07 June 2024

Monitoring children’s development through primary health care in Europe and Central Asia

A large amount of scientific knowledge has accumulated on the importance of early childhood development (ECD) for societal prosperity. Early childhood is the period that sets the foundations for health, well-being, learning, and productivity over the course of a person’s life, and has an impact on subsequent generations.Awareness of the importance of ECD is reflected in the United Nations Sustainable Development Goals. The World Health Organization (WHO) and the United Nations International Children’s Emergency Fund (UNICEF) have also launched the Nurturing Care Framework (NCF), which clarifies that ECD efforts need to be theory- and framework-based and holistic.The NCF indicates that good health, adequate nutrition, safety and security, responsive caregiving and opportunities for early learning are all central to the development of children. This framework aims to provide governments and societies with strategic directions for the holistic support of children’s well-being and has inspired multiple sectors, including health, education, labour, finance and social and child protection, to consider what they can do to promote the development of children. Despite the long-established importance of ECD, the translation of theory into practice is still slow and uneven. The Lancet ECD series points to an unacceptably high number of children who are unable to fulfil their developmental potential, with a large number living in low- and middle-income countries. Being unable to fulfil one’s developmental potential stands for a suboptimal developmental trajectory, decreased school readiness and learning abilities, and ultimately, decreased adult productivity. Any condition that puts a child at risk of suboptimal development, or that causes a child to have a developmental deviance, delay, disorder or disability is defined as a developmental difficulty. A wide array of conditions resulting in deficiencies in one or more components of the NCF may adversely affect a child’s well-being during this period and result in developmental difficulties. The true global prevalence of developmental difficulties is unknown; however, it is estimated to be high, given its broad definition. Surveys of developmental disability provide us with an estimate that one out of every six, or 17%, of children in the United States have a developmental disability. Estimates of the prevalence of developmental difficulties based on proxy measures of stunting and poverty point to a prevalence of 43% in low- and middle-income countries.Public health measures in most countries have programmes for the primary, secondary and tertiary prevention of the causes of developmental difficulties. A detailed discussion of these prevention measures is beyond the scope of this publication; however, interested readers are referred to an exemplary model for the prevention of developmental difficulties provided in Annex 2, which is an excellent resource that may help advocates, clinicians, researchers and policy makers to think holistically about the programmatic aspects of prevention.Irrespective of their causes, developmental difficulties in early childhood often manifest with delays in language, relating, play, motor function or self-help skills. A systematic, holistic and comprehensive approach embedded in the bioecological theory of early childhood development must be pursued to prevent, identify and address developmental difficulties as early as possible.Developmental monitoring represents such an approach, and means to keep track of, and support, every child’s development. This approach aims to maximize every child’s developmental potential through ECD promotion, early identification of developmental difficulties and the provision of timely early intervention. The text below outlines the tenets of developmental monitoring based on seminal publications published in the last two decades.
06 June 2024

Strengthening confidence in vaccines, demand for immunization and addressing vaccine hesitancy

To increase confidence in childhood vaccines and demand for immunization, UNICEF ECARO (Europe and Central Asia Regional Office) has created a training package on IPC for immunization. The training package, developed and tested in collaboration with John Hopkins Centre for Communication Programmes in 2018, aims to strengthen the capacity of health care professionals to understand and affect positive change in demand for immunization. The training modules are designed to address health workers bias, build on participants’ experiences, promote step-by-step skill building, and reinforce skills and self-efficacy through practice. Although there may be a multitude of factors leading to vaccine hesitancy among caregivers/ vaccine recipients, health workers have the power to influence some of these factors. For example, health workers can address knowledge gaps, attitudes, concerns and beliefs; improve service delivery; improve communication and engagement; address and decrease immunization related concerns (such as pain); and reorganize services (such as scheduling, waiting time, and reminders) to make them more accessible and meet caregivers’/vaccine recipients’ needs and expectations. In this guidance you will find information along with tips and techniques of what health workers can directly do to strengthen confidence, decrease hesitancy, and support demand for immunizations.
08 May 2024

