Monthly Archives: April 2013

Uganda to Save Children’s Lives With Pneumonia Vaccine Drive

Pneumonia kills thousands of Ugandan children every year. A new vaccination programme aims to defeat the illness.

Uganda is rolling out the immunisation against pneumonia using a new vaccine called Pneumococcal Conjugate Vaccine (PCV 10). The vaccine has been introduced to mitigate the high infant and childhood death rate and illnesses due to lung infections.

Pneumococcal Conjugate Vaccine was first introduced in sub-Saharan Africa two years ago.

In Kenya and Ethiopia the vaccine was introduced in 2011.

Madagascar and Mozambique started using this vaccine in 2012.

Uganda and Zambia are introducing the vaccine in their routine immunisation programme this year.

Pneumonia is the second leading cause of infant mortality in Uganda after malaria with 18,000 children below the age of five dying of pneumonia every year.

Children under one year are most at risk of getting pneumonia. Factors that expose a child to the lung infection are lack of exclusive breastfeeding, indoor air pollution, poor nutrition and inadequate ventilation.

The health ministry’s director general of health services, Dr Jane Ruth Aceng, says the introduction of PCV 10 into the routine immunisation programme will prevent more than 94,071 new cases and save more than 10,796 lives per year.

“Children have been suffering from pneumonia without any measure of prevention, and we are happy that the government of Uganda in collaboration with GAVI [a coalition of children’s health NGOs] in introducing this new vaccine free of charge for all children under one year age” she says.

Children will get three doses. Infants will receive the first dose at six weeks, another at 10 weeks and the last dose at 14 weeks after birth.

Unicef’s Dr Irene Mwenyango says the drug is safe, free and effective against diseases caused by pneumococcus bacteria. It will offer immunity against infection of the brain covering (meningitis), infection of the lungs (pneumonia), bacteria in blood (bacteraemia), ear infections among others.

A total of 1,521,061 children are expected to be immunised this year across the country.

Administration of this vaccine was set to start on Saturday 27 April in the eastern district of Iganga and then rolled out throughout the country in all health centres

Uganda has low immunisation coverage with only 52 per cent of children fully immunised, so half the child population at a greater risk of being wiped out by preventable killer diseases.

This is attributed to inadequate community sensitisation and mobilisation.

And a sect calling itself 666 is reported to be campaigning against immunisation in rural areas, telling parents and guardians it is not safe. The government has vowed to deal with them since their message is confusing parents.

It is estimated that 17,216,000 euros will be spent on the new drug. Under the cost-sharing arrangement, the government of Uganda will contribute 919,000 euros while GAVI is contributing 16,296,000 euros.

According to the World Health Organisation (WHO) pneumonia is the world’s leading cause of child deaths, killing an estimated 1.2 million children under the age of five every year, more than Aids, malaria and tuberculosis combined.

[Courtesy of All Africa News]


Somalia: Building health systems from scratch.

MOGADISHU, 26 April 2013  – Lul Mohamed, director of the paediatric ward at Banadir Hospital in the Somali capital, Mogadishu, treated five children after two bomb attacks killed 30 people on 14 April. “And they were shooting last night. One died, a bullet in his liver,” she said of an eight-year-old boy.

Yet these are conditions of relative peace in Mogadishu. While the conflict is not over, insecurity has diminished since the withdrawal of insurgent group Al-Shabab in 2011. This relative security is allowing Mohamed to focus on preventative healthcare, a luxury she did not have two years ago.

In March 2013, she admitted 26 cases with measles, 19 with tuberculosis, 14 with tetanus and nine with meningitis. She is frustrated because all of these diseases are immunizable. Six of the children admitted that month died.

Mohamed hopes this year to immunize 1,000 children per month in the hospital’s tiny but brightly painted vaccination room. Two volunteers sit at a desk, another monitors those coming in and out. They say they became volunteers when donors pulled out and staff were let go. By 1pm that day, they had vaccinated 28 children.

