Child mortality is declining in The Gambia, although not fast enough to reach MDG 4 by 2015. Infant mortality stands at 81 and under-five mortality at 109 per 1000 live births, according to the Multiple Indicator Cluster Survey (MICS) 2010. In 2010, under-five mortality rates in the rural areas were 36 per cent higher than those in urban areas due to contributing factors such as malaria, pneumonia, and diarrhoeal diseases which are the leading cause of child morbidity and mortality. The national maternal mortality rate has declined from 730 per 100,000 in 2001 to an estimated 360 per 100,000 deaths (WHO, UNICEF, UNFPA 2012 estimates), nonetheless, the country is unlikely to meet the MDG 5 target of 263 per 100,000. Nationally, 56.6 per cent of women were assisted at birth by a skilled health worker (MICS, 2010) while, in the impoverished Central River Region South, only 32 per cent of them were assisted at birth.
Most children are now immunized from diseases such as measles, meningitis and polio. According to the 2010 Multiple Indicator Cluster Survey, 87.4 per cent of children had all nine antigens as recommended in the first 12 months of life while 99 per cent of children aged 12-23 months received a Bacille de Calmette et Guérin (BCG) vaccination by the age of 12 months. The first dose of Diphtheria Petussis and Tetanus (DPT) was given to 96.5 per cent and the second and third doses were respectively given to 96.2 per cent and 89.3 per cent of children aged 12-23 months. Over 87 per cent of children were vaccinated against measles before their first birthday.
According to the 2010 MICS, 41.1 per cent of under-five children slept under a bednet the night before the survey interview, and 33.3 per cent of these bednets were impregnated with insecticide. About 71 per cent of the households reported to have at least one insecticide treated net or received indoor residual spray (IRS) in the last 12 months preceding the survey. Health seeking behaviour for prevention and management of pneumonia is on the rise because, of the 6 per cent of children age 0-59 months reported to have had symptoms of pneumonia during the two weeks preceding the survey, 68.8 per cent were taken to an appropriate health provider.
In terms of the knowledge, attitudes and practices of families and communities towards child and maternal health, the primary caregivers of the children have an important role to play in preventing and managing preventable diseases like diarrhoea and pneumonia. Evidence has shown that large scale communication focusing on the four key household behaviours of exclusive breast feeding, hand washing with soap at critical times, use of insecticide treated nets to prevent malaria and use of oral rehydration solution to treat diarrhoea can reduce child hood mortality by 40 per cent.
UNICEF carries out its mission through a unique programme of cooperation jointly developed and agreed on with the government of The Gambia for a five-year period. This programme of cooperation, well informed by a situational analysis of women and children, guides our work within the country in support of the national development priorities. Our presence is visible in all high-level decision-making forums and is well positioned to directly influence major decisions made on policy design and development as well as downstream service delivery.
At the policy level, UNICEF influences decision-making through advocacy and sector-wide donor coordination processes. We provide technical support and contribute to shaping the development of various policies and plans on maternal and child health. In 2009, UNICEF was instrumental in developing the National Health Policy 2010 – 2020 and the Malaria Strategic Plan for 2010 – 2014. UNICEF is a key member of the Inter-agency Co-ordination Committee (ICC) for immunization and the Primary Health Care Working Party Group.
At the service delivery level, we support the village health service in our three intervention regions (Central River, Upper River and North Bank regions) by providing supplies of basic paediatric drugs for the management of common childhood diseases such as diarrhoea and pneumonia, which remain among the three top killers of children under five. Cold chain equipment have been expanded to maintain the quality of vaccines. Training activities to improve the capacity and skills of health staff, village health workers, village development committees and baby-friendly community initiatives (BFCI) groups are also supported. UNICEF actively participates and plays a lead role in national polio campaigns (integrated with Vitamin A and de-worming), reaching, on average, more than 95 per cent of all children under five years nationally.
At the grassroots level, we work with and support communities to improve the capacities of caregivers, mothers, families and communities for the adoption of essential care practices. This component supports the scaled-up use of communication for development to ensure the adoption of hand washing practices, household water treatment, use of insecticide treated nets for pregnant women and children under the age of five, preparation and use of oral rehydration salts for diarrhoeal cases, and promotion of exclusive breastfeeding for the first six months of life.
The health of the most vulnerable children and women will be improved through more access to supplies; routine and integrated supplemental immunization, vitamin A supplementation for children under the age of five and post-partum mothers; deworming; promotion of exclusive breastfeeding; use of insecticide treated nets to prevent malaria; oral rehydration solution to treat diarrhoea; hand washing with soap at critical times; and the consumption of iodized salt. At the same time, partners will be provided logistic support to enhance the services for children and women.
The provision of supplies and capacity building will not only allow for the treatment of childhood illness at community level and provide a comprehensive and cost effective system, but also contribute to the reduction of under-five mortality.