unicef: the state of the world's children 1986

THE STATEOF THEWORLD'S

CHILDREN1986

United Nations ChiId ren'sFund(UNICEF)

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UMI_,.... ,., UNICEF _Otc}tmI u.-lJOp,.., loy " 5: L ........ &0-.~ UX

THE STATEOF THEWORLD'S

CHILDREN1986

-James P. GrantExecutive Director of the

United Nations Children's Fund(UNICEF)

PUI ,JSHED FOa US 'CEF

Oxford University Press

CONTENTS

I THE STATE OF THE WORLD'S CHILDREN 1986

Immunizationleads the way

Reachingall children

The benefitsfor women

The self-healthpotential

Children andworld development

o.-.llor ...- .. dot twO,.... ....__.. _-~_... .... _..,..;r,. .. ""

:-,tlS,~...:::~_ ""'~"""~~-::' -:':---:..".j, • ., • _'0 -. Mcoo-. __ io.. .. ,eli,... · ....." _ ........ IW<> '" -.II _ • .-~ _io ,II<'" , bf Ilo<.-... opnd.r_oItlo< _ 011 ~,..,.... .... ___

~ .._o<_ .... _.._ _ _.... _ ' s .-W-_"'..-olboat7__ __4oJ. .... _ io ' _

_ of _ . _ ... _ '" -.- ..... IIdp .. IIftIIoI _.... .. ..._.._..--"_ i1......,.... __ .mlW

....... ? .,... ... __ _ .. _ .... 1._, r .... ' -w.. .. _ _ .. _ ._----- -- ' , ............ ......,"""*~ .-.n.--._._-_......--:-_ .._..

_,",p ........ e >'":r ... .....w_........____0Ii1_

-"l1I<~__ • " ",-. " ..,._ . ... ___.$ .._T..... .._._..._ .._---,. $: .. ...... _-- ..~_.----_..-..--.__..,_ _ _ il il ' Jcw,...., _ ..... _ __Mo...,,"' .._ _Ioooi<__. dM * 2 ."lIIia-...,

II LIFELINES ill STATISrICSE%l rrt~ and ,llInIJWi.. from rCC<:Dt research Economic and social amisticson the pallonsofand ",ri, ing on COi\I..<ITeruve $lra,q ies for , h. world, with particular reference t<>p">le<:t;n,l the U_ and lIOI'1JW development children'. wd l-bting.of lh. world'scltild=

F ull index "A .... OIl I!>< .... iDdn ... in/." ,- .... cIIild......wy /101' no

Growth monitoringA1pb1be<ka1 -. to """",ric> _lll

~, " Basic indicators .... lllOral rehydrationtherapy -• Nutrition !'"II' l~

Breast-feeding -• Health - '"Immunization -,. Education - '"Iron, iodine and Demographic indicators -'"vitamin A _107

Economic indicators """. 1'1Acute respiratoryinfections """. 110 Basic indicators for less

populous countries - "Combating malaria _II'Sill.. -.t " pIaM<o-, ..,..ru _.

_lOSFemale education

...... <lit...... 111

I'........ ,. ti l ..ble< _1' /

Food supplements _119 ....... r<l< l lll

~- _lSI

Family spacing _Ill N",. .. ...n.u..o. io I"' ~ ,,;, IW> .-"" ... _ ISl

PANElS

~tion: 1 ......., 14a~ pge Iorwan:l ""~ WI Ci,e""'....Immunlutlon: 2 Etlliop\tl: 15a new SU'08 Iofward (coot) the $llenl emergeocy

Turb y: 3 Balli1adMh: 16to imt'nurnze 5 milliOn visl!Ing 5 million homeS

EI Salvador. 4 Niger" : 17chOClI80 - a zone orpeace going naliOn-w!de

C<I'om~: 5 Sri u nlte: 18a chikl Sl.n'IYaI pliIn leaching lhI poOIesl

8urklna ':..0: 6 """, 19a .... ii1lJOn OO,"".dO OAT reaches !he ITIiIfOrity

Domlnlcan Republic: 7 ''''''' 20......._..... IOwaIOs • l)OIic)-free Madras

••11." 8 1lI8Iland: 21l1ICluclng ch ,kl oea.1tIs PH(; in prlIC!ICe

EiYpt : 9 Iodin.: 22leading 100 WOfkl on ORT protecl,ng !he mifld

BriWl : 10 The Cod.: 23wec::dnellng 20 miIion a pl'ogr_ repofl

P. "" q,n: 11 P.rasltes: 24SlM"Ig 100.000 lives !he diVnllge 10 grow1h

Hlcar8gu.: 12 POp'lI, tIon: 25chid dealhs down 30... less dAh - less t.1h5

IlIdou....: 13 Vlt8m11l A:cne miIion hea/lh worketI $IOfY ot • bfeaklhrough _22

TEXT FIGURES

Fio. Estimated 3!111Ua l numbers of (Jea lhs and prevellled OO,Hhs !rom VacClflItptCVC011able diseases(chtld<en undel 5)

Fig 2 Imml/fOllng all children by 1990 progress achill_ea and prog,ll$S '9Quued

Fig. 3 Percentage 01 pregnant women immuniZed a<;jatrlSl tetanus

F. • Petcentago of Children immunlled 1I1 me first year ot Ille

F. 5 l'etcentllge of infants fully immunized. Paklstan, 1980-1 987

F. , Global SllppIy 01 oral rehydratJon sans {WHO/ UNICEF fo<mu",)

Fig. 7 Dechne In bleast·leedioO. SAo Paulo, Btaz~. 197 4-1980

Fig 8 1mpa<;1 ot ORTon ""'ant dearns. Alel<3nd<ia. Egypt. 1980-1984

Fig 9 Changes in l'eaUT1el11 lor <1iarrhocal (lI$CilSO, $odan, 1980-1 982

Fog.! 0 DevaIopmg coonlnes prOllUCIJlg oral rehyarallOO sans

FIll.l t Male and lemale shares 01 agriculllll'si rases and lr81nWlg, AfJK:a

FIlI 12 RelallVe rales of inlecbon by feed,ng meThod

FIQ.13 OwoerSll,p Ollarld ana oa)~ Inta~e 01 1000. Manaras/11ra. If\Clla , 198 2

Fig.14 Inlan! deaths by btflh interval, uneducated mothers, 25 eccouee

Fill 15 DlaI1'tloe3I illoess by teeding method and oncome. Dar-es-Sataam

FIll.16 Energy content of children 's ccts. nell and po(lf nabons

Fill 11 Breast·feedlng and cacoe jntake in 100 secooc year of hTe

Fog . ' 8 Effect of OAT on welgh! gam ltl ChIldren W11l' diarrhoea

FIg. l 9 MlUtaJ'f an<l akl c, pendilures, ,nouslrializcd naiIOOS, \ 960-198 2

FIg.20 Food r><oouc1iol1 pof person. Atnca. ASIa . and la~" AmerICil . 1961~1983

FIQ 21 eeeese in low b.,lh--weigllt. Recilc. B'31~, 1977- 1984

FIQ.22 lncroase 111 child malnutritlon, GIlarl3. 1980- T983

PREFACETho lange at _ which <:aJId legoldT\lltely be

""""""'" ....",. D>e titIot I"., SIaM 0: /I'le~'s

ChiIttJIen" clea rly _ ""'" 1M focus 01 """ year 's

""'"In PWlOJIar. lt1e eHe<;ts 01 eocooornoc ' flO ' .,

continue 10 .....beI.te IIIIougfI Itle worId "s poorest~ as Inct.........~ ani! taM.....reaJ 'Na\I9S bear down most Iltt3Wy "" """'" """"sPe'ld !he~ percen tago 01 '- Irocome onnec8SlIIt~ - !he POOl AI ee SilITlI! Ilmll. gcwernmeolCUl-backs on sum...._ IIems 01~e aa_ dnc$ III'(j bod SlltlSiIl.es also leavee~lMose "'"" are moot~ on """" SOlIVIces "II"'" lIle poor As . resull. progress !OI ChIldren IIt>eong se-ee down ., """'" natJons Dr<! ll'iI""'" ln10,......se In O!he<a.

....1 yeas • s;>edal UNlC[F $l""Y ~ rile /mpaI:l orWctta f/e(e:>SiOI ' "" CtWdten- 08I3Iled the llIC1CeSS by_ !he~ bu,-. 01 fIC(IOiOOroc rec8SSIOn .. '"

mDISI ClISeS paswl on 10 IhOOll """ are leasl _ 10

IIIISla<n ~ This year. ' '''''''''''" '" II>e CDIIl."""ll1mpaclof that process on \he _ 01 the pooteSl Cl\ildren ..conbf'UirolllO conI!! In lsee, fore"""'llle. r 001 . 21 iIld22 '" !tie nIlIin_ of !IlII f8lIOI1l.

_ "'""'*MteIy, 1M CfJsis lor lIle !l0"....1 ISs.;rl8Cll'\g Itl SUb-Satw.., Amea ..r>erlt, asai m.. worldI'Ios WIIneSSed . IIIe lailur'e 01 (levelopmenI_ and o! IIIol, ...... - !IaS pus!l(I(Ilw,md.- oIlhOO5an<lS oIlM11loes 10lhe m;org..., 01 SUN1YaI and Ile'/<>n<l Beo;ause 01 IlIlI<ltWJt\lIlV anl! 00tIIPIe...... 01 lM crisls. lJl\lCEf Ms IIIiS_ 1J,JI;IIistIOO • SfP8<3le tel>O" 0I11h11 D1oll1&ms n(l\O/

tac.'lll "'" p<lOfflSl~, """ P3tIlCuIarIY INC!IIlOrtIn, 01 Akg

S<IC/l PJtIbIems hi... *'~ted ,alt>el 1ha<1caused by immedoale prllSSUtes sum as tee .ion ondIlfOU\lll1 E""" In j9Im 01~ ,• ." ... . " ""'I' millooros01 r,Na,en at. Il'ow.ng UP o:l!!lJorlWld of whal m:J$lpeapIe IM<!ing lM page WOUI<l~ to De _

1'I"O!I$SIl0llS oIli1e -8deQuate bod, <:le"" ....ter. sate......<l!M. ~ tlducallOl\ 0 .-.:1 compelenl -.cace,

8IJt IaceO ..rh a mvnad Oh>«sc prOOIems, BI'ICl anIIIrl1l;JGl~ s/IoI1iIge01 resourc«I tor o:IeaIlng W!tfl!hem. IhOOll cl>arged "" Ih 1M ~DilI:y 01l"fl"g 10bnng atlOUl pmc\IClII~lS ... !fie ...... 01cllben """" no <:I'lQiCe 1>.>1 10 """,0 """'" <lto<>slons

"""~.The1"_'" 01~ are ..1imely",,,,,pi',. The

ca_, "" II wefI i<ncMrl. lIl'e POiI>caI . """""""".

SOCIal. tislOflCal. 5l'lOO<l\IlI'IOClII. IIQflCIiIurIL But ..n<dIs I{lQ\IIrel;I now 011 no! 8 mole ' e!1IIlJd and~Ieo

8N1~ 01~ to.rl rJlOfet means ,,*,ll/y1ng Pf3Clocal $lartl<lgPD/nl!l. FDI tile prDOlem O! IeSll 0I<eIv to M::<:umb to 8~ ana~ oot 01 BDIUti<lns .,t,1Ch"""" to t>ll 'ea!izecl all al """" ttwll0 a $lnlC!Ul' od_ D1llC!l1evab1e pie wnich, Whllo! lle<ng mxx,>n&n!

i'l~, aIsD IIIlIp to l!Ia(l "" wat. stGll byacnievable Sl"ll, towa/<!s more com~ lonrr\erJ1I P< <>O< _ .

To find IIl.O;:/l bego ....... ~ Is v/taI 10 IlOClI lheaceurr>JtIllecl knD,A'dge 01 a _lJOtl 01 deYeIo:oD,,*,1 al!DtI$ and lei """ tl'os pas t e><pene(lCe to~the a :taek "" DIeserd PfDlllems

In !he (lrOCeSl;, many 01 tt>ose II"IDS1 cioseI'y """CWeclara <:omofl!lto!he~ ll>elwe are row t3l*l no1~ wittI 11"""1 <lolf!O.lllias ll<rt IIISO Wltt1 a Yf!fY grea tDQIXIItuf'W!'I FDI n Os cIeaI th31 mate are OON .......eralIow-<:Dsl and poI""tJaIy "et'/ PD'W'!<luI WO\'$ OIIl'DlGCling !he Ms and rhot norrTIBl ae.eIopmenl 01 many-.. DI dliIOren In Wll\'$ which are DOlil>Cdy and~ _ ....., "' :such d ,ho::ull econoIJ'IIC

ItmeS The C<loIII::I<lenc of technical and SOCIlII ..,.....-.- WIlid\ IIItI CI....lGd tl'II$~ Os ,....!~"""". and lis poIIlnllal lS t!lerelDnI vasI:iIi <nIere>.plooted .

ThII1 IS WIly lM; \'881'1 Sla!e 01l1li WO!ld"s CI"oldrel',epon 1"""",,, on • Iom<lad~ o! """""",,tIIa 8IIlII

sucn "I "'_ lmmt.nIzallDll, ItIe SIll'MIl or oralrehYQrallon ther3O)'(OAT), ancl ll1elDw-QQ$l P!8'tel"l1iOnDImalnuII\tion - .-nsWIlid\ at. ''''''''''IID lIIe _ 01children OON as ..... as to 1or1gar-19f111~

In tnis oon le><l, the ,easons lor seIecllng 1l>8Iaparocu!ar I)tI(lriIlaI~ be ""'PI'; a><pIar,e(l.-

o TaKen IOg&IIW, \tlICClnOl-ll'''''''' liID1<l "'fecllons,d<arfhoeal oseese.anclllOO< 001rl!1QfliIi 11e1111ll , CO"ISIIIuIa II'\' fat rn. II"IDS1 imponam pro!lIam ., ""l" GlbIacIMlCOf'llOdera l"'" of the 'SUIte o! the lio<)<\i;i '1~'

Common 10 _ all - eIOpi< 'lI CO<.<ltnos, II1eyaccoont lor ll>agreat majonI)o of fr.e 15 .....", .,tamMel crIIld dee.1h$ in lila world eiId'l yea. and a~ theorint:lPal cause D1 both Dh'/SClIland mental~

o The t8<:tlI"*'Oy acd ll>a io.r"oN1edga 10 soIWI tlIesooproblems ilIO row ava ilat*' ill a COSI I'tIoch mostnafoons ancl """'I IatniOBs couIcl 8i'lof(l _ In hardeconorn<: w.- -espeaaIIy Wl1/'l a mo<lCI.<I'I ot lIlIIliflla,~ ..".,

a Moll "IllOi*' 01 III. ... """"- _ ..-.~ irJ\lIlIwell In! CIlMI _ ~ encugI1 lor___lOlIero......... !*' .... '"_ _ I .. ""'"~ III NCNl IIIInII'\'_01_01'" '..._~__

~__ " ......lU. IIl<'" ...-.-, '" c!oII).

-'''--~

0 '" """'"_ tlllJ'l:IIt' r-. .. _ ~_.., ... d' "'__~.... __ _1Ic.it:W 10-. ......... _

twpplI\ ..._IIIIIPtr'" ...... 1'1 . ' i' iQ~'.... ' >JOt n. .. ". -__ ~ corn-_ __ Ill lolll ' ~.- ..

OrtrIIr '_41"*""'" I*lPIa illlV-.g ......_ ....dliQ __-.g ...... _ __ ,.. ~CIn__ " ..._...".ORT_~_ __It.e ... i Ill< ... -. roo "' ___ _ _ CIn" toI "'_•• """*""'"__ .. .1'1- ".•••.II'""*Y_.....~. FoI .,...I-'-. --.; - ...... _",it ' I llIDIIl."._ lor .. "*""oIiIr1an_.... n I ' ClIlPC>'V!IIY Ill< '" ' ._.......__"'.knl_ ~_.

__ 10_..,. ... _ '" _ ogonI

-'Y_1II "..,. 1ftd ..""''''' ' ..

fa''' '" .. _ b::I.- .... _

...~-tfld .... "'-1I*:Ik -.I coe....__ I!!lXtI CIn co. .. 10 biG .,,,_

.". __ • -.g ..•....·0 .... ·-..

............. - b' etob'en "' ,.., IldllY

As ... DrIIlJ ......,~ _-'-1'-' - -- --- ... ....-.., Deong~ by~ Fo'""""JIlIl __ ..." •_'eQllll. <;01 .., .... . -.-.10 ....,., .....~, .., <lI!IQoII _ '" ..-uIQ'1OClel\'10~ bnI'lQ ". 0l'IIV'I2..... gI ...-.. .... ""'c7I .. .-aolI' IOKIIiC 10..",tell>T/ _ ..,..~

n. _ co'" ..... . IacIIlt .. _.101. net ""'

~ llUIl'1e _CMJ' rtolle_"' llIClI lOI~ gOalS_ <:a'I toI tUlItYtd Ill< _ now r_ tI.

~ "" """'C/'l ....., or-. '" IlII COIl I\elI) III lito.""._ ""* AncI "" 000'lQ IIIlI~ """",, __or-. ~ IiIIl _ ac:Iloe""'ll "'" ilV4ldt-

WithinHumanReach-

afuture forAfrica'S children

nus san1al u~m' n'p.n

OOCumlns~~d~trlJn:I uc lkdine d t.q ~an:lards

il \Cfb ani~ tIE IR1kalstep> _tlI:tl C3Il ani are~ IlW.'n

10catnn th: mss, The maP'argumerl d ~ 1l1JOl\ is 1hiI. UI'

Il.'gkn u tIE bJman dilntrtiirl' isamaJ:r c::3IR d ACooI's prem.prOOIc:m; am 1M. DUns "iI

dqmd 00 linlq "'lI)'S 10 IiIQa&calii enIwk:e ee l.U'tl'ib.lm ..1*.11id\iOOaIlTOl and ..unm rnaI;(> 10

the. dt.'\~ d ire lXlItJtICI'L

The repIrt is a-.'3ilati:l in I::nelish and~'rcndI. nee u dIiV"ge. fromLL\ K};FHcadllllalU.'lS (866 UN rtrza, 1'OcIl'

rcrt. Nr IOOl7.lJ&\j. from U,\JQ;rUC:i!I:kjOOltCT'S b ElIfOIXl (PaIat;tb ~(}i-1 211 Qn."lllO,S'foilMland). from ruDlnal and

I1'gIooaI UNI(U' c-nk:ffi. md fromNlliooal QlITIlTI ~tooi for UN I(};~',

----1--- THE STATE

OF THEWORLD'SCHILDREN

1986James P. Grant

Immunization leads the way

Reaching all children

T be benefits for women

The self-health potential

Children and world development

I THE STATE OF THE WORLDS CHJLDREN 1986

IIII,""l MortalitJ Rate

"1'boo infaat lDllrIllity "Ue (IMR) .. tIM: Il lU11M

fA cIeatIlI bd'0ln' 1M I&l' 01 OM JUt -pc IIJ'/J1m birtht.Fipra Ii..", lor the ia!mt lDlIrt&Iily rita vi.,.ua.Jar~ ill boch the lal aad_ ..jsrinl tabla 01 this rqxJrt,. an. l::AilDlllS

prepared b7 do<- Van"'" N........ Papt......0;..... _ .. ;"temrim.Dy~ bias,IIIiIlI ...an- -=s. lll_~ u.- ....,.IiifJcr rrc... " aliJmt...

M-. nu 1lMR licurcs an: coIkcud na"l'live or tal l'OI' • pm or the n .....1~and do _ I'd ldI«t tbe impKI of uy vi II..remll CllIl~and child ..,mval ptIlIruIIIIICI

Illf:fItional in !he tal.

..; <

Immunization leads the way

IklpilC Ihecoo1inuillic:rWs in Africa,' lbcK isdl'LlDltic prOSral to 'CJKll1 this year on lheS[TUU Ie 10 implOV1: lbe ~.cs and lb. health of"","y millio... of !he world', children.

[n ,b. la, rigJuttn months, "",.raJ nationsha. c doubled and trebled their 1"",,1s of immlmi ·zatinn agains t tht n<rin~pm'.nlabl. diseaseswhich were l,illinS al""", 4 million cbildre n a}"..r and leaving onolnt' 4 million permanc",lydis>bkd. Throughout 1985, world-wide demandfor """"ines has bom running al appmn m'" cly,lue<: \;m.,, ;1:1 1983 ~l ' and the annual numberof cl\ild denbs being p~nted by yllCrioes is nowCStimaled 10 be approaching one million. ynr(Fi,. I).

With ,b. co,uinuil\J: and n p;d uptu.. of oral",bydnll;on therapy (ORT) ," the new figuresmean ,hI, ,h. Ii_ of ..ell O'"Cl" o ne millionchildren hIV., been saved_ in ,he las' . wd ....IIIOIU"" - by Ihe recem spl'tld of tWO of !be leastapen.;.... of au cbild proleclion tcchniq.....

IlIUIIunintlon for aU by 1990

l'hi$ sudden acccl. ", tion ;0 immuni~tion

".m,n ge hIS bec:n mad. """,,ble, in tU!" paM , byO<:w Kntegics for reac;hing I much grr:1llcr pro-

• UNICEF lou dli. 1"" I'U_ • opccioI r<pon "" tile................ focifla tIot <llildmt ol "mo. (... bos i:lpt<focc lot d<uib).

.. Onl ..Juodnb<>a tIl<npy IOIlT J io• .u.,.l< t.c/uli~'" lot_ .... mel Ifntina tIot <Iianboetr <ldl)'ln..... _

""""" tIot u- 01~.l, • ,.;n;..,clIildr<o """'''''""';, tIot It.ooliooI~ oJdIiId <It. ... ;" Lb<~_

portillo of I nation'. par<:ot. than ~ normallytDlOdled by modcrn bealth smrm. T ogctbct witbimpro,"t<! vxcinc tochnologies and thc traitlioB oflIWIy thOUSlltldl of immUoiutiOD tUI1ll in WC198iA, these new O\Itrnch .tntcgies now offer anew dlan« to bring immuniutioa to thc vUlmajority of lhc world'. dllld~n within tM oatfcw yean.

Acting "" tbis infOn'llllion , thc Scc~tary

General of lbe United NatiOD$ h.ol; tlIkffl theUIIpread....ted ..ep of writing to tbo presidents orprime miniSlC," of alii S9 J1tO'Iltber it. lC$, drawingtheir . ll('lltion to tltis new poIcntial and~for their pcJSIlIIai support for tho goo.! nf intltluni_utiOll fnr 0.\1tboW<>rld'lC~n bytbe yu r 1990(Fig. 2).'"

Sc:"oral nat ions art already moving to within" MOB dialan« of that goal . N aplnSl an'VC!IiC of I... than S\\ immuniutillo covorago forlbe children of the dcvdopina world only • few~an ago, coverago rates against """'" or aU of thevaccine-p",vc.ntable discaseI have rcttlltly beellpushed til~, 7~ OrCvt'll 80\\ ill Pakistan andTurkey, in El Salvad<>< and , h. DominicanRepublic, ill Bolivia and Brazil , in ColombilandNicaragua, in Burkina F.... and Losoth o, io SaudiArabia and Zimblb_, and in pam of India and

""".t... Wo_ OIlT). UNICEF~ ...... Lb<.,.....4 or,be 'o<boiq.. iI _1 ....... 00'<1 SOO,OO(I~•• Ii><t"",b 1""

•.•no or~ " ...,n; .., "" lot oil <biIobnI by19\10 bl' Lb< World H....b "-mb!y ;" 1m ODdiI 01 tb< k<y <"-o,.oJtIlc World lteoIth o...,.;z.";,,.~

.......u ..,.. ol' '''lIth for AU bl' ,be ,.... lOOO".

I THE STATE OFTHE WORLD'S CHILDREN 1986

Immunization:a new surge forward

,

EICIfmII/eS !f(rn !till Iosl egtI _ ~ ofacIIOl. _ and 0l:I'7II'7IIlma In me """W/<IfOlQ'l1I !till ffl'lII.IfU8!lln 0' '"CilIt/IlI<J bY r99Q.

o In lndIa. """'" Mnste< Rat< GIrd'i fl8I_ .... .,ear 1'>01~ -v diIll

bom III_" III boI hi 'MIll ".'101" III r."*""'Y ol n _ Inclra Conch__ IS~llIfgM...,~..... _ .. _01 , __-..__ 1o ,*". _ " DoIh__

~_'-"'''''''''''''IIl_'''.............. _ Ir<m _ 20'10 1Il_fWI 8Q1lo WI Iid!o _ ..

o In tin. en. _ ...,_, no-. _ ...........- _ ..., _ 40' 10 llO'o In.... 01 .... -..._._;qo_ol90~--.cl .. f\_l ,.. ... 'fI* __no<n::IId ............ w ..... t..IIi.-1IlIew;I'l lIS'li ...-..- QMf9~ ......... ' I ...._"'o-~..encCll l~,

o In EISPladot 1M l'U. h8l__lla)'S ol-"re~ _ by llCIIh _ In tt. CMI_ 10 _ two-lhIrds 01 !he .........·0 400.000.............m. l""J"',I _en «I'UId t.'lI PfOIeCIedIlIM* I". maJDI inlec1lOU:S ~ 11"_ on ""eeNal\onII vaeenalDl Oars,8orog.-lg the~ Vlol:c>""\IOn Dwr III an IIlIlll on 3 r...",..., 1985. 0SelIo_'.~ D.olrI<I~ ~

"... naa.. <la)I 01~, .. '*Y d . ... "",01hOIJt/ IMeIlltld 4 )

o In TliIUY _ I1110/SecMo._ 19l1f:01""Pi .... _ 01_....,.,....IIl&9. 10 __ SO.. 01 .. _ '.1W'lCI d'IbIrI --= Mill'" l:'lIIDf-."'" ."0 b\lh_al..,.. In"" ..,. "-P al _ hi ""'"" Cll III '8Soic:W._ t MS). __3_et*'-'_

• _'**310 11 ... Do"';'_ . "","otI'ic. _ /'IIloOIlIl__ lM'\'I '- -.oy ~..... lIlOIll .._ is''al-''~ 1lOlO__•

II.- 1!I'II'Ilnl1tlocn~ ,"ot!he majOf doMaseI01~ it .1)eCIIld 10 be aet>iIMo(l by lII&II1I(J(je or 198a (see p;IIIII na In Brad. h lIfQlIII mrronzaIjQn~_ .... _...",...,,~~iF'- bYirIm.nmg 20 "..", d'iiIlWIn 0I'l _ al _........... v_.-co,~~ _ 1or·... lISl-.e,.... In l~ _ wid OPT 'iKU"_ ~__~ I'I1II I'IOOt

...... _ 6O'\io _. -ooI0I95.. 111r 19851o 1'8Id'I" laII;JIl .. ..-. mnu:>~_

-~ _-- .... ", ..-~ r ,.,.,~ IIll

o WI e-. "*-'0 ... .. r. 19&t....' _ ' IIOO.OOO~....__ ... _ ·&__ 10

rro;n..,7$'bheof ...___.. I .PI "' 01 ..~ ......~ IhiI ..WI..PV"""&'IWIU"lllt'lI..... ""*"" o.rM ..... no .....". _ of~C I I t . t-PanIIl $)

O Wl Ec:uador. ". lor$l llMse of & ..-1"""~~ --.l 0lIl> IlCIoon on 26, 21aod 28 0CI00eI (1 90851 ""'" 1h8.." 01~80% oT IhlI nat>on', 1.f1deI_ (an;! 9$'ll\ oTthose lIQIIO 0". 10 t-> "IJ'I"l$I 1he .. mejoI~ds,_

0 " lloIMI IhiI yoea<.~ roll. 'bMo'lllUll'*110_70~ b POIoO_1O8$' b~ "'0I0Il0 ... ca.ogh. _ ..... t---0 11 PoldooIan, ......."""" of """"'-' Uf\OIfM.-, _~·~~"-_knW.... $ Ne.!y lHOIIO_ 'M ') U""-.,~w¥__ 01~ .......~bulCD_<&J')'_..._~ B. I .. _ 10 Wl::o'IcI _00..-_, - 01...- 110,000__bt_~ ••_at,.AlA*' UP __ ....,_, .-....

_ ...Pa& I _~1l~

~ ... f'4I>CI~

In all, al'P-=ttly 40 nations wi,h appmsi.mal~ly ,W(>.,birds of Ihe developinJ world'. childre-n '"'" rap;dJy occelcnting ,heir voerioaliooproarammes :and now hive I rulistic chance ofimmunizing almoatalilheir young cbil<mn by Ibeyear 1990.

Immunizatioo IIKl oral rehydralloo ,henpy(ORT) '"'" therefore beginning '0 lead the waytowards Ibe ,,"olulioo in ohild surviva.l which Iusbeen the main theme of lin. repon for ,be lIStIhree yean.

h is I revoIulioo made possible by newknowlcdg~ aboo, how paren,s th~o1SdVCI migh,I.ke action 10 pro'''''1 ,be ~v.. and nonnaJdevelopmen, of lbeit childtrJ:l qoins' "'''''' of ,heWOrsl effCC\ll of the poverty mID whicb they '"'"boro.

h is. revolulion based On • small nwnbtt ofrtJotively simple and inexpensive methods whichItt' now known '0 exert powerful le'et'2l!e 00chUd health-me,hodllike ORT and immuniution, brnst-f«ding and improved weanillll, main·lainillll vilamiD A levela and checking weightgain, a\'Oiding low birth·weights and leavinglonger inlervals betw~o births.

1, is I ,,"olution which rould reduee childde.llu Ind child malnulrilion by half, in lJIIJIyollions of the world, over ,he nen .....n or eigh,,....

It is I revoIulion which could help 10 ~uce

binha II well II delltlts IJId JO contribule to thes1owi"ll dOW1l of popula,ioa growth {see panel2S ).

II i. a revolutioo which is " ready beginning inseven! of Ih~ n.tiom whose rommilmmt mdachievements ore briefly sUlJllJ\lriud in ,be pandson ,be lef,·lto.nd pages of tIIis year's rtport.

Above all, il is I revolu,ion which dependsl.lIl'Rely on lhe commilment of a ~,ion's leader.ship ond on ,be mobi~ulion of I na,ion'.o'!!:lJIiud ruourceli in ordtt 10 hreok pr=J1'kno....ledge and lechniquCl out nf the mrdicoJchm and put th<m ;'110 lhe IwId. or lJIIJIymillions of paten!$.

Recen, achievements in ut~nding immun.iz:o·tion coverage flOlll I.. thaD 20'l ln lIlCI« rllInBO'l of I nation'. chilclno l"",,,fore hive. doubleimpnrtaDCe for the '>'"Ie of Ihe world'. children '.NO! only h.ve Ih.... sharply occeletlled immuniZI,iOl\ PI'O(tl"lDlDlCl saved ,eos of thousands of~v.. and p"" 'e med ,ens of lhousands of diubjJj·ties, they h.ve also pioneered DeW wa)'l of wliJqh oom ..n~,iq,u It> h<uit~IIA problorll,,,.4 puui",,lnn <11 llu dilposol Df llu _jority Df IhiM who orntI,-

And il is precisely this lair. _Ihe lair. of making.yail.bl~ ou I nwloive scale wAD' is Dlm>dyh"""'- lO'hicb could lI{)IO' help 10 bring lboul I

FIg, 1 Estimated annual numbers of deaths and prevented deathsh om vaccine-preventable diseases (chll dren under 5)

......2,COO.cm

~-=-_ ...__..- ~ .---- ......_,--_...-...........,s_._ ... -_ 'm--....,,~-_ .....-_..._............._,--...._------_.._---_ ..s..- _ ..... ,_-.-"' _

-"-=--'-'

T......0l3.<XX>

--_.- _-_..--""'"""-- -.---"',,-_ ... _111 _

-~------_ _---_._-- ""- -._- _...__... ~ ...._----~--~-

,

I THE srATE OF THE WORLD'S CHILDREN 1986

Immunization:a new surge forward (cont.)

•

o In $<I LanlI.. _e ." e.<lllII'108d 1"00'''''''''''or lIMI\lf\IUI<IIll\a$#eaI3v ,__ over "'"tn. "Il 1~'1 ~ren, l/le PI_I lIr'ICl Prlf'l'lll~ "'00 Iaurlchea a r_ dtNe (6 5epteo ,iOef1965) .-.a W iO iOo»:IIhllllOVll" il11ElhlIll ....................... lIle -.:l 01 1986 l.- 1*lIII

'"o '"~ NIm. lIIe _ .......-- PI<>0"f'I'I'II • -.g ......-_ 10 _ .... .,.....