“A huge improvement in a short time – if peace holds,” Mohamed said.


Coinciding with World Immunization Week, the Somali government announced on 24 April its intention to vaccinate all children under the age of one with a new five-in-one vaccine, known as a pentavalent vaccine, funded by the GAVI Alliance, with the UN Children’s Fund (UNICEF) and the UN World Health Organization (WHO) as implementing partners.

“Children in Somalia are dying of diseases that are prevented in the rest of the world,” said Maryam Qasim, the Minister of Development and Social Affairs, speaking at the vaccine’s launch. “Introducing this vaccine is a milestone in history.”

President of Somalia Hassan Sheikh Mohamud also presided over the launch, showing unprecedented support for improving child and maternal health in Somalia, two of the eight UN Millennium Development Goals. He also announced that his government would consider co-financing the vaccination programme, as other countries do, in the future.

Currently, fewer than half of children in Somalia have received the mandatory diphtheria, tetanus and pertussis (DTP) vaccine, a rate that Anne Zeindl-Cronin, senior programme manager at the GAVI Alliance, describes as “incredibly low”. Only 7 percent of children in Puntland and 11 percent of children in Somaliland receive the required three doses by their first birthday, according to a joint UNICEF and government survey.

The pentavalent will protect immunized children against these three diseases, as well as heptatitis B and Haemophilius influenzae type b.

Health system strengthening

“Coming from such a low base, if we have system strengthening, we should see a huge improvement in a short time – if peace holds,” Zeindl-Cronin said.

The pentavalent has taken 18 months to go from the country’s decision to use it to implementation, but she recognizes that GAVI’s implementing partners still have a difficult task ahead. “It’s easy to come here and put [the vaccines] in [a] fridge. It’s getting them into the children that’s the challenge.”

There is not a great deal of infrastructure to rely on. Somalia has suffered close to 25 years of civil war. Its health system is fragmented, supported by an unregulated pharmaceutical industry and dominated by private practitioners who offer help only to those who can afford it. Private doctors in Somalia are earning up to US$10,000 per month.

A legal framework for healthcare is absent, and the federal state, which includes the semi-autonomous regions Somaliland and Puntland, raises questions about how any system might be structured.

“Normally, there is one food and drug administration. But where? Is it in Mogadishu? Or in each of the zones [south-central Somalia, Somaliland and Puntland]?” said Marthe Everard, WHO’s representative for Somalia.

In addition to the systemic and infrastructural challenges of delivering healthcare in Somalia, large areas of the country are still controlled by Al-Shabab; others are inaccessible due to armed groups that have filled the vacuum left by Al-Shabab. Omar Saleh of WHO estimates that 30-40 percent of southern Somalia is accessible to external healthcare providers at any one time.

Risk persists

In his speech at the pentavalent launch, President Mohamud condemned Al-Shabab for blocking access: “In the certain areas they control, there have been no vaccinations at all in the past few years. Al-Shabab needs to understand that they are not only killing people through explosions, but every child that misses vaccinations they have practically killed.”

The pentavalent vaccine launch is being accompanied by an awareness-raising campaign. Sikander Khan, UNICEF Somalia Representative, hopes that, once demand is created, the vaccine will reach women even in areas that Al-Shabab controls. “There is no parent in the world who doesn’t care about the well-being of their child,” he said.

F[ourtesyarhiyo Mohamed, who has six children, brought her youngest to an outpatient clinic in Benadir, Mogadishu, to receive the pentavalent at no cost. The mother says she visited the clinic when Al-Shabab was still in the city, but that it was dangerous to do so. “Al-Shabab would question you when you came back. Today, we are happy,” she said.

While prospects are improving, inequitable access remains a major challenge. Paediatrician Mohamed, at Benadir Hospital, calls for a three-pronged commitment, not only from the government, but also the community and health workers. She says motivating and engaging private and public sector workers is critical to improving the reach of healthcare, and the reach of vaccines in particular.