Early childhood development country situation analysis

Children’s health and well-being are shaped from the moment of conception. Each stage of a child’s life is unique in terms of development and requires adequate care and attention. It is recognized that children’s early years are crucial and that providing nurturing and good-quality care for children in the first years of life will have benefits throughout their lives and into adulthood. Importantly, providing good early development is an investment in a child’s future and society’s future, but it is also a child’s right.Despite progress in child health made in Europe and Central Asia, where infant and child mortality rates are the lowest in the world, mortality in countries with the highest rate for children under 5 years is 22 times higher than that in countries with the lowest rate, and inequities are even greater for maternal mortality. A child born in the countries of Central Asia is three times as likely to die before the age of 5 years as a child born in a European Union (EU) country. Unequal progress towards good health outcomes, particularly for the most vulnerable groups, can be partially attributed to the poor quality of the services provided. Investing in early childhood development (ECD) could contribute significantly to improving the situation of children and addressing the remaining disparities between and within countries in the WHO European Region. Investment in ECD must be brought about by improving comprehensive and integrated health care and other services in countries that are capable of responding to and addressing the complexities of children’s development. ECD covers the period from pregnancy to entry into primary school, with a main focus on the development of the child from conception to the age of 3 years. The COVID-19 pandemic placed an extra burden on families, undermining the foundations on which children are nurtured in their early years. The closing-down of childcare facilities, balancing family and work life under lockdown conditions, and related long-term effects such as poor mental health and poverty, will need to be carefully addressed by governments. This situation has demonstrated the fragility of systems and the need to provide holistic whole-family support for young children and their caretakers so that long-term losses at individual and societal level stemming from suboptimal child development can be avoided.
20 March 2024

Best practices and common bottlenecks in eliminating mother-to-child transmission of HIV

According to Global AIDS Monitoring (GAM) 2021 and UNAIDS 2021 estimates, HIV prevalence among adults aged 15 to 49 years is systematically increasing in the Eastern Europe and Central Asia (EECA) region, while global estimates remain stable (Figure 1).1 Almost all new HIV infections in younger children from EECA are diagnosed in the 0 to 4 years age group, indicating that they occur either through pregnancy, birth or breastfeeding. In 2021, the estimated coverage of antiretroviral therapy among pregnant women in EECA was 65 per cent [59 to 75 per cent], which was lower than the global average. However, these estimates are not always in agreement with country surveillance data, as indicated both by independent consultants, and reports of national validation committees (NVCs) and regional validation committees (RVCs). In general EECA is a region that has shown significant improvement in the cascade of HIV care in adults, from 21 per cent of diagnosed persons being on treatment at the beginning of the 90-90-90 initiative in 2015 to 51 per cent in 2022, and from 19 per cent of persons with viral suppression in 2015 to 48 per cent in 2022. The significant improvements both in general health care and in HIV care in the region does not, however, translate into progress towards certification of the elimination of mother to child transmission (EMTCT). In 2014, WHO released the ‘Global guidance on criteria and processes for validation: elimination of mother-to-child transmission of HIV and syphilis’ (the ‘Orange Book’) and updates it regularly. The process of validation is the responsibility of ministries of health, and committees and secretariats at national, regional and global levels. In 2016, shortly after the Global Validation Advisory Committee (GVAC) for EMTCT was established, Belarus became the first country in the EECA region to obtain validation of achieving HIV EMTCT, followed by Armenia in the same year. As EMTCT for single or dual validation is provided for 3 to 5 years, Armenia has re-applied and is currently undergoing assessment by WHO. Belarus requested re-assessment and in 2018 the GVAC endorsed its continued validation status for HIV and syphilis. Belarus requested re-assessment again in 2022, hosted the RVC in 2023 and awaits a decision from the GVAC. Moldova also obtained validation of the EMTCT of syphilis in 2016 and revalidation in 2018.7 Kazakhstan and the Republic of Moldova went through external validation by WHO for EMTCT of HIV and syphilis but did not meet all the required criteria. In addition, Kazakhstan and Uzbekistan invited external consultants to review their current status regarding country EMTCT and received advice on the process of preparing the request to the RVC (Table 1). These countries are close to meeting EMTCT indicators but could not yet obtain EMTCT approval. Other countries in the region, namely Georgia, Kyrgyzstan and Ukraine, went through the process of national evaluation, but have not yet requested external validation by the RVC. In comparison with other regions, as of 2021 eight countries from Latin America and the Caribbean region (Anguilla, Antigua and Barbuda, Bermuda, Cayman Islands, Cuba, Dominica, Montserrat, and Saint Kitts and Nevis), were validated by WHO for the EMTCT of HIV and syphilis and four additional countries are on track for the dual validation of HIV and syphilis in 2023-2024 (PAHO communication). Recognizing high prevalence countries’ struggle in meeting the criteria and to enable the application for triple elimination, in 2017 WHO introduced the Path to Elimination in order to recognize countries with high prevalence of maternal HIV, syphilis or hepatitis B virus in their efforts to reduce MTCT.9 It was fully incorporated into the global guidance in 2021. According to this strategy there are three levels (tiers) of impact and programme indicators (bronze, silver and gold) and countries are expected to gradually advance from one tier to the next, ultimately reaching the goal of elimination (Prevalence requirements, indicators and targets for certification on the path to elimination of MTCT of HIV, syphilis, and/or hepatitis B virus).5 In addition, the process was supplemented by the acknowledgement of the role of engaging civil societies, protecting human rights and gender equality, ensuring that these key elements have been addressed.