573.000~..,""'_""'-ot11N15... 8ddoc.m ID'" 3503.000 _,.,., 8lICI'I_ lit __ .................ogo_"'• .,IlUlg .._....-._10 -'I' 100. torN"_0 11 ,..-g..,.. .... lC\a<I()tJIIlUJID-. _ . ..• '4_11\ <lI'«> _ """"' _aoo _ .-~_ ...... 1~ 10 ....... _&0'-. .. _ ....r-eMl~ hl0l1esAs Irtrn re CiJIPII;II OCGlit II ' 9 _ 01 !'ligoN __ .... -elIll1ll "'"_ • IIIlIlIY et*lrllll~ IleonG _,,*,eac/'lrnonIIl • ..., .-:tlecl ...... 1IIll~__ 01 198-4 lSoe PWlII , 7)

O InT..-n/a~tOOll~r>as_

PI*""O fO 56~ to< polio, 82 '10 to< ........, lIr'ICl54" kif IuI:leICI.b\I$

o In Ihll Sudan. ",",,', ""'Oe'I I;OUI'IIry

200,000 cI'lInn 111 M QIIlI\Il aIY '" Kl\aIIw'II__~ .............. (l lNI5)-.:l me

u.r- 01 HIIIIlIII hal rfIOU'IC8d lIIal #Ie~ Qj ' ..... ' ......... fNOo ..... oJ •..,_, ..__ 01 SU*ol'. <1IIIIhn !ly,ggq 0.. __ .... 110 III SWon I~"" be "~

Idler - _ - lit' """"'" 1986o ~ ~, .... _ at HilIIlrI ,..,_ ( 13 F-....y I iIIS} ....,_, 10

.......- .-y """ .. AddIt _ IQWllII ...-.~ ...,~

...............__ ..... a,.s..-., gaS, .... SO'Io '" Voe 011"~ I'..:J~__t-lIWlIl I 5j

0 11 SotnaIII ..._~""~ (9 ...""..,1965) haS ,_led llII , tgoOrno 10 l:W_re torI/MU"IllIlKIn dllYllII lO tePei\11l>e SlICe to l/le"lOll 01 Harge,sa an<! MogadI$lllJ _ e more '"""1I0'llo 01~ lJ'IGOI fWO Mve been ilIVnuru.clIt-. _ e- I*lIII , .~

o In 57"1. _ ."., ...- --""'0 .. .,..._.~ • • "" n ld\lng_~ 110m 13" 10 &3'" ... 1M RIggi _-,.."' _-_... "gowtf-

nc<a'!& 11\ CCUWy

o In 8uI1<lnI; FaICI, • " __'--'1ll 195tll:*ri_ lM<1 lid ID .. ..........-,gol_....'Va;g d~"'''"'_ClU ....,."COO I b'.. ~oI RI'· ..........,. tlrOugIll 6S.. 01 _."'*Jr1In ID 0. hi ..,," ed_~ ....... If ..a ............. The ..... epoden>(:e.. ..-. Ihoo I cit 01c!lIlnn .. .., _ 01""" do ... cNfOr<!n IIJlI_ CIUSIy e, _ 1I'>e«<>V _ P<"._-~

!hi! I'leallh _ .1lI~ .. _ IDbuoIcl -.<1:1 I _ ... f09IJl;lr IrnmurWITICIf-.kif all <;:hoIdfe'l 1C8"lll1l'll 0'I3f0I',,_~.

I ble "" P (MIl pa<lII 6 ).

a SUrinl.... ............ b<In CO\/eI'39l' 1\ilI_,ID 60" I ller II'IeQrOCIamoIl>On oIlh1 Na/looIejVlLOIOIlIOo , Ad -. I'lC/ft~ tIlI1 IIc!'oIdrtIn ...... lOge ....... tie~lP(lU'lIl dii>Nf* _'0 ctIJl/o, _..,-0 -. ... Q,I, CIfo'Iwo _I-=t>e<l .................. _ or 10' tIr_01~".utt_ Cll:lDtlef , ll&§ ThI '-"*d ,...,~,._ _ 6O'co, ..... 01.__SaLd _Nl_ IlS___ 33.... lIMO III IS 198A

O -' KaW..~.· t ..~ _,,,,,,,,,,,-

_="""'II ......... t:ft1.~..-_~ lrom !III Nfl 20.. » m;n ,., lM)<j,__ .. _ , .....*iOf__,,;,;..

rcvoIution in child survival and prnICC1 <.henormal growth and d~dopmenl of many millionsof lOOIY' chiJdrm Ifld to:morrow'l cituc.... For InIfl ofreo unjust world, I mojor impravement In<.he pnllCC1ion afforded 10 the child~n of <.he pont".. unJillely '0 come .bool lhn>llgltany l<~P rUe inincomes for the poot<SI <him oft"" human fomilyfor 01 IUl< the nexl len or fifleen )"Un. Prott<'iingtives ond health, during thaI time , will lM~f_conrinu e 10 depend , for the mosl port , on lhe kindof ='" which flllli lits . nd comm uniticl; 're oble InI"'O"ide, !t.nd il .. in <.hIt letling thaI recemb<cIll<.hraugh, assume OIICh impnrlonce. For ir isnow possible fur fllllilia themselves 10 quite

dmlicaJly increase their children ', chan,," ofsurvival and IlOmlIll gro wtb - i/ 1M 100)'1 ondmeans CI1l ho found 10 put lhol knowledge 1\ lhe<fupoaJ of ,'''' lIlIjorilY.

In the PlOCCSl, large oumben ofpaunll ore oJ",bccnming iovnlvcd in pUltini O<:$h ond blood Onlhe bones of the primary heallh care idea. Byknowin& IlIOn' ond demand1Dg more and doingmnrc obolu such basic Mahh Itnn cgies ... immu_o;2ation and ORT, latie numbelS of people arc6nding I pnlCtical stoning-poinl fram ..hieb " ,prosrcss. su p by odut">lIble slep, toward. lheII.fiCJ goal of more comprebensive primary hnJth

Fig. 2 Immunizing all children by 1990: pt'OQress achieved and progress requ iredTho l;,gel Ill..-sot .... I'MU1i!IIM tJ,o two ..... Tho..... ' .... Ihow Il>o IClUlll""" ...__(I QIG-83l ;,"""""'" OyNo "'-riJlV"' 1Qn ia_ III orm>rirrog""""'''- """~ '" ,..~_.

ltoI! """ _ '" "" _ _ OO""' lUt"........ TloI_!nl"dcmosN "'~ll983-

{IOIIj '" _ b' M tJ,o tho..... 2000' IlQ , .... lat\IOl"'~~ "1O ""moI t>,19901983 ioIIW> 1al:$O! _ In< ,.... . -.

,

rsso""1975

-=..:.---<o

"Xl

~fl'IHOI_ "'~P,t9 ..,,,. on~f3'!I ;' tQ74.._."-ltoIl_"'~ ""P*l lOr~-__"...e--_..._.-_-.._ c _,__

1 THE STATE OF THE WORLD'S CHILDREN 1986

care an d a Sm.,•• dq:= of COllUIII oyrt Lboi. 0100and tbtit families' helhh.

This YUI'SS'tU D/ llu WlWld'f ChiL:iffll repon,h...fort IUnu tim IGan attOUO' of Ihis ul"'llficin immunization ro'es, of how 'hey.... bein,XhitVN, md of whal lessons ,hty migh. hold forputling OIlier~ child prolection techniques II,he disposal of Lb. majori.y of ~nl"

nt .....u.i.DJ: of i"''''W1izatioo

Immuni....tlon coverage ,oday rallies btlWttn20S and 4<n of tbe dr.,doping world'schildren(F ig. 4) - despite ,h. lheor<1ical availabili ty ofvaccines 10 • much gretttt propon;on of theirpopulations. BUI in 1M lan cight~ mOlllhs 10lwtl yun, sevenl nations Iul~ effectively COIJI-.

milled .hemsch·cs 10 Unmu.a;,...ion coverage of •different order of lI1l&o;,ude.

Some of ,b. ou,,1.aDdinj; mmplc:l of .hisconunillnc,u ~ LIId x hicvcmtot - If'' listed in ,h.linl tWO pan.1lI of this report. In sum, 'he:I<",,"mples «'present an inBectioo point in ,b.grap h of immunization'. progress, and 'h e factson<! ligUle ciled are the hard rvilknQ r",.UNICEFs belief that uni""csal dlild immuniza·lion by 199(1' is 110 loDger liD impossiblt drum

BUt 1m the perttn.ages aJld the millionsbctv"'" mcaninglO$, lhis is what il mesns ifimmun.i2lltion is not avaiLable:-

Al fim il may mean \hall child who is slighllymalnourished btgilu 10 los< his 01' hc. appelil e

• I. pt><Ii« .. _ '1 . ..... ;" III< Ia<lUlUiali ba..... xlli<vod loot. ;m"'''.i'''ion of ... rMd:n. ·UIll.......~ ;,. ,_ b<so iD«rpr<o'" .. isIpI u..iIl<ol , Iw .. c!IiJ<l _ b< _ i...." i"' ........IUI><maIooio. di"".-"""_(......""... ""'&!>1."""""POIiooryo~1io, IlCd ......... It i>,-.....,.,....ny II&f'Od llw00li<o - "i'"""_r ""''''''.~ at _ or IIIOt<,11<0 __ • • poIl<"" ., dioo1Jp<<d ..

w ..-;do: at ,"",«lion far u.. """""'"<loiId.<lo """' "'"'" _uai (pmwidi... ,bo, ,be.....;.my at ,be,.,. iood """,,1oIioo ... .... ..-......,«1.... Im< ..ba< --.~, ......n.. Iow).

I' ;, ...., impartoo, d dril<lmI .... i- e " iood """'" ,betin> _ at liIr>04 _ ati o· ;n...................... ....._~- ;,. _ ...-•

and fttl Ih. Ixgi"inv of a rmalI fevcr. Ai... adl Yor two, lhe f..'t'T is higher, appeti .. is gOflC,COOJ,hiog btgios, a, d a vivid !lorid rash ilappearing 00 \h. ~kin all if fl'OlQ 'owh....,. As ,h.days pass, lhe dillThoelibegins,Ih. W.o dries, andIhc ruh IpreadS until ,he tya also becom<inr"<"ed and i,fIamcd. By 'he Krond w"<'k, Ih.ra.h has Ixgun III~l, le3ving OpeD ra W IOrtS OJ>th. skio , and by now lhe cou&hins is persiR.n land prolOlllled and 'he dian-hoeo is u, ,,,mining.No foOO is being li ken , and WlI1e<, p h s, andnutrients ~ draining from lhr wraUoed body.Dehydraled 10 the poi,1 wh. .. the \hii'll isullbcon. ble and racked hy ~hing fits which arcbecoming lOll weak 10 d ear Ihe lu,p bUI lOllSlroog fOY the muxla of th• .<mall hem , thelighls of thc body begin to go OUI.

Inlhis way, me:osIa killed 2 miUiOl\ chi ldrm in1985.

o. it may mean tho' a ",",her notk.. that he<fou . -dl y-old hohy !\OemS ~udd...,ly In feel ma.etc'se. As she wooders whether .he is GIllyimagining Ihot something is WfORi, ....C .... Ihclil'lt s1ighl'paoms ~"llth1Wgh the musclc$ ofhcr child. The lnfanl sleeps, ilS mUK1.. 'elax, andall sec"", peaceful again.

Whe n the child wakes, Ihe mother speaks andlhe respcmse is. spasm l;hootiog through the tinyframe. Now every Mise, t!¥¢ry.<mall dmurbancc,every comforting lnuc h, produc.. Ii""", $p;o$<n$,

holding the baby rigid, arching i\l..,..]l back.

Ov¢. tb¢ oOXI !by and the Oelil oishI, the,~come longer and m(lf¢ ofl¢n , ho lding tb.bo.by lncked rigid for long SCCOlld ' at alilOC. AllcnOliCt produCQ another $JIasrtl and even bfQ5tfcediog has '" SlOp. In bl:rwcm, rhe bllby visiblyweakens. Nn Ol1ids COIl 1M! ,. k.n in, 00 mUCl\$'kared from the lungs. By M W, lhe $pi$Olli hovc,pread In 'he muscles of the m<>IIth and lheroolh.r is loolti>lg down 0 0 an ago,UcrJ grin .

A, ot h", nighl and !by and ,h. spwos Iltt

toolting impo:aibl e demands on the baby' $ bean.Now the whnle body is bcioi held riaid, Ihe . iny6su c1enchtd, th. r~ fised i, gnm.cc, the backarched, lh. $Inrnach locked like imn, the milch..1 clam ped dnwn against all breathing. For,hiny uow serond$the smol1 bod y is l<>eked in IhioJ

vice, then !Jowly n:laxe:l, o\ll$d a lwilChing asthey l<>O!lto thei r grip and !he spasms recede.

A g...tle, comforting touth and lmmodlatelyaImal body spasm locb Ihe chi ld <iBid all 0''Uagain , as if il we", ",pcllod by its mot h..,', 10 ,.".

In !his way, manus killo<! alm06t a millio niofam s in 1915.

Or il mo:uts that a child, in any <>Tdinary villageor oeighbourhood, bogi", 10 mime or cough withwbat seems Uke the boginlliogs of another oroioary cold. Over lhe nO'lll week, very slowly aDd11_ ollDooced, lhe rough bo«Imrs d..pcr andmon: pcrmtenl. Soddenly, ;t is 00 loog... ordi_nary. The <:<loglling II<lW is SO n pid-liriug, aston ering engine pompiog air from lhe luogs,Lbat Lb. ", is 00 time In l:de any inward b""'lh lISlIIOfe and mon: air is hlJllInotfd oOt until lhe'" isnon. al a1llerl 10foel ""other coogh and the cbild!JomP6 for....ard. cba t collapsed. SI"",ly, wilb •sboddor. <hecllild hrealb'" ;11, relua tbe leo.Yon,and .... op agaio wilh sWQting skin and frigh l_ened eyes.

At tbe Dell 6t, lbe parents 100 are growin gfrightOtlod as Lbe child', face darken. and !hecoogbing goa 00 and 011 notil ;t ....tnS tbat ."inward brealb will lIevOl' be l:den. Now, thewhole body of the eb.ild is gtut'd to the luk of

O'llpclli"l air unlil, . , th. end, <he cb.ild finallyinhales uncontrollably, smJJowing coug hed-upmUCUl from the bronchial 1m: aod choking fromthe vomit d....wn intn the lunl S. With . vcry litnow comes more vomitin g as Ihe muscles of Ihestomach contrlCt wilh 'he coughing and fo~

everything, food, dri nk, milk, hack !hl'OUl-b <hethroal and nOlle - only 10 be inhaled cbo ltingly asthat inwanl breath is finally tok....

Weakeno<! by vomiting and cOUj.blng,struggl_ing 10 breat h. tbl'Otlgb longs blocltcd by muctl.

Fig.3 Percentage of pregnant womenimmunized against tetanus

_ Two I.......__ in oeQo.Qd 1'1 progvtty :o_ ~ _ rJ tne.-.. """"""""""" lor 1lla_ ~ rJ lnlrol__

1'1 IN ""' . . ... """'*'_ "'<J,,"_ 'NCP""_r,,___d......--...... _ _

,

_ AW .. Asia _ rJ ~/fl

S<:UI> & Eeal A$Io - ....1rJ"'"~~ wNctl . "'"nclJ<IOtll'1 1Ha labIol.

llPT ..~~ twr'IOOPflII <'O.J'I"f. /II'"(! retarl.S.r'l """'" <:<IU"CreS DPf _ .-._ giYII<1 i1 .... "'*" .""l'I CCU'III1eS~ ........ va:;:cn1ib)n " QHtrl _ lho IIIJIIrJ 11""""'-, ""19n"'" . .....~ COoe'agD rJ1 Ie 5 _ oI:ls.

Polio III

_ ..BCG OPT III

NaIr.n._.-.ce_ tne"""'"~ _","~~n . _ _ i'o" __'StolerJ!t>lIWG"d'.~ "llM '"~ 1l:t~~i'o","d .r _rJ~~~

""" Ill' ""..,.,.~ .. o:ta\I coIae1iot, w!'icIl_~mom_or<!lQ to_~b'

............... CCI\'EIIagIL~....,,,,_...,.;v __..._ __~"'l>-._""__

Fig. 4 Percentage of children Immunized in the first year of life. 32~ 33

~rn~ - "_.""'"-""'- - "

Turkey:to immunize 5 million

,

~rIls~, .,..,I"fI" ~I¥>I """'.'I)' IlIIlI i'l1i'!<J 00tiFItly ....~ .. '" .. ,., l urloll>"'_ Kenan E_. <1umg, 11 5e(Ilel,ltl8Iceremony M """"'" lie .............-d n lnl _iIlItInls., ~ au"",... ",,1lQr>.WIdt """""""'Don,..,.. In ........ -.Jay 1*lQllI. ,.. ......... _ 10

~ _ Nn 80' ", ... !> moIion ...•

.....~ "" - _!"OW-.g

.......... SOIl1_ <:tIIIdoen~~

rlOfll" _ 1llIIIIoml, """""..... TWQt.lI0l:III_... 1IlIl.... 1CI8V'_' ..._......""........._'""" _ til" ".~..... '" he Dlke. woe ..... """"",Oil ot IIIatT~.67__-...g ... _~,_ ......r.,~~.. 1IlICh..-...~~"'X \_.._ .. ...-..~

_ ". • ..., ..,.,., lOW • _ ElWIll~ ... s..o.., ..., Synlr. """ -.P,_.E..., 10.,.,..~ III ... -. oflIa' l/Ioe __ beloIe r>e tn:l 01 .. 0lICI0e................~ T..mey l\8IlIll. 3S-._ol vao:::o:>e l\ad lIrrNed 111 h . 5,000 ............lIl.On

1181'::-' *"" III 536~ (IDeal dlsltl(:l~ __ also~ cIIklr""

0Wr Ihe ne>:1 ...". <lBys (_ 10'lt '" I!le_ Sla!lOJ1ls IIamg~ ., 1I$ lhoIlIICQCIUI1l _ to IlIBSSl.• lOIII ot 3 2 .....,.,____led - 1\oICHIlr05 01 !he nat!l<ltI'.l,n(jojr.,....

• aICII m_<:a'I1lIt· $ *' .. h.,,;oncl...,....., ro.n;l:I~-.dNcMo•• ' 1ila5l... T...u, be on lot ___tJr _d 1908e - __ 01... 1990 ""IJII_

_ tItIIIngs • ......:::£F I ' . _ '" Newvoro.. ....e- lot e-e.:.- .. ...-.rd I _ ID _ CClIollc. • ........- carr>-

I*!l"" -.. I......... r..- ,.........._.......: ",..w... '" I\gf 11l1S10"-"~-.. Ito",.. ca'. • I The _...,.,..lIf1IoI_........_lO_....--

l OWl o!allhe ....oon'. """"-""" 101IlCI_~It>e "'~11 01. an<! I/lII derMnd b', ...........l ...

'"The ......._~. -...as on", ..aadeo .."'" ,,"bOneI .lIoIl _ bl" ttM!l MirosIIy IIIHeiIIIh F(O' ... '" __• III 6 1 .. melIDgiItIlur ..~ -10 ne t:>neIcI on ,.. _ .~ ICIlII _ peeted 01 "*"- The l U'lulll _IorI:es llUt ". ..,... "'"' __ ...., 1_......_'~.. '<l' ' ."'5'0_........__30__ .-

1Ii..-...a..,. 10"~ ,eo ...,._ ..-.of.........~_«1.h_

A lOIII of $.000 Po •• ftlIIO _ 60_ _~.....,. 11.'_' of .. 1_ AIcIer- .XI'II-_ W-"" _... CIO'lF The __ .... _1Iit1_'_'jpr-""d ........_~_I0'.....Sll(Jnftg..x:roll A __ ...., PIiId lor $

........ " '0111 10 "....,... 0<It'Ilan<lg • chid

.............., _ . • Q<OWl!I _~ -.d~go blIac ""., I\MIllI'o ,*-,

In "'" monlhS~ uP to 5eIl1emr>et, <ITIIIfIIlIllCI _ I ., _0,000~ lIllCI roogl tOOul~, IlIllPed lly pnmat'/ !CIOO le8Ct'eIs lI"(J_ PUPob. ..- .... l1\li --.._ "'ll!x>Jllt'll eIIl'<*9" And lIS 1he_10' lI'le IonlKI<lf'O(I _ , .......... '"' """""""" _

.._ ., s.o 000 ..---

~ ifill ."1 _'II lui __-. ., T'"!<e1_.. .....",.". ...........~.., _ ,.~ of Qtr.'QfY _ aN

_J'Jelor9-..... oe I .",...","~r~....... _ "..,..... Ardn lXki"."'...._or"".., .l_"'-_""""*11)_",, --..t.,...~ort:NtJ,... ...........

01 chld /WIWl to. II) -... r¢l1!r II) II

."...,., gonf*'" ... - ,.".----

and rood, lbe dUld begins anotber 61, unconl1Ollabl. cnughing pumping lbe air unremittinglyfrom Lbe lungs, finally f<>tcing lbe cbosl IncnU.psc, lIumpina Lb. cb.ild forward until lb. fi.ends and Ibe bouse is suddenly silent. Only Ibistime, lb. cbiJd d DCll no! breath. in.

In this .... y, wbooping cwgb kiUed eere Ibanbalf> million dilldrcn in 1985.

lb. rosl nf pmucticm qaill$l all Ibis is.pproximalely 55 per child. The ron of immuniz.ina all cb.ildrcn, and ,,"ving more <.ban 3 millioJ>cbildren from dyins in Ibis way, is 'PprozUnalcJy$500 mil~on per year" - slightly less than Lb. (00

of Ibree ildvauccd 6ghler planes.

The lWObRaktllrouaJu;

Based on infQnl\Jtion . vailable IS of mid·198S,lboo< cou.nlriQ accciculillll Iheir immunizalionprogrammes 10'A'lrdJ <.be 1990 loal include:_A'1CUlina, Bangladesh, Bhutan, Bolivia, Bot·01nl1a, Bmil, Bur kin. Faso, Chile, China, C0lombia, Democralic Yemen, the Dominian kpubUc, EcuadOl", Egyp!, EI SaJvidor, Elbiopia,Haiti , India, Indonesi<l, Iraq, Jordan, Lesotbo ,NiClll'lllOJa, Nigeria, Fabllll, Peru, PanIIIla,Rwanda , Sal>di Arabia, SencgaJ, Somalia, SriLanka, lb. Sl>dan, Suriname, Syria, T .nzania,Trinilbd and T obago, Turkey, Lbc United ArabEmi rales, Uruguay, Viet Nom, V. men, and Zimbabwe.

lbis .udd.n ou'1. of pl<Jllrcss, a ourg. whichwill bring man y n.lions wilhin $<riling distanceof univon:al immunization, is h.appttlin8 in lh.mid.1980s bcoU$C of lwo diffcrcnl bruk·lh!tlIlg!u.

The 61'51 is ......pp1y btc:aklhl'Ollgh' I>r<>ugbl. boUI by morc hcaHl.lbl. vaccines, by "IOn'

reli. ble 'enid chains', by COnlilluing research andImoina, by Lb. insl lUilli of more equi pmcnland...ppIics, and by ,b. , fi)Wjng numbers of beal,h

, hllbuIIP ar;:n..-rcco If< _ it ....pl of ani........• iWM>o '" IWO.."'b<-._.. "' ....ocly rauaim. 1f.m.cnaJ im.." i'll"" h I. Ix -.t....._oiD<d. ,11<0 ~ io Il1o <OIf1I~ 10 fiAd ol~,.~"'_ tniaiDa,"' ......."' .... fIObti<, n'..,;". "' .... =, ' h M....-

WOlken Utined in lb . "",nag.menl and orsanizll·liOll of immunization Pl'Oll'lllllllCi.' In Lbe 1981l$,lherc h.u been solid proe:..... on aU lb... £ronlS.lb. 1.ICSl frccze..dricd measles vK<:ines, formmple, nomain pctem £or up to Ihree ....kirooD in l ropical I.mpcratu.....• Cold c~ns o£rc£rigcntiotl - hased on k.roocne, boItlcd 'llS,clcaricily, solar COCl'iY, 01" icc bo>;os~llI'C no... inplace in most Mlionl. Mosl importanl of all, manyLbnusands nf immunizalion lum< hive beenlrainalllld 6clded sine. the WHO launched LbeExpand ed Pmgrammcon lnun unization (EPI) in1974. To dal., almos, 17,000 peoplcfrom over [00natiOl\i uve beeo lrain ed OIl COUlll:S $pOII5Oredby WHO and UN ICEF and many limes morehaw: been lrained by IO""""""'nli ,bCIllSClves.Cb.i"" alone, for exampl., has dra....n on EPIprogramm<:s 10 Inin Over 100.000 heal1b WOlkenin immunization man agemenl. '

BUI Ihe sco::ood awl equally imponllOl advanceis ,h. 'demand hr...b hmu gh ' by which somelhirty or fort y nalions .... oo w mobilizing, on Imassil"C sale, 10 make immunizatioo .Y:l.illblc inpl"lCliceand no< jUiI in ,heoJ)'. And il is fNllilitalcommilmenl 10 ne... "'0)'5 of reaching oul 10inform lIOd suppon lhe .....jori/)' of jIOftllIS whichno .... offen MW ho~ for punm, in,o practict:o< hcr child proIcctinn ....'..ia on a acaIc whichis commcOSUI1lI. wilh ee problem.

To brio, vaccin'lioa III peo pl., 10 inform manyl.no of milli<>m of pattnlO of the wben and lhe....b.~ IlId lbe why of immunization , IQd tn gClmany more mil~..... of chiJdf'C1l 10 lbe righl placeI t <.be righl time on ..,vera! "pOl1lt. ocasioo.oeach JICllr, is I massive organizlliional lIOd communicalions II!I<. ...hich usually far . KCCdo Ih.capacily IlId the experi.nce of over·stretchedmcdicaI xrvkes. In 1110$' developing n.tion.,,hose medic:aJ servi<:a reach only lboul l~ orlS", of <.be people ItId .... inevillbly mon:conccrocd wiLb ~ina d.mand IbllO crealing il .

For all~ reason .. comprehensive immlUl;'za,ion coYC<I/l. h.u risen only slowly, oll.nn:aching only on. in 6v. of I n'lion's childnon,cYUI "bell vaccination IICrric:c:I have b=t lbcor·eticaJly .vailabl. In <.be majorilJ £01" ","ny yean..'

C1car1y, somtLbing cI,ra is needed, some newdyrwnic, some new way of foro:cfUUy lalting tbe

•

I THE SI'ATE OF THE WORLD'S CHILDREN 1986

EI Salvador:children - a zone of peace

"

~ QO'\'e'm1IIOI am _ sobers~ S\CIlJP8d IOOolIllg 9iiCll olheron 1965 WI\iIetho oat"" COfllron'.ed a COO'III'On foe _ the <lil_ ....1'IicIl 10.1 some ~O,OOO smail chClr"" a)"lilt aro:llJ\llWl\ """'l' 1tIDUSlIn<I$ ft'()t8.

nlrlle P&/lIOUS oav4cng pauses on 1M TghIJnQSO "ad lM1 edgy olbooIs stlI9Cl away lrom calhngIlJemceaSfH_ or UI,OI;ll$ -enatlled someQUInta<of a ..-...on chIkl<(lrI undilr IiYe to bI vaeonaIOdagains1 ~, dIpI' ~lll!J8. telanllS. !I"IMSIe!I aMwIIoopor>g cougIl.

The '<!irYs '" UBnQuoMy' - llQ!eed 10 by lIO'M".....11 and guenolla lea<la<$ ""th tho haIp '" '-klgRoman ealllolC prelale$ - alrnc:<lllell QllaN on . '

~--Hoo.n b8Iote !lle~ '" 11>0 sec:or>llllllllOi'lal

............ ,"'" day, on Sunclay 3~, "''''20.000 rteaIUI~ rod 1IOlun1""'" ""'""".,more IhIIn 2,000 vacanMoon cern"", lICIQSS!heCOUIIhY. _ oN03IS llUptlunIIslcally caIIe l:helIfSl dayolthe Cll'T\Pa9' and scamd oH man y PIlfeIlIS andCIlbeI' PrOflll'll lnl(JM.lflloon by rep'esentalJv9S 01Il>eRoman Galt>ollc ChulC/I prevented a COllapse01 IhIl d<> tacto tn.o:e.

TIw:Iu(Ih tho lOIals lei sI>or1 01 IIlft taI~1 oj>'3CCIft3ltlll 8O'J. '" EI $aIYa<lQo", 400,000 Ufwn

murorod chiIo:lIlII1 under 1Ml. on '0l,l0(! 1l\ll"'llS2 17.000 C/llidren -.. 'each!lCl on 3 ret>ruary,262000 on 3 MarCIl and N 1000 on 1M las!

'"Bul~ tho lXll'tlPI!Ile llM1UIlIZlIoon 01ah'05llWO-llIJrds at 'IS -..n _ ngI1t~ tIaiIedas I '6tIlaII<at>le lIdlilMlmarll rn a 031"", at warwith dSell

.•rills r<JCOI'ICIloabDn lot lJIOQ(ass Ittll1 !lie cal 'mon good ........,....,.", I:JId)I (I~"I; oomm.rmen l 10 • p(iQIM> rum", _ ,.,. _ /Ill

n\P<ail<>', ro tho rest01 lI'Ie WOrld.' · u..ted NabOtlS

~lIi_~W:""c.Matsaid "' .lIlller to Preso:lCnl NapoIeon !lllarle '" EI Salvador

100 war was but one otlStado! Wllh 5 8~ 01the""Ill~ h 'SIS, ....." mal<olg parents

""""''' 011M~liOf\ <:anII'lIQ1 was. """""-1iouse-1O-lIOuSe ...... by 3. 100 _ worl<e«lto lQCa'e an<! "' form ~_ incrnase<:I l)o!twWn

,he his! and secoocl Y/ICGIOlIlJQI1 days and weteIltoeti cnldittld lor llle """eased nUlTill<lt olC/'IIIOIOOl....ntrlg up 10!III im" .....zed OIl 3 Maleh

I'os161S and IJ1flI8d twxlbllls arlIIOOf\CeCI Ina<!aleS tor VllCQn8Ilon and ......, 10Uer, 1><:l<elscamad tna carmaoon emblem e:!d lhe sIoQan'-"' "" "3Ct."IBI" _ '" I'lICOJ'Iale .. 10

P'"",""t Cl\heI P<JbI!al>' ncl\.<le<l "" drOOlS 01laafle1s ., lIIIOOla eees Mole COIIVCi'ltlorlllty"-", magar..... radoo and~ slaloOrlS ea"llId many~ 01~_pIaeed tJy g<M'lI"""""! and tJy pmralO busniiossesas _ as le.1""a <UliCI8S and news _ 00 1M

ClIl ''''''' iIseIl[8C/1 &.nda1, dl"'''9 IIl8 woekS lO»d<ng up to

!he~~, llle C/'IurCh ClIJried me~ 10 lh8 people !rom llle puIpo1. Ielliogparera ,! W8$ '- .My '" PlCIIeC1 Ihaor clloO:l,en..........

Tna 81eas COIlI'olIed by guemIIas 18OOII'edsp8CIlII lrea lfll«ll, ""Tfl 1l8a11tl """""'" !rom llleitlten'tlll>Oflal c:.omn-.u. 01 llle Rea CI_ opaIal ·"'lI "'" """"""latoon posts PoolOi'$ 8O"ef1l5ed ee""""",,,I"'" <lays "' IllCI5e dIWlclS _ 1>Jl Wl"",,"QIWllI!he dates, t>eC3US<I !ebo!I avthort\ieSIIl'ISIIed10 _ gMrlg llle~ 01b!IIno <lIelllte<l1O

tJy !he _""""" .