[Courtesy of IRIN]

Nigeria polio: Immunising the vaccine fears

Usman Al Hassan and his children, including on his lap Abubarkar who contracted polio in 2013, on their home in the outskirts of Nigeria's capital, Abuja

Two-year-old Abubarkar Al Hassan has the unfortunate tag of being Nigeria’s first polio victim of 2013.

“It’s quite upsetting to see that my son cannot play with his friends when they come here,” says his father Usman Al Hassan, who lives on the outskirts of Nigeria’s capital, Abuja.

“He cannot move unless someone carries him. This makes him cry.”

As Mr Al Hassan strokes his son’s legs, some of his daughters sit around and one of his two wives prepares a meal in a tiny kitchen off the courtyard.

“I have 14 children and 13 of them are vaccinated; it is very unfortunate that when the vaccinators came around this area they missed my house and my son was not vaccinated,” he says, looking at his son who is sitting on his lap.

In the long winding alleys of this community, houses are packed close together.

Open gutters like streams run like central veins carrying household waste water from homes.

Passers-by leap over them to avoid the dirty greyish sludge.

Nigeria has been making some strides in the battle against the polio, which can cause lifelong paralysis, but the task has been slow and fraught with challenges.

The West African nation is only one of three countries where polio is endemic – Afghanistan and Pakistan being the other two.

Journalists Arrested

Last year, 122 cases of the virus were reported and the government is hoping to keep the numbers down this year.

“We still continue to miss too many children. In a campaign where you aim to reach 32 million children house-to-house there are number of challenges,” says Melissa Corkum spokesperson for the UN children agency’s polio campaign in Nigeria.

“In Nigeria there are a lot of nomadic populations on the move… there is no fixed address where you can knock on their door during the campaign,” she says.

“This leads to many children being… missed.”

Together with the government of Nigeria, Unicef is running nationwide immunisation campaigns.

Polio cases in Nigeria are mostly found in the mainly Muslim north of the country.

In the past few months there have been violent attacks against health workers believed to be connected with polio vaccination drives.

In the most recent attack nine female health workers killed in Kano state.

It is possible that these attacks were the result of religious and political leaders who have opposed the vaccine, saying it is a Western plot to sterilise Nigerian Muslims.

Suspicions about vaccination programmes were fuelled in part by the Pfizer scandal in 1996 when the US drugs firm used an experimental drug during a meningitis outbreak in Kano. Eleven children died and dozens became disabled as a result.

In 2003, these fears and conspiracy theories led to the suspension of vaccination campaigns in Kano, leading to a high number of children contracting the disease.

Then earlier this year, a Muslim cleric and two journalists from Kano were arrested for broadcasting a report saying the vaccines were not safe.

Not all religious leaders are of this school of thought and some regret the harm caused by their colleagues.

“The problem was caused by those who were preaching against it,” says Alhaji Attahiru Ahmad, the Emir of Anka in the northern-western state of Zamfara.

‘Attitudes Changing’

He blames the slow response by the government to the statements.

“They allowed them to have a field day before the intervention, and you know it’s difficult to repair damage,” the emir said.

He and other traditional rulers in the area have been trying to counter criticism of the vaccine.

During the last polio campaign in this area, a father refused to have his child immunised.

He was brought to the emir who convinced him to immunise his child.

However the talk of polio remains a very sensitive subject and many in these communities shy away from talking about refusing immunisation.

But the Nigerian government says they are making strides in reducing suspicion among vulnerable communities.

“People are becoming more aware and are realising that in fact the vaccine is safe, it’s efficacious, and that other parts of the world have actually used it to eradicate this disease,” says Dr Ali Pate, Nigeria’s junior minister of health who also heads the presidential campaign against polio.

