Child and adolescent health in Bangladesh

WHO has been supporting Bangladesh for it to achieve highest standards of health and development for children and adolescents, whereby they are nurtured to live their life to its full potential while ensuring that their needs and rights are fulfilled and respected. Child and Adolescent health unit of WHO Bangladesh is supporting Bangladesh to achieve MDG-4 and 5 by Strengthening/formulating /developing, health policies/ strategies related to newborn, child and adolescent health based on evidence based interventions using the human right framework. In addition provision for continuum of care throughout the life course is supported to achieve universal access on an equitable basis for quality health services for mothers, newborn, children and adolescents. The Child and Adolescent health activities of the country are being supported using approaches including Integrated Management of Childhood Illness, Infant and Young Child Feeding, Newborn Care, and Youth Friendly Health Service.

Country situation

Bangladesh has made significant advances in the survival of infants and children under five years. Bangladesh is one of the 16 countries in the world that are on track to reduce child mortality. The major contributors to the reduction in mortality over the last decades are immunization, vitamin A supplementation, oral rehydration therapy (ORT), improved education (especially of mothers), as well as safe water provision, which has had a positive impact on diarrhoea and other water-borne diseases. About 34 million adolescents aged 10-19 constitute 21% of total population of Bangladesh. Early marriage is a social norm in Bangladesh.

Bangladesh is second only to Niger in having the highest percentage of adolescent brides in the world. Early pregnancy is common in Bangladesh. An estimated 2 million births (17% of total births) were attributed to adolescents between the age 15 and 19 in a period of 2005-20101.

The fertility rate among the 15-19 years old age group is one of the highest rates, in the world. One of the major challenges in achieving MDG 4 is the slow progress in preventing neonatal deaths, which now account for 57 percent of all under-five deaths and 70 percent of infant deaths. There is strong evidence linking early childbearing with higher perinatal and neonatal death rates.

Bangladesh DHS 2007 reported that the risk of dying in first month of life is double among births occurring to adolescent women as compared with women aged 20-29. The latter is associated with a low rate of institutional delivery, low birth attendance by skilled personnel, high incidence of low birth weight and low utilization of antenatal care services.

These along with low rates of essential newborn care practices such as immediate drying and wrapping, coupled with the fact that only 19 percent of mothers received postnatal care from a medically trained provider within the first two days of delivery presents major challenges for increasing demand and improved provision of services. The high prevalence of under-nutrition presents an additional serious challenge to the continuing progress in reaching the child survival goals.

The BDHS 2007 found that 41 percent of children under-five years of age were underweight. Accelerating the slow rate of malnutrition reduction and improving stagnant breast feeding practices is another challenge for Bangladesh. While the mortality rates have improved overall, major inequalities among the population still need to be addressed. Diarrheal Diseases and Acute Respiratory Infections (ARI) still threaten the lives of countless children and are responsible for more than one-quarter of under-5 deaths. Childhood injuries, especially drowning, have emerged as a considerable public health problem responsible for a full quarter of the deaths among children 1-4 years of age. IMCI has been expanded to more than 350 Upazilas and community level acivities initiated in around 30 upazilas.

Expansion of IMCI with maintainance of quality is a challenege for the programme. Provision of Adolescent and youth friendly services of acceptable quality and increasing age of marriage with delayed child birth based on developed strategy and standards jointly by various departments are some of the additional challenges.

WHO Contribution

Assistance in implementation of IMCI including capacity building, supportive supervision, improved monitoring and review processes and assessment of activities.

Support in development of national neonatal strategy and action plan for implementation

Guidance in development of tools and conduction of assessment of facilities for referral care of sick children and adaptation of guidelines for use at health facilities

Assistance in Preparation of Compendium of Institutions working on Adolescents Sexual and Reproductive Health (ASRH) and HIV/AIDS among young people

Support in development of national neonatal strategy and action plan for implementation

WHO current collaboration

Newborn and Child health component for next sector plan.

Adaptation and Support for National plan of implementation of IMCI

WHO is supporting second adaptation of IMCI and health workers packages based on new advancements in the area of new growth standards, updated signs for detection of sickness in young infants, early child care and development, revision of drugs for pneumonia and dysentery and revised deworming policy based on global evidences and WHO recommendations.

WHO is supporting accelerated implementation of pre service IMCI teaching as a part of Undergraduate medical education by providing assistance in conduction of Expert Group Meeting and development of revised teaching material and pilot testing in medical colleges.

Training guidelines for Community health workers

Technical assistance is being provided to develop training guidelines for community health workers for providing home based newborn care promoting ANC and birth preparedness and post natal care. In addition support is being provided for updating existing package of basic health workers by using generic WHO and UNICEF developed package on managing sick children.

Improvement of Inpatient care for children in Bangladesh

WHO is assisting in development of capacity building package for Emergency Triage and Treatment and care of sick newborn in health facilities.

Adolescent and Youth friendly services in Bangladesh

WHO is supporting assessment of laws and Policies related to Adolescent’s Reproductive and Sexual Health in Bangladesh using of Human Rights framework. WHO in supporting development of tools and conduction of quality and coverage assessment for youth friendly health services.

WHO is working towards development of implementation guide based on standards of services for provision of quality services to adolescents and youth and is assisting in revising operational procedures for adolescent and youth friendly services.