A1 one pclIf1t guemlas abducIed No<) <lOC1OISand ""'" t/'Iem 10 1\11 "'""""""" _ <:<!<lI,a,-.. _aI IIi"OOlS aro::I e/'IoIdIen Wl;Iited 10 !IIIv;o::onaled. n ", .........-.es admolliS\el'ed, It>e !we~ """8 "''''' '''''' 10IMor _

_"'G_" "'_ """"==------".......-

Fig. 5 Percentage of infants fullyrmmuni~ed, Pakistan . 1980- 1987

/1 71 --,------,r-t-f-t-f-t-

and play, by cinema ODd 100000pcaker. by school·tesch... and villall.lcad.... by members of parliament and panchayal, by Rotary d ubs and worn-<n·. OIJlonization s, by Hindu and Methodistleaden, by youlh _ tJl<oUODd f1miJy planning"""""ia,ions, and by .he bundreds of Yill...""lunt..~ "'ho lravelled hnWIC to house '0 mal«1urc Iltot aU JI1«'nts we.. aware of the need 10..aecinale and '0 remind tbem of Ihe lime .IlIldplat:o.

In l'lItiIt-an, 7,000 , at:<inat<m and IS,oootradi tional birtb an <ndanlS have beentnincd andlhe number of immuniution post~ "- beenineeeased by m in the last eighteen monlbsalone (Fi g. 5 and panclll ).

In Nigeria, tbe pushing of Ihe immuniulionrate in the , ..I It.. of Own from 9'!10 to Ovt1" KO%within twelve monlh, -an achi....ement now be;ng attempted in ..,.,., sta,o _ _ made JIOS'ibleby the IUppon of the community leaden, the",hoolleachrn. Ihe Indilj~ ehieb, lhe tn<ISS

world'. _ powtrluJ public h.allh lechnol"lYoff lhe ped..I:oI of in \'301 poImtilll and pUlling il10 .~ryday W<llk ill a million , ill.."" llOdneighbourh<><><b.

Sumelhing .pe<:ial is n..-ded. And """,,,tbing•peciaI ill whal Ih. natiol15 who an: nnw movingIOwanb full immunization ha,'. begun In pion.....in Ih. mid·19llOs:-

SociallllOlnli"",tinn

Bruil', N>tional Vaccinalion Days, forUlJllpl., ha, . mohililed ec less lhan 400,000,00unt ..... - from all section. of sociely _ to , upPO" the he:llth~ in manning 0'..... 90,000...accinltion poots mel bringing irnmuni~tion

within w:olklng disIan« of almost..,.,., family, Altbe oamc time, tb. conntty's mass media ha~

nude 1iU~ that vinuall ~ ..... ry pamu in thecunnlf)' ;s wt:1l-infom>e<! abou l lhe lime, place,l1IId imponan« of lhe immunization days th.mselva. On lelevision l1IId radio, 3O-so:cund inunu·nization 'ad~nise"",ot.' hl~ been broadca.slIwenlY nees a day. In lhe _imilalionn. .... papas, pagCl of editorial hav. been devoted10 the ~"",paign for .....\:$ ill advance. On wall.l1IId in windo.... Ih"",ghout the land, I..., ofmillioas of POOlers ha~ kePi the meuaa. in fromof the public. On bank otatemen,., electricitybills, and louery licltt lS, lh. remind... hl5 goneOIIt that e~ry child mould be immunized. Insupermark. ts iI:ld football $lIdiutIlS, lhe publi.add~ 'l'Stetllll ha". iI:lnllUnccd the same: mcsuge. And in 10,000 parishes, Catho~. priO$u andthe Church', 14,000 health woeke" have lalkedwilh miJ ~ons of PllflllS . boUI vaociDaling lbeirchildren (we panel 10) .

In Ind ia, <heimmunization of mo.. than gO!lo ofthe youog ~b ild ren ;n dimiet, of Delhi andKama, alta "- been ..hicoed nOl jusllhrough lhepassi~ avail.bitity of vaccinr:s, bUI , brough IhelC1ive involvemenl of ...tirc communities. T obring vilCCinatiOll withiD the ....h of all pare nlS,immuoi:t.:ltioo posts wcrc "" up in l. mpl" .IlIld..bools and pol~og hooth .. To lel paren ts knowabou t ,he imponl1llcc of vaccination, messag..wt:.. carried lry radio and o. wspapcrs, by l'O"1erand cu stick.r, by bann....and proc<$Sion . by song

.,ieee

,.,.et

,,.

r21%

-II~ ,4·2% I

B2 83 84 B5 87

"

I THE STATE OF THE WORLD'S CHlLDREN 1986

....w., I1le MUIlim aden aad a..-.1Iw Cal ....k bisbopI aad priom. die iDtenlII.iouI .......mel 1M IcQl crpnju...... <_ ptDd 11) .

In Colombia, llx fu1I immuniratica ol 7S~ ofall ull<kf -foun ~ bee> 1lC~ by Ollf ol l be_ sj.nj5an~ rettIIl eumpl.. ollm$l participotion in public bealth. Watched by obKrvttIfrom Hail;, El Salvador, Burkina Fuo, andBnladOl", 10,000 immu.nWlioo pose. "01: let up.,.,..... 1M nllion- in healtb c~nia, ICbooI.. d vi<:""uu, markt-plao!:I and porb. To inform <benatioll'l plfCllIl, &1mosI alllllljor lll:wspIPftS IUld~ aU rIdio aDd <dtvi$ioo -*" promo..'"tho a m" !! 10 • poial~ iI .. rinll&1ly........blo: lOr~ 10 ~_wvc olwlw::R aadwbm md "ydIiId=I "-I 10 be taka lOr,..m.Mioa To p'bWi". aad ...... \.be IiorHNIlioul v............ Days, lOO,OOO tcailm...... on_" IS ill. ........ _l,llllll priau ..eocbid ;.....,nj7aricwl from pulpits ill "«'Ipaiah,.,...,. 110,000 """Wileen, pl.. the po&eaad Ute anne<! ior-, bdpcd ';llI tbc ....... 01tho: , . I C". aDd IppiO:U"'lilldy 1),000 0Ilhm' ..... f.- 1M CoIambi:ul. Red er.. __Old theIteaIlb wmm "';!h lbe lICluai YXCiDatioa oloouIllrtt-q lllf1m of. millioa childrrn (1ft pIJld 5) .

In El SalV1dor this ytal', 1M immuniution of0"" I q......o:r of I Q>iJ1ioa duld~D ...... mod.~blc by the lov•....",.n'lIId 'M IlICrrillas, byrhe health smriceI and the Catholic CbW'(h, bythe ROl&rian. and ,he Boy s..W lI, by lh. Roden. todtIiu IIld the international .,.,acia, by14,000 1Il_ 1I<;l:IIItII1S 011 I'ldio IIld lmvisioll, bylloo 5 ,000 'llI"M'OICJ1' who"ent """'" 10 boule 10iJlr_~1S atlAocampaip, aod b)' die 20.000ncciDatioa-lClDl 1!lC1llbm wllo manMd 0ftJlIJI» IC:mpCInIY 1laJtlI pcIIlS lac. tlo< Ulioa(.... puel4).

u. Kabul, Afabon ;,ua, l""' m"'" of~IIno: breIl jm""""iPd ill ""*fIllS lhiI: ,... _ !be....,n·bs Illd !be ' IOOiry IeIOc:n "'"' jl:Iined.ilb llIo: baah ocrri<:a aIId !be .... lDOdia toqllldnlpk !be jrmmrnjzwjm talC IlIIOllI Kabura

"""".1ft Turkey, this yar', "'mpo;,D to immuDiJz~ JOI, III 1M !Utioo',dUld= l\I$inWJlwd II«

iUII 1M IlcaJth Krricu but tile Pr$dcnl IIDd

u

!'limo MlaiMcr, te¥aaI ahiDet miD....... tileAqnd..... III~ aDd _, diff=D1<kpanmmu III bolh pro.inciaI aDd DllioDllpmunml. 1M COIItIuy'. 2lO1#J primuyICbooI lnCbcn belaa wert thm: weeks euly tobdp ill 11'1/ p••panuioou; for tIIII a m,," i,n. The~Ii&ious lt1dm (I1IU(tU1 lUld imams) dcli"fffd5IImIOlI$ in ""ppon of the immunization pro.g<2nlIll< from 5<4,000 lIIO$'lutS. Tbll military p_\'idee! transport lJId fuc:I, . bll JOVllmnwn, ', melland lilb ~hOllla provided cold lIonall fornccinIIa, and lIudcnll "' Hxcm~ U..;.,m",ook on .be Dlliona! ""rYt}'I ' 0 cn!UI'" Y1«i.rIaIioa w .a ... bolh before aDd after tile q mpolilD10 lOtI!, $10 1llillioII'a wonh of ,d ..iNoIl aDdradio tiIIIII hal bem 6oDalee! to publicilc ~ampoip (_ poIIld 3) ,

La 1M IuDaic:M, ' M Dinaor oi 1M PmAmaicaa H<alth Orp!!izwjm (PAMO) haI __ ...a d pIaDs for I -.-.., "'1 jw,., rJJ-t. ........ ,., --.-. -J ,.. Jr- tfwA--.....· 10 tile ..... 01 PAHO', Dina_~ Dr. CarfyIc Gucmt dc MJado" lhi$ CUIb1111dUncd _ by tIlc haolth .....iocs..rom. .....,bal byM."..,,., .......,.., .., ·Mn- iIl ...."fftll l»', ;"n/illfllw~iI1tIllf ..v __ ...n..""-'q iAliitWturI f-iJies IIW ....."" irirf _11M~ II ",,1ilM-mu ./Jon ;" tfJt'Y _~/1y,

dtdi«lltd W II (lHfI_ m lllllfY, rIIIfllllil1td '" II

"""_ ,..,,1 ...~ ,!It Ii.... hI>s~ fur III "' UI:I,I..JI II ll llllQ(ltPUlbJ. fur II~Y dild i~ ,1.4 A.....,"'0 SlIffrr t- ,.,Iio",'

TIle huhh lott\'ica """" ptoridcd tIIIIllCh.n1>-losy al\d tIIII .-li<:aI Itllpenisc for all Ibao::achit.cmu,lJ.. Illl, II•• , teclutology anel blow-bowhas bem IIIIdc .nilablc 10JOI, iDslcad ollK 01tile people bca_ it ""'" bcI<rI fil,ed to 1M maillt01 -w mghiljnrioa aDd zand 10 wwbtat.luwcb I wbole raIlF III orpnioal ' ...........with I '-iaI radl' ..... fat bcyaDd the IIIlWlllIllQCb III lhe- hclJlh ..mcc:s tb........h a.la tbiI;

· _ .... n ...... . ' ... . ._ _--. 'WIfO !of _ ... ,. __00. . . ,.,J... m."tCU_................... . -_... .. '_._-- _...... odp- ~-_ ....- . ~•.-. ..,l_.-.~ .... _.w· ..... ..... ....EI'l.

way, in nation after ~tiO<l, it is provinl possiblelO inform &lid involvc ,he majority of purlllS and'0 help boIh o;Jttle &lid mee' • much lnuderdcllllDd for the immonizatlllll of childl'Cll.

lmmwtiulioo ,..1<1 priJury bea lLb care

Thc$c atraor<linuy efforts :ul' of I;OII.f$C attend«l by a twwknce of C<lIIceml about theirsus,ainabili,y, abou ' the rompl:acency they maytemporarily ind1le<', IlJ>d about their place inIdvanciol the broader loa! of Il>Ol'C compreMa_sive and permaMlI1 primary IteaIth eare suv~.

Sustainabi1ity is a legitima le worry. AehllOie nfgovcm ment or of. key minister, a fa.l.ling-ofl ofinlO1C$l by 'he medii , • fai lure to edoale newparents .bout the impomncc of immunizatioll any and all ofthcsec can tnClJI a dwindling . way ofcoVCfllle .... es and ,h e sudden ",turn of tetanol,measles, whooping cough , or polio.

luToth... W(>ITy is that tbe boosting of immuni....tion cu.crage to tWOor throe times ito previouslco<cl will be considered achievemenl enoogh. 11thl' hlppens, then the ida of Immunization foriIIl will nOl be carri«l rigbt through.o .he p<lin,where i. reaches those who:arc the hanl..t of all torca<h, those who belon g to the vcry P"I"'C'1~of 5Ocicty, those whooc lack of money IlJ>d timeand information &lid confidence means thaI .beyan: usually lef, in ,he margin s of I IIItioo', life,thooc whooc childJ'cn :arc most in need of th.a.deg ree of protKtioD against plvmy which immu_oization CIJI pro'lide.

A thin! question mark over ...... imm\lJli....tionasks whether such campaign. an: merely. substitute for the more patient and Is spectacularWOfk of building cumpreheosive and permanentWUC'l1l"C! of prinwy heal.h """'.

In answer to thcsec COIt<'ClIIS,u pcrn,n<:c to daleSUggCSlS that the ClUse of prinwy heall h care canin fact be sitl:nili=lTly odvanecd .hmugh theinvol. ....... , of bealth profc:aion.als in a majorachievement lor national dCl'e!opmcnt, throughthe piooccriq of ....ys IJId mean. to bring. basicpi""" of health technology within reach of themajority, through Ihe 5Cl.tillj up 01 the neccssaryou,~h $tfU<:torcs, and throllih .he in"Olvemcntof the majority of the poblic in kno wing more and

doing I>"IO<e .boo. ,h ei, own and their famili",'heal th. It is fill" this rc:wn lhat immuniz:l.lio:oProtlummcs CI.II "rYe boIh 1$ an end and ... .<OCIfI. of prinwy health care, .chicving bothimmediate protection against specifK: dlscasa IIIIdthe invol\'CmCnl of ...bole socicti", in the wid...and looger-term <:IUIC of heallh promotion.

Such cunccms deserve sustaioed . " ention. Butafle' I~IY ~ean of va<.:tine availlbility, lhedenial of ill protmion 10 t~hinb of lhed....eloping WOI"ld 's children deJlllllds th.1 s0mething new m....t nOW be lried.

It would of course be prel.... ble if there we","""""" fuel IlfId ro-ds and n<frig....to<s IlJ>dclinic:s and scllools IlJ>d hca1th .."..kers SO thaIevery paI'CIIt kJlew all abou t immunization, livedwithin easy reach of pcmLIIIent immunization..rvie... l'O<'l:i,'ed computemed mnindm in themail, IlfId bro ught his or h... child",n to hevaccina,ed al c:n.ctly the right time for eachindividual child. BUI th.aT U 10 say nothing morethllfl thaI il would be prdel'lOble if de-elopingCOUntries were not d....eloping eowllrics. And lhe!ICIIlellCC !lutt Mnittmal i"' ,"MMiMrioll ",MSI <ltWi,,">I,,,,,,;,, dnot/op1Mlo' cmd IIv """in, 4 d pcmur_ ,willi clinic '" ft""JI fJi/1t.ge ill simply. llente""" ofIlII.neccssary da th and disability lor lIWly millio... of todlly'. child l'CO IIIId for eveo Jl">QI'C'

millimu nf lhose IOho In' still to be borD.

If immuniulion rcmai....t loda Y. levels tbenpolio, to IIlke just one eumple, will paraI)'$C forlife IPprtWmately 2.5 million childl'Cll over thenelrt u n run (Fig. I ) . Ln addi lloO !O tMJ'Cl'1JOnalwfferilli, the process of economic de.-eJ_opmen, it..lf will . h«eby be dep.iv«l of thecon tribution 01most nf th llliC childl'CO and of mostof those upon w!>om they be<:nmc and ",maindependent. When a cheap and simple techoology10 prevent polio is already ,n 0\11" bands, it isIhcrdore neither humane nor economic to allowthe disease to continue crippling over • quaner ofa million children. ytllf.

111 the case of nxules, the lij;urcs becomeuothinl<.ahlc. A, presen. ~ls of immunizationCOYCr.llle, • Imalof at ICZS1 20 million children In'coodemned 10 die over . he oel.. ,en ye:us flOJl\ •disease which can be preven ted by • singleinjection (Fl,. I ) .

u

[ THE SI'ATE OF THE WORLD'S CHILDREN 1986

Colombia:a child survival plan

"

£_ 110m h'-' """.OW til' P WIIleIunc llelIncu- on _ " .sa, <l'I'"---.0 01 ,. PIIn lOr o.t s..r- ...,0., ' . i. l .. CoIII!Io. on ' 9 O&oa,~ I 9&<

we PfQIll ID l» It. -.i '" pro.11' ..., _ ..........._ til' IJNICEf.. <Ill tepor'I on ,,,. Sr.1'" 01 N _ 's~Iflll b'fll'llWOIId HlWlhOr~ r10tsplan \01_ lot ,.. til' "'"~ 2000

wa _ ~ on a "'II'"'~ dIar>go InWI lIl\'lIQICI'I lO '-<1110 lld\IcalloIl jfXI lt!e ptOrrlOlion 01 ..... 1«1............ WI _ t>egI.f1 to--. .._1II1d .. lIIl<:lOtS ol lhol~..tv _ IC_ ...tl as me .-. na!JOnBI'f3OCO'lMlOn~I wtlocf1 , )'CI<l d .8(:81. III>t1IBd ..~ oo;hQ

, .... ~ 1 " II.- _ we sliI .-l 0llellCtana _ "l" _ .. .eto'I E"'It'/1'- " (;oIcm.

~ 60 000~ \RIel M s1II OIl !rom" ••Illy _ . ... __ ' '''' doe '""""","01-' __• • _ .. "'-'. <lnlg""'*'i.__

TIw _ ...... , 1IurIWl ...qAi__'-110m -.0__10_~ -,. __ "'"".......~

_ .. __ -'0 .. _ "'""'.9 our'_Ie"'.. ..."" llunn;_I'Ml"'~ IN_d60,OOO~.-y_TOxr--. PO ID puI"" ..........,.01 ....._ ...... s1.., Ol ... MonIIWy 01'-- _ • PIIn "" 0IIIll Str-.n. DIl .. _ ...... _ ...

.. CCIlorr'Cl<I' lor .....,,~_

we_PIlIllI_each_,__d..... 3 , _ <:r*l!M W"* yurt; or •

we _ P"II IO.- _IO_..._ . ..., _ lNW~. ~., .....,.lI-

"'ll .... _ol ......

.. ......... . at<:t*hn·._

YJe.._IO~"""~"10 ..~ '" CoIDn"coI ., ,.. no <:l:>ll<IIen ...---Wea' p>g 10 '*'P "l1InlnUlQ .,...-............... ""_...- 01 _* -

we ~.. goong II>~ looll suppieI,." ,IS 10 "'"c/lIklI'.." 10~ Lnl8r lWO. and 10 pregnanl"..,..., ill nul"'''''.... <l3rVtI All<! weBtl 11"""11 10llICM1e~.. "fit"""'l lO _ ... Sl,ltltnnglr<Im ~Ill fll5pOrl lCry onlclctiorl!l

llu1 -. .. IO ..... ..., ....,

~ .notl WlIIl .. lIle ......... .-. ....." 1l>ll... lIC>iJ\lIIl:W. ot all III \'011, <nl 01 Ihe enIInIconwnurol'\' 10~ tau>ers ..., r'I'IOIhOr1 10lII8l Ihe\I __ sn'QIe I<l IO ' ! ~oe aIlCI WI'II*"_o~. I 'Il lhe _ano ... 01--To del 11'0I. _ WIll _ t.C> .....01.,,,".._ ..ij(Ii .... -.:I \lIUl,IlIllDllIl' EluI we lie_ -.ng b .....-. at ... ...,..QIlImU'ofI' ... ..-.,. bPOla. IIIe1«1en..Ioe "'*"-Y__ Ioe __ .........

"""""""'" -. _115 ..~_+ ..__, ••Jb>Or .. cu -.._ ...• r' .... l<qIOIlol ~--""'"1Il ~ ..clII ". "' ~.,'" ..., CtIICIaIIi..I......~ 01 " el "*"'-...__Qllld_ __ 01

... - _... j - j'lll.IIh~...."., ..... _......,__........ Ollle

~01_ Toc:uy, CdorrDlo his IieI;IlJecJ 10c::oI_ .. N........,._ . _01 ...._ no! 10 go 10 _ "'" (WI !he 00I'hfy 10Qo'rY CllIl .. _ _ 01 _ ltle _ 01

~__01Cobl~1 cNdo'erI

Thm:;" nn valid rea«ln for fumer del. y. Andthere ;" no pre-crdained reason why the developing n.tions should tread the same penh In fullill\Rluni..,ion 0$ was bea.,en by Ihe indumializedworld .gen....tion "In. f or like JJW:ly nf Ihe lllherpo...erlullow<Oi\t ba$k hahh $,ta,egies .,oail.bk10 ,be developing wo<!d ' O<UY, immuniz'uiohcould become I oomributing elU.. m her tMn IneventlLlll Cilnsequetl« of ec<lnomic: I"Owtb andtomprebenl.ive heallb care. 11 iodear lb.t tbere is• Jong-leJ1ll Cilnne<:llon between lb. menw IIIdpbysi<l.l developmen' of children and 'M! socio.Iand economic:developmen, of 'beir n.rions. Andhaic ".ps ,oward$ prou,cting the lives and ht:althand norma/growtb of lb. young are tberefore IlIowly maturing but uceplion.lIy high-yieldingin.mmcnt in ec<l<lomk d.velopment ilOClf.

There ore also shorter·teJ1ll e<;0<l0JJIic benefi's.In lhe industrialized world, the immediat. ce<>nmnk gains from immuni:ta1ion programmes haveb}' nOw allllOSl been forgotten. BUI to lue lheUllited Sill.... In e..mple, the prC$C<l1 COl' ofvacdnarion progtalllJllC$ agliDSi three of theCilrnmon infectiow diseases comes out ., S96million I y..... Witboul lbio P"'llromme, lbe cos,10sociely of dealing with tb_ threed~ (forhospitllllttUnenl and reh.hililaliO<l) would beal1..., SI,400 million I year-meanins tb.uppm";_mold y Sl. is saved for " ery SI invnled in the.<Krin.,ion programme! Similarly, the UnitedStiles io now avilli SSOO milIiO<l • year onmeW.. lrealment _for III out lly of onl y S5<Imillion I year On ~nting measles by immullizarion PfOI1OII1I1IC$-' ACl'ording 10 D1'. Williamfocg., former Direc,or of lbe Unilcd SI.lesCen lers for Disease Conu<.>land DOW hud ofth.international T..u. Force on Child Survival:"M17rc "'~m "" 'IIC~ On ,...... ,....., in 1M dtulopi",

' 11>< T.... f""" I.. CbiIoJ s..m..I_Iormod bip-k-o<l~ io BdI";" "01,, ;" 10$>, I'<I«:I<>J<0IIII";'" ill iD<r<asiDJ "'" ul1/'i"i"S~'" <OW....,'0 i<IeIHi/;' ........~ _ io oJ>< lioIdoJ iolwO_. 0001 10~ '"""""" for i.......i..,;... _fUIIII<>. 110< T»ltF-. ......·N·' ·d br. _ ...,..,. l6, !to< .........""""oed willi tbild bnltlo: WHO, U1,aCE ~ WcridIl&ok. til< UI'i,es""'" h<IoJ it>>«D<NI aior ...... i....~ lI· . oi eon.f<"',~ ill OCto!>« 198~

fJJ«/d, wMrt """/Niil)' "ltd """uzlil)' for -..In ore~itlsn, WOIlId '" twit f'(Qltr. .. 0 prelillf;IfI)'Y" .../yriJ ~f """ ilV p<orrollf/IfD ;~ 1M I..,., eo..."for .""",pll, '"",,,u 1M />eJwfi' 10 ",.. rori<> "",y _ 1It xcud 20:1",'

N.w leclutolotiu

So fa" i ' has bttn conv~lli~o, 10 discuss lhelecbno/OIlYor immuniU l;On IIId the Sltategies formalting il mere widely availabl. IS t....c xparotecomponems. In practic e, of course, lechnologit:alchangn <an h."" • Ioigoilicllll effect on bulbsupply and demaad.

And lodly, vaccine te<;hno!otly bill moved on 10the poin l ....h. .. I hallon', . bilily 10 reach high[e",,1s of immunWlion COVC1'aie bas become:oignific1ntly las dependent on ilS 1.,'.1or o..-nolIownomie developmenl.

h has been commonplace for some years, foru ampk , for two drops of oral polio vaccine 10 beacIminiJ..recl by vWaae helllh worken.. BUI recen, trials in Cen,ral and Soulb An!crKa have$hown lhal chUdren can also be injeclcd Wilhvaccine- against DPT IIId .......1.._ uloinB diJpoteable $yringes in ' he hand. of conununily YOluntten wilb I rew houl'$ well, thoughH, ul Inrinin~

(see panel 7). And .. thiI repott gDes 10 I'ffl&,trial. are bqinning in Gu. ..mal. wi' h the'E,"ject' 'j'$tem of vacQnalion in which bothvaccine and needle come packed l"Ielher in I~le-1h0l disposoblc plastic JYl'inge. AI yel,lhere h.. been nO compiet. evaluallon of l lU$method and lh. $yrillJe-nredk-vaccin. pacbge ionot in commercial prodoction,"

BUI in the last few y...... more conv.ntionalkiods of di.posabl. syriog. h.o.c demonslntcdth.ir power to Clliend lh. oulreacb of immuniza_lion's arm in seltings as differenl as r akislan, ElSaIVlldor. Bm::il, ond lhe Dominican Republic.

.. SfI<cific U'IiJUol: " ~oir<d 10 ... ohe ·Eleja;t· .....!Iod01'

._....,.,. .... ... 1<••..,., of "'" lioId lri>Jo .-_,

._ • JnlOIp d lJIOO <1IiIdIeo ill &.1>1 _ be,""""Nr b)' ...., 1-.~ _ ";Ill ,be ·E>rio«'.,.....,. __ «IIIdU<t<d ill .... Uoitod So".. _ Cool. Ili<o""rioa 1976 _ 1m , hu' ,,,=, .. . om! l<Jr runb<t!lridev>l",,;"'.

"

I TIfE SI'ATE OF THE WORLD'S CHILDREN1986

Burkina Faso:a vaccination commando

"

III one Ihr......... eeee, S\aIIJlllI on 25 Noo·....- 198. , BurkmrR!lOh<II~Ie<l_'molIoon ol flli~ 803fISl1ll6aSlel.. vIIIow tewIt"'" 10__9'" '" t>e _ 01 1981. me__ IIall ............., onl\I 25.000 01 lIle..,."....... hill • _ c!lollIren urdef 1WO

No e>.P8'1 -... ., Buttu,o,. F..,./omIIrIIt \JllIler -. • INtf .._ to< ..",___••,.ll 0...0:- ; l)llCII Ile3!l: Of.... __ '" """O1l f '- .... or IN r.gr,...... "O' ....i_.. ,.'-'O_l~~_, .000~ _ less ..., ".oflN~I\Al

P"C"..... _""""""01.__0. • .-.c 01 """"lI~ .. d'oOClll\'__ -.g .... __ IO ..

.....,... _ _ ..ClUIWyoUng ..ory_ .."", F..-y 1O..u... The _ .. "',... 5 ' . ClIlllnIl<s __ 11 _

_"':lol" _ol~1lII Salone_ b.II _ .. a ba<l_"~C*l90.nognas ' 3.000 ClOSeS

n- ........ .--ed 1IIlI~ I nowgo.e< '.' ", ~ 110 'Vilfl[lr'IlIUon Com'r\iIr(Ig- -. mas·SIVeC&1CI'I-uP IfTI/nlIf'OZlIllOII til".. 08SIgnIld 10OMJme 1leaI~ _ a _ 110m me~' IOC

_. _ • b'88lIl~ on _ to pj«ll",

~ "'" regular vacdnalIan CO¥efalII.1o _ people's 01 lie ...... cI

O'I'II'lIUr"OUDOn. V_ Co... eoOO_ lIle0' Illl:Il known as 101m In IUluNI F.,V ,. ..__10 lJ""I

_ _ ant, .... stooIbW .............

On 19 SocMi'iOS IN CClA:iI 01""'-' _.. _ TN __ ~....._, Coo .._ lJf .... ~otl'ldc~ ._ --' IIor:l .."._ 01..._• bit.... \ ..,."...., ..., _ ..., .."",............. , W'i'- .. \1l1l~ QN;Mi ..-.ct.~_-. lHCU. .. AId c....ltd CIitIIr lib _OIl ...... _ ..,.. __ p_" •• e, llCCIEIIy er....,..Aop.t>.

Ie oIl<orea. -'W"M Ieo::tnclll =......

The CorrmtHl8:l b' .,. DeIerJce oI lto!Revl*J.I01lCOAsj- POIillCal .aII.<I_ Ql OUP!l llCIMI IIIIYf:Iy ~. lOWn ...... --'<.place - look ort !hemosI c:ruoaI _ 01 ..~ t'- COIIWn,f'II.

~

As 25~ _ . COR " . ,_ . __lIIXII' 10ooor~ IN lBlef:Cs 01 ........._,10__ 1l'Iey I'Jl,lI uP _ WI~, -.IO'lI1 lltJ1*:__ III _ 1>1~ III.' 1 I_OO~ ....., \ l*Ys ""'"___I*bn"ld ~ The

f-.t_ ......._~'"...._IIr9.. ....-o__.,.....,_caAnlI ...... "'¥ camen

......... \I'llI __ p.-s --' IllI b__~_0If ~N! b_~"

_ gl _ ...., d'Iben *".,*' b Wo....... --'rwMf'lIlI'o'OI.ql"l»y r...carne "..- ... _ kim~ __.-. lIIeI1lIll til' _ re:;alMlS '" illmrIa Fa$OCtilcIrename__"..- _ ...... _ •....,

*""-"t~~..".-lIOn~ '*'10""""" ..ttl .-.cconlI because lat /IIOIe C/lIlcIIenIl.rnN! ~ _ eJ<l)eCIN!. _ have -. onIhlIITlOI'e i'l Burlunll FlI8O. as .. al lIIecounttOfiottIIll &ough1-1lnCk.., 5ahaI

The -.II. '" I I!"9_oIl'J1l"- 1......",62'l. gl -.. ...... III.-. life """"""'*'agaql '--"""~ ..~ """.0\jIIII._ .._ "''"*_......lII<l--',...,.... ,... frOm 7'" k11i1l'1o

................... '" CD' .agoocanbe..-..cl"' _ loci '" ..... Cll:U*'(Id. ..k1111-. llulV ,Co," ,. d;>__....... ablgo'.'ll The 7 ......__""- 11> ....... ClIIclMrl·. _ .. _ or.... )01. "-- 01__

.,.-.gon kim •• • .......~ r_

.... '*-'*' ....b~pmWy_

... 10.. II 30 llIOO' _ • ....,..........-.g at II.....,.,__ by 1090

'" panicul;ll", ,he UK " f disJl<>Uble syrinSes inthe hmds of «Immuni,y VIlIUnlttl$on certlin SCIdays '" .... d ,s of the yrsr is "pening up broad newpubs I" the immunization of all chi ld=,_

o !lcrIux the syringe isdispootd m rolhn ,hOllsteeitized for mISC, vaccinal ion P!'ORramJII[S anbe: frttd from Ihe weiBh' of ,ime llld energyIt'quitcd rc boil syring ... for 20 minul ... bc:fon:n:use (al the W\>[ time .. reducin S the por;:sib'~IY

of disease tra.ll<mis>.i"o via muhjp~ ux of 'hesame n=l~) .

o !lcrIusc: r<>mmuni,y ,'<lJun'e<rt can be IIUVII'0uS[ ,he syrinS', immuniza,ion P!'ORramJII[S an_ape rrom . he Slrail-jar ke, of the dorIor's wbileCOI.I ( fully qualified docIon an p~ a supeniiOl)' role in sucb PTOllraJllllltS, ra ther than ~Ili

penonally inV<llved in giYing ...b aDd <wryinie<1ioo ) .

o !lcrIux vitLaae varcino'ors rttciv. supplies00 jus, ,wo occtSions I yur and u,e ,hem withindays ,,{ their arrival, lmmUnizatiOCl P!'ORramJll<:S<»old be cu' f_ from ,he <:old chains ofrefrigmnion.

o And becau se lhi. method [()Illd be used toimmunize such a biSb proponion of ch,ldren l ll a,one , ime, il mi8h, mun , hl l ,he lransmission oflhe iortcti<MIs diseues W;II $0 sc~n:ly ;n,errup,edtha, I dCVtt of pro ,ecUoo would be provided....0 '0 those ...1>0 W<rl: no< reacbed by ,be:neeioolion juelf.