“This [is a] collective effort. For the first time, you have the entire global community focusing on a single disease, after smallpox, to eradicate.”

Part of the government campaign has involved community mobilisation workers who talk to people about the benefits of the vaccine.

In the case of Abubarkar, his contracting polio has had a positive effect on his neighbours.

“People are aware, now they know that the disease is real,” says Yakubu Yahaya, a social mobilisation officer.

He has in the past had difficulties convincing the people in that community that polio as a disease was a reality.

“They were saying it is either politics or religion or because they want to make their children infertile,” he says.

“So they are really now ready to comply with all the vaccinators.”

For Abubarkar and his father, the lesson learnt has been a harsh one.

“I do not blame the vaccinators for missing my son, what has happened was God’s will,” says Mr Al Hassan.

“At least because of him, others can now take this seriously and immunise their children.”

Those working on the government’s drive against polio, will also be hoping that lessons can be learnt and they can indeed make strides towards eradicating the disease by 2014.

[Courtesy of BBC News]


Major price cut for five-in-one vaccine

NAIROBI, 18 April 2013 – The cost of vaccinating children with the pentavalent vaccine – a five-in-one formulation – is set to drop significantly following a deal between the GAVI Alliance and an Indian drug manufacturer that is reducing its price by 30 percent.

GAVI will now be able to purchase the pentavalent vaccine – which protects against diphtheria, tetanus, whooping cough, heptatitis B and Haemophilius influenzae type b – from Indian firm Biological E for US$1.19 per dose, down from its current price of $2.17 (and down from $3.56 per dose a decade ago). Millions of children in 73 GAVI-eligible countries are set to benefit from the price drop, which will free up an estimated $150 million for GAVI over the next four years.

“Working to secure price reductions means we are able to make our funding go further, reaching more children and protecting more lives,” a GAVI Alliance spokesman said.

Experts say reductions in the price of vaccines – and the price of transporting and storing them, which often requires expensive refrigeration – will be crucial to lowering child mortality and meeting the UN Millennium Development Goal on child survival.

Shortages of new one-a-day ARV pills in South Africa

19 April 2013 – The South African ARV programme, worth about US$672 million, was awarded in November 2012 and introduced a 3-in-1 pill combining tenofovir, emtricitabine and efevarinz.

However just days into the rollout of fixed-dose combination (FDC) antiretrovirals (ARVs) by South Africa’s HIV treatment programme – the world’s largest – activists are raising fears of drug shortages.

Patients on the triple-therapy regimen will be able to take just one pill daily to control the virus. This has the advantages of improving adherence, simplifying regimens so that prescribing errors are reduced, and enabling the introduction of community models of care.

Motsoaledi launched the phased rollout of FDCs on 8 April at a small community health centre north of the country’s capital, Pretoria. New patients and HIV-positive women who are pregnant or breastfeeding will be the first to receive the new medication. They will initially receive a one-month supply of FDCs, while stable patients will be given a three-month supply.

“The central procurement unit in the national department of health has worked tirelessly with suppliers, provincial medical depots as well as facilities, to ensure that depots placed orders with suppliers, and health facilities placed orders with depots,” Health Minister Dr Aaron Motsoaledi said. “We are confident that we have sufficient supplies of ARVs for all patients who are eligible for the FDCs.”

But stock shortages have already been reported in Western Cape Province and more are thought to be occurring in other provinces, according to activists. In March, the Western Cape Department of Health told AIDS lobby group the Treatment Action Campaign (TAC) and Médecins Sans Frontières (MSF) / Doctors Without Borders that it had received significantly smaller stocks of the FDCs than had been ordered from suppliers.

Dr Lynne Wilkinson, the MSF project coordinator in Khayelitsha, a township on the outskirts of Cape Town, said this meant the depot could not maintain the usual two- or three-month buffer stock.

