REDUCE CHILD MORTALITY

The aim of this goal is to assist in formulation of child health policy and the evaluation of programs intended to improve the well being and survival prospects of young children by the year 2015:

The indicators are :

• Under-five Mortality Rate (U5 MR) (probability of dying between birth and the fifth birthday per 1,000 live births);
• Infant Mortality Rate (IMR) (probability of dying before the first birthday
  expressed per 1,000 live births); and
  
• Proportion of one-year old children immunized against measles. (%)

Proportion of 9 month up to 15 Years Olds Immunized Against Measles

The concern for measles immunization coverage is premised on two considerations:

• Measles is the last vaccine within the immunization cycle that should ideally end at the age of 9 months up to 15 years;
• And it is the commonest vaccination-preventable disease.

The Puntland Expanded Program of Immunization (PEPI) was started in 1991. According to the WHO/ UNICEF Review of National Immunization Coverage, the reported coverage levels using administrative data for 2005 and 2006 were high in the measles vaccine coverage in Puntland at 76%. However, the Measles vaccine coverage is particularly low in Eastern Sanag and Cayn regions.

Challenges

Efforts to reduce child mortality have been pulled back by a number of factors

• Decline in levels of immunization coverage against the six childhood disease, a key indicator of utilization of child health services. Children age 12-23 months receiving full vaccination against vaccine preventable diseases fell from 25% in 2000 to 60% in 2007.
• Recurring incidences of hunger and the resultant child protein-energy malnutrition (PEM) among children. Although chronic under nutrition among under five declined from 33% in 2000 to 30% in 2005, micro nutrient deficiencies still affect large number of children and women.
• Widespread incidences of malaria, diarrhea, acute respiratory infections which have impact on children mainly. These diseases currently contribute to about 50% of all reported morbidity and about 25% of all reported deaths.
• HIV/AIDS scourge and its related opportunistic infections -- increasing HIV infections rates among pregnant mothers.
• Lack of comprehensive obstetrics, neo natal care services and emergency obstetrics in many hospitals particularity in rural areas.
• Widespread poverty levels in the state particularly in the rural area.
• Literacy levels ? low mothers education levels in many parts of the state. It has been observed that children of mothers with little or no education at all have had the larges risk of mortality.
• Delivery complications arising from many such delivery done outside health care facilities and not supervised by skilled health workers.- lack of proper medical attention and hygienic conditions during delivery can reduce the risk of complications and infections that can cause death or serious illness of the mother
• Lack of access to PMTCT services to all HIV positive mothers.
• Poor infant feeding and weaning practices.
• Inadequate access to sustainable clean water sources and sanitation facilities
• Lack of access to health services in many parts of the state due mainly to their mal -distribution.
• Insufficient resources e.g. trained health workers, equipment, drugs

Maternal Mortality Ratio

At the national level, the maternal mortality ratio (MMR) was 1600 maternal deaths per 100,000 live births. However, the figure for Puntland produced by WHO and UNICEF for 2004, using an estimation process, was children born under weight 25.8%, children U5 mortality rate 219 per 1,000 live birth, 1 year old fully immunized is 36% .