Techo<>ltllicaJ d...elopmeol1 of 11m kind an:Ille",fo« malting il tnCIf[ pos$ible r", OIhe!"'llan izcd =tions of "",ie,y, far Srellel' in lhei ,OII,n:ach thIIl the bealth services themselves, '0bec<lm< inVlll_ed in . x«odinS immunizltioo ' " alla nl tinn', chi ld..n.

BUI makinS uni~na1 immunization possible by00 means lIlIkc:a n in...itable. And 10toll...rt ,1moew po,ential f<>r uni""rsal lmmUniulioo lo,,, II«loCIull vxcinatioll of all child....., an act ofgaJ ....izinll poli,ial will -by a nation's lcallen - is,be: c:a, lIyst wbicb ,. $0 d<SJlC'ro«ly oceded. AI Ill.S=c,ary-Generol said ,his ScptClllbcr (I!nS) in1m n:port ' 0 'he Geoeral ~mbly nn 11«<><CUion of , he fortieth anoiven&l)" oftbe Uni ledNa,ions:-

..nt 1Ui"~ '" """l j", ,,," ,,,=,,iorr I~ all<hildml ill 1M IDDfItJ ~ /990 II(IW Uirm.l ' ''fIIlhk ~f...,I,=,';"" if ,Irnr is " u>ill 10 .tt ,M ji""l . fftm."

'" the las' y= and I half, me ou'Slandin,g~nmples of Illa, 'will' Ju,,,,, bf<n KCO ;n Sl'"ttaloa,ions of ,he dc\'Cloping world. Thty ho"" beenmmples ..., by heads of state and governmentmiois tries, by health xrvicc adminissrotof1 lindprillW}' beallh care workCf1, by dOCIOI$ andnunes, by local 80vemmenl officials Ind civillm'1fItS, by the 'NQI:I><O'S "'llaniaations ond theyou,h lOO\'tmems, by ,he reptt:SCmllti"csof ;n":1natiooal qeocic:a aDd of voluntary " rgmiDtlons,by jourollisll ond broadcasIen, by priests andimams, by leacllm and SllIdeoll, by ,he RedC.... IJld the Rotarians, by ' he private sector andtho tnd. unions, and by llWIy millions of patenu.

10 mos, if nor III cases, lhe mobil ization of a5OCiety" reoources on sucb I >eale and behindsuch a ""USC has heen lllade pos$ibl~ by rhedecision of a notion's political leaders to pu' thei r"wn per$OJl;O/ and po~tir:IIcommiun~n',..,d ,heirll"yemmcnt's financilll and mpnlza,ional ,.".seurces, be:hind the d fon 10 immunize the OUIOIlIj<>rity "f tbe os',,,o', child..o. In EI Salvad<>rand ,he Dominican Repubije, in o,lombia ondBrazil. in Turkey and Sri Lank.l., in Burkina Fa.oand the Sudan, fIIC«Sl $0 f;ll" Ju"o beeo madepossible by I oalioo'l lcallership decidUl& 00 I

lloal which it could see was both dramalicllllylntp<ll1an, and reoJisl iaUy achievable,

The illdusuillliud worid

In ,h. indus'riaJiud world, ,h~ COlIUni"n~n'to

world_wide lmmUnizatiOCl bas $0 far, and with afew honounble e~C<pOOns, been modesl. Anaceptinn large eno ugh '0 demand acknowledge_1Il<'tl\ is the $100 million allOCll,ed ,his year by ,hegOV<ntIllCOl of Italy IS a special roOlrihution'owards ........., rli. lit>t1 of 011<", ill;"" (lIiltJrnI","

(Hulll, ,b. rl<,.. loping rooo,ries ,be,.,..lvesIf[ providinS oyer SOll. " f the: t'CSI>IU'C<S for theirneeinatio o progrmuncs."

Meanwbile ,be 'otlll :utIOIIJI, of :sid bringprovided by ,be gOYcrntnCnllof <he indllSlrializednation. for all health suvic<s ;n the de".loping

"

I THE STATE OF THEWORW 'S CHILDREN 1986

Dominican Republic:reaching every home

"

l he II'BaI8Sl'""!jlo lfftall<>'-ot aet»evwlg

a """""bOn ., d'IIIi:l health is ee <liHOCUIIy 01leaching "'" WIlY poooresl 01 "'" C1e" e'JP"ll-"'"0 C/l.lOrCl1.

1t>o d lll:<:uhv SIems from !he fac t lha t POOIeIeeeee I1iwe less~llon ana C<lI1ftlence. lessstalL.l!l and access. end _lime and _ IV'Id1lo'Il81 makes if ooutlt,t imP<><\<lIIl ;S \lie fact ilia!I'Iealth J)f(lblems SUCI1 as _ d_ 01_ are both moRICOO' ....... ,andmor.. __>g "'" poorer _ fIOne (II;mySQQet~

Tl'ioll I••\Ila(I'8'''''' prOblOm \1"'0$ 9IleCiaI sigoIl~

<:I>i'oca to _ 1 IS tlO'" beong~-and

pIanneO- ., Ihe Dorrw1io:a1Ile1lutl1oC

0It>et ClDI.WIIOCS M oe a n<'mple<l to~O'eal(ll' J'I\IAItIer$ 01 the IlOO< by setlinlllJll~'aI'I lI'IIIT"OJ....zallOtl posl$ dDser Ie pe(lJlI!l'$ tunIlsBuI 1"" Dom>nocan RSllUbhc is goong all "'".....~ ~ CII"Y""1l oacdnahan right i<lt<> !he Mrne 01every sOr>gIe famjy

In 19113. the t.linislry ot _ 's ...... syslemwM1 "'to 81:1"'" 101 "'" !ltSl _ as 20 ,000~ gave OI'aI POlio . _ 10 choIc2renun<leI I"", One ol I/>OI'le '''llIu'IIOOfS' WirS 11...Pr_ 1(l1 1!Ie Oomncan Repo.Clloc - wlIO ...11tIe. <ampie ~ I'W!I$f>t """.....zng 27 etWll",n " Ills0WIl l~tlOOd . Some 9S% oj IN MIIon".cNIdreo !\aYe bee<> ,...,. prOleCle<.l "9all'l$l poIIa

_ sn:a . and flO nowcases MWl be"" '''I'OI1ea101 0I'8r t¥l'O l'88f&

follo\w'lg tne Hea/tll MinISIer's Slep-by-SIeopI/In. !he syswn -.. onIO BCl><:o1l>gaJ'1ll 0cI0bert 985 - u... lime 10 lal<8 01'1 "'" mom a U""'" lask01 -aconallOg all tne n,u.on·. clIiklr~ ag8OflS1measles In malt)' 1ll1IicInG. """" QUlIlihecl (lOC/Or.OI.....- ,,'" IIIIcY.lId 1O I'SelS'fl"'lle5 and~ to_ ~. But ., 1M 00rn0'I0:an Republic.

PlOII'l"'InQ metho<ls hMl reecee Iho UiWW>g tooriy lour _l/'><lIq'I1<Mll hOurs , An ,, <,I(I~

I9aCIwlU package-beid 1_..-.andteS1e(I ogan Dy !he MO'IOllry 01 _ - C(I(IVfIY'!me ""'"C t .,Ioomat>col a -0101'1_ _ 10 I"ljeCl a

chdd sately "IJ"lf\$l measIios. I"" f9d Ir3I<WIgCOIne haS been foIowed by all 2!1.00a voII,onTOOrlI. WOIlmg ill m l !l't'IJIlII U'lClt< ee _$ion 01 sPecIallY _ IlW!l<IIlMI Dutmg lhlItranng >'llIuo!\lflrS practISed ac1lJaI ..........-.z.31ionby lI'I"'l!I cac!l _ an ""toon 01_ .... a12Durlnq !he C3II1l'l9" iIseII. <Iisl>oseble symges__ u<M to otwIate !he d ;fl,cu'hes 01 SleoOZIOII...-,

Aline ena 01 1985 Ine ..,..." .... 101"" I$llue 10irrrJulil:e ell VIQI1lef1 ot clIIId·~ "I/tl ilgaII'ISIIeIanUS. so 8lso PfC_"", lhe ncw-t:>om bafloft!I ot!lie M UM . Al !he same llrM. allc!Wdlen unO<or two..... doe to be~ Ine l:<$l Ollhe lI'lrlle ~IOI'IS

IIQairosl diI>Illnens . wf'lOOPonO <:W;II1. IIIld lei""""

PrOVldOd the CUl rlllll 5CfledI,.iO;>s ",,, mel . llleDorrOncan FIeputIIIc~ have """'InleIJ l'>e IIaslmllp' Ll\' 01 ~s und!lI·l.ves~ the ""'"' loUer~ o!c!lokh:.lOO by rrOd-1 986 -tf'j'aaaoll ahal! year, _ oIlne iJltomauonal target dllte.

By w.sMullng r\ll.tiOnill v&eanallOn dII'/S (...",_ sen! out [USl iJl advance !rom 8 """,,<IICOlil :l!o<agol <lepoI). the progranme "- scI'vedthe prOblem of~ year-'wn<l "'.. lgm....lion IllI!Vef)' 1lea1l!1 cJiroc By lIll1/1111\l tnOllSaIl<lli 01ilCUo1OOiS. Ihe prO\ll""""" lIeS _ Ihe pral).lem 011101 tleVll1g ..-....gIl llodors 01 p<Ilamedic8ByVISflirIg -.ry home, meprogrlll1Wlle1Ias_!he pr-., at feacIlII1g the POOl"" By 1lutI01~

the S\IIfl and fundlng fer nalIOnaI vaoornlo:Jl1 daVsinlo !he Mnslry 0111001""" ""'" budgellinl:l\ll:ll"llPfO"'SI(II1 fQI tho reouw lIaonroQ 01~vo/l.UlIeeIsl. Ihe prograrnrne 1IeS!llCl<Je<l 1/'18 DIal).""--To IlJPPOI1 theSe e/Ior1S. 1/'18 _nmenl ..AUQUSI 1985 IauocIled 8 Natmal f'rogr8llVlll: 10<Mol!'ers end Cl>iidren. 00\h the ~.?"" onirnllrOYll1ll tneIr '''XlIIll8i "" III llOOl rural am si,mor""" , he plans r>cludc larrllly p/emIng~.

pre.netal CiQ IIrIO ,...,..;te lIaorOo\; , aklI10 ...mM\IoCe on OIeasl._ng, gowt~ 11"I0I1I1OI1110. end0"'1,~""" to IorestaII diar<hoeaI <)eI1\'dt1lbOfl

world i< only abou' ~,DOO million a Y"ar" -th~

tQ.uiV:l.I~nt of about we dlYS' militllY apendll1R(Fij. 19). ADd of that ~ billion, only about 10'goes to 11I1 m<llb~r Ind ch,ld heal,h servict5,,1I<:IOO,ng immuniution ."

By conlnsl, many priYlle groups ;n lhe indus'rialized nations '''' heavily and generously involved in conlributing 'oward$ ,h~ goal of imm....nization for aU child",,, by 1990.. To mc:Dlionanothc:' particularly ou'standingmmpl~, ,b~ onemillion mc:mber$ of Rotary In,ernational baveconunim:d the:mso:lya 10 PlIyillJ fo, all lhe:vaccine required in any polio cam paign in lOyd~vdoping country 0"'" ,b~ live years from nowuntil lhe }'Uf 1990. The loW COIIt of R01I1YIn' UI1J.llonal'. 'PoIio 1990' campaisn mIlld bo in<h~ "'lion of SIM million; <h~ tOlal benefit couldbo ,b~ prevention of mon: than I milUon C'ases ofPlIrllytk poliomyelitiL " In many ;ndustrlaliud.ountria, utionol ronuniTlees rOf UNICEF andother non~ov,,",me"lal organiut,Of\lI a", alsoworlcing '0 help nisf: funds -and aWateness-'0support the goal of immun,za,ion fOf 011 th~

world'. child",n by 1m.

Then: are pe, haps two oWn ",asan, wby thego""mmenll of <he indUSlfialized wOfld migh,wish to consider a much grea ter levelof IUppon inorder '0 help ",alize thi! new polent,al fo,u",venaI immuniut'on .

The lim, and m<l5l imponan" '" thaI lheimrnuniution of IlII child "", ",OWlIS one of th~

gm n e>! of all human,tarian goala.

T1>c second i< that it would abel ","ult in vr:rj

signiliaonl economic goin. fOf the ,nduotrializednati"", th......I....

Eyjd"""" fnr thi< i< '0 bo klund in the an nal. ofth~ in ,ernational ampalin 10 eradi"l~ omaIlpox:-

10 1%7, omallpox killed an estimated 2 millionpe<>ple. In 19n, the last case of smallpox wun:corded ;n Somalia. Th e l:OSl of the er.Idicationcampaign was Ipproxilf\ll, ely $24 millio n a year.of which about ont-thini came from Ih~ indUllria1ized natiou, and , wc>-!hirds came from Ih~

deY~loping countria IM"""Iva. " For Ih~ dUnltion of the programme, the Uniled Stata ronlril>u,ed I total nf $32 million (in 1970 dollln). ~

Sin"" Ihen , th~ Un,,«l Smell g~rnmen, hiS

been able In diK:ontinue smallpox vaccination anddismantle ill elabtlnl'~ quan.nti ne aDd surveillance ,YSlems _ which w= =ting IpproWnatelySl 20 million I }'Uf in ,<>day'. ,~rms. " In otherwords, the ~tion or I major disease hasmean, thaI th. Uniled Stala i< now ...vil1R tflt'Yfew """'1M~ Iballthe tOiailmO un',1 invell,edin the e1"Idiralion P"'lrammc: irsolf.

As we have already menucned, the UnitedS'"lelI i< 'oday .pentlini approximat~ly $50 mi1lion a year on vac:cinal ion and routin~ surveiU""""lll ainsl measles and will ecnnaue '0 do SO rOl" aslong II _ I.. i. a, Iarg~ in ,he world. A$u=fu1 er.Idiation programme would ,h~re

rore lave the United Smell $SO millioo a year <:Ye1)' year fmm now 011.

The humanitarilll CIS< for immunizing all. hildrm ia boyond all question. The ,echnologyfor immunizin x all ch~d",n ia radii)" lvaillbk.Th e ctl5, of immun izil1R aU child"", would be",paid many , irneli over for boIh ,ndUitrlaliudand developing nmOllL And the all·imponantorgarliulional and rommunicatio ... capaci'y forl'elIChinX OU' 10 ereo", and met' l Ihe dema.nd forimmunizing all children, has been sIIown to llewi, hin ,he power of ,hose nltion. with ,h~ wUJand commitmrnl'o do it.

In tM process, imponlnt mid.. could lle made'nward$ primary bcaltb .... fOf all and new wayscould be opened up for putting other pHo:ea ofvila! heal,h I<.nowledge and other Inw<OOl.technc>lOll'" at Ih~ dispooal of th~ IOIjorily of the p<:Opl~.

Th . next chapter of th i, ",pon dixUSl<Ol $()nIO

of , hose othe, low..cost l«hniqua Ind Ioola I Iwhal CXIl bo l~amed from experienccuo fa' in ,h~

allempl to put ,hem II tbe diopo$al of ,hemajorily. And as wjth inununization, Ibe solutiondoes nOl ..... solely in the lechniqua th......lv...,bu t ""her mid.. in the w~1 and the capaci,y ofnatio"" _and Iheir leaden - for ",aching OUt toinform and .uppnn parenti in ulin x those ,ecbuiq u.. 10 taIr.e mo'" controlnve, their own andtheir familia' healt h.

If thl' ClIII be achi..<d, and if in 'M Pl'OCCSllhealth eare can come tn bo IttO not only .. pasoivereeipienoe of services when sick bu, ;OS aocti,-e and

"

I THE STATE OF THE WORLD'S CHILDREN1986

informed ifIvol""....nl in lhe daily proc:aII of$llIying well, thO'll the lechnolOllies and thekno1olqe D<lW available,,"", cheap enough andmanageable enough ror parents ,hemselves 10

bring . bou, • revolu tion in child health an d CUIby II lew IWfthc n lc of mabull'ilion, infection,and death among ,h. childre n of the d• ••lopiJII~,,,,-

Reaching aU childrenPatents canDO< make <hcir own vaccines. BUI

'h= is a product which pamlrs can make, whicbthey can gi•• '" Ibcir OWn duJdnn, and whkb "jU$l as ,mpon ant for ptOIecting .bcir Ii""" andthor hnlth.

Tb..o.t prodUCt is on.! rehydration mlut;on. ItOld "" 1tIld. -.vilb nne of the 200million _ h. .. oforal ",bydnllion WI. _ rut h wen: mass.producedin 1M d~loping wmid 10$l. yc:u (Fill. 6). Or itcall be mad. I ' bllllH' usinB ci'lI.... .al l and ruguoolu,;ons or tAditional remedies . uclI as riel'COll~ or <:aITQI _ ps.' ElIhU WI)', such •solution COP dl"c<:ti""ly prevent or lltt! ,h.dWrllooll dehydnt;on which is $tin killing apoprolcirnalely 4 million child ,..." _b 1"','

The technical de ,aib of O RT a,., KI lKI' in PartII of this "'PO" (xc lifelines: ORT ). BUl luch Ihrellklhrt>uih hnrs restating in all itl simplicity:.

171m is MIll nn iotmdibJy dwp, fi",pk, "'ft,alii•ff«riw /lVlhod ~ ",/lic/l po...... ,,,--1m, .ww....... ptNr, <>:1ft jJrQ<tt:, 1M Ii«> IIJId , .."" ,/1 ~f ,lvi,cllildrtn aga;MI ON of 1M """" """_ "'run of

, Lo .... r-~. OP-T __-u."",, 10.,;.... <midI"O<! "'" _ o.n..",<$lito<k of <lianboea. T. f't\"IAo:< til<<»<AtioI ~oidI ..... ooll~ ani ....)'drMioo aoI_ "'" b<odmiDiP.<ted b\l' til< _ .. in til< <AiI<l~ """ _ _,.",.citba. 10 «III _ of _ ....'fdntioo 001<0; 0< . _ '_ 001. ,* of oo/t. "'I-'< (0< rWo< rowd<r). ood ...1« (i<>.... ""bl __h Of • v<nioo of OIl< of til< <ff«tj""l.-JitioDo1 _ _ • • rita _ i<c> Of <VJOl _ po........ ....w, 10'Ii oI lIII ""'" will _ ....... opodali>«lttQl.IIItlI, {oudo .. til<_ ofWHOjUNla~ lormul& <nl....ydn<ioo. ..- 10,_ "'"'Pl'l . "'" io oil"""'" til< ri>I< ....m, 01d<b~"-...... tb<<II of ~ ;,~. b\l'!II< , ao1miIlioIruioo of oral l'\lfotioo> "' tb< -.

</IUd ..,In.,n',;"" uJ <lI ilJ tIrolll i. 1M .......

-~At present, only abou t 20'4 of 1M world '.

families know ~o01l&h l bou l ORT 10 be . hle 10u.se ir. BUI il ill aireldy "'Wnlllrd 10 lit saviog th~

tim; of lOOIl' tblJl hllf a miJlioa chil.mn a ycu.

TCliether with risio g immunizat ion rovenge,th~ spread of ORT .h~rd.,... h<llds ou l lhepromise of a d<utic reduction in dtiJd. deo\~ andchild malnutrilioa ever lhe ntlt few ye"an. Bu. aswilh Unmuniz:a.wn, rulizing this tDormo"" p<>t~ntial DOW d~pends not on Ih~ Id~ntifi< break·through itselfbUI on finding the ~ulv.lenl 'socialhrultLbrough' whi<:h <111 pUt ORT I I th~ d.isposalof lIIIDy millionsof ~nl""

.. TIlt lI.i,td StoIa o\icII<}' lor Lot~ Ut" loiWaiil(liSAIO). _ do AdmimIo",.. ,..., .""~ III>11II6<...... '_.,'0 til< pn;>oaioo of onI "b1dn.... ......", in til< _ loP.. _ ..... is _ ,ribW...........1ioIIy 10 ...- 01 til< ... OllT __

.. din thio ...... "',.,.. (I« _I n The lINDP ....oloo rio,... • Iiltoili<u, 1<1I< ill .... _ ....-' triDc-""", 01 oral ,- """"'. l!lh>qb it> ......"'pport 01 .... I C<out !<It IIiotrllo<ol Uitt__ b 10 Bo011 • "" (ICIl DR.B). th.wob .. _ ..........of . hiclI OllT _ ... ;, ... . ".." ..... ' ........b .. """,--,"p (_ WHO, UNICf.F "'" us.o.1 D) of til<IoI_ Cod ,_ o..I lt<II,..... The<an.TIlt__ 000_ ;, _ in "' ,00 D.C.• tIIio~ ..,.. ,. _ a1>d -ill apio brio& ' 01 ltoto_y<liIl' , ..tiooo, . ....... .....~ """ "'" <Ii=llyin in ' M ,.. 0I 1IfOIIlO'ioI a RT. ADoUct UoiItd" _, FIlIld !<It """"'I'" A<1ioitirll UNFPo\l -.1< ..~I_tri_ to ....

-uk of lCDD R.B..... iollO"i<ulu. ... fuzIdod .......... lUo:h -...... du' _ '" dIild '0 l>oo~ ""-«l....-.;..J,.,.. ...... d<diIo< .. -..IM"'I""",b (_ ....... I l l .

cllildmt who arc now dying exh day in lhe:de"eloping " wid.

It has been found, fot u&Dlpl.. !h11 babies inpoor communilies who :In ooul...fed .... lWO orIh"", times mo", likely 10 die io infancy thanbabies who are breast-fed (Fig. 12). R... r>iDgthe l",nd 10Wliros the .... of artificial infantfottIlulas (Fig, 7) «Iuld th.refore Ave lh.c ~ ... _and p7QIC<:I the norm.aJ gro wth - of hundreds oftbouwtds of infanu in lhe d..... lopilli world {Ittpanel 23 Ind lifelines: b.et1l.f~}.

II is also now lhoushl that regular growth. hoelting, al""g with ebanges in the lUning andmr!hod of _inll, could reduce by half theincidence and ~""rily of maloUlrilioo among lhcpon. wwld', children (_ lifelines: llrowthmonilorilli) ·

This yea" anoth..,. poIcotial.bl'9klhrough 10\11I

be added 10 tho list, The finding, from • majorchild health study ;n IndD<lClia appc# 10 haveronfinned I loog-held suspicion lhal a lack of.itllnin A in lhe child's diel, long known 10 be Icau.. of =<>phtb.tJmia (drying of lh. cyet) and....cmull blindnl::ll, is 'll1lO an important delcrminanl of a child ', overall health. Pag. 12 illUSlralCSIhe remarkabl. findioglhat lho incidM<'eof bothrespinUOl}' and dimhocal infcctioos {the twottIOSI CQlIlblOI\ c~\ISe:l of illn.... and dealb amoogchild rm of lbe d.....IOI'ing WO>"ld} i. c1o.d yassodaled wilh Ibe dCS"'" of Yitamio A defici,ency.'

Al Ml, it was believed thaI Ibis IIIIIOciatioocould h.c explained by lbe idea Iha! the lack of,ilamio A Wll$ probably only an ind w,110, of IheIIIUt1: l encral malnutrilion which is w.U I:nown \0predispose a child 10 illncu. BUI fonbcr anal]'1il;hOI lug.gated lhat Olhe:twisc well-nourishedchildtw who lack Yiwnin A are lOOre prooe toboth dimbocal and =piralory iIlnCSlCli than an:poorly nourished child. en who happen 10 haveadcqual . 1.....10 of vilamin A.I

In the OM maior lest of Ibe prxtical $ignilican« of lhose findiogs, 'I oppeatl thaI diflri bulion of the fl andard UN ICEF vilamin A capsul...cry IiI lOOOlhs has suc:cceded in , educilli childdealh r:atl'$ (in the "ie 8r<)11P one 10 lbru ytVf)by apprnlrimately 30% among I population of 0" '"IS,ooo cbildno in Indonesia.'

"

Rosie proIe<:tioo ..,d vita"';" A

ORT and hnmunin.lion 1"",0(= 'l"",d in the:from line of a rnolulil!n in child iUM val BUIlhey do nol fland alone.

Ove, lhe lut th"", yun, tl>c: 514,. oj1M W",./d'iC.ildffll rq:>(In has broullhtlOll.tha raean:b "",daperie""" from :around lhe world 10 show lhat....eral such basic brcal<lh'OUIlIu have BOWbeenImde. Taken 1000eth..,., lh.y could enable _pw:nl' in poor communities to protCl:l !he ~v..,

and nonnalilrowlh or their childn:n.

Specifically, pre,iOllS )'CaQ' "'pons b"e d...monstrat ed lhal knowlcd.lle about breasl·fcedilli,impro\'f;d we:oniJli, and rcogular tDOoi\o}rinll ofchikJ",n', llrowth could , aIooll Wilh immunizalionand ORT, ssve the ~_ nf II leul balf lhe 40,OOO

_ F_....uI!:I co'",......·pmclL.Clion n lIdOIIon 101'WI_~, .. _ IO_POdalU ....~~0Cte~ ...._8C--~

Fig. 6 Global supply of oral rehydrat ionsalts lWHO/UNICEF formula)

'70

"""""""". ''''~ 110

~ '00

§ :;" 70~ 60> 60

so:JOeo

'", ""J"..ao-~~-"",-~!,----,J~

"

THE VITAMIN A STORY

"

~._lrQ-.""""" .....~ :r.;o,oooe:tW<nn _ blndo<l-r _ tt,o "'""4Joll ....... 1><O.g1l orolly__A_..... , ~ono~IioId "'"'Y.._--_..""'_ ..",_ -Ol _ A8rll ."..... dlI1d _ Fe< ....18 porilxl,• .000 10> i -. ogoa 1 10 5. """" gt.eo__ -V It'noI~ _ Irom• lI)t.oIal""'" :>0.000~ 'l1'II<l -.. _

,t:too lNl _ .. ""' .. "'" .-. _ cJ __ Inl WIIIlCIUl _ A~ !lO _ tt,o ""Oogmo"'" l<ro '" ey&Jif#. flOOlliIlo .Cll _ ".,~Tte '"" """""'., c:Nrl A.M _ -. "'" l1'II<l_ JlO. _ ~ ""'"

0Il0I:tI """- ...... <l!IliJtIe 01 _ A <!IIk:i!n::V

Tho ......... -.. "'*' .. _';'oed 10 "" 10"""'" ""'r_ """ _ "" """" I'IgI1oor among """'" Wfh......,,,-.:y.As..., """"'>.eO\<>VlgPOi"ll. lI'e ....."lookecIal1hI...........0l_"""""''"'"~WoJ::lmII"",oIh.....,_or__,,1heCll!' ' ,' .. _

Iho~ "'"~ In et>aIl8

AgGIR. "(I'>aol """"'" ..... dtitnwilli ...... A '*"""'".... """'" _,..".lkIit)' lOoonIrW;t"'''~_ _

'eII'i_, i "JelU llt8.f ..- io on __ <bLJI '" bol _ oto..l _

~ ..-arnn A-.:t(.... . ...... ... 4_.,1Is ""'"fVlI"I Or fJSl '" rOc8ta Ol !he """. _al ......__..._ 10 t»_rtd...;ml'/gl:WrraleSoIe:tlOCI....Tc lncl out. IIlll _ CIl be <I"IIi)'\lI'l n IhI stu2y __

- .... ..., - - """'" "'"' """" """,,",>j ,.,....ished lO'I(l_ 1Iof>O_~. Tte6lIeo._.............. ... e:twIc.~ mcnll'O'"110

.-. thiollt'ooe """__II!I'j .......... BIl ...dWlC_.~ ....~mIt1""'-""A.-boo.., .. 61~ ISk cI~,.., <$.~_ctrIdM1lcU-....A-.cy - _IIW "._01.........," " ._~_j ili ...cJttlk 10 ltIIl_l1wI" ""'drId"5__ -..s.Tte _ ...." ,.". to \ty 10 lir'Il WI __ 1r>O<Igs

""'*' btl .... to ....- .... - .. """" Vl<>"ll< wW<l Iho~ d v:\in"in A~ 10~ '-* in........<tIf ?

o-.v"' __""'~"'Ob ' ,.".~ ......0<\1 ..~ A -.."",.._S!U:tt __ 10 I0OI< '" h-.Ol3J.(XXl..-,""Ol_

...... """""'r _ IN -.:JIr<I I.NICEF _ A

__ora -V "'" rroiIhs _ hoi .. """'" told '"" l"ll-. _ by..,. """" -.... A ..........,. .. ""'" 0_N_AI ctoItnn__ 1Il "'" begI.... 01 study ..-.lIhon", _ _ lo,.,(alIof_~ , .. ,..te:l ........__rJ_14,

MctelO-. ...._01""""'A'"""""'<I_"., _ .... by """ "....., '""""ll _ """ ..."GO ~<:no_.n..,_~rJlhiIIn.ct,<"",,,_~lC>lI)I.. prFo:;opel ......._,O<._~.

'Tho .... "'""""'" rJ It'eM~ It otM<:w. '" _ bcoo.nrills ....00..... WI> J<n:)w IIJiIl lM> to \Orl '""'"_ ~ mid _ ........... ,... ""'"'" ""'......, "

do(...q,~_.~lrWellgo.-. ....aIre'e 1_'''_ ...-<In!la-._nWI, on:!~-'...."..- ......,,, .........""1.a"""'~ *" .. """,,,as~"...pr~.- ..""" '..g~.", •. Ie ,g ......... " ~"Wl'-.. be Ire fI'IO!Il~ olIoldMo n-.. b~ <Hd .......... ., !nolie'> ' ,+g-."

."....~.._--....._.., _,-

...._m-..-..n,,_ ~Tho ••, _

-. ...:...-...."..st..ar.~_..........,.~~a_".,.....',..... ., ...... tu.......w_a;y .... lhirl lOOl11. DoIII~ .,.,.. """_ ..._" ...__10_.........~_<OO>'.-vc__.. _.....,..." "._"" "" '- ..__ '" -.,., "..-.... """ bonl( -.g "'" 1'...:>_ 10< •~"...,., _ ~..,__ hi _....,...; "" be

_lhirl_bo__ ., ,,-,--.g.....-__...-.". """'--,... ""-__,.".......,.. ...., __ ..... '*"<-...o..-nn .-.1 ., "'""-" _ ..-. __ " '"~ "' ",_~""""_a--.:;y • "" -. ...., ..~ progo:aon, N

-...,.., """"*"- ...".- - --- "...,...."., .... ""_ ..._ ...._'~bv.~2OO.OOO l,i_ .V_ ..._.wI "".... ."""__a

_~...__ "'8"'t~_.Fu1fo_'"

.. ........hI """-'-__

"~_a_"' ""'*" .._,,_.....--."

OWtC _oId""-_l'eIpO'mory_..-.g~--~___0Iith0ut~.lb1'Otl

O -.,.., ...w oa ....,. ffln MlO ........ ....'..

=:-!=.:§ ===:.,~R~;::;;::;;;;;;:::~,

o lfu 200 socRespWatory disease ra1lI (pet I.COO child Inlervals)

NB + 8S

o-tA~_1oI""""''''~_,(incli<aIoo01_Aototusj

Ctwt8 _01__~_

..-.g -... willi _ wiIIlouI.....",...,....!bY _l

0 - ..........011_· _ >baplolld ," ·

N."3 ~

'I:- "

45·5

g35·5BITOT'S SPQTS (BS)

-~

~ ~~ 14'S_NlGHT BUND IN

5. NORM'C~Eyesig11 stalUS

5 N ~

4 3:1.

3 SIl', """" 1 III

o 250RespIra10ry eseese rate (pel' 1.m

"MIhOuI w'aiUl ... .~ Ml'1 .....,.., _ 1l1;Kllll"'" -. om <lI"'" 3 monItl-.-'-VI<ll'1 oaiUl' • •~ ""'"mid ","w ,a..,..tIQI'Il blio.o_ '""*'" 1lOoo.. """'II III"".. ""'"""'...,.....,<lillie i"Jlerw;lj.

