals that promote, encourage and support breastfeeding;
• Integrated management of childhood illnesses, safe immunization practices, lactation management and micronutrients deficiency control incorporated into medical curricula and becomes part of the Primary Health Care.

The Makhalla Kindergarten

Makhallas. (neighbourhoods) a traditional Uzbek method of local self-rule, distinct from government,  are being given increasing responsibilities for community development and social assistance by the government. A UNICEF/government initiative is the establishment of the ‘Makhalla Kindergarten’, a home-based kindergarten supported by the State, to serve those families in rural areas who cannot send their children to school.

The primary objective of the kindergarten is to improve the knowledge and the skills of parents and communities on early childhood care that ensures a child’s survival, growth and development. The kindergartens focus on the survival and protection of newborns and women by promoting health issues, reducing the incidence of  childhood diseases, providing access to safe immunization services, encouraging breast-feeding and mobilizing families and communities to encourage better parenting skills.

Impact

The health and education systems are improving as a result of the above initiatives. The threat of infant mortality, childhood illness, malnutrition and restricted physical, intellectual and emotional development is slowly being reduced. Parents are learning how to provide the necessary love, attention and mental stimulation that their children need.

UNICEF are working with the government to ensure that current and future generations of children will not be handicapped by illness, poor nutrition and limited access to education. Instead, they will grow into healthy adults and be able to take advantage of the opportunities that are presented to them.