Researcher Simonia Mashangoane said TAC continues to receive reports from health facilities in Mpumalanga and Gauteng provinces, with some saying they have received insufficient supplies of the FDCs. Recent shortages of the ARV, lamivudine, have also been reported. In a joint statement with the National Association of People Living with HIV and AIDS (NAPWA), TAC criticised the health department’s communications and called for clear timelines regarding the introduction of FDC drugs.

“Public announcements created the expectation that the pills will be widely available from 1 April, but non-priority groups might have to wait many more months before being switched to the FDCs,” TAC and NAPWA said in their statement. “Patients have not been given any indication as to when the various phases will be initiated, and how long they will have to wait.”

Wilkinson said there are also concerns that because new ARV patients have been prioritized to receive the FDC, they could be especially vulnerable if FDC stockouts force clinicians to switch them to the old regimen of three separate ARVs.

“Newly initiated patients are counselled about the treatment that they are about to receive,” Wilkinson told IRIN. “The problem is if they are counselled on how to take one pill a day, and in a few months that stock runs out and they have to be put on three separate pills, the clinic has to re-counsel them. If that doesn’t happen, then there’s a chance patients won’t take the treatment properly.”

According to Western Cape Department of Health spokesperson Hélène Rossouw, the problem lies with the National Department of Health. “The problem is that the national government procures the medicines, so it’s all centralized at the national level in accordance with treasury regulations,” Rossouw told IRIN. “The awarding of the tenders… the signing of contracts… takes time.”

“What’s happening in the Western Cape is a domino effect of [those delays],” she added. “The Western Cape Minister of Health Theuns Botha is looking at the possibility of procuring our own stocks separately because we have had too many problems with national government delays, and our patients go without.”

Supply and demand

The inability of pharmaceutical companies to ramp up production to meet demand after winning a tender has at times been seen as contributing to the threat of drug shortages.

Stavros Nicolaou, Senior Executive at Aspen Pharmacare, one of three companies to be given the FDC tender, said the latest award had sought to avoid stockouts at dispensing level by introducing a grace period for suppliers. Aspen is the largest supplier of generic medicines to the public and private health sectors in South Africa, he said, and is also the only local company producing the FDCs.

“Historically, what happened was that a tender was awarded on 15 December, and on 1 January… you’d be expected to supply,” Nicolaou told IRIN. “If it was the first time you were going to supply, you had to have anticipated winning the tender to be ready to go out with product on the first of January.”

Drug companies need about three months of lead-time to order, ship, receive and assure the quality of the active pharmaceutical ingredients needed for manufacturing drugs. In the case of FDCs, Aspen had also had to make structural alterations to its manufacturing facilities to accommodate the special technology required to manufacture a pill that combines three drugs.

Nicolaou said he did not believe that any possible FDC shortage was attributable to the inability of drug companies to supply. He noted that Aspen and other drug companies had met with the Department of Health in June 2012, before the tender was opened, to devise feasible timelines for ramped up production of the FDCs, develop plans for a phased rollout, and discuss the requirements of the tender, which hinged largely on projections of how many patients would make the switch to FDCs.

Stopping stockouts

An estimated 70 to 80 percent of patients on the triple regimen are expected to make the switch by the end of the year. To combat stockouts, data is being collected on a weekly basis from provincial depots to identify weaknesses in the supply chain, and the department has also instituted monthly meetings with suppliers, at which three-month forecasts are presented.

Recent stockouts of regularly prescribed ARVs in Gauteng Province have been attributed to financial management problems, including corruption, in the provincial department of health, rather than to supply-chain issues. The Gauteng provincial treasury intervened in December 2012.

“We’ve been told that some of the drug shortages in Gauteng are due to poor budgeting and financial management,” said TAC provincial coordinator Stephen Ngcobo. “We did our own research and found that… the budget was not covering the need, and that the [ARV] budget had been cut in half over the past two or three years, and this was having an effect… [now].”