~wm<m00 f.-- \orr...,..,.. A -~

j " ~

~~eo - \lIT_A ___~

~

0- -AfJ8 at first oose

"

I THE STATE OF THE WORW'S CIllLDREN 1986

SboaId tbcK fiad;.... be COIIfi:nlled, t!IaI ....1NilI1~ ol aa adcqUlI~ Ind iii l'iwnia A.;u jola .... l'UICof ..........puml~ ..}'I

'" procectiq lAo health IDd Ii_ or childtm iJI.... poor COIIIllIunilia of IIlI:. woOd.. For r¥nl if,be "",,-'h1y a pouleo aI1' _ l"aiJ.blc (alld,My COlI OIlly 1 or 3 ""nlS each), then Ilkqualcvitlllllin A kvcls can be chelply ll'IIialaiofd bypbtOt. lhtm$Clva _ iflhey ~ cmpolnrt<l withthe knowkd • • that ";tanUa A is vital for <heirclIikllc n', I>calth and if they know thaI it aD bI:pI'O"idcd by tbe cbrk1r«11 lwy ftlou bl....!lith lite: allIOIII .... rom .........' aDd chclpeslfoods ill at- all~ or .... dntlopiqwMd. ' Or ..... Exca~ Oinaor or HdmKelkr laurnotioall! h2s c:qwe.td ii ,~ AII • ...,., Io.-I .......... tIw, .... _ ....• -' .... .... .,..vn- ., ... -W~ _.......... diI4Ifto~.'"

Aca- .. me 'dWlha'.~·

TOfClba", lI:cx -"uta ia t.ic dlilcl bQl thpnlltaioolldd III' 10 • flO'"" i" lC'tOllllion fat ....~u., . ldd'. dliIdrtII.. ADd iI iI;. rnolutioa...bicll ewlcl ........ surtiJla:·poilll for buildinaIII' ........ DDCDprd>cnsiyc baOc: I>eaIlh fySl md10 lIdp 10 pmIlOIc tbe kind of hnhlliu, ........producti.e, ond ""'"' coaliden t rommllni ,iQwhich m the pel__ I.IId Lb. PuI'J"* behind , heI'fIlllI'I$$ of d••el0pllIcm itself.

Bill lIS wilh immunization lechno!oly, the ruIpoceatial of lulmrlcd&c br.u.throu. "," aboutQRT, .bout infant.focdiDtl methods, or .boonn,amiD A~Is, raida IlOlOIIly ia the d6cKyol.... IcchDiq.... ,"'""-loa but ia lbe ra<;lUIM lheyCIIII be pvl mIG ", oo:tier by parm.... M OIl of ....DC'W ICCIarUqua an: dleap aDd Iimplc CllOIIP 10~ l*"l 01. lIIlllbor's 1lGnlIIIIl1nJ of brillaUII

. o.a... • " ..01 _-_.._...-__......,...

..... 5 ' q • "_ fL

.."- ...-_... ....-. ....M __ ..,. ... 1JSA1D'" iI .. _ onioC* •_ .. U_ .. .-A............ _~-

"

up IDd c:uiaa for !aft dti:kIr¢a. A.:ld thillIIaDIWI lIll' bmdiu: til thiI~ c:wIcl br IIIIfkaYIilol* 10 aU doiIdrm IDd "'" just 10 lilt ffWwho hne _ 10oopbisrirM«I -.tic2I fKiliticq.

BUl by 1M .......ak.e:n. m. chal"'~ of lbechild luniYIJ rnollilioa bas DOW bmKnc Ibecb.alJtnle of bdin& "")'I1IId lI>CUlJ 10 mobillu:much IJ>On rlNnchinl f~ ,han illS. thehnhh fKilitin ill order 10 reach OuI 10 informIJId suppon the ... IlIJjori' y of panOI$ io llIi.olIIbis nfW knowledao 10 brio. Iha l rnollilion....,.

This)Ut. oeftfaI ....tiom ha"" lDObili-' lMirIOOietia 10 double and trebIr m. 1'"="•.,. oldlildrtlI orilo~ rtal:btd by immllnju,ioa Kfri<a. 8111 _ IlIIioGI hi"" abo bcea ........IUaliq Uw tho amqyolmgt,ilirin.1ll poIIibloorpnjn" IIIIddYoodl olmmmRD;c"ijoa aD... be -.l 10 puI o<htt IooH:oI1 methodI oldoiId pralectioe • lIll' diop'Fd of llll' mliorilJ olIII pamuo. s..- Ulmpk=s:-

nt A........

III 1ln.D1, dlild SlUViYIJ IfIIIl d... dopmrlllpro(i; rII1II\lIII 1ft hrioa IaWldled __ly by lIll'Miaislry ol HW lb bill by~ differenl 'OYmlmat. ministrie: iJIeo-opemioo with lhe:Cltl>olicCbun:b, l he: _ media, lite~ AI$islAllttUaa\l(, Illd Ih. 18.00G-stl'llllJl Bruilil n Aatocillion of Paodia.ricilOl .

To promoIe btnSl-roodini. IJId '0 ~OIK

llruil', loIIs..,aodioll ''''lid 10wards anificiIJioflm fOOllllIal, rno:n Ihall ~.ooo bl'al th workmhi"" beI::o trained 10 iJlformand ..,ppon Il>Olbnawith praml ltnowlrd,e.. A, tho ...... limo, lilt_lIXdilI ba"" dcYoIod $1 lIIiIIioll iJIaif.limo10ee l-.k of pruwMillll lile fxto 10 1M IftlIIl"Ilpublic.. 10 the IUIe .,...,.tjc;ol mi' 80s, lbt ...we ofm-.{ftdiII& io_.~ )~ Alldil:l all _e ....mIity IrapiuIo. ., ....................~ w--fttdiac &ooll binIl iI _staDd.ard pnoni<:c..' Iolemau....u,., the UNFPAhal lO1lo<Med SIS DIiIIioa in ...ppon of thiIompeip

Growth ~Iorilla iI also brinI llklpI:od asIlmdard P""Iicc ill all mllauaI and ohild bnIthdiIIJcs and • new ~ian ,rowtb cban iI DOW

beilll.tsInl.

_ •••_'_"-d_ _ ""_ ' _

...._--,""

Fig.7 Decline in breast-leeding, saoPaulo, Brazil, 1974-1980F'l:>CO"W.O\IO 01 01.... _ ·100 ll>r _ ......... or ..."..

0"" ~hydfatio<> th....py, backed by tM f=diMribulion of OVer 10 million sacbets a ye:or, basnow $pJUd to d.e point ....btre al k1l51 5 millionaocs of diarrhoeal illness in Brazilian childreneeve beentmlled ..ith 1M new therapy in lbe Wtlwch"C months.

To increase the ouuuch of lbe child $UfVivoJ."",paign in the dC5pCnllely poor nonh-G5t, ,beNational Council of Brazilian Bi5bllpll has decidedlba, its 'Puto"'te o£ 11>. Child' prngr;OIIUUC willmeh I million o£ lI>e poorest ch.iJdn:o by tbe endof 199~. Pillll compaigllS in ,he $OU,hern ,own ofFlorcslopoln _ including immuniza<ion, ,rOWlhll'IOnilorin" oral l"ChydntioQ 'M:nPY, and chi ldSpacin8 - have oharply reduced infanl and chi ldd...,hs and 1M prngrart>Irl< i) nOW being ulmded10 20 ether cilies. ' In all, lbe outreach capac ily ofBnozU's Calhulic Churcb includes nOl ooly inS,OOO parish priests bUl 14,000 heaI,b workers,1,200 Catholic hospilsJl, 120 Catholic radio stations., 23 n"'"5pa""", 3S maguin.., a maiorpublishin, hou$C, Ind OVCf 3,000 bullwm andnewsleners. ~ni.l jomlidDh~ po~~,ill4 ri reporuUNICEF'< olfiu i~ Brtuilio, "'if ..... bri", 1tW~·

liuJ in <mkr ro hriJIl child",,..,,,,,,1JlrtJurin '0 rAoMl"th-.," ( sec panel 10) ,

In ~Ulral Amerka, UNICEF and 1M PanAmerican Hcallb OrpniZition b."" <his year

signed an _ ,......,nl 10 support na,ional cltildsurvival pl:ua in Belize, Coa. Ria, III Salvador,GualW\ala, Hond~ Nicarag ua, and Pan......All of ,be regioD', governmenu plan to " 0national' with ORT and to pu$b lbtir immuniulioD ra,« above 'M 8()'j1, mark before 1990 aspanof an effon In bal"" the region" infan, _"a1ilY"'Ie and save lhc lives of IpproIimately 90,000childl"CQ eloCh year.

In Nicaragua, UN IC EF ha5 li~ 10 provideI.S million sache," of nrsJ ~hydra.ioo $1.11$ peryear _ £0. diltribulion lhrnll/lh the caunuy's IOUof , housandl of "",,,,",uu (Ilw lb voIuntccra) ..well 0$ 'brough commercial pharmacies, com••"'opt, market-ualIen, and tbe 35(; nrsJ rehyd....lion uni.. wlticll ha"" ~ set up ac...... , hecou ntry 0"'" the W I thr« years. Al . he IDOmCnl,an estimaled 58'1 of aU CISCS of ch.iJdbnoddimbn.. in Nicarag ua are brin, u cated lil'itbORT. Othc:. ch.iJd proteclion '1lntcgics are nowbrin, put II parmI" disposal via ' he lh ....P..",le' , Healtb Days which mobilize 20,000volumccncacb year. Sin<:e 1982, for cnmple, no lI .single case of polio ha5 been reponed ( pond ll ),

In Haiti, 0 ''''' 80'l10 of Pll"nU in lh. oJums ofpon -l u· Print:e-and 30\\ in 11>. rural areas _ ha""no.. begon 10 tnC ORT. Sachcu o£ the salts havebeen di$tribulcd lhroll&h lhoUAllds of sm.ucommercial OUllets: and demand has been C~ledby prornoliltll lb. ORT idea ,hrnugh newspaperand n1dio advcrtiscme.lls. To rein£ntee 11>. imper_sonal nxuage of the media, one day'. 'roning inORT hn been Biv.n 10 all otpnizcd 8roUP'll "1Ioare in regular conI'" with I ..;do public -.he5Choolte:lChcn, Lbe bealth IVOrkcn., the I3ricult.ural ntcn5ion ",or kers, lbe uadi<ionsJ hulon,andove, I5,000 members of ,he Boy Seou l. ( pan . 1l9),

In Colombi., 1M Presid.nl b.. announced aNotional Plan for Child Survival and o.""lopmen, "", Jtmtt"' ,.. tkf,,/u of 60,000 childmt twryytor". Ilacki"i up 'M professional bcal lb $ervie.....lhe plan will involve the Catholic Chureh, , hemass media, tbe Red Cl'OtlS, tbe volunlary organi~

uliOP$, 1M co-opcra,i,"CS, lhe police, ,h. army,and ..,.,.. of the 120,000 mmmunily volunl""..ho bn. been involved in lI>e """"I immuniza_tion campaigns. ., W. <m goi", '" mu:h Nth Mta.o,tafh o~ "1 011' J.6 ",ill;"" chiJdrm ~Mcr /roc yeaTS

""'"19761974

"'"

"'"

[ THE srATE OF THE WORLD'S CHILDREN 1986

Bolivia:reducing child deaths

•

De$pll! ~8b1o oo::ooomC Dllic<lIIoes. l/Ie~ oJ BoW.a lias !)eM can'YJ'Il oul allIogrammll 10 redox:e ilS .,ram ooath Illtes by50'110 ovel l/Ie ne>:1 l...e y<Ii1tJ, '*'II kl'w-<:oslte<:IInQJes !lOCh 3$ 8l<llMded ltI'IfIII.O'hZal"'" arM:!oral rehyOralion thetac:tr

,,.,. "'_ ""'" cIe3rII' _ r,;g Iof l/Ie heaIlh_10 ladde aIDnB The reou!'l~orograrrwno. to< example, was ,eaenong _IIWI a"""""orBoIrvia'. CIUr:Iren. ....!<l lleon\l l_uca8y~ 10 'II , So in f etlluafy 1983 !tieUinisler 01 _ de<::i<led 10_ Il1e heIIJ oIlhooounIIy'. O!het oroarozeo teSOUIC<lS -It>e!IChDoIs,ItlIt~ the mass _ . IIle __

.......... llncllhe !armers' ..........- .. order to 'eachmor"~ ltno:l SUPIlOl1I11em III i'nIJ<O'M\IIIleI'""""....,. l!leII Chldr<lO " heatttl '~'5_

(:(III'fIlI\\8e' , e:acIl _ by a~ 'pe(lflifl's tlfallll r~lNe· . _ aoe1 uptrwouol'>001 ElolivIa

The "'$1 10Sl carTWl will'l lhe aflb.p<JIiD Cl\O"I'IP89101 lettl 1983 and e<Vf\I 1984 E-V IlOS$IIlle

"'!I''''''''' was IlII'Illk>IOO 10If'IGfealle the av.m-....01 rfIO'UlIl;IIion and 10 inform parents ot itSirr,oorIance, 1M ,eso.AI ..... lIIallhree $IIOtI 01or"polio """""'l! reached 70'" ol cNldrOll III llolMa'sRJflIl IIre85 and BO,*, 01 1M cnokhn .. _ andO m .

A lew n>::Wl~ lator. on 8 AprlI 1984 , themaclw>eIy """" inIo ac1"", agaon 10~ theMlIOn" CI'I<kltM~ measles -and ag801 ,()I'\!f hall a million thldren_e V8OCIt\iIred

In 1985 3 6lfOIlar llSS3U~ was IauncheO 00cllllhU>eria. pertussis ('WI'looponQ CO<.IgI1) and Iels....... l.'Sir1g OPT 'u iple """"""" , Newspapers,-. m loons and sarno 80 radio SliIloons:lIe<t9d parents to me (;(IfI'Iing~ <:lays.The people 's II8a/Ih le(I(eSeOlalNeS V1Sll«l lMlrV_ 10 . dorm .. p&llrllS 11\II1 vllCQl\ll/lQn _llVaIIabIe ard _bal. In hl crly ofSaIlt.a en...aspec.aI messaI)'l ~om lhIt E\I$tI<lp, ~'9l"Il P8<e<l1$10 _ 1_ C/W(lren to "'" Immur-.zad, was r&l><l

eM '" SWIfy _ 01 l/Ie CII't' wrong Sunday-Two days before II>e leurd1 <late 01 10 Marcn.&*via'. nabQn;)l t,_ ......,., called • _lII$IfIk<>, 10,000 <lemonIIlrators POU'e<J """ rhecapnal, La Paz. and roao-tlIOCI<S WOOl UP 00 rom1"II1''''ll\'lI lhrougl1Ou! "'" ooun1IY But ,",Ill "'"III'I,o,n 5Ul»Ofl. "'" vaeenaIioo campajgrI ",aNa_,-""""",ell I'> lOIaI, 1~ ,OOO health """"'.en;, rnostIy ..........1-.;, """""'" 5.000~po$IS and .aconaled 215.231 ctold<en - liS'\. QIBoIMa's _en uncler _ , In Ill""""'" '"""",l"DIe \IlICanII haP react>ed ooly lCl.. 01 uooer·m._

_ "'"""~ III BolMa's dlIki""' -<1IaI·_ oetly(lrBlIOO - is bo:lInIl t<:M.:l<lIld bY SlIlUn\1 upor"tellyarallorl ........ bD'J11O IlfPllIY oral renyaratlon salls and 10 team P"'l"'U1 ......, 11Mhow !O""" !hem 10 tores1a1 <leIYyd,atoon. So far ~ ,OOO

uroIS , moo:! of !ham manageIl b'I' "'" peopIa' ,h8a!ltl "'P'~lawes. II;Ne beo<>~ To

<nate Iha <lenwlo:l and 10teadl "'" ;)Ublic; Ilow 10usa me saIlS. all QOSSIble conl'I"lIf'ICatJon C!'taMllIS;_ -. USed - k<:wn CIlur<:l1 _ 10 ra<loo11M _ '__Is' , lrom Wee! dra

mas 10 WId """aIS,

I'> a h.o1her """'" 10 saleguat<l etokl<..,·a """beong, aI stlla mIIternity flOSPo\8lS t\lI"'l lklOPle<1!he polK;y 01 ' fQOrnng-J:l' new-O<;o'n bioblelI ....IhmeiI II10lhers 10 1IflCOIjI<>gIl b<eBs1.Iee<l,ng Tho~ IS aI!Io~ laDle $81110 <;OlIrllilr

icIdone <Ie!laer<:y, SlflC<l 6S.. oll301Nen!lChocllc!liIdren $lI11er Tmm godIa, Andn : ISfIll' 00 c!liklSUI'o'I\'al ...a now pan 01 lila CU' ''''''''''' 0/ Malpnmary &Ch;)OIs 11M 00I!lgeI

The Mnostry of Helllln', programm& tlaS ....Nojysaved It\ousatIM 01 C/IIldren'. '-11M PUt tJaso::__01 _ CIl,e at Iha dISll<;>$al of threeor10ur limes lISmany c/liIIj-en ason P/l!'IIOlIS years. nTn<! JlI0g0... " ,1tI can I)e """'.......,. n .... bnoIl a""""1M"'" WI cl\ild ........a1 1o!he.,.,..,.,.ry.m.cn SlIIllIltS "'" IIIghe51 r>Ianl and clW;! <l8aln 'slell '""""'.....

.,......~ laid Prnidc1l1 8ewIcw ~ 1M IaWIChin&of the CIlDpqD; MnJ....1m""MI_' t>:il.li olJF.wa -.. ..,."...,.. -1* 1I<n- .,pr.- ./1«n.- ;" llot "."..,.. -I , ftJJrf,, )"',iM

C_ puld 5).ID HoDduz-, dcatha froID dianbocal ddll"b

tioa Inc rtpOncd 10 bo: falIi"I aClCr . ......,ar......po;p to marketORT .... t~aad...uo.Willi _1llCdiI lDCSAIa t.;ka:I lI.p by 1,lOObdllh ....un ...wac llomc >ilia, _ '" ..HoDd t- about thc _

........t,o lor diarTtIocM ilbls IIIld~ !oM haftbqvA UIi"'I 1..MoM-m. Iocol bnad __ foron! rdJ.j'dIotiaD WtL

III ee-lor.' _ ......1pba hal beea IauDdord10 ~ bit .. thr _ bail: IIlBlqja of c:bild.....m.I (........11 dIo;killa. cnl rdrydtaUoa t!oa'•Il'f, brasl-fmlial uod iIDpn:m:d ftllliDI• .:I.....o j..... ) Uno pcxtiec .... . aM;"'ol oaJc.The Minislrin of Ed , ' Il" , J)rimce,...s SocialWdfan:, • "'ll:ll • 11K MiRisuy of Health, ...,ilI0'0h-td _ thc pba ill beiDa mpJlOfWIII b1 the_1D<d:ia, thc Satioaal A...w;. rJ. Medicol

Sdloab, uod thc Nilioul O ,,, neil ol AAbopLYk .... bail: cblId IleIhh 1tnl4;;a IR boia&~.~~~~ilI lO thc~=of ~~aad':' 1..,. Jthooll; IIIld "'CIhm, wtiftniry . ...,,",If, .... W<iItIa~ ;""""'011 fJI :aU:fOWIC dIildrta ..~ ror 1M ...uo.w...,;....ioe~

Ill. VC'llnIIl'!. 6Oll,llllll childrm an: _ l"KCi...iq poonlI lDCIOitori"l cbam wl!dl ... anyad\'1tt 011 bnat·fudiaI, i!Mll,n jZMion, andORT.

10 Iloli'ria, wllm: _ 10ll,llllll child ..... hanbe><!l drinl I!:IIliI yar from dianboeal ddlydratiOIl,_ 5.000 oral tdlyditiioa u.aill han DOWbfen 1ft lI.p _7Oll.ofthem _uftity-t.Kd _and_ 2 million _ bm of onl rdI)'dmioa alIIhaw: bem dislribute4. To pl'OlQOIc bteast·fccdi"l,Slale """emity boIpil.ab hive~ to poIicinof 'roorniq.ill' , IClevisiorl and radio IR mU:inathe ram ~1I11l1"" publ k , md I natiooaloc.kit bciaI dn"'" liP 10 prcYCll\ the marketinM ofm ilicill infant fonnu* dir«t 10 tM public: (_paMllJ) . In I llPpon of these policies, the bIooic:"'"""II" of 1M 'l:hijel lurvin l l nd d.,~lopmf;Dt

rcvoIution' h,," been imroduml ;,uo,be 'health

IJld Ilome-l>IU.ioI·l;Utriculum.. aU ,lie COIUI,ry'Irun! primary lCbools (_ pand I ).

...III 1Ddia, whom: ee I'liIoIe MiniA.... --n·

"""" Ilas opaxd the '"Y for • utiooo-nk~ '0 '''''''''a i.. aU chiIdrro 0ftI the naI6ft faJl, Ol!lcr cbiId 1lI'OI«Iioo SlnI.... ~,"1:nIl)' IJDioI dlllOII:Iino 'ria the lnoqmed CIIiIdDt.elt>jml Su ,itu (KD$l """ tbc U..Balic Su,icu • '''',,OJ _bill'' outn:adIpai«a,whido, ia tbc _ .. tbc ICDS ..... ~ _proridina !laic can: 10 10 IIIiIlioa .. IAdiIo',.....-

to ..., IR3O, the mula .. llle ICDS UC:oImdr C'i'idc:n. in. kowt f2'lU .. D8lD..uiIioD,liillina nus <I. ..... binJo.~ hiP<r~ <I.im_ oi..... coou.... """ (twa" dlild dcMIaI.Sar<IrI< SIlIdics in 15 SlOta h:ove --. WI n 'l'<I. ma1Dollrisbed dUkltc:o . ... wei&ht I!ItIluP tllI:ICDS docme -' lloc 0Wnam .. tbc ICDSTech-;""! ea-.:.itlft arinwa .... almnoI10D,lllIl dWdn::a', Ims~ alro:ly bmI u "fd. 'Tbc primary p:onicipuu ill lloc ICDS ..., the...... ADd 0ftI m. nat 6ft"""" lbc ochccnoc ;.IthtdWcd ... rudl 6010 <I. Ihc dIiIdral liYiIll illl...m'. poor .,...,mbon>os.

Bro.d...m,; the baK .. \.bit ptO)ItCI&, IDdiI'......"'l driDkiDa _.. prncnmaICI ~ _

rac:hcd lDIII'C lhall lOO,OOO viIbI.. md ucbelioaia"o ha"'l'" df<a ...~ iDf«Uorl.

to R'all*b, the ' OVU1UDCD'.. ...... N I!ioMlOn! kcbydmioo PnIcru=c il4iltributinc 0ftI17 IIIillioo achctl. ..~ rdlydrllioll AlII eachyar md the m:olIItDCdia ..., bel...... '0 crtIl. ,bedemat>d by~ the ORT mesAl' in,omil.lioat al b_

Meanwhile ,be 8an&ltdcsb Rural Ad~

men, Q:lmmi" ... {. o....-sO¥'Crnmeo'II! otpaiDotiool hzs ,rained Illd fielded II1moo 1,000 ORTwor l<cn who hive so rlf m;,ed ...er j millklam<>l.hm md 15,800 :ICboob: 10 live pl"lCticlldelDOl1$lra\ions of why, whc:n IOd how .0 UK

"

I TIlE SI'ATE OF TIlEWORLD'S CIllLDREN 1986

Egypt:leading the world on ORT

"

E9\'IlI has~ the 1\lll1·lVily IlOJlIIl d$ 1fV&war can"""lI" III P<O<\'IOlll oral rehydration!hefallY lORn and _ thellYesof !he 80.000 antlmor" choIoren whc> .,.... dOl eacn _ fromdolIrrhOe6l <latlyO"aloon ResullS so tat """"" malCfl<kj <learn ,at"" havu-. ClJI l>Y lIllllfOUIlatoly3D'\> In I..... Ies!~ale01 AJe,,"'''''''

!MIg w!Ial ,.,.. Il»r~ "' ~... thepr(IjllCI 0$ ' ''''''' PIlI ''''!ll»WIOO As01 rrod-, ~~.

""'" ~ .OOO cW\oc$ !htoug~t E\NPl1'llMl "'ailedoral Illt!Y<Jrll100n cel ~'es 10__ 00 I and 10teadlll'<>lhet$l'lOw to use the new l!lefapy Mea<!01 SC!>e<lule. the pnq........... is already~In have anmpa<:l on the .,lam doom 'al~ n;JllQ<1""'" ·' By ftlll _ oI lhrsptOfl'C/.'· saysa"wribet01 tilecampaogn team III C8',o, " Wl! /lJIt't f/XPIJCl,l;;I..a- a 2~~ 'educlJOt' .. (}Wl(8/I mc>'Uib1ylIffl<Wlll (gyp!"'" cIliI\*M "

rO/ ten 1'l3"I. OAT has bee!> an ol!lclally,,,,,,,, ,,'.eooJud "ealmen1 .. ElMll. 8u1 Ihe $111!(l

were llOIV .......- M IlIflSCI'Il'/lO antlll>ele_' I!le poo""o,,,", to the JIUbli<;. So PlooaoI'/ !ewe<1M" 1~ 01EgyplIM pa<en1S were """'" Il>echeallite.savlnll brwl<!M:IUgI1 ......encoukl enable ltlem10 t..", It>e II/>gIe llIggeSll/'trlW III !heirr;:I\jd"",'s_ and Plea,",

But on JilrIuaty 1963 . after $0>: years 01eate!ulptllPllRllO<Y _ and lOaIs, 1M Egyp\I;In g0vern

ment llolCar\'Ie """ 0l 1'>e ftslin lrOI WO<ld 10 pod<uP the OAT wellllOO on a 'llItJOool :lC/I18 am-.. ,,''' on the~_''~tcrI'IaIt oIl1l1 C!IId 09al/tS 0'1 [gypl WiTh lI>il~ 01 "giant 01$26 ....."'" kom 1M lhlOl(! StateS~\01 ~1I~. the MirMsI'Y ol_ IaLlf>CllfMj the NalJOn3l ClIarJ1loeal 0-Control I'r<lg!aIlYnI UIlOi!f a~8<l seemIarlal WIl!l a leIa l bullI/eI 01"""" II\a<l $ 50 1Tl!Oo(wl .

SIlecoiIily ""arI\IIlllIeClurM. _ ':Illoos, iWlidesII medi<:aI~. ooa """'""" 111 a dolen,...-s>liE$ - plus ltIo >Ie/llng UP 01""" ll){1 ORTtraonorlij ur>1o - ..wea ted !wile ......oors 01 (gyp.tIan \1DClOI. aM nurses &bout the new U&alJ'J'Ie(1!

To capt~ Ihe _ I Q':nel"looo 01 neautlllfOles........., OAT c:aII!le!I have lleen " WOOUCe<l onIOr... t\II'rlCI.M of .. meoIcal coIeges, 100<:II0'l0""""lIIls, and ""'50:lIl schools

lhe Iarget 0001" 10 _ rnoIIJorS !te,_10~ dOOvora llOll ana 10 prol9Cl tr>e C....:fS""lr1llOnal hcal\tl 0)' me early _ 01 OAI, 0)'~ 10 _ pIerJIy 01 food and lluds, Andesoeoafv ~ COf'1lJlUrllI tlrllilSl'IooaIog, lUiro,I~ of <!IaI1f'lQea. In tr>e AIe><ancln3 lnaIs,~ convnercials lor OAT Iwod oeen _caS! every nogIIllor a .........111 8. P8lllI "'il'Mng lImeS.

By !tie enl ol "'" "lDIllh. nlO5l mclt1a13 IiMwaboul OAT IlOCI 36 % h8<lalreadY lleglm --.;I II.Now II1II _ ~ to t,.,;ng _

oalO'lally and 1ne 001 symbOl ISfOPOIl lId 10 00Ihe _ wo:lely recogn;",a I>dYeo1is<>merd In

'-'To meel the _> more__ana ..most casesIOlatt .-.effecfMI), Na.oonal prCldlCUOt1ol "'" _ Is. _ IS fKNI """""lI a. 80_.-

When lIle Nalional ~'fIIOe8I ~ ConlIoif'rogt11tM'lll comes 10 an and If\ 1987, OAT_ be 8 normal part Of the nalJOn'S neatt~

sysl<!m 8M Of tho people's.,..." """1Ih betlavJooJ'In the rMa<1tJme, Pre$otlcrIt Mubar(lk has anrouro:ed Ills \lO"E"'I~Il8I11 'S ImeniO . to sece lIlene~t l/Ie>J'~ lor 1l'0Ie0:\Ir'Ig Ihe li..es ancl111e growth 01 Ihe nat"",'. chddr"" - acceIet;ollnglhe CW!IlJ)"S ormlU/'IIZ8lIon progr3!1VJ>e lI(/8II1Slme "'fec llOUS _ """<:II fKNI ~ """8 !/lan50,000 EQ\'llIlOO chldten eac:tl yeIlr and leave a.......... ruT1tI<II _ lhe large! ..... be mel

balorn 1990 and. n81 all posgbIo, by September1987 - me morty-film """""-~saIY of Ihe EUYP<"'".-..,

__""""_ _ Ct>«I,,__-......-

Fig. 8 Impact of OAT on Infant deaths,Alexandria, Egypt, 1980- 1984009aI ..... _ .. lII""""""ltDtlg Iho 1knTnOr·_~.;'~~El/l'Pl. t-".f9.,<w"pa.... ~ "'" '"'" po<~;, ago w<JUP.

h<>m,e.made on.! rebyellltl ion solution' (see pmel16). In Dbaka, the 1,000 urban volun teers whoelisnibute 4.000 ..chell of 0IaI ...hy<lration Alt'eacb w~k are abo now distributing viIamin AtlIpoula and bringing p= t knowledge Ottc1iarrboul disease control and improved wtaningand feeding mcthod$ to the pooresl a..... of the"'ty.

(0 ThaiWld., more than half of the nation's 3.3millioo under_tbrees arc uOlV l'I'8ularly growth _cb« ked anel more thm half of . be nltion',patCIIt. have begun '0 use OR T 10 treat diarThoeal~In... (see pan el 21 ).

In Inelon"", "hil d survival .tratqi.. art' Min iin trod uced , . ia tbe Fontily NUlri tion ImproveI!IC1It Prosramtl1C, inlO l lVOo-tbitds of the ""un try'.67,000 villaga. A few days' lraininl bas beengivcn 10 400,000 YO!um.... nutriti""~ woo= nOW able to ad.i", parCflIl on b2sic healtb IUdinfanl {tcding and refer lDIII'<: di fficult tlISC$ 10on eof over5,000dinics. By 1990, tbe aimis to in volvevinuaUy all lodon esian lIIOlhm; in the regular"h""king of their ehildren ', . rOWlb ( panel 13).

In the /'lIilippincs, appro;cimately 70%of moth_

en nnw kn nw abou t ORT anel "" at im;oted 1St.m ve begun using Ibe new tbenpy.

In PWstln, 1,300 dOCtors and 4,500 paramcdi<$ have hcc n trained in ORT and an annualsupply of 2.2 million sachet. or 0"'1 rebyd"'t iouIll!IS is being promoted 10 the pu blic viate lcvWon ,nCWSj>apcrs, post ..... meetinp ofcommunity lcaders, 1fIe1 by the uaining of 5,000 tBditional hinhatt enelant . each year (sec paJlel 11).

In Kabul, Afghaniatan, I nmpaign hu alreadybegun to hal ve Ihe city's inClUt mortality ",Ie by1990 th rough basic: ehild .urvi\'ll st rategies.Approslmalcly 100,000 children now have 8rQWlhchs.ru, immunizotion ",tes bav. begun to risosharply , and an initial I million uehets of 0IaIrebydn.tion WIS have been made availablethrouSb bealth posl., day-care CC1Il res, locals ovem mcnt offices, ronunm:isl pbartnacie$, ~ t.,..

acy centres, kinderganell$, and th . ci,y's youthand womon's Otl';lfIiutions. T o reach tbe pu blic..ith the tJlCMIge of ORT , over 100 td.vision'sdvcrtisanents' have beCfI broadcast, ra.dio hucarried tho in rormslKln up to twemy til1lC5 a <by,anel 300,000 lcallell and postm; h2., e gon e up onwalls and in windows throughout tbe capi tal cily.

Backed by the lu thority of 250 paediatrician..heallb W<ltken arc o:artying chi ld survival mcssaga into the poorest bomes of K.abu~ o'er 4,000t....h.r'S art' no w introducing 'child protectioo'ICSSOtII into the city'. schools, IUd most ....ter andSlt\ilatino ptOBmtI1I"lC5 .... also beinll \lied topron>ote boIh ORT and imm uni ution.

