Young Child Survival and Development


UNICEF in action: Strategies and priorities


Maternal and newborn health

Water, sanitation and hygiene



Child Health Days

Results for children


Results for children

© UNICEF/NYHQ2007-2068/Mutabazi
Women wait to see the doctor outside an antenatal clinic in Rwanda.


Exclusive breastfeeding rates in five countries have improved by at least 10 percentage points over the last decade. In Zambia, for example, it increased from 10 percent in 1996 to 61 percent in 2009. Notable progress has also been achieved in Lesotho, Malawi and Tanzania. However, countries such as Angola and Kenya lag behind with exclusive breastfeeding rates below 15 percent, and South Africa and Somalia even below 10 percent.

Thirteen countries in the Eastern and Southern Africa region (ESAR) are being supported in organizing twice yearly vitamin A supplementation (VAS) campaigns.VAS has been integrated into Child Health Days, together with other cost-effective and high-impact interventions like de-worming, immunization and distribution of insecticide-treated mosquito nets.

Countries are increasingly recognizing Integrated Management of Acute Malnutrition (IMAM) as part of the minimum core package of nutrition interventions. Nineteen of the 20 countries in the region have begun to build national capacities to scale up this approach.


In 2010, 10 countries in ESAR reached a routine immunization coverage rate of 80 percent or more for the six major childhood diseases, compared to 11 countries in 2009. Five countries – Angola, Botswana, Burundi, Eritrea and Malawi recorded an impressive coverage of over 90 percent.

New vaccines against Hepatitis B and Haemophilus influenza type B, are now part of the routine Expanded Programme on Immunization (EPI) in all ESAR countries, except for Botswana and Somalia. For the first time in 2009, pneumococcal vaccine was introduced in Rwanda and South Africa, and approved for Kenya.

Massive immunization campaigns in ESAR led to a significant reduction of 89 percent in child mortality due to measles in 2007 compared to 2000. Five of the remaining nine countries still classified as high-risk for maternal and neonatal tetanus have made remarkable progress towards elimination. The intense efforts made by UNICEF and partners also led to an interruption of the transmission of the polio virus in Burundi, Kenya and Uganda in 2009.

© UNICEF/NYHQ2008-1490/Nesbitt
A health worker treats a child for cholera during the 2008-2009 cholera outbreak in Zimbabwe.

Water and environmental sanitation

By the end of 2009, nine countries in the region have sanitation-specific policies compared to only three countries at the outset of the International Year of Sanitation (2008).

The number of countries in the region with national behaviour change communication programmes that promote hand washing with soap is gradually increasing. The second Global Hand Washing Day (GHD) in October 2009 helped galvanize efforts around this important initiative.

Across the region, an unprecedented number of communities have become open defecation-free (ODF), corresponding to a high number of people gaining access to household sanitation.

In the area of water, UNICEF has made significant progress in scaling up of household water treatment and safe storage, particularly in emergency settings in the region. As emergency cluster lead for WASH, as well as a key partner in the health cluster, led by WHO, UNICEF responded to a series of crises in 2009, including the cholera outbreaks in Zimbabwe, Kenya, Malawi and Ethiopia.

Four countries, Burundi, Malawi and Tanzania and Zambia are now mapping the availability of improved water and sanitation facilities in schools. As a result, Zambia has allocated funds to improve school sanitation in its state budget for 2010.

Maternal and newborn health

UNICEF has taken the lead in scaling up community-based newborn care, which is found to have reduced newborn deaths by 30 to 61 percent in villages where health workers make home visits.

One of the most ambitious initiatives that UNICEF supports to address maternal and newborn mortality is to be found in Ethiopia, where health-extension workers are being trained to provide safe delivery.

On a regional scale, Child Health Days are among the most successful initiatives in which UNICEF plays a key role in ESAR. Usually held in remote villages, these events have been organised twice a year since 2004 to combine a full range of maternal and child health services, such as immunization, vitamin A supplementation, de-worming and distribution of insecticide-treated mosquito nets to prevent malaria, as well as water and sanitation services. In 2009, almost all 20 countries in the region conducted Child Health Days.


In countries that have achieved high coverage of long-lasting insecticide-treated nets (LLIN) usage and treatment programmes, recorded cases and deaths due to malaria have fallen by 50 percent, indicating that the related target of Millennium Development Goal 6 (MDG) of reversing the incidence of malaria can be achieved. And there is evidence from Zanzibar and Zambia that large decreases in malaria cases and deaths have been mirrored by steep declines in all-cause deaths among children less than five years of age, suggesting that intensive efforts in malaria control could help many African countries to reach, by 2015, a two thirds reduction in child mortality as set forth in MDG 4.



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