Activists have begun a civil disobedience campaign in the province to draw attention to ARV and other drug stockouts, and civil society organizations will soon be launching a project to monitor supply problems.

[Courtesy of IRIN]

Kenya: Technology Revolutionizes TB Management

NAIROBI, 18 April 2013: The use of technology is revolutionizing the way Kenya manages tuberculosis (TB). Through a computer- and mobile-phone based programme called TIBU, health facilities are able to request TB drugs in real-time and manage TB patient data more effectively, health officials say. They also use the platform to carry out health education.

“One of the challenges we have had with TB treatment is people defaulting [on treatment], but this will reduce significantly because through TIBU we will be able to track down patient treatment progress,” Joseph Sitienei, head of the Division of Leprosy, TB and Lung Disease at Kenya’s National AIDS Control Programme, told IRIN.

“By being able to track a patient, the health workers can send them reminders on their mobile phones when they fail to appear for drug refills,” Sitienei added.

Information sharing

In Kenya, a dearth of information on TB among patients and poor management of patient data have always been a challenge.

“People at times default not because they want to but because they lack information, and health facilities do not share patient data and history. Now the government is beginning to appreciate the relevance of technology in managing diseases such as TB,” said Vincent Munada, a clinical officer at the Kenyatta National Hospital in Nairobi.

Sitienei noted that TIBU – which is Swahili for “treat” – has also helped health facilities better manage drug supplies.

“Initially, health facilities used to request for TB drugs manually, but with this new system, they can ask for the same and the request is relayed to the ministry headquarters immediately. That way, drugs are supplied on time,” he said.

Kenya is ranked at 15 on the UN World Health Organization (WHO) list of 22 countries with the highest TB burden in the world, and it has the fifth-highest TB burden in Africa.

The government says an estimated 250 district hospitals, out of the country’s 290, are using the programme, which was launched in November 2012.

The government is also using the technology to support multi-drug-resistant tuberculosis (MDR-TB) patients living far from medical facilities, sending money to patients via the Mpesa mobile phone money-transfer system  to cover transport costs.

Enormous potential

Mobile phone platforms like TIBU could have even wider life-saving potential.

A recent report by multinational firm PricewaterhouseCoopers noted that mobile phone applications such as short text messages could, over the next five years, help African countries save over one million of the estimated three million lives lost annually across the continent to HIV/AIDS, TB, malaria and pregnancy-related conditions.

“SMS reminders to check for stock levels at the health centres have shown promising results in reducing stock-outs of key combination therapy medications for malaria, TB and HIV. For HIV patients, simple weekly text reminders have consistently shown higher adherence amongst the patients,” said the report.

According to the report, Kenya alone could save some 61,200 lives over the next five years by embracing mobile-based health information management.

On TB, PricewaterhouseCoopers said: “TB is a largely curable disease, but requires six months of diligent adherence to the medication regime. mHealth [mobile health] could help control TB mortalities by ensuring treatment compliance through simple SMS reminders.”

The report noted that mobile phone-based care for patients could reduce emergency visits to health facilities by up to “10 percent.”

“You know, at certain times, a patient doesn’t even need to come to a facility. You simply share what you have with them over the phone. It saves patients time and relieves the health worker to attend to other pressing issues,” Kenyatta National Hospital’s Munada said.

A 2012 study in Kenya found that the use of mobile phones between patients and health workers improved antiretroviral therapy adherence among people living with HIV.

In one mobile health project, community health workers were able to track their patients’ conditions through the use of text messages.

[Courtesy of IRIN]

165 million children under the age of five globally malnourished.

Hunger kills more people worldwide than HIV, tuberculosis, and malaria combined, and children are the most vulnerable. According to the World Health Organization, an estimated 104 million children around the world are undernourished and 175.5 million suffer from stunted growth because their bodies do not have enough nutrients. Malnutrition and hunger-related diseases account for 35 percent (3.1 million) of the 8.8 million deaths of children younger than five each year. Malnutrition is a complex disease that can be caused by lack of adequate food, illness, and poor caring practices – but it is preventable and curable.