Ajri(a

In EUPt, death rat"f from di arrhoeal di .....h.ve beCfI hal .ed by ORT in a l"'l!. p~OI

campaign whicb has 0 ",," beto ""leoeled to thewbole nation (Fig. 8) . Approrimately 8,000eloctors hue been l'C1rainui and, 1$ of miel-1985,4,000 dinios IuKl Slaned to "'" ORT agaitlS1 thedimboeal dehydr:ltion wbich lUlls me re than80,000 EU pt ian childn: o each year . T o promoteik"",~d, television commercials for ORT havebeen bro:ldcas< oiI htly an el all doctors .... Mingasked to =-ornrncnd the new the",PJI. To tnC<1

tbe elemanel, 80 million sacbm of salts • year arc.nOW being locally prod uced anel made available

"

''''

,,'H)

IViOO (35-2)

,,"'j•, 2.000 i~

I •.. 500 ~,

~! ~

~,' .000z ' 980 "" "'2 ""

both from "...1111 I'OS.\I and from ,housand, ofCOIllmtrciai pharmacies.

In la,. 1981, only 5" of Alexandria'. mothenk.rl~ about ORT and only about IS IIad ."c.uoed it. Today, 90'1. know of ORT and 50'4 havelIsed it (_ paod 9).

Following lb. SUCl:C:5iSfuJ wunch of lhe O RTprnsramme, Pl'tSi<kn, Mubual< has thi, ~.r

mad. the cammillllell l \Ouniven:al ,mmunwt;onby or b<fOl't 1990. At 1'''''''''1, IlIOn: tha" ~,OOO

EgYPlim children ~ dying ncb year fromVX'Cin._p...vtnt:lbJed~

In Djibouti, Ihe OJuncil of Milli!um hISappro.«J I ,,11lIl I" halve tb. counuy', infantlI>I)rIaJi,y by 1990 and h.. launched. N ationalChild Sumval Plan, to be ro-or<!inatm by •central committee inchldiDg ~en.I govcrnmrmminis,... ""d repraenlal;vts from the mass mediaand the ",.UMa! women'~ urganiut;ons.

In Ethiopia, wbf!T the dfon 10 relic,'o tbedmnalic suffering of the countryside h.. b«n 'Mfocus of world .wid••umtioll, I quieter effon isalso bcing mouou,d to try 10 Cl.lPl' with (h..veryday crisis facina: """'y of the d tildn:n ofAddio Ababa. Last year, the Minis.ry of HeahhODd city cQl,l/Il;i1 :se1 th"'llSClvcs the thcalleoge ofrtducing Ihe <apital city', inf1lll1 monality ,"[t

from 136 pu 1.000 in 1985 101m lhan SO per1,000 by 1990. Supponed by th. Mioisuy ofHcah b lAd UN ICEF, "'" Addis child survivalcamJ>ailln is now goill8 into action lhrough [Mcity's 284 Cily d....llen' II!S<lciation. or lubtlu.Volu""''''' from oach lubtk , trained lAd supervised by I 'lw.lifitd communily helhh anddevelopmen[ ~cn[, arc promoliq ORT,wpni.....ill8 immunizatioo, and helpiog lnO\he.. to monilor [b. progress of their children on [h. ne",ly.dCloigned Amharic groWlh chan (.... """,eI15).

In Somalia, I monlb of radio hroadcast>,ntwspaper wicks, TV Pn>lranllPCS, loud.peakerlnIlounccmcnu, and oommunily lIICC1iogs hi""prepared [ht groun d for 0'1'" 2,50(1 volunl«tS,drawn from poIilical parties and women'. orglOi.ulions, to " isit 150,000 bomes in the capilli cilyof Mogadishu -rqi'lcrlog child ...o Ind lIlIingthtir pamllS 10 bring lhcno [0 lhe """,inationcellIrcs.

•

In the Sudan , Nsic ch.iJd .urvival "',,,egi.. Itt

pnwing their slwpcncd ..levlnCl:' in the mid" ofdrought and fantin~ Through the emergeocyopention>, and [hf0U8h [h. llrfl~le Wi t...supply progl1Immcs, ORT and immun ization arccombating the dia,.,hocll and ot.hu discO$C$ 10which ovcrcrowdcd refugee camps I nd emergencyfeeding centre! an: particQlarly vulnereble, Sofar,c'- 10 6 mill;on ""hCl' oforal rdll"lnlion AlISbOYt bc<:n di"ributcd during 1985 and hundred.of rommwtily Mahb """k.n bl"" bc<:o lrailledin their usc (Fig. 9). Rtron' UN ICEF's uffice inKharloum: ~AII w40 Iurot wMlite1011' _ including,Iu ~sIy 1U1>1wl-S4Y 11141 ,Mi. _//.., is,.,.",kdhk.M Fot both ORT lAd the presentimmwtizatiwl dri"e, demand is hcinll promoledby every means from media bJilUS [0 ,ra".lling,roupc$ of nomad p!ayc",.

ne soc:ial brcaktbroqh

Nut aU o( ,,,- IIObi,ious progl'alll/lltS will.uccud. And~ of the difficuh ics whicb f:occlbem will be di$cus$cd in Ibe oot cbapw. 8uI an...tnordinary beginning h.. been maok. And inaU of these cases, i[ is d t ... ,ha[ [he 'socialbreaklbrough' in ....ays Illl<l mean! of rucbinJI outIn th. "",jonly of parenu iI just as impon1lll[ asany scientific btcaklhrough in knowkdg. aboutcbild heahb,

Slead~y o"er "'" WI leo or twenty YC2rl,tml\ynotion. """. levered ,bcmsclvCl into a pesition tomake t""l 'social b...aklhrouSb'. And [bil nowpotential for mobilitiog organiml resceeces, andfor n'aclUng out '0 inform ond involve the \'151ma;orh y of citizen., ia today ooe of [he vel[... ofa1llCSOUro:I oot only (or ilIa'easina "'" prota:tioowhicb can he offordcd [0 children bu. abo for [bepromotion of not;onal developmenl ;uelf.

This ae .... potential has bc<:n urivcd 01 by •largely unnoliccd procas of chang~ And [hesh..... sca\e of that change is w.1I illus'ra'ed bywbol bas bc<:o happening in India. Ovtrtwenly ormore years, amid lIlIny ...p....ron. of hopelmn... from ouulde commen!.O[on., ludia bassteadily ronsll'UClcd • _I mechanism for lOCiald.velopmenl wbich iI 0"'" Cllpahle of ,oucbiogtbe lives of the V2It """iority of the ~tion's 670million people.

R tsOU",H lot ou~ub

P. rhaps the tlIOR undcruscd of all those reSlIurces is the formal education sysl.m itseU. OverIhe last twenty yars, the developing nat ioos .. awhol. hay. tllOl'C than doubled the propottioo oftheir child....n who are enrolled in school. Andlod ay, a, lENt~ or all ehildreo are enrollina iofonnal cdtlClltion for at ICUI I few )'t'lI rii.

By COntr:tlt, only . bou , 2()lf, of the dcvdol'iolwarid's childre n b... lOy regular conI..... withformal health servi<:ci. III 10<!ooC$ia, for enmpl.,tb..... are 5,000 primary heal,h ~entnli wi,b 0""

dOCtouacb as npp<>sed to 100,000 scbools wilh 10l\'efSllC of six teach.rs each .u

In ot her word$, the school S)"It= is one of thelIIOSl ;mpottan t ~hannels of <:(Immollication withthe VI$! .... jori,y of 'oday'$ and tomorrow'sparents. By tbe most elemeo,ary driinitioo ofeducatioo as a p....paration for ~fe, prc$COI kno wledgc lbout lwic ~hild protec1ion lechoiques is$1U"C"ly W<Ilt.h ito plaoc in the world 's schools. findthe uampl. of Thliland , whe", ch~d survival andd..·. loplQCflt lessons an! now being introduced0010 the fonna1 curriculum of 6.3 million school_ehi1clren, is . u....ly on. worth~ of beill1l follo-.lby et her nations."

Not ha~ the mass media been Olalldillg stiU.Toda~, lbe lIilian has It least 20,000 newspa,,"",includin, 0.... 1,000 dailies, and radio servica00'0 reacb more lhan 90'- nf Ih. nalion." Andunthinkable llII it mi,bt ba"" .cemed ooly adecad. "10, it is BOW estima,ed thallelevision wiUbe within ....acb of .. llIlln~ as three--quorte", ofIndia'. people: befol. the rod of the decad•.

Not least :unoPg these ine ruses io resources fordevelopmen, is the growth of tM more lhan12,000 nat ional and intooatiooal voluntary or_,anizalions whicb .... new opcratill1l in Indio,ofl.o in the .ery ~I"CSI <:(ImIDuni,ies.

Thac are rI"ll8enog acbio:«mcn ts -with equivalents in many O\her oatioDl. ADd since, in IDOIt...... tM health servicc:s 'b......lves arc a necesSItY bu, sci11 not sufficienl l'CSOIIfCe for rtaChin,lb. majori ty, a full io ....IOl)" of these 'ou treacbresources' will need to be tol<~n if praco,1tIIowltdg. abou t Iow<OSt ehild pmtCClMln is to beplaced al lb. disposal of all families.

2 1980 3 4 1981 198251 __ <>I OAT(M1<d1 I!IQ

2 n".,g """"'" api<JIric Un! 19lQ3 0..."......." _ "- _ IO<;!<JDO< I!IQ• s...n monlIliI_ traiToII l<sl ~ 198115_.....-_~-.two (o'ool'9ll2l__n-.""'-''''

Each of the couotry's 5,100 'de~lopmcnl

blocks' now has an Oll[.m~ 1!ruetu", wilb thecapacily 10 begin rnching oul 10 infonn andiovoh' e communi,i.. in developmenl .....ivili...AU of lhoK o1c""lopmcnl block.s now bav.11 ICUI00. pritrwy health <:col", and an • •erag. of mo....than len ...~nl""" T o Sl aff Ihac heallb cenlraover 300,000doctol'l and 300,000 paramedics ha~~n lnined. And 0. ... the nu , fi~ years thenumber of 'health guides' is scbeduled 10 dou ble10 600,000-00. for o:«ry villJg. in India. findnow, und<:r 1MICDS scMme, an oddilional5,oooa"",nwa4i WOlke", and 2,500 NPCrvisol'l an:being trained CYCfY year 10 b.lp bring b;qicservices 10 all of Indill' s famiti...•

fll lhe ...... lime, Ims of lhousands of schoolsu,~ ~n buill aIld hundreds of thousands ofluch... ha~ bcf:ll lraintd - pul ting a primaryschool within one kilomet .... of~ of Indio '.children. As a rcsull, 8011 of the nation's chi ldrennnw start ochool, an<! tilcracy - bringin, wilh il •vas!ly incl"CllSCd caPK ity for til< communielolianof 0.... koow!cd8e - is steadily rising."

F"IQ. 9 Changes in treat ment fordiarrhoeal d isease, Sudan, 1980-19820:>Irl;J0" ....-..<>I_.-_ """'..".,.,....,., ,,...,.. _ ORT \taOWlg__ Ie< _~ 19aO-I2~ <>1 01 _ otaticnsI.

OJ

70

OJ

~ 50

I '"f 30

20toot-t-:-:-+--

"

I THE SI'ATE OF THE WORLD'S CHILDREN 1986

Brazil:vaccinating 20 million

"

61.... '5 ""I..... PlOOfammll !of molI>e<!l an(I

cl'Oldlen. law1ched '" 0c10be< 1984 .... Ihe wakeola s" , tsJ<,.j tnasl-lli'lIClkIg eampajgrl, <;<lmll!neS,.q lIIe _ ~ """"""'"" <l<SCU!Wld "' The$lJ1<'I 01 Jl'I8 WotI:l sCl'loli-erl repon -

a The rl9Jlar we.gIIIng Gl clIiIdrllfl to IIlO<"IOrIheiI Ill""""~ lho Il'ogramme: me fO'$lhea/l!l IfIQrI<etS began IheIr ~a"""O .., oc_198-4, '" 10 01 8<lwI'. 23 states. ano:l A nal>l:lnallJIOWIh charl IS""""II tesIe<I.

o 1o COUIl\eI 1I'olI 80,000 dlIid (!ol\llhIl a yearIfom 0IafJ'M00I <:IefIy(lra.too. ell'" '" ""'" rJ'IlWlUlactuoog or" n'hydm1"'" _ !of I'ee ""'OM!OisInOulOO lItItl b ~ 10~lIl!l Sllll""An estm'l<llad 5 ""*'" cases oJ _ "'EltazOlao etliklreo WIlle treaTed Dv oral 'lI/Iy(Irabon!hetlIOI' '' \985

o 10 reveffle ltle ""~ _ llQIUe-teedlng,50 ,000 heaIlh PeI'ml\IoeI ""'"~ m....ed toJ)I(ImO\/l tIfeasl·leUng Tt>e'~' 01 nswoom _ """ ""'" rMlI'Itt<$, to """""""IDreasHeedlllO. ill ....... """""'tory ., all gCMlOInMllll·ba<:I<ed I1col>\als

o Unlj Bra" 1tJtJodI.c:e<l vaconabOn <lay> inl!l6O, some 2.000 <;!IIIdreo WIlle 1l3Ia!ysed l>/l)OIIO caetl \'8il' IDClay lIIe Ill""S Jess lII8n 40 SIl<ye3IS on "'" NabOrl!ll VaconaloOn Days are an_ compIemenl to !he regula! _

_ In 1984 OIfler vaet:nlS -.. aaded t<>

!tlIl J<lIIIIlf PIOleclJOn 01 CI'oIGren l.O'Idefone agansImeasles nas ,,,;en !I'omseq,:, in 197810 80 \10. anlI

PfOIeC\W)II agansl 0i$lIllhe0a. whoopoog <XIU\lI1an<l1fllao.",!tom 39q,:, on T980 to 61'1(" Ana sn:::eJune 1985. all _ .... l\lffW'll up 01'1 ""CCnal1Onday nave Dee11 ,..,. registerea and \<iloCCWIalionCM<lS~ to IheIr ..-.

On ""'" oJ II>a Moo yearl)' """"""'loon daySmewe III8n 20 n"" Chil<Iren..n1el bveha>'& bae!lvnoon819d "l/lIlnSl (JOIio. Wo:TIeI>'s gmops,schc<ils, e/'IufCII or~ BrIll !he amw:l !orcfIsMYiI ..1 par\JCiIl&led. ""-,,, ,3(100 andte\eviSIOn. IooodSpea.... sysIern!; aM """" lottery

bCl<ets e:atrj Ihe cal 10 '<lCCiIIlIl"", III 0- !heC<IUI\lry BrazIl can ,..,..draw on 400.000 "Xp"'''enced ...o....neers - irtcluOl>g 1eaC!ll!fs. bremen,and pelIce-1O man 90,000 VllCClnallCln IX>Sts3ClOSS a lOml"'Y lBtoer lNIn We!ilem ElIIOJ>e

In a I""'aMeIlTlOYe 10 sall9l'lJ<l CIlIk!<tIn', wellDe>IIg. BtBlll~ a """""'" b",asl.Jae<lIJ'lQeatIljI8ogn, 1<1 \ 981 , whid1 os ...... pall at IhemoItw BOd CI>okl programme Pos\er!. e.<!Ollingtlroasl·t-'Irlg __ <lI5trb<Jl8<ll\illoor-Kle. near!'1S1 mtlioon WO<lII 01 r<KlIO and 1eI8\18IOl' lima waslIOn&Ie<l lor breasl.\eedIng <XlI'I'VnIl<ciaIs' , I".I>3f!(li3lric1ans' a<llOCIAbon, 18.000 SI""'ll. 80IMIIy PI'omoleS Ihe campalll". an<! Bt<ll:U's"cal schools now indu<le breas~ 1<1 It>cirClOricuIum In Ihe d lY ~ Reole, 10 C1'" DII8...""""". Ihe fIOOPQOllOo, 01 cI"oIdren bfeas1.JfId 8lthree' mon1hS tes C\CII.08(j,

Tile catholic Cluch ~ reeoa Ill.1lOf BIIy .,these e/Ions lis 370 bi$I>opSan<!$ ,000 POBSIS.3IO!'lg ..1tI H.OOO rT\llIll<$......, 01.0'lS NO)1Qng 1<1ClI<1lC!l 11osllrta~ backecl lli _ •.magaz all" 120 ra<llo "'au",,", mall. It ap<IWIl<lull"«lll'lOO" B<azoloan o:IaiIy ~kl In 198$Ihe Natbnal ConI",ence 01 BtaziIiM Bosr.opsesIatlllShOO a 'PaslOffila 01 Ihe ChI<l' 10 dlS5Mlf.nala CIIoId "'''''''''' me<>sures The Paslorntl! IS""panclo'lg 1tI.. yea< 10 tack.. an ambotrr:o.tS goaI _roocI1lng a "'"""" etoI<lrM un<le< SO' ., lNI~ r'lOrlt>oosI . wtlemlnl3o"1l"""'8lI1y is~ if !'ooJC<l1he nalllllal rate

On 29 ....ugusI 199$, 1t>a l/Cl'V'll<OO1eI alSO~ a map roaw O'lI\lalova 10< chrld ........aI.Ero::tIOXa\lOO l1V two llO1Ol protedS"' urban slum•.DII8 01 """C!I b«:IuO"l .,honI_"""'" kom 7610 20 pet 1.000 M _ . ItIa Po_u has10"""""" a na t"...., 'C/lolct r-"",'~, 10bePUl "'10 8CIiOn l1V me EkWIlNl ;,....13""" legion..Ih fInlloo 01 S1$0 IllIllIon lor 1t>a lir!;l yea<Slarllng "' Jaru:lry 1986 ., pCIOI" UIban area« 01Iha JJOtlh.iIasl, Iha pr"I1",,,,,,,a WIlt locuson low·COSI wa)'$ '" rnpove cl'liI<lre.", cI1ances 01~

MeV' ''''''

en?...COST"""ClDOI_ teANf6'UBUCe. $OI..Y.ooa'I~

""""'",- ,-

'm"",*,,", its -md-wido: 'OUId AIM' ......with 1M 1aT sp<ci6I; i111e111io11 • k n.,r lriU ...... .,. n I " , .... _I _ ", ..

...,.... t1trnlW"."

... -..d ...... raaa= for radWIc I ....;om,tJ. aU pwmtl is~ W _ awdia ilMff.....I'lh I ,lllII of t,DllO...rio p l........atiDcUIlO aI.- eoay~ u:k ;'"~10~ tJ. W PftJllk ill _ IIJ'bu. --. IIld...., 1iIUX]' IJria&Uq; ill ita -aU I .....

~ roadoonI1j", W " lClopiq ~,dmroDic aDd prulled _ media _ U"' 'MpoteotWlO ........ _ iafonn l1Ioo ... ma;om, 01W pcoplo ill 01_ all COWIIricL

UIUllIy. 1M_1Dfdia '"'" IIl«-.yb," oatsul'liaall SOWtt 01 _ iafurmation IboII! _,bin, .. fUDd' nrntal .. bmil, hi!:l hb . If thi!_her is to makeI clwIac La ....... llpe('! of dIiIdare, Ibm aM will IlC'ed 10 bear I boIIl ii, ODd be.-vinoed of it, r""" leYen.I rapoc1ed JOUtCeI,.

The bal.ic ll'ICISIIe may be first hurd or IUdl houl 0fI tbe rsdio or in tbe newspaper, bu, it mayneed '0 be m nfOl'CCd by the he..hh worker ord«tor, san<'1iooed by I ~ligioul 0. politkaJInde•. or I ppro _cd by bu peer ,roup or parco...in·Ia.....

Nonctbelcs&, it b..II ","olly been lhe lnIII

lPcdia _bid! hlft PUI suc:bsubjern as ioununa.,ion., ORT, and brasI-fccdinf; 0.110 the OI1ioaa1lIen4I -1J1d 01110 tbe family acCDda - ill COUIIlriesIitc p~~ TYtt.ey. Colom bia, Bmil, HODd...,., EaYPc, ODd the G&IIIbia.

"'"0 REGION":i.. .CIlIlIgt~ .."_ ceu.-" ~_.._lI.6:iIrC

"~-_____13;__

III otba _trios, l1Ioo alalaI1In;"'jms ....___ cI 0fIIIlizcd~ - 01 W prina; aad!be Calbaijr CIlwcb ill Brazil, lAkmhil aad eSal......, • lbc moo- aatl MtlSlim Iadm illI. ' =;lo-a,lDdtllePlailippiaa, ...... 1loeBo»dlliM prieRs ill tile ...w:.a • Burma md Srilub-loI..: abo bdpcd to hriD:r;_~eIt.! dWd pmt<etioo 10 , mil1_ • r--ellIS, .... from "_uuaed .........

NCJ:I eeee the~ or the priql. "lIl1lll1IIY .,I" i"ion, R:so&iaI fromI -w......1........., orpoinrion with 2IlO III<:IIIben ill I

Y\Ibi•• lllCliIIO I Rowy lllicml Uoal 1 wM Imillion _ _ ZI,DOOdubi ia 1S9 DltioDs,lhe _ tol ....&DiD..... brte been Ipan 011'" aetioo in aImoP eYa'J fill 01 ehildsumnl <Ia1P'li1n1_hieh have re:ac:lIfd nu, to tbeftSt lIIIjority of I lWian·. parmtl.

To qht dialTbonl discaoc. the Rcd CrOI* IIaI

"

I THE STATE OF THE WORLDS CIllLDREN 1986

Pakistan:saving 100,000 lives

In -Ule 1985. Pa1<isIarI'$ hN/lll pI3oi"nerS orewUP tNI baIatIce _ !of 1M "OunlrfS tllr ....Y8l"Ac:ceIIltWlCI Heallh Programme. lao.Jnched .,1982 to ta<:kIe PaIoSlan"$ hlQh.,f/lrll rmrIaOty ,ateol120 deat!l\'l Per 1,000,,", borlhS.

oV~ disease: 60'1> olllle bullgel 1"8$~ 3Ioeal\ll;l 10 an aklul eIIon to~ eve<V c/1iId~ !he iii>< d....ases""""d'1 k,. a (JI3rIlJf 01a lTIIionPakJSlanl c!lIl<Iren-r year [->- P' '''''''Ce haS O<g3rIl e<l mass~t.on d...... which d,a.. OIl SllIICIaIy_wo<kers.m mMia ClIIl'1pa1gnS . a<"d '"""Y8\IlIilable fl!$OUl'OO 10 morivataconm_, 8V .Nne1965 O"l!f 3.000 VlICCIIIatiCV\ POS!!I , molMI twtoams. and .- ~hOn ......Is were ..OPllfa\>Oll1hrougl'loul tile country

The 0'80/1 on page 11 sOOws me resultS. In1982 llareIy 5110 of un<\er.!ivw were 1fM>.IIUed.by rtlid-1985. 65'11> _ .. WCClrIa1e<l . wnlcl1means !hal llklIa ""'" 100.000 _ life Ueady~ _ ......... year, and 3 miIion ilIne$$es

_ led, The~l" confiOOnl Ihlll 75'11\QIcNIcIr.., ";1 be PlOleCted by"'" em ol llle yea,In the Punjab. """""'" 55'1. 01 Paki$lan'.~live.~. lias aIread)' passe<lllle 60 " marl<Co«espondingly. OO>I'lIaoe "' ar_ SUCh asB!IIIrct'islan IS below _age and II'<SiJttioenIlO protr(lI8 'hekl immunity'

To l:>acl< UP me ..-.......zalJOn 00_. Pair...."Is now one 01 !he lirsI oew.lcpo~ COIJ1~'" Iel:>eC(Ime seIl....._ ...-vae::<;IIllI , _

10 a P«lWct>oo plant~ in 1 9a ~ arw:jhnanc:«I tl'1 !he e/IoIIS 01 HIlI Royal HigIInessPnnce TaJal 01 Saudi AI_

o 0Iat""""'" dehydt8llOn; lhOl second """'*'t 01Ihe lICCelera\eO progratnme II 0181 r«¥Jrallonthe<ltl>Y, 10 lO<8Slal !he 00_ <lehy<lr"'"",WIIiCIl kills oearIy 300,000 Pal<JsIano dloklroo"""'Y year Aro:l here the record is r>:>1 SO~. ProcIuctiDn 01 0ID1 """\'CllallOn saltslias-. Sl8pped up, from 1 _10 22 _sachets a year Bult11e programmeM5 _less

StK:aISSlul n cruatn;I oemand l/'laII ., U'ICl8aS/TIQSUIllllY Man-; OOC!O<S """" l'$l to adoIll !fieIt>erapy, many phalmaosts pre\er 10 ..... moral<:rawe -and irlllflecwe - "'''9''; and lI\IQ IS lIS

yeI no greaI~ In PUIring """ ~"'r>v~ al ee d!sPosaI 01 t!>e vilSl 'TIIIIOOlY 01_n', parenl5, TOllaV PIlfl\all$ only 10<;, 01PakJslan'. parents .. oral ~lI\lOn ll'erapy de5pne t!>e Iacl INt <barol>Oeal <leIWratlOn ' ...maIllS tne _ one IolIer 01 Pakisla<lo <::hb""

In an eIlort Ig Ium !he Ide. !he PaldoI..,P~~", Assooal>i:ln lIaS IOl>boo<l succesoIuIIy (llf_ anl><lo_ 1<lr«;lS '0 be laken ott Ihoo"icIal Of\lg JegISI&', ancI ltle Mnslryol Hl:lalJh !lasI8oJnChe(I a "*""~ 1lor0000od al doc1or.as ........ p:venIs, 10onc<ease tne demand fororal'eh)U'atlOn TIlle'tt$Ion~l$ ",a beingbr_ iOl ..-ima ""'" to u.ocata pa,eots aDouIoral 'l!t¥ltal>i:lnancl_ Icfw.coR Il'IIlIl5U'IIZ lha1can"'$ tt>lIir~'.1ives

o Trllli'llng ~aoibonal bor1h lI1leno:tanls: tne IIwOelemenl IS ee nnng 01 ll'aOollO<lal bIrttl lltler>""'"" [TBA'J r OO' ilia majorrly or Pakislan '.1l'IO!t>ert, TBAs are !he malemal ancl ctOll:l _ Itt>_ . 'hel' (leIivet80'lool_ in ....-a1 ar.....IIO<l U- ....... 01~-abou1 PlagMrICy.sale oetrverv, !'Jl'QIl!ne, ancI ;,ram C<IIe- is a kay_n• • ~ or matemal an<!ctOkI r-Itt> througI\lIle Mbor1 .

Tho anllS 10 tr301 50,000 TeAs SI,Il!lat <JYel'IVlIage ancl ..m 1'1~an v.iII _ a tlotast oneTBA able 10 dell.- babies ..!ely and 0He< soondacMca on -.. care Sc> tar, 15 ,000 llaw'eceMld """" rnc>ntI"e' lraitWlg IItld _ re1~10 lII!!II oonmnIies.

Wi," l\lII balance shee1 lookng "l heaIth~._llI\ is ..._ng "'" Acceleraled Heall1

Programme "" anot!le< 1hfoo._ 11lIrn. " 1/111second lerm can match 1/111 <KJoIe'U' '''15 oIlhord , Pal<iolan will _ !l<amIlIIcaI'I ""provao:! Its<::!Wclren', chanc:es of ",,"""!II ar<l of heaIIhy---

();, !.be immuniution fron" Roury InlemaIwnll'$ Pn~n 1990 iniu..,iw :md !.b. Sa,... tb.Childral Fund', SlOP Polio campai$n""" he:lpill$go""",,,,,,,,, health ..,."ices ' 0 lij;h,lbe pan.lytiopolio wbicb is Slill disabling 5,000 cAi!d.trI a liJttkin tbe de....loping world. And IS pan of tbllirworld_wide Child Alive prosramme, national RodCross Incinia Mve been heavily involved in ,h.'1I<:CeSS of the recen, immun izalion caDI!Win, inthe AlI>eI'icu - fielding 100'" lban 13,000 volun_t« r vaccinalOfl for the Colombian cam paignalone.

For lbe promotion of knowledge .bou, vi'aminA, HeI.n Keller hnwtalional (HKI) iI nowlaunching a $6 million Child Surviwl Plan '0M .....l:t " '""""'lie ;"'p4<1 '"' child ",""""I tryf>rtt'<IIli"l mui ,.....,Uog "-'f1m'd "'lJlml ~ ,.f tlef":itlII)'''' (»;<~17ieo fIJhnt , kildml aTfI ar """,,;u, ofb1indlUSf ,,06 chill! ....,,"'/ily..." A, the WDe 'imo ,HKl has also moved 5 million doses of vi'amin AiDIOIhe camps of E,biopia and lbe Sudan whe:'" ilia not un,ypical for 10" of child",n 10 h. wadvan<:cd symploms of vinmtin A defici"""Y :mdwbere m:my""" irreversi bly b~nd."

In ,he: iDdusuia~~ world !.bere .... nuw """r3,000 voluD'ary organiza, ion, $tlIding :m esumaled SI,500 million a }'Qr 10 thllir coun,er partOflIanizalions in Ihe devdoping world. And in "'"d. vdoping D.OOO$ themsel vu, UDCOIID,ed lbOll·Wl ds of mganiutions - an estimated 6,000 inBangladesh. for elWllple _ """ workin g wi'b ,he:people of lite pnnral villoges and neighbourltnndowit<", child= .... I0OI1 . 1 risk.

In exh n.tion, laal kno wledg. and cteln ivitywill o, ually be able In pick OIIt nther "'"Y" andmean' of melting ou, ' 0 partu,ular group" ofpar<nl5. In Bruil, for enmplt, child $urviyal isDOW 00. of lbe ' badges' wllieb can be: earned by!he nation'. 10 mil~on Boy Scouts. In Colomhia,the goVttDlllCflt lias decided 10 booiIt '''' N.lionalPlan for Child Survival and [:lew,lop.....nl bycn:ating a fom of 18(1,000 'heallh guards' througb• La.... ...Ilieb ob4a all founb-~ar bigb«bonlstudents 10 hc: lfIined in cbild survival kno wledgeand to .....e . 1 leasl 100 hou,", I yur in thecommunity. In N.pal, an anem pl is heinl made10 take odvan,qe of a contraoeptive distributiou$}'Stem in oed.. to promot. _bets of onl

"'hydr1tion sal,s througb lb. $IfI1e 5,000 "'tailO\ltl<l$. In IndCl>eSia, il wu lbe slrIlClum set upto promote family planning, and the: 10,000 familyPlartt>in5 workers already in pI""" acr<lSS thecounuy, ....Ilieh made po$$ibl< the sulKquentlaunch of Ihe Family NUtrilion Impro~'

Prosramme (Itt panel U ). In lbe Middle Eut,ilj, Ibe national women' , orglniution$ ( in Otnanand lbe Uniled Arab Eminna ) . nd Ih. WO~'Sunions (in Ir1q, S)'ri.. and Democra.lic YfiDt n)wbo h..ve tqun to take I particular interest in lb.prmoolion of immunization and ORT. In Nigeri. ,it lias b<en lit< Ir3lIi,inna1 chief. who b••e helpedimmunization WlI~n$ '0 re:oc:b much Lacgernumhc:fl of paren lS. In Honduns, local _yon oralea1d.. h..ve len' 'btU- a.. lhori,y '0,It<m<3S38aabou l ORT going OU' on lbe radio staUol1l. InIndia, villagers who bave b<en ,rained 10 mainllliDvillas e hand-pumps ..... now alsoheing train~ topromole ORT al""l wilb lbe d ean ....'er .opp~es. In 8ruil, tbe tnditional healers or ruadei . as ..... also promoting ORT. In Bombay,"'hookbild"'o ba•• hoIb prepared the list, of alluod.......,.. in the community and belped 10inform their parents of the Ii\ne$ and places forimmuni..,iOfl. In Haiti, O"er 2,000 ord inuy110","" "'Ilicb .... abn omall $bops for cY<')"(Ia1pro vi$i<JO$ like bontries and !IOf, drinks are nowsd lin, _ b", of oraI ldtydntion salts .....d!.