 

Child and adolescent health in Bangladesh

WHO has been supporting Bangladesh for it to achieve highest standards of health and development for children and adolescents, whereby they are nurtured to live their life to its full potential while ensuring that their needs and rights are fulfilled and respected. Child and Adolescent health unit of WHO Bangladesh is supporting Bangladesh to achieve MDG-4 and 5 by Strengthening/formulating /developing, health policies/ strategies related to newborn, child and adolescent health based on evidence based interventions using the human right framework. In addition provision for continuum of care throughout the life course is supported to achieve universal access on an equitable basis for quality health services for mothers, newborn, children and adolescents. The Child and Adolescent health activities of the country are being supported using approaches including Integrated Management of Childhood Illness, Infant and Young Child Feeding, Newborn Care, and Youth Friendly Health Service. Country situation Bangladesh has made significant advances in the survival of infants and children under five years. Bangladesh is one of the 16 countries in the world that are on track to reduce child mortality. The major contributors to the reduction in mortality over the last decades are immunization, vitamin A supplementation, oral rehydration therapy (ORT), improved education (especially of mothers), as well as safe water provision, which has had a positive impact on diarrhoea and other water-borne diseases. About 34 million adolescents aged 10-19 constitute 21% of total population of Bangladesh. Early marriage is a social norm in Bangladesh. Bangladesh is second only to Niger in having the highest percentage of adolescent brides in the world. Early pregnancy is common in Bangladesh. An estimated 2 million births (17% of total births) were attributed to adolescents between the age 15 and 19 in a period of 2005-20101. The fertility rate among the 15-19 years old age group is one of the highest rates, in the world. One of the major challenges in achieving MDG 4 is the slow progress in preventing neonatal deaths, which now account for 57 percent of all under-five deaths and 70 percent of infant deaths. There is strong evidence linking early childbearing with higher perinatal and neonatal death rates. Bangladesh DHS 2007 reported that the risk of dying in first month of life is double among births occurring to adolescent women as compared with women aged 20-29. The latter is associated with a low rate of institutional delivery, low birth attendance by skilled personnel, high incidence of low birth weight and low utilization of antenatal care services. These along with low rates of essential newborn care practices such as immediate drying and wrapping, coupled with the fact that only 19 percent of mothers received postnatal care from a medically trained provider within the first two days of delivery presents major challenges for increasing demand and improved provision of services. The high prevalence of under-nutrition presents an additional serious challenge to the continuing progress in reaching the child survival goals. The BDHS 2007 found that 41 percent of children under-five years of age were underweight. Accelerating the slow rate of malnutrition reduction and improving stagnant breast feeding practices is another challenge for Bangladesh. While the mortality rates have improved overall, major inequalities among the population still need to be addressed. Diarrheal Diseases and Acute Respiratory Infections (ARI) still threaten the lives of countless children and are responsible for more than one-quarter of under-5 deaths. Childhood injuries, especially drowning, have emerged as a considerable public health problem responsible for a full quarter of the deaths among children 1-4 years of age. IMCI has been expanded to more than 350 Upazilas and community level acivities initiated in around 30 upazilas. Expansion of IMCI with maintainance of quality is a challenege for the programme. Provision of Adolescent and youth friendly services of acceptable quality and increasing age of marriage with delayed child birth based on developed strategy and standards jointly by various departments are some of the additional challenges. WHO Contribution Assistance in implementation of IMCI including capacity building, supportive supervision, improved monitoring and review processes and assessment of activities. Support in development of national neonatal strategy and action plan for implementation Guidance in development of tools and conduction of assessment of facilities for referral care of sick children and adaptation of guidelines for use at health facilities Assistance in Preparation of Compendium of Institutions working on Adolescents Sexual and Reproductive Health (ASRH) and HIV/AIDS among young people Support in development of national neonatal strategy and action plan for implementation WHO current collaboration Newborn and Child health component for next sector plan. Adaptation and Support for National plan of implementation of IMCI WHO is supporting second adaptation of IMCI and health workers packages based on new advancements in the area of new growth standards, updated signs for detection of sickness in young infants, early child care and development, revision of drugs for pneumonia and dysentery and revised deworming policy based on global evidences and WHO recommendations. WHO is supporting accelerated implementation of pre service IMCI teaching as a part of Undergraduate medical education by providing assistance in conduction of Expert Group Meeting and development of revised teaching material and pilot testing in medical colleges. Training guidelines for Community health workers Technical assistance is being provided to develop training guidelines for community health workers for providing home based newborn care promoting ANC and birth preparedness and post natal care. In addition support is being provided for updating existing package of basic health workers by using generic WHO and UNICEF developed package on managing sick children. Improvement of Inpatient care for children in Bangladesh WHO is assisting in development of capacity building package for Emergency Triage and Treatment and care of sick newborn in health facilities. Adolescent and Youth friendly services in Bangladesh WHO is supporting assessment of laws and Policies related to Adolescents Reproductive and Sexual Health in Bangladesh using of Human Rights framework. WHO in supporting development of tools and conduction of quality and coverage assessment for youth friendly health services. WHO is working towards development of implementation guide based on standards of services for provision of quality services to adolescents and youth and is assisting in revising operational procedures for adolescent and youth friendly services.