Stunting can lead to irreversible brain and body damage in children, making them more susceptible to illness and more likely to fall behind in school. Based on UNICEF’s report, IRIN has put together a round-up of the nutrition situations in six East and Central African countries that are among 24 countries with the largest burden and highest prevalence of stunting.

Burundi: Under-five mortality in this small central African country dropped from 183 deaths per 1,000 live births in 1990 to 139 per 1,000 live births in 2012. This is far short of the 63 deaths per 1,000 live births necessary for the country to achieve UN Millennium Development Goal (MDG) 4, which aims to reduce child mortality by two-thirds by 2015. An estimated 58 percent of children under age five are stunted, compared with 56 percent in 1987, according to demographic and health surveys from those years.

According to the UNICEF report, Burundi has made “no progress” on MDG 1, which aims to eradicate extreme poverty and hunger.

Central African Republic (CAR): An estimated 28 percent of under-five deaths in CAR occur within the first month of a child’s life; the biggest killers of children under five are malaria, diarrhoea and pneumonia. The percentage of children under age five who are stunted has changed little since 1995, standing at 41 percent in 2010, as has the percentage of children who are underweight, which has remained at about 24 percent for the last 18 years.

There has, however, been significant progress in the number of mothers exclusively breastfeeding their infants. In 2010, 34 percent of infants under six months old were breastfed, compared to just 3 percent in 1995. According to UNICEF, infants who are not breastfed in the first six months of life are “more than 14 times more likely to die from all causes than an exclusively breastfed infant”.

Democratic Republic of Congo: Africa’s second-largest country bears 3 percent of the global stunting burden, with 43 percent of children under age five suffering from stunting and 24 percent being underweight. Stunting is significantly higher (47 percent) in rural areas than it is in urban areas (34 percent).

The percentage of children who are underweight dropped from 34 percent in 2001 to 24 percent in 2010. DRC’s progress towards MDG 1 is described as “insufficient”.

Ethiopia: The Horn of Africa nation, which bears 3 percent of the global stunting burden, has seen a steep drop in stunting levels, from an estimated 57 percent in 2000 to 44 percent in 2011. The percentage of underweight under-fives has also dropped significantly, from 42 percent in 2000 to 29 percent in 2011. Between 2000 and 2011, under-five mortality was cut from 139 deaths per 1,000 live births to 77 per 1,000 live births – within striking distance of its MDG 4 target of 66 per 1,000.

A national nutrition programme launched in 2008 has been key to reducing national food insecurity, a major cause of stunting. The country’s health service extension programme has also played a role in bringing nutritional interventions to villages.

Rwanda: Community interventions – such as kitchen gardens and increasing the availability of livestock, as well as measures to boost healthy infant feeding practices like exclusive breastfeeding and the provision of nutritional supplements – saw the percentage of underweight under-fives in Rwanda drop from 20 percent in 2000 to 11 percent in 2010. Enhanced data collection and analysis has also enabled the government to improve its planning and monitoring of child malnutrition.

The report describes the country as “on track” to meet MDG 1.

Tanzania: Bearing 2 percent of the world’s stunting burden, Tanzania has made significant strides in improving child nutrition. An estimated 50 percent of infants under six months old were breastfed in 2010, compared to 23 percent in 1992. The country has also brought under-five stunting levels down from 50 percent in 1992 to 42 percent in 2010, but continues to suffer significantly higher stunting in rural children (45 percent) compared to urban children (39 percent).

Tanzania’s under-five mortality rate dropped from 158 per 1,000 live births in 1990 to 68 deaths per 1,000 live births in 2010, putting it close to its MDG 4 target of 53 deaths per 1,000 live births. UNICEF’s report says the country is “on track” to meet its MDG 1 targets.

[Courtesy of IRIN]