Primary h",o wodel'll

When formal health ..rvicu reach on1~ •minnri'y of the popul.t ion, it ;, only by mobi~","

ing all of IbOK resDlU'CCS tba' preoent knowledgeabou, family health can be: broken 001 or itsmedial sho"'~ and put in,o th r It.and$ ofmilliollSof fami~...

Bu' u perioncc b.as shown lb•• all of ,b ese nowideas about heal,h """ pu ' in, o pra<ti<e mortquidl.l y and mon: . "",ly if !here i' a be.•hhwork.., eeea one wilh only a few w«ks' or0I0II1bs' training, "'ho actually ~y.. in the <:ommuni,y and who ;, tbere .t !he lime tbe molber_ immedia, e1y oeeds the ad"itt .bout how touse tbe DeWoraI rebydration lberapy, aboo l JOinIfor an injec<ion in prt8n...-y, .boo, wb"".. '0lake • chi ld for I third immunization , abotll

"

"'lOUnuing '0 brust-feed or about Wh~Jl IO bc1l;nwaning. If Illth a person is part of, ODd av:ailable'0, 'he commuoity, wheth... il be an anganwadiworker in lodi.a or • f'TI>I'W- rJ" S4/rul '"Colombia, [Mn aU OIh<:r IZIrSSIlll:ll from all OIherJOUrceI"", mon: likely ' 0 lake tOOl.

AI the mom<'lll, ,here is st ill . long way to gobefore cvcsyvillagc lJId ncighbourhO<ld has ac<:ess,n lI>Qdcm k<lowlcdge of family health mctbodl;via _ kind of residen, lnincd health wmktt.

10 JlIO$I lkvclopl,,& COUDtries, ,hrtt-quor'lcr1 ormon: of ,I!<: hnhh budg<l is still de_ cd '0e>:pensivcc hospital and doaor-bucd can: for lesstban 20"' of lb. population." In moo.I co uotries,primary hcahh tare is m ll lO""'thin g 10 be'kl«don to the cxis/ing health s<n'ic... - if 'bere isIn)'lltillJ: left in the bodiet wben 1M hOfpi,mIIId the urban_bucd curat ive lel'\'ices have beenpaid for. [0 0><)$' COU ntr1cs, there are still 'DO fewprinwy h<:ahh cart workers with 100 lin l. ' rain_iog and supm'ision IIIld wilh not ntmy mough.uppon from referral~ lIut dQpit••Util;..progl"t$$~ bffil mad. in the last r~ yeatS.

Almost all dev¢loping nat ions h.... DQWadopted primary tle:lIth <= as officiJl policy. Insome, luI commi tment il llO far on ly rhetorical . 10othen, Ib= has already b«n a ";Rni6<an' AA inth~ numbm; of~ks and community healthworke r$;-

In Chifla 'hert a", O~r 2 mill ion 'bartfOOIdOClon' I t work in th~ WDUnunhy. In Indi., ashas :already been m.miOll<:d, there an. nOW ovn300,000 health luides at work and ,h.rt will """nbe 600,000 in villag.. throughout 'he coun,ry. "But these, the IWO most populous nations of theworld, .... nOl tM naly aampl.. of larz~l.trainilli of paramedial staff.

In Bu""", 26,l58 community health work. ...and 8,700 .ullliary workers hi,'. been pl.J5ted andthe plan i> now '0 put OM commuoity healthworker in each 01 Burtlll.'s loS,ooo viHages.

10 Thailand, 43,000 village heal'h workers . ndover 419,000 ' health communieaton' h. ... beentrained to briol basic hellith """"""80$ '0 fatni1iesin .....,.~ of Ill1 villages. 10 tot:al, Thailand no whas more tlwl 7.000 heallh ceOIm., uch sl.ffed

•

by a tnioed midwife and a health san itari.so (seepaneI 21 ). ~

In Pakislan, t.ns of thOtlSOrlds of lradiliOflalkin h .tt.ndonts are he:ina ' rained in basic motherand child protect ion str:;uegiO$ (see~e1 I I ) .

In the Repuhlic of Koru, communi'y healthproctitioo... In' now .vailabl. to ........ llO% of .IlrunJ pcop1e.

In 8aPlliodeslt , there are now 23,000 tninedmid wives and 30,000 mort art "'hed uJed '0 betrained by 1m.

In Nepal, thm: are now almost 2,l1OO .uxilioryheallh wOKk~rs, wilh either eeeOr'WOy.....' basictraining, working in 800 rural health posts.

[n Tonzoni.., 90'1. nf tbe pop ulotion nOW lives" i thi n 10 kilometres of a bea.hb pos< (ond over7(l'Jl; within 5 kllonx:trcs ) .

In Nis..., 13,000 community IltIl1th WOrk...ha... be<n trained to"""~ .!moot 4,000 villages.

And in ,hrt<>-qur.n... of . 11 the develop;lIi<:oUlltries, 'h.... art now some lUnd of ' rai ningPTOllratnme:i for the tradition.1 binh .umdants(:see po.oe1 I I ) who are rtUed upon by themojority of ,he world 's mothe.. fnr help ""dIldvice in tllIlters of bearina ""d nr1n1 forchildrm."

In SUrrutlOry, the techniques and th~ k.nowledlefor a rtvolution in child SUMVlJ art now avail·able, The ClIpx;ty to inform and suppon JI.roItSin hrinll ina that revolu tion about _and beginning' 0 pu, pril1\llry h..hh care into ptXIi"" ~ i ' a1.., inplaIT in tt>DSl nations of the world . T he on lycalalyst nftded to rompoun d ,It... two elementsin to . practial imprn.......n' in ' he ii ..... of theworld'$ dtildrm is thcnfOfC the politi cal will andro nuni tmen t to do ;1 ,

In sn<tai nOlion$, nation. where tha' politicalwill and commillnent ha~ already been demon·strared, it is already clear th . t the~ i.loinllto he:a u ccp roll in the nI,e of child ma\nU,";tiOfl andchild dellt'" 0 ..... th~ oal few ya....

But in all <:oUntries, there ore important diffi·rulues to be acknowledlled.

The benefits for womenThe 8,eal($\ of ,h""" difficultia iI <.be ran lhOl

lhe majority of lb. dev<!loping world'a wceeehave [00 lars<' a~ of responsibili,y for family..ell-beiog lLIId [00 <mall a~ in lh. decisionswhich aff~ it.

For wheth.. "'" are ralki"ll about breastf.eding or -aning, onl .chydra,ion <.bcn.py orimmuni.,tion, regul... growth ch«k.i ng ur f*quen, h.ondW2$biog, it is obviOWl tha, ,b. moth...stands II lbe Ctlltre of the child S\lf\'ival ~olu

lion.

Acquirina: :ond applying p=' knowltdgcabout child huhh ,hC1('[Ort lIIllMsgrea t demand.011 the mother. But .. lilil cbapler wilhummariu,..,....,gits for protoc,ing Ihe U"cs of chHm " arealso """'''II the Il1O$1 ""1'0"...., stra'<xi.. forimJlflJ\'lng the li"es of \IIOITleD. loasmueh lIS theylO"" ronsiderabJe ImounU of monO)', th(')' eff«lively in<nO$O I woman'. income. Inumuch lISthey prevent iIIom and disability, they Uberate awoman'. time IlIld cOOlly. !.......,n. b as they sa....,Iivq, Ih<')' hdp In liberat e women fram the ,niP oftoo-frtq uenl pregnancy (see JlUId2S) . lnumW:h.. lh<y emil'::" "'" a WOman 10 protect ber own andbOT childrtn'. heahh by h<o' own ..,..ions, theyincrease a woman 's I bility and confidence til takem<>re control nver her nwn life,

On 26 July this yell, at I World Confaence inNairobi, the United Nal ions Ik<:ade fnr Womenformall y d,..,w til :til end. And ah ho..,b it is 001

poo$ible h= to .s.arnine Ihe whole f.bric of is$....whicb has bo:cn woven during the o.ca.k, it isuseful to follow IbOle strands which Iud directlyto the quality of chilmn's Ii"" and 10 thecopacity of mothen to bring l hau l impnwL'eeme-

Filllt of all, the Ik<:ade hooWsp¢lled forneriMidea that ' fanmr' ill I ~ne noun. Su~dk r sunoey boo showu tb .t womo:n of'en wor k"""" hour< I""" day and mote days I""" y= in the6dds than their nltJlfolk ( F;'. II ) and lhat theyIfC di=tJy ....ponsible fo r producing more tbanb.lf of 011 til<: food grown ifI 'he de""lopingworld. ' In Wo:st Africo, for aampl., women do70'10 to 80$ of al l ltIlr>cultural work and prodlK'C4M. In~ of.1l st lpl< food rrops.'

Then, ofler , pending up to iii or ..,,,,,n hou rl Idly plantmg, w...w"l, hwiflg, threshiflg andgJeani"ll, Ih. woman relutn$ hotll/! 10 the: tasks ofpoundi!18 and winnowi ng, grindiog and boi ling,dryUtg: and storing, al'lYing and mrkrling,cookinJ and ..,lYing:.

Af,e , £ttding: the men and ..,.,;og that thechild ren ha"" ,",'''', $1\. he""lf ..u I ,millpn,lpnrli<:ln of the food she hol; grow n. Then shetuOU to the tosks of washing the pots, duningtho hOll5(, , w((]>ing lb. compound., bathing rn.infllllS, mending the clo, hl:S, laying out thebalding, f«<l ing Ih. animals, ,.odiog Ihe kitchmguden, golna ' 0 Ih. mark¢!, fetching thofil'(wood , cmying Ih. .....1..., and loolti!18aflCr theelderly, rn. sid . . n and th. ch ildn:n .

In nt h.,. words, women pUI ifI I pp"wmot. lytwi<:<: u many bOUlll of work os mc:n.

At the same time, th. Decade for Womrn hasalso brough, OUt til<: fOC1 th., many millions OhMworld's womc:n at'( permanmtly in poor hoalth.To !m on. indicati'" cnmple, almost half of th .wont<'U in the:developing world at'( anotmic _ andamong pregnan l wo"""'" that figu", rises d_ ' tom (_ Lifd inc:s' iron, iodill" and vitamin A).'

Tb. C1.,.., ill nOi usuaJIy a specific ill ness. It io"'ther lh. B""....I ' matern al dep lttion ' cans«! by100 much wo,k and 100 littl. food combined with'OIl many pttgllancies tOO cIOK ("lImer.

From girlhood to wOlllllJl bood, lbe ftmales oflIIIlJIy soci.,ies an: fed IllS! and 1...1.' Maloutri·t ion in girls is much mol'( commoo ,han amongboys and III<: fat! ,bat, 011 a~t, III Americanwoman wciJlh$ I pp rnmnotd y 2S... ""'''' lJIan anIndian WOlllllJl is 10 iN: esplaiMd oOt by rIoCfc butby food.'

Fuqu' II' pregnan cy slwpens tbe problem.Poo, growtb in ber owo childhood moy ha,'. I.flthe lIIIIIher Ins Ible to withstand 1M bl'l vy

"

I TIfE srATE OF TIfE WORLD'S CHILDREN 1986

Nicaragua:child deaths down 30%

"

II> me 1960. ar<l 1910. N"",,"9U& r.aa one 01!he hlQllBsl _ aI 0tIatl1 morIBlity "' latinArnefIca DIarrhoe.a was the cnoe! ...... ol lntanl$l1IId clllld<flI'. !oIoWed ll',' re5ll"31cwy onleclo:>ns.lei......, moasles. maIilrta ancl~ cougI\

/lJle( lho ~ 01 \ICl"G'1'lrl'IeJll in 19 79 .Nlcalllll...•• hea/tI1 and sooal seeuntv Sl'S1e/Tl!I_ e~ to begin~ II OO'l'I(Irel>enI'iYo pnmary _ can!I sysIem In lour yeNs, TheI1I>'I"tIeI 01 IIeI,I/Ih POSIS .m;l hea~ cennes was~_. and <NfJI 80'l> ol !he lIOPUla!JOO1 nowhasaccess to free~ nealth cartl_

Umoled 1es<l\lfCCS r.ave IIlIWll """ch'''11 tor~. rwgh-impBcl,~v-_ wars at~ !he hioaIth of I'IlOlI'Il:n ar<l )'OU"l\I

ChiIcIren , So -. """"'_ Mve <:eoUod aroondc!lkI growl!' (1\0" 100 ;"11 , doatmoe\ll disease.,..,.uol, PlOOllllrog bleasHeed..g IIl1d "IJPfOPf\illl1-""Il.~ab/)f'l , t8rnIIy Iood supplemeoIsand !IIlI carll ot~ ;VI(! l3e1atO'lO women.

SuI~ tIeaI!h CllIe Is roll eQualed oot,o...1Il1lle c>.pllllSion 01goyemment _ . ~tth.. also soon as !he responabolity ol orgorOWpoopll, ,,QfO\I\lS. 'People'5/lea~h COU1CIlS' 0!I'\Il0.&lm<lII ......... neognboI.ohocd OIIl'1" ,atior>ll. ar<lliSSOCI3tlCitlS of yCIUr'Ig fll!<lllle and women 10 la1<eon aewe ,ole '" C3JI'1lI1Il "'" _ programmes

8u11d"'ll on lhll .,.per.ence O! 1IIe na\iorlal. temey ctIJSaCle 11\ 1980, II O,,"es of PeodI!'s_ Deys (1C'ffWaS~ ... sat.:t was....OCI'IOCI "' 1981 Co-ot"'nale<l l)y !he peopI(I '.he!I/Ih t<:IOJf'Ob, !he health liars tIave eeeeee 1111!lIla<Ing edge oj campaigns "'9""* "'""'03.(len'PI teYer, POliOand~ In 198 1. lhe maJanaana dengue CllIIIJl'IIQO'I ..- 1 9 .....", peollle/70" 0l1lle~liO<llMcl 70,OD(l -..:>lamhealIh _~ 01 bn<}l>dlSIM E""'V year, onthr.... __~ ........ry ond ..u-...!heatl!lilOloO 3ro:I mBllISI8S campaogos ,egUartv moo;.1l/;11",~zo.ooa~

I/np<ove<! _ SUllIlIie$ """ _ allOn _

'oWce<J "'" If>XIerI(:e of dlllHt"""" """,,og voungCIlidren. IIO"Id ClMths kom oenyd'3b/)f'1 NMl beenCUI by seIlO'lg W 356 01111 ,enyeJral"'" ""'IS '"heal!!' ceeees and I'le.3l\1'l posts Nurses 31 the....'" _ mot!lerli _10 ..... antl ...........ter ",al<elr,<lIatJon salls . and also lIduc;ite I""'" '"preWl1"'11 __ V«>ugh con!lnIJG'j~.

~ andOll11«~ in the home I t>e salISa~ now doe 10 eeceee wr.1eI)' """'lable Irom/;Ifig.od<s/as- ano trvough 0U1IC\$ $I.CI\ as 8rTIaIIshops ano rnarI<eI-Ulldtn To~ IN 8XIl<lC:od~. UNlCEF" S<.(lpIy01g 1S _ pae~ets

of oral ""'y<lrsPorl salls a year

Man~_ play a 'wy role '" I""neaItt1 carnpaigns.~ or\l¥'18tlOf'lSorDOuce tt>eo< own~. lea nets and nDIJCllJ ,

ana annDulCe lor'\rIcomIng r>Ba1t/l 001\'$ ""'" 0Ju(I.~ mounIcd 011 cars

_"10"1"1 Il'og<.......... """ a1'ead)' yoIOldedr........ SIIlce <IfHI rtlh)'ll<al>Oll 1heI"PI'was i<1M ·lII>Ced In 1980, the _ rete amoog 1;/liI<Ir""Wtlt1 (/i3rmooo in hOsI>!Ilb has _ I>'y ~2 "" , anddl3lTlloOO 1l3!l1a1lot11rom too f1r.;t IDthe lltth CIIlIS801 c1tlid _It> lrnmI.nizatlOO ralC$ fJIIaI ItlCISOI 01"""'" developea CQ<JflIties.... t 98~ . IICCO<ll>no to~r ewmaIBS, 91~ 01",lan11 were ll'ot<lClOOBIll""St lidlet'C\JlosIs. 60'!!> Il9"'/1$I measles and76'1ti aganst IlOkI No IlOkI case has lleef'lr~ SIIlC<t 1981 . ..............lI1JOII~~f!lana, """"",," 'II cough _ fe\arU IS ...,......1"'1/llu! ""'" 33'10 01 ..fMIA _ My ptOl8C1od nt 96~ Naonalal teIanus II &IIIJ PIfMllent. buf al1li_ campaign bfIOun '" 1963 IllrTIS fQ.lICCIIlalB all....,....., til cIOlO-bear,ng age.

A/lllOI.lQII lOme n'JIl(>IUIftI _ SI. r_ 10

OIl fackleO. N0Cil/3IgUIl's lOCuS on fhe PI'orrt)'flea/lI'lll'Olllorns 01women and CIliIdrGt> is hlMog 0l!'l<laSIIIabie nallOMl lrrc>act 8e1_ 1976 and1963 tile oYefal .,IM mortaIily ""a leII by 00lI'ftwU. kom 12.1 1080 per 1.000 .... OInns ~ """ atthe JTIOSl </rllmIIUc mpr<Mlmilllts '" dlIla lIIIIVMJIin the rleYeIopong world

__"-'.e-...,....,~ ... '..... _.., ...-,~

AGRlCUlTURAL. TRAINING......__ oao......-.i.,~

..-...g f>'''Il'''''''_ .....,.

IQ1JII

Fig. 11 Mala and f&mala shares ofagricultural ta sks and training, Africa

1Male share _ Female share

infanl formula in a bOlOeis worth lhe e. pense asit means thaI somebod y elsc _a sisle' OJ ayandmotbCl' -tan feed lbe thild and allow themoth to eany OIl workin&-

To V(: time and eoc:fJYin the fields, Jhe mayswileh to less demanding food tJOps like cassavainstead of roaiu: Or rice. not bIowin! of thenutritional I".,.., litis will brin& '0 Itt< chi ldren.

To makc sure tUI the: supl. cro p is planled orh.,vcsted, she may n.glect lhe kitchen garden.even though it is lbe "'W'a: of lbe vesetables,butts, 0 1 f", its which plOYide the minc rals. lheoils. the vitamln A. which arc euenti.ll iogmliCOlJ or the rou"ll child's diet.

(85%

AGRlCULWRAl.. WORK~ 01>InI_ t¥ lOOk ..., _ •.....,.

LLO')l,_l~_

I"'"

"""I"'"

nUln'iona/ burdem of pl'(jlnancy and br=t[«ding.' A prqnancy (Very eightttn monll..wi'h oDibing in be, wetn hu' han! work, frcqumtillness, ...,d poor food, gradually deple, " ,hemDiher's body of pro,ein IIld ealories, halth and"""illY. And if the ll,e stqes of pregnancy alsohoPfl(ll ' 0 eoin cide wilh the KalGn of he<tvimwork in the fields, thm the mmher·'n-be may~n flilln gain ""y we:if;hl 01 . 11 ash... pregnancyadvances. '

To save oomin& bome every few bou rs. theIllOIhe, may only breast· feed her infant two orlhree times a day - evco lhou£b litis may lead toless mill: and lbe pre ma'ure end ing of breast·feedirt&- Or she may decide that usin l anHicial

Th e nel resuh is that the: mother', time andeoel'l Y- the most valua hle of all resources fo,imp rov"'l; child heal th -are eroded by botb theJ'lGveny.nd the injl1Stice of her cireullU\.aJlc:es.

Inevitably. ohon <Ul$ hove 10 be laken merelyto reaeh the end of the: day.

To " ve time and firewood. Ihe mother mayrook food less fre<lUeolly and in large r quam iii·CI- ""riot; i, for Ion!er in uohyt;ieoic: $IIlTOund·irt&S and al trop ical temperatures.

To allow a loo! day', earniop in the fields orplantl, iOlls., a o infanl may be len with an eight ·y¢at-ol d brother nr slsle, for ,he whole day.

T o seve a trip N ek from lhe lit ldl nr tl><mar ket. a YOWlfl thild may be fed only twiee aday, al adult mealtimes. instead of the rour or fiV(:smaller meals which a youn! child', smallstomach o«<ls.,

T o iSVe firewood, wate, may t,<> unboiled. AndIn $IV. an hout's trip '0 the well. lite family'sband.! may MI alwa ys he ......bed after \/Sin! the:IaUine or hefore preps";"! the food.

To SIV(: tim. io rookin! . the mot her may CIltdowo 00 pmtein. rieh foods like pu~ wbic:hllSuaUy ,ake longer ", prepa...

T o save ll\llk"'l; specia l weaniol foods., thild·reo may he weaned 00 a J'lGnid&e made from the:same food as is &iven w the aduhs - ..eo tboupthildren o«d more ealorie« nsc: foods to avoidberomitl& malnourished.

"

I THE STATE OF THE WORW'S CHILDREN 1986

Indonesia:one million health workers

•

"' 0YIlI 40.000 01 __ 's 67 ,000...nages,u...... \OIage~. or I<8a9rs, are WQf1<Jng10 t>oIP theor caTIII'IIlMy orOl<ld >IS enild",',..1'oeiI1lI1. Ono ,e&JI " II\lII 5 moIIon~__ ale now J1l(IUIa"Y weogIWIg "- cllolOren

;nj~ 1.O l)I'\ tn8IIl1aw1/l.

f1lll _ara <:/lu$m by l!1eoI commuroIi85 lOtbnel tran>g and osualti _ 10 to 15 houseIIOlds Thew do"ll9S :nckJOe 1\eIflir'll moU>ers toW9IQIl Uf1(ler-l,.. ......-; monlt\: P<OYICI<lQ a<l'YK;:<I

l)I'\ nutrioon. <l<SUlbolng food """'*"'1(\"1$ to~ chiIdrfIn,~ "'!"""" A, 1/011IlIJI)pIernenIS aod oral rehyoralkwl s"lIs, pmmootlQ!81l'lly pIanfwlQ aro:l ISStMlg <:001'~. .....,~g~. lor """"-""UlIlIO<.

Cloae10 oM _ klOWSara now .. pIlIC(! . ",

8 count,,! "'1I'l 160 "*'" pe<>pI8 ~ QUaI\('i ota...1Ion of """" wc<1< ""'" "'" tarTIIIV planningP'''Il'''''''''' Some 400 ,000 """""""!IIe F8<riIyNulnl>On~1 I'fogr;orrwne, Ttvee-<lU¥letS01 ,,_ """' ",II>~·s IaInly welfare!I"IIlVemO:!flt as WlIlI Many ~aders wcwI< ""Tn IwO'""""" 01 Ihese <l lle<.." PI<JlIIiIrmleS.

The <l8II 01 """lIe ......meer. is "'" oow TO1n<lOoesoa. ThlllgOHlldUOOllOrl0I~.01 !nJ1ua1 self.heIp. 0UIlIgr$31 value on VOIunlary_ lorlh&~. lnl played on WT(lO(Ian1

role ., SPloadong lhe message 01 lhe "Crlllll'RevoUloo' """"'" 3D oo.mabCaIIV ,_ In<lon8$llI'. nee~ III The 197& lat\J8IY nee"'$8 of!hoi """"'1BJy trad<OOo. !he basoc """""""1"_bl' ......~"'" _CCSI only 52 Pel' dliiIaI POPUlat>orl of 16.00 0 TIl<t,esearCllOOllounlllhal-

o 119'l1o 01 00(ler·1.- reg<JIarly atrenoe<,l "'".....1IhIy~ ...SSIOnS.

o IlS~ ot moltle<. DelioMl<l III ""'"U......1Il Of

IflCfN:Ilrog It>Br food ontal<e <lurinII PfeII(lallCy - aP'lIC!>Ce "'"""'Il eo<m'" 10 trad__

o 75", 01 II'II:lIl1ct$ brI!aSl.1M for IwO 1'fW8 01_.o Altnosl 90% 01 moIherS _ vegoIables andmore energy.ridl tood to the< cM:l', dIcllle!O<e\he ave 01 a year

o 51 % 01 ChilOren """ bee!1 ...........-:l~llb!lC\.Oosls and 57.,. roo Md two 8hoIs agaOl'lSldop/l lher...~ cough ana letanus

o 65'1.atlTClhe<s I<,new 8boo1 0181 rnI¥l<8!lQn10PI.......... _ de<1ydra_. 57':1> ooJId """the~ oral ,~atiDn salts ar'IIl (7'10

I<MW 1M lI'IgIfldo&r'lt$ "" making 8 sail am~""" it /lome

Suet> IIg<.OCS !>a..... yel 10 be react>e<l on aMllonal oc;IIe lrnPIoved chikl nu\<u.... has -."Ml1O documenl, ctWWen"'.- at ,e'ar'lIIlJM!";pped trwOUlJl> IIIe nel, Mel ka<Ia<s h8ve _tlmes TIIlIen $lof1 "' Ihet~ lasIc ofoour--.g mottIets 8Il<Ju' Iloalth aJlJ r uU,_ AQOJlI/Ief 01 the ( OQ,OOQ flIM\JOn I<a<Iets _rl'I<l'<'<!d Of <!lopped O<.ll

Nl!\IOr>._~ 5ll,*, 01 C!'IIkl...... wno <:'O'JIdrome fo< ,~ W(JIQhing 'Cll"'~ do SQ. an<llh<;>$O wno Slay iway may .... De _ IIUl .._ -a Il«>bIem common 10 most P'OII'ammet3"'"'0 at UI'IiveIsal """"""ll'

[>'e'\ 00. Ihe JoJIe 01 50$ comPlllc:'l_ WllhItle I ll'" 01 """"'-IIYes al!(!rdng '-1It1 cIfIIcs"roo' me l)eIl)lel<"'O "11/..,1'1 01 _ kadl>/!;".....,oa "e now lleIrog booo.9'! IOgO\heI .. meUOS)'atIlIu - '"" 'Oloe-SIOP' _ IAJ5l _eIhemonll1ly W8lgtlo'l\l :IIl8SIOI1 Blso~oes IIle r;ett,rog!Of _1ft, . rrnl....zallOn and !amoIy pIar"o\InQ~

AnoIher mAon I<8Oers ee dlllllO be 1'_byllle eM 01 "'"~, and IndOnesI.a kicks ...1to11(_ as statM gMIs tor 1969 - no as",18<11 rnortahIy 'ale to 70 <lea"'" per l , llOll Jo.oebol'\hS. ''''"'''II "'",...f\IlabOrl1e'\teIS lOa m",,,,,,", 0165... . IIIlll eo<\erllIIng tho r;,rnily NulII\lOll Improve."'e,n I'fogr8rnrne to """'Y .,.~ "' Ihe COlOlIry

To .., e 10l!0i~ a day'. work in lbe 6elds duriqbarvesllime••be may decide that one immunizalion is enou&h.

To .."" an bour·. "'allr to lbe dini~ when Jhc isprepanl. and poJJibly 1"'0 hours queucin& in Ibei un when Jhe getJ lbere, Jhe may decide not 10bother wilb anOlher prc-lIalal checlt Or a secondlelan llJ mjection. And to .., e yel anOlher tripwilb an ei&f!l-monlb-old baby 10 <any• • be m.oydecide not 10 bolher we;y,il\& lbe child Ibatmonth.

To ba"" more bd p wilb aU of !his. a womanmay decide thaI sbe needs more: dau&hters- andIb,1t lb. needs thema, home. not in Khool .'

Sariaglime, 1II000ey, an.d elIe""

All of lhr:se dnnand. on the time and enugyand hnlth of women help In explain, if nor 10501"", one of rhe <noJ1 inU1UlligCllt of aU developmem's probierm.tht problem of "reKhing lbepoorest'.

For al<.b""8h i' is among Ihe poo<u< 25% orm of a nation', people tM' lhe problems ofmllloulri'ion and ill heallh are <:<lneettlnIM, il isal$o mlhis gr'OUp ,hat women ba, e ' he least timeand ern''1ly, the lelil infonnatinn and COtllide"""to become in ""l~ in acquiring and .pplyingnew knowledge or liol<ing advantage of anib ble.=

Tht pr<>blem i, one whicb ruM IiI:• • faull ~J\C

Ihrnugh m<tSl. d.""lopmclll effortS in most oa_, ioll$. For whelber we an: taUtiog ahour JJ\CIhodsof imp1"Ol'iog Ibe prodl>Ctivi,y of lbe land ormelhods of impnw in8 lb. growth and de""IOJ"men' of child", o, i' is Ibe poor, lh_ wh_ needif grcll.'eJl , who h."" the least surp lus of fCIOIl l'Ce$

-of money, time, enerllY, heihh, lutowledge and""ofidCllCl' -10 invest in impro""menl1 ThaI istbe catcb·22 of po....n y. Aod it means thll theproblem is pcrpttlllted througb a cycle of pooT

nutri' ioo, poor heallh, poor P<Tformanec . l lCboolInd It work, poor productivity, low inoome, nOsu.rph.'s money or effan '0 in>'CS1 in improvement,leading to """tinued """e.,y, ""otinu<'d pooroUlrilion ... and:lO the cycle goes on.

Prolectiq the normal pbysjeal and mentaldcvdopment of children is clearly essential if ' hal<yd. iJ cYf'r to be brok"". Today, bcca .... of n. wknowledge and new outreacb CI~iIy, lhal pi'(>.

lecUonean bc provided to the majorily of tbe poorworld's oItild= al a "IIil which is within thecapacity of _ of ,b. poor world'. familia. IIUIfor all the ot her l:i.ads of ,uppon whicb wi11 heoeccssary to bring lhis ahout , lbe crit ical heal<.b",or\:et II Iht ecru", of the child sum..,.) rcvolu·tKln is .tillihe ch~d's mother.

Doco lb. fOCI that 10 many WlImC1I Ire :lOo,.""orlted me.an thai lbere iJno "'aJistie hope ofn~w knowJ<'dS. and new lechniques bcinS ac_quired and Ipp~ed? Or an lh. ltUlior Iow<OJt.....ys now .-ailahle fo' protectiR3 child healthalso allow mothers themselves 10 sa... borh limeand \DOlley and COnSCT\.. their OWl) health ...dstn:ngth?

AnsW<:rin,l thaI q uestion means laokin3 a, :lOmCof tbe practical and everyd.y ISpccll of tb.l.cttniques themsch-es:_

8~ti l_foeding. a1lbough lalti"ll • eon.;dcnlbJeImOUnl of lh. mother', time, can save the $200'0$300 a year whieh is <.b. average COlt, in Id~,..loping COUntry, of bottle-ftedin. I h:tby onanificial infant fonnulas.· A family living on ueofficial minimum wage in Mexico, for example,would need to sPetld 25'1 of its food budget onmilk fonn uJI to provide enougb for jll$l oneinfant." In Africa, <.b. proportiona,e COW . '"ev.n ltigher - alld C' 'CJl an employed penon, say •h""pital deane. or I govem menl cieri:, wouldhave to spend OW:r ]~ uf his or her monthlysalary to buy enough milk I"lwder for a twonloo,b..,1d infanl."

In addi tion , hl'Cl$t.ftc<\ing usnally dclaY' Ihe"'lum of menslruatioo and uffe... the motber arotI$iderablc dcgrcc of prOIec\iOl\ agaittSl thest~ of anOlher prrgllll1C)' foUowinll too d oseupon the last. On Iverage, the post.lll <a1 periCld ofin fcni~,y lasl. foc 3 \DOlItb. for a WlIlZWI weedoes not breasl_feed I I aU and for l] monlhs fonWOman whu brelSt_feeds fot 18 monlbs." Anda1thwgh IlOl a 10000ly "'liabl. method of COOtrat:eplion from the individual woman's poml ofview, it iJ still , h..... tha" on .-crage, each

"

I THE SI'ATE OFTHE WORLD'S CIDLDREN 1986

addition&! """,r.h of br<:alt-feeding em Jive theIllOIher 111 additiotlllllllOluh or pftll"Clion 'IlainslPl'ql.llancy."

Not I.... , bttasl· f«ding can halve th e numberur illnesses - particularly diarrb""'] and rQpiralory infections- which I child bas 10 be nursedthrough;o its lim year of life (Figs. 12 and IS).

0 ... . rdldralioo therapy alsooffen ..~;"gs ofboIh money and l ime. For of aU the childhooddi~ whic:h I IIK,Ithor bas to Copt with,diarrh..... is Lb. mIl$I {mju.n!. Each episodeusually lasts foot or ~v. daY' and !he.e "'"1 be Il$

IIlIIlY iii m. Of ecre tpisodC$ a yur. And ia the011< ",udy 011 the subject so far. i, bas bttn foundthat Ih. lve~. length of diarrboeal illn<$S wasreduced from iu" under five days III apptOli_maldy lWO and I half dol'S in homes whm: ORTwas 1Utd." The mull is 001 Oflly I mluction ofnuning and worryilli t ime, but also less bathin&of chiJdn o and I... washing of lKlilfd doth....

Once I mother h.. 1M COQ6dcr= to UK O RTin ha own hOll1l:, beina cmzin th>t it is the timpossible therapy, th C1l the time, U1lvdling .,._pUlKf . nd "Ullmnt «Jots of clinic and b""p;,,1visit!! em usually be Sllvro. In IOOSt developingnluom today, diarrhoeoJ diR_ ..,d respiratoryinfections= 1M tl"O most common ''- fotI'isiIS to pharmacies, hcahh clinics, and bospitals.In some counlrics, families 1Ir. 00... s~oding upto 10" of th eir income WI anti-diarrbncol drugswhlc;b arc of 00 valu.," Th. early USC of oralrehydration in th. home will nomWly mean thatdehydraunn will nOl $t1 in and a clinic visit willIIQI be ncccswy. But ....n if th. diarrboea ~l'$iStS

and dcbydtatl<lo bcgi ll$, a chUd who hIS beentreated at home with an oral rehydration SOIUMOwill arrive a, a clinic in bet l.r condition an d anbe Jiv.o Ih. ne<:cssary treatment ( withWHO/ UNICEF_formula oral rdlydratioo saltsQt , in lIl(Ir<: Utrcmc Ca$C$, in ...... enous therapy ) inI... time and at leu .s""".. and with g....terc. ruim y of SIlCXCSl.

• Tho'-' ond otlc d ..ri~ dr\q1 !>II _ lIyb«oI _ ia /«<IaII ..... lbo _ ...... ill S"u. lboJOl'Of'Ul'OO1 1U\IoOI;a for ""'" pood.... _ _ ";'bdn_

"

Immunizati on would tak. nu l :n leas' 'WO orthree major, wonyilll ilIJlCS$CS whicb I chi ldwnu ld OIberwise hlV. to be ounal through. Itwould abo pttVcnt at least half of thc childhooddil.IIbi~ties. especial ly panilytic po~o and blindness, whicb nave a serious dfect on the ~fe of themother as well as 00 the dcvdopmcnt of the child.Wilh full immunizalion, fOf example, me chancesof a child becoming disabled arc m1uccd hyapprnximaldy~.

SinUlarly. Iow<OIt action 10 fortify di m withvitamin A, iodin., or iron may be essen tial forprotecting th. nonnal d.velopment of youngchilm n in certaio arc2! of the world (see panel22 ). And the time tak CJl tO includ. these mi.ocnlsand vitamins in ,he diet _ Of to coIlCC1 capsulcafrom a clinic- can also protect the DlOlber fromlhe ronscquencca of a child 's d isablement . Vitamin A supplements, or the inclll3ion of IIl<ll"C

green vqClablcs in th e child 's ItIC'als, could savethe eyesigbt of the qUln.r of I million child re owho no w go blind each year from vitamin Adeficicocy , But the sameaction could al!ltl SI'. th emothe.. of those children from the "3ooy ofwatching their child ren 's eyes slowly doud "". rIOd from the ~fclong alta WQrk of bringing up.sigh tlcss child. In ot her arus, going for iodineinjections or buyina iodized salt itn~ toprmect both the foet us from brain damage andthe mother from the consequ.nces of Jiving birthto. pmnanelllly retardc<l ba by.

G rowth moollonOi will oonn.aJly mean. visitto I din.. or I villlgo wrighioa ooo tre onoo I

mooth. But it too an rcp,Iy with interCSlthe time:iov.:nc<l. Th. main aim of regltl.o.r srowth moDi·t<>rina is to bring th e IIlOIhcr into regular l.-ontlClwith basio odvicc ond help on child health and togivctbll """het urly wamin8 of ony fal«rina inher ohild 's growth. And II thlt .Irly SllJe,relatively oheap and simple action can be tltoO to"Dp the child fl'OfIl lJippi"i ioto tbe oyde ofmaloutrition and freqUC1l1 illoO$S - I C)'('lo whichtakes sltoh I to ll botb on tbe ohild', arowth and onth e moth .....s time: ond .nergy.

Thole demands on I Yl"O<tUIIl'. t ime causc<l bythe lhocr flC<l",eOC'Y of ohiJd j]lnnscs oro h.ard toima,gine from the f'C'l!p«:tivc of th e iodusuwizedworld. In very poor "DIlIl1ncs. children lilly be illfor 3O'C. Ul 5~ of thoir YOUD8 1ivcs.According to

one . urvey in IbogJadah, for eJW1Ipl., the1>~r2ie child h.s oee lIlnOM or another for75" ofall the~ of ;" lif•. " Such 6f!u,.. P>eaO that a!DOther, with perhaps three Of four ch;ld~o tolook after, is permanemly COP;nl ";tb the illn~

of at I...t on. child. And nOl onl y d.... this taketime, ;t abo <'0$" In<Iney. Many families in thedeveloping world spend Over lin of their incomeon health _;0 ItIvtlliq ..peoses to clinia, in<:oW of medicines, and in r""" ' 0 dOClol'1 Ortradit ional healers. In I CC\IIIU)' like Malawi, for..ample, it h.s been calculated that one-third ofthe lUtio n'. tOlal elp<n<!ilUftc on health is apenthy families thentS<I.,ea.~ Or in Hondu.., when:the lV.rog. family ,uataina about thiny illneuca ayear, the dim:! cost to the family isapproximatelySU O per ill..... or a tOlal of over S200 ayear - half of whicb goa on dNg$." So 'hefinancial COO" of illness, as...·ell as the <:oW in tb.mother" time, en.IlI Y, and wony, .... propon;OIIalely mIlCh bilb.t than in tb. indum ;aJizednatioas.

Fig. 12 Relative rates of infect ion byfeeding method

D 8leBsI.1ed 80 ttkHed

USArxerroee

1978 1979 1:;;;::::;:==~

UK

Gaslroenterrtis ~~!!!••••II.I!!:=lI:::l~1936-1942~

Ras~~o~", "~O'-'~5~"~'-8~'~'·Oc,c,c,',c,.,c,c.

Relative risk" oI lnlection

--..""" II"' roII'l:*"OI _1Q t t '9"lW_Jod__ by .... _Q1...n ' OO~·..tllIIliMtom l1lt.-no aodo-........ ,..""' O,t "' . <1M "'"----_..,-_...."" .._-

Growth chedting, ., a focal point of cbildhWlh prolCClion, could bring together presentkno wledge both ,bout the prevention of illnessand aboul lb. , ptciaJ _iog and fcedins nee<bof the )"(lung: child. The "'IIuh cou ld be It lew ,5~ <eduction in the daynpeol in i1ln~ during achild'. carlic:o' year$.

The 'th ree F. '

In previou$~' rcpotU, child , lU'Yinl andwell_being has also been show n to be closely~lated to the 'thtce F,' of family tpacing, food~upplerneD1S, Ind femak educa.ti<lll. AJI of these...n powerful upward l.....rage 011 a ebild',chances of s.urvivaland normal growth , But all ofthem also exm pow.rful upward I....Cf'Ol!. on thewell-being of women tholll$Clve:s:_

Family spaciq. LoaviJ1ll I I leasl t..., yearI

betW«n <IIIe prcsoancy and lhe nOlI can <educetbe ri!k of I.Il infant's death by 5011 or lDOlC (f jg,14). BUI it is also 0 0. of the most imponanl ways,perhaps tbe moal imponant way, of main'aioinstbe health of tltoK ..hose bodi.. arc depleted bythe heavy nutritional RrcssCI of 11_ contin u_OU$ p<egnancy, child·beating, and btt:aot-fccding.In _ d.....loping countries, 'matern al t l Uses'ate the leading ""\1# of dealb lor women betweenthe asCi of 25 and 35." In other word.. """" du.na Ihnugnd young mot h.... an: nnw dying ••uyday _and many of .hose 'mat.mal deaths' an: the"'IIull of too many birth. too dose togolher .

Female educatio n. Th. education of themoth er has been found 10 be perhaps the moM

imponant social det.rminant of a child ', chanccaof survival _ e~n allowing for differeru,a ineconomic class (scc Lifelines: femal. educa.tion) ."But it too is a powerful fOftt For improving IheIi... of motben Ih<mscl.,CI,

E. en with only fuuror 6"e yean of IICltooJiog inwhich to achi..... basic IiletlC}', a WO!llOIl SlIZlW I

very mIlCh hiKher chance of acquirioa the knowledge ...d the conlid...... 10 plan and space hetpte&.lIouci<s, to lNke usc of a"Oilable h. a1thservices, to disrov.r and apply new kno wledge, 10work oulSide the hnme and earna biKber illC'<>JM,and to panJcipate in 'be flmily and communitydecisions whiclt affect her life.

1 THE SIl\TE OF THEWORLD'S CHILDREN 1986

Somalia:protection in emergencies

rtle I:WIC SVIltelWS flOW~ lot MngonQII!XtUI a __ In CfId(I sumva/ fMfI~

.....,... ,.,.." lIl.Wl In AI1/CIJ. """"" tne """""'I= P$ S>:acet'OaMg me l>.1Sic _ ~,..>0«1 or _cm .. all p<XIf ctlmf1JUMI8S An~ trom Soma/I;J-

I:UJrJo;j Apr~ <nl May 1995 3t1 epdernc oj_a, ItJe swllesl and "lOS! IelhaIlll Ooar_dI:;eases. $W<lpI lhrough lII1 er\Cafl1llmOltlt oj

45 .000 (1/lIOl><8Il 'MYgee9 aI~ "' no<l~·_ 5o<TNl1la, k-.g 1,300 people. ""'"'1 oIl11emIOOOleO and~ , In !he r1eIllIItlol.oJng ltl'WTl 01HarQeI$a~ 33 PeOPiII """,-_to H3<g&osa's Ilm'W\' N!ailtl eee llIOllIa"""" and tr.eroeaIlh WO<ker$ .mo _e """""""'11 <:nolO<oollgaoJISllt>e ...." _ llI5eases 01 d'*jhoo<l

Hat_.MIn •~ JlOI)UIol1«1 01 _120.000. IIlIhecapita loI00eot Jen legions whefepnmatjI _ tlI/e """,.oes are IleIrIIl __ . BuI """" IhougII~tJoI> was avaij.

0010.~ 15' 01 Harge<;a'. cr.1"",,, _" tuIv>'aCOIlalod As 1M posUIoIrtyot IaIT*'" lO<l<ned "'!ale 19/14,lIlong WIItlIhe fISk 01 measles oeatl'lS inCIlIIOfe(l w&ai<lInIld by maln,muoon , "'" <loosoonwas made to Yl!<:Ula1e 1iat1l.1ISO". ctokl,en 115~1IS_ble

The 10'Sl ra;m oj VllC\:II\1lI00rts was se1 !orJaro.oary 1965 To~ lIa,_'s 'oogulal~tors. SlUOl:<11 nurses were tr_, V3a:O:llI~ _e o<de<ed .. , local offioals ......

twoeleC, 3llO tna lc.lders 01 !abelIoo !UIlltS of 50t~J ,eogosteroo .. I!le choIOr"" ..-.de< """ "'lheir /atleIlIt Radio~,~ IoI.<l.$pIlIll<Of$ en::! $I>CI<en __ the carnpalgn

Ou<'o>\l t/la,l.-sl 'OUrol. ail <>l Hat_', 15,000lA1er.h¥es _e V<lCC'oIaIed againsI measles andfeawed lIleII 'RI (loooo !or POlo,d~.

~<:oug~ arl(l IeI3nuS

Tile second rOUnd W3$ atlOOl to . tM ....roen_. broke wi .1 GarvIel aM II'Irutenea melawn. A.irM<!y lra.'llld In <>raI reIlydrallOn Iherapy

lot cfwmoea. the P/lI'II3tY _ eMe petsonneIworked day and ,.gill aIongsode II>e lOWl'"fl'lOlllo10 Veal w:lJmI BOO call"'" me epcleoiOC 'hoOUlllreal< was SlemI'I'l!kl oef<,xo ~ 0QUlr;I cbm moleIIJlIn 33 lives.

A measles ",,!bIMl< IolIowtlll lI>e _ . In

CannlII 365 chben eee . In Halge.sa no chlill,.,[rocaII8ge<l IIy~ <e$JIIs. Ih!t~

lIdoIlled II mora ¥T\tNIIous goaI- imrrIuntD1g the65.000 chokI!en at ee capital <:>t10I~,

_a tI'ol,~\IlICClfIlI1lOn _ wera '0001:1\.IIIIl GIlly 11%. 1M t~Sl S!ell_ II P'Ol~In taoty 1995. in II pOOr~_..

_ lMn 3 'lo at .".,"'" un<ter lWO wt!fO t.-y""'OC«I'lted. m """ mO,II\'\$ ltle "'''' ~8d ..-. l<>.,.

1M Inl <(lI..n<l at ..... t:Itl'_ canlpalgtl wasIao.ncI>eo on 3 .l'*t ar.... II roon!l1 ot . """"""prepam!JOn'< itl¥oMnQ ""'" 2.000 POlotJtal andCQtIlJTIIJtOl1 """"",,", 500 _ "*"'100<1 . ...'0(1

500 SIucSent vaox.\atots, Commo..nIV _~_ tJr9t"'"Zed. l'anng COI.OS8! 001UP, anatadootab. Sl>OflI and ,ngoIes broaao;ast tMIfY "'y I'rOS$1IIl;elEtll Illl6'Il:IOtl pttlQIllInme5. b!(lSpeal<et iIt1'nooocernents. loollets. 1l8t1net$ and eat~.S\lCl<ets PUlllicQe<l ~toOfI. VoLn\eerSV$Ied some 150.000 _ fQ '-"" cI>iklrenunclot t"", and _ patlltl\S l<> 1III<e lNlmlO one01I\'Ie CIll"1 62 VlICClOaliOfl """~es. 50 oj them<Jl>Ilt"ld~ lor lila _.long ca~9'

Mora man 55.000 chokI!eon 865 '\0 at me c/IiI.lit"" """ tIa<l OOM l!lgISIereIl- """,a btougIll totn<I centres, and ""'" 17,000 women _

~-When~_ ana UoQatI"""" ~""" con'4lIelOO

~..... """"""'tJon p<ogr~. aboul II IJIm ol$omalifs chiIlir....wiatill ptQlel;lOO The~tJaI dirflC\n'e 'MIIC!1 eslablisllecl lIN! MogadisI>JeatTIP3'Q'l '8QlI9Sted all _ "lgIO<1S ot !~

COU1lty to.....,_,~bonCMr\P!lIl)tl$. SO

mal allIIN! COU1tr{1 ChoI<>'en .... till ptOIGCted

Food lu pplemeots. A relativ.ly small amoun'of am. food each day, rot" 'l-ris\: progn"l1womeo, b.. beeo shown 10 reduce ,he incid",,""of 10.... binh-wei5h' wbitb is "Mnit>tr'S<Jlly alldin allpopulatio!1 """P>. tile ""lie ItWtr i..parwnl dtlmnillanl aJ 1M ,/ullll"-of 1M _"""' 10 nom... alldfa<xpfflnia ImlI,Ay """"rh alldIkwlapJfIel""," Similarly, eJIl'll rood for ~r-feeding W<llDoo canmean IJIOI'C ",,<ussful and looger I"",alioo ."

Bu' os well os being. kty child ' ul'Viv:al" "' logy, um food is obvioruly ju,' ...;ral formaitlrainiog 1M nUlritioaal hcallb of lhe motb ...he~lf. In the indll$tri:ilizcd world, an ,...,rag.wom:m goins .pproximolely 12 kilos ill weightduring bff proglW1<y" _ much of which i. accounl"" (or by Ihe fal Slorcs and Ihe .nCrJ:yrcservtS needed for child-btmng .tId brCllSl._feeding. Many of Ihe dc...,loping wwld', wom.n _ " '"",,,n wi,h 100 mllCb bird work 10 do and100 Unle good food ID eal - gain only 6ltilos or lessin pregoan cy and ,herefore da nOi build up anyodcqual. rcservcs." BUI lhe boby will "ill be boroand will still bJnI,l-fm! - al Ihe inevitable COliI ofdeplet inJ Ih. moth... •• own nUlritional beal,h.

Suppol'! for womeo

Applying pr,*nl knowledge ,houl prorectingIhe ijv,," and Ihe normal developmelll of childrmcould Ih.refore be ,he kind of invcsuncnl ....ltkhwould yield 1'C'lurllS in timc, money, hcallh, . ndenClllY for WOIl1C1l in poor communiti", BUI rc,ake full a<!van'lIle of Ihis opponunily, women inmasl poor communi , i" will need more supportfrom their owo lOCi~ from lhe: imemalionalcommunilY, I.IId above a.lI from men.

They need basi<: I«hnologi" 10sa..., lime andene'SY in Ihe growing , processing. cooking and,loring of food -including improved IIlriculiUroJlools and ~hincry, grinding mills for gnin,more fucl..fficicnl SlovCS and ur.nsils, easierme,hods of C<llIceting and conserving .....1.',andI... back-brcaJUnl .....ys of g.,ting food frum Ih.fi.ldsto Ih. market.

They nm! the kind of dtvelopll>Om proIlramtIICI ,,'hich do nOI dl..,rimin... againsllhemby cnlistin5 lheir Lobo", in casb-<roppin5 10imPfO\"t men'. iuoomes from land whicb wumcn

h.ve I,oditionally used for 'minor crups' '0improve md vary the family diet . for during IheDec:ad. for Women, _ seri.. of .ut\-cys has sho....nlhal lbe C<I~lintiun of cconomi.. in thename of d.vc!opmcnl b.is frequenlly rcsuhed in afunher Ir....fer of pow.r from womeo 10 men."MO<II women, for ....mpl., used 10 Iulve _dogltt of conlrol over whal was done wi th lhe_Vlilable land and ' he food Ih........ Brown OIl ii,whereas men bav. almosl Inial <:ontrol over wh..ill dooe wilh ee ineo..... from cash crops." AndIhc evidence iSlha< women devole. significandybigber propo niOl1 of Ihe incomc al thei r disposal10 the feeding of children.'"

NUl, women nted credil and lraitti.., (Fig.III in ord.r 10 buy 1lIld 10 use Ihe feniliun,pesticid... inigation cquipmc:m, and ether lcebnulogin wbich could increase their productivilY_ and their in...l>bl••urpllil- as the prineiP"lproducers offood . And overthe WI f.w years, th~50,000 landl... women of lhe Gramccn Bankpruiett in Banglodcsb have di.proved the id.atlult poor women II'C abI> • poor credi, risk.Loantd a 100ai of $ll million, lb. Gramccn Bankwomen ha_e inVCSled il SOsuccessfully ill incomecaming oppo nuniliel lba' lheit communilY repaymenl record b.is rcmai.o"" at l~.n

in many ...... of Ih. wlllld, women Ibn needIalld refOl'1l1 lo et1iure Ihallhcy are nnl f~ togrow food on ...er smaller ond lI>D1'C marginallands: before finally having 10 pack up and Ic.w:for the n....... cily where th.y must set lObI!wor k Ihcy can while otruulin5 '0 bring up lheirchildren in overcrowded slums.

From c",plnyon in ,b. cities, 'O'Ot11C1I nted lIOtonly a dec.m day's pay for a decent day' s worl<but Ibn civilized provisiOl1 for child care, bremfceding, and malernily lcavcs.And in lb. coun lry_sid~, th.y need _ ~ving " 'age for day·labourirmead of n<lel wbich II'C so mucb 'lower lhanlltCII'sthal, 10 lake an Cllamplefrom Tamil Nodu,womeo can 6nd employment for 310 dal" of lb.year wbcrcas men can only work for 190."

From the beallb services, rhey need more<:onvcniemly localed and bener organiml ~linics

10Iba< lb. ",efaile wailini time is less Ihm lhe 2bours 42 minuI" wbid< _ recorded in a rcccn,survcy in West Africa." And Ih.y need immuniu-.,

I THE STATE OFTHE WORLD'S CHILDREN 1986

Ethiopia:the silent emergency

•

19~5 tIBS t>een Il'le I~ kr meIl'llll'llmmlI launcned • rea< "l/O by Elroopa',Mnslr/ 01 Heoollh and 1hII CIIy ClOOOCII 01 _.-.- to CUl ltle "'!Y', m.nl """*"" by _l!Wtlt, 10_ """ 50 _llef 1 , OOO~_

~ ""....,. N SW'l1l'l'lll!lft 01 dfW,jtIl_l'U'illS' n

.. [r-~ _ bKorr-. _

... -em 0- hi _ .i.""'""" '-:r4l .....f;ftIkItwI 01 .. co.r'*Y I QIJIllIl ,..~_*"'d Y"_'~.OOO~__dp1g

-r ,.. II """"" "-- <)'ougP'C 01 no-........ -fIom .. _ " __bIlJulll'Il_ 10'" ..... CInClI n ... l'IClm

no. _ Ii" ""'" tlWoll_IO_'" III... ...,..-- -'""" -~W1dl__ .:l1lW'lV 1N_ - .... ( 11 """'"

CII'I'" '_"**-'",OCWOIclCO_,,_~ II>__<lIIi'>',O_ tOllI".,,-.aoo Jt9llIr gil""'" nO ....... 10 IllIlp _

d\Ilclrell lKIln lIII;:Jllon(j IfIlO h ~d IIlDI 01n'IInI!r,oon ..-.cl inleclon

Solar. 1 .062~_IlOOt'_I_

_ 'ect\II«l . !l/tlefYISolld by 128 QOIIWIUlIIy.....,." __.....neo ~ aoe<IIS ",m two montr'oll~-.g II_ y .....

~, 1~.OOO SllCI'IelS 01 o<aI flIt>\'G'aIO'I salls_ -.disIrC>Jle<I. _a _ll"O"""_"~~oell Aln_-. CIl'f__ *'*""" ".. Ii one,-_", "-.0.-_10<_- '."..,

TllI :no ary-a n .. : l' : • (~

.. ,_ .. efklrI. AI 01 .... C!tf' , S_it T" Ii .. ~".'_i, _--.,._-';IO_~

..__-.sct..... 1... _ ..

_ ~lliCMdby"_~...._~_IO_,..._-...-.-d -...... ,., __

!he omI ~'1IOI'l ...lIlJIe ~.. komk_~.we ato<...

The~, ,_...., ""Wh&Ol' ....~_" ! Ill«' on cNkl -.I, an<! ..~.-....._-~-~.....101""" by ........K'P ............ ' ""'""" ........ )'eiQI\ilScJ~~iIiltncY... 4r1mCflll-_ ... _ ...... ..... 0" I S

fllbn8'y 1985 IN"*- orHIiItlI_....."...,0... "".-0'" _.-- 10 ............ -.- o:t'*" ...- I0IO 0IgII'C .....,_ 1 olr;hd_n~ ~____ "000 _

36 OlIO -.. ... II AI III '""" ctr'I H at.....,.._.., onJIr ' " 01 tIIeQi.' _-.........._ , .- - SIealIIyfoOm ... "*'-10 _ , pr«:eclIld l7I' • _IcnU~ ' ThI_.ftoocled_

-- - ~. - p.omoIerS - --.. 110 _ 10 dOOf l.Ogong _ idio<e II It>I~_ MIlmbln of1llllwomen', _J'OO1ll _ tlOl" "Ill! fM/I('f hc<J!lonold, regoster1ng chIldr9n 11"<1 P<OIl""'. \NOI'I"l9O> $0 thO ~:n_ <;a'l foIow lIP on ''''''"''ttenel8rI,On 1l1li..... of \I3COJ\alJon Clay , 1l)!~......,_ 11111

eeee Ill'·' Ibi'lllt>l tal 10 QCClII/O'>

Till~ '-~ ..... dIl' I\1iIl IIII1lCIor.sI _ 7,5000 -.... _CI'Ob.-I _ In! ........_ sa/a!l!lIIe$ 81' ... ...., 01' Soo*W'_ SMo 01'... CIIY·s cI'*lrIn _ ..........-

to _ ......... til""'..,....... Of(s_"'" ,..., _ lOt! IlfW1lI ....I"OIC _ _. : ,....~_..pIsmsO 11;0~ __~ CIW1 __

..... II:> 0. -....- TN 110"*'",. .....planilD.._...P""'..'.'.ID _Jl9CIIll,IO_...-Ole"",,·s_WIItli1I'"'*'d Ircm ... -.l .................... bN'lI

lion dlIys _ bil:h m: _ Ie! d...u., l be .-b 01barint llricultunl 'Wlrl; or It titDtsor the l'Qf_beD poor __ ~ ' 0 tn'td 10 _k <bybbow UIOOIlr)' or plaamioa.

F..... !be .....'_ they Dud _ b... 10obtiF flthm 10 bdp SUpport lbeU dlik1ml ianp;dly~ ..n..o __bet<: II»-

KioIIaI ItN<tILRl 0( obliptioa and fC$flIlIISibilitr...., IlO Ioafl... be ...foond by 1ft)' IWwI 0(.......

FI'OIII !be rd_ on, they Dud poIiCa -.hicb~ _ &irk 10 mrol ilIIlCbocl and .midiaDo- 0(_ tlnibililylO tab ;"to KaIWI' !be':::::.:.; bbow "", ' ibj JiIJ 0110 _ r pm PI

"""-"Fl'OIII l1lriI'"_ ;",wI", . orden, and f.....U11.....0ri00·1 til: am • 11, """"'Il

ocal _ oaIr ilI-...::a' ad cmfil IDd tniaiA;bon abo I fair mUCll far tbc:ir~ F..... 1bt0iIil"", plaa~ 01 !be' AmaiCIa 10 !be' Ia........ 01....... __~ 100 hard rot looloocl

&ad for too link. To ciu: eee e ,.......aoillioo po:aible _mrk, !be'__ woden 01......., IarIeat lalilo faaory, I aut.idiuy 01 ""!uroeriealI .·.Y.~ pat SO cmtI POI" dar,riaitla 10 S5 CCIID POI" <by aft... "" yean' ....,;,..,(19S1 1irum). Witb~m-__ Qll

a.no .lDlIdI. SI6 1_lll, -"idI is_ .......pto mm lbe baait IIeIICb ollhaaocl.... IDd lhotitb milW Eadl 0( tIait WOIIIIe1l fIlmS out _tblIIl _ htmdnd pain 01 &Iofta . dar - eJowhidI .... C"O'ftlttllllr 1OIcI;,,!be UAi,rd Stu.. for_ thaa 40ll times that _i daily "''I;Ie.'

T'Ilm: it IlO jllSlia: in lhis. AM althoollb it it_imn 11M! thai m jr rdatiortJhj". ...._ !be__ 01 OI$lltiutionll IiU UNICEF.1M day-to-day ..II. tJI. ItICb ~tioDs isCOlUWltly briD;ia& them up opifut lbe !act lhatthe principal elUJt or ill ba.lt.lllllli poor nutrioo..aIDINtI 11M: dlild,.... tJI. ItICb -..men is ,hat <heirIIIOIIIm .... DVCfW'IIl'ked and IIlId«paid by thesyst~ or tl:OI1omk rdf.lioBUti". _hich nopttftiIs both betwem IlId wiLhin ILltions.

Alai,." clnl bt the flJllily

Finally. _omen need I fairff dnJ wilhin theirOWJI fmUlin. In th' d~u; bu lion of food illtd

l"l'KJI,Itce$ and ...,.1:. ......... fm: badly ill .,.,Qnics ollbe wwIcl- rid! or poor. Bw io poorJOcieties, il is Ibis .-qual Iood .bJctt abo1Xpri_ 1O",""y """""" of bolb the limo: and lhentUI1' arid !be rduatioo 10~ their .....and tbrir clliIdn:r>', lift$. ADd lbe .....m tJI.Amartya Sea. althou&b -nntll~ 10 lIIldfur his"'"' -,""y,1IO to tho ban of ,he man... illmuatril:l otber t!wI Irdia.~

~0.,-.... ~.triof pnUu .,. ....... dha_ '" • ,,"p i.a'--m, .. . ~ ••,.m./ft« .{.,........... no, _ _ w J-~

_ ... npIMItJ~• . ...k ....__ p.»U '""'" tit: t-J •• ....,.Intdn....... Ill ~.j '.. pItty ....mp«tiut a4...~ ........oaqww.t~ Ib ..JUyt ".- ,..._,............ri. '" ...... _ i A __ '".....,. ...t .... a4 _ ~_~~

, aiM~.. aU .... . did ..

~ WI , ..a,...~ ""...., II , ...

..""" -tW')' -*'IJ'difjIrta, 'Y1G".......... ""~ ..,..._ ia ...~ '" um..·J-:ibo......... no, J-iIy if '.)1IralIy _ - cull ,.._ _ _ -t ..... "'..... "'--./iu,.__ .-I _ J-lly <l1li u.t t1tr1_U

........, dm.-.m.ritI. na,..w dewJIl '"

... _ ill ... IIlIJIt- '" J-~ _w......... /toptJasly .n-I ., IWt ,... n tIW_ '"...... .-Ju-'1tICfi}iasJ- _ ".......,.._~ilI,... ,.....-t_ ;"~ IfIdWI -'<t1. no, aoditiMtIlJ-~ if .fMM~ '" _0. .. ,... _ ltat aU

~"" .. dor",""_~/. ... /VU -t u.Wr.;".J-~ oliunh ..... ,...~~ ,. ~ if . =rill pm ~I.

~ ilJJ<lf. N ...,...,...,., ~ ,. 4trp iuIt~l

iria ,u,crin rrjltm 1M MpdI ./ 1M. ,,,,,,,"IIIWi'" "",II ... .......-., .. ....,.,;" ,...... R<Ik ...... of...,.. ad6iTls ' ' '';11 ,M. iMpIid,ly /« I. "",..mm of 1Mmperlir:rr pIlSIlioIU.

MI, iI won. iJIftI lJIIII;'" iIr IAis W llnt '411' I.IQiNq""tiria i. M ......"" aNl li/t t lllnJC tw')' r/toTO';" tMia........'Y. I, "'" Iwa Nwmrd ,...., tiTls/lt1Ulitll 'M fZIG of I a4 S oWtI 0 .ipi{ltllntly.;'~ WWIIl1;ry rou ,""" boyJ. :n.. diffntJIM ?'f..,J a>ItlMMpI';'" oW- /'O</ltlkt<ly .oW", ,.disl"" 1;'lIGriom _ 17wrr;, /It. "" orA roidtNu II""

"

I THE STATE OF THE WORLD'S CIllLDREN 1986

rltf jmtlJW ,MU_ ...m., "lICk 1m",";,,~i ~".., .... IM~ 11M ' ''''II,o..J'''' ...,Ie ,Aild_ dl>. l~·",,,,,lin.. ill II.. dum.'"", tlf J-I ...,AiN ,litf/l.~ JJ. .... ,.01:;' ",...J ""Imf of "I4tint.,....-

'71lr fIIrf1ItttIW ., . "Its ..,. " """ t-JIM l1li)' -Jim ., .._ .... _ of tttnU J-oJ... .".., f«iIi- _ J'",ai,cd _"••faaJ:/.R<Il,. -ij '_J--rw_'7m ;'-'-"1'U!of ,.lor ,..wn. itMlj,'" ,"''', wp .. ,....,.... ...

dirt/it. ,;,"",..... " II> ""'.. rJw "'bitt/if" fK"«~

riciN"'... </osn l<IIM"....... rnJIil)l. no pUid", 11/_ ilttJ.JiJ<t Ii"lt p!J, ... lilt ,....... .,,........., -.. ill ... Milia"", "c~f11f4. 1I....Jtf.J ~ b~ fr- Iltt......,~.,tlw .........f w -... A.......,. ... ..-.u,. ..... .__ of..,..,... of iaml-f-iIy 4UrriaIn. " _ orr"'"""" W. alii ..w,• lOr __ ..... " ""_,..-. _..,........

The self-health potentialIf pumts aa be""'I cut with DeW kDow·

Iedae .boIR dliId ptllI«tioll -1Dd alppxI<d rramall ... ;., tbe usIr. ol pontiac tbII~. iDlO~-l!IQ il __ pcG~ 10 Ilal.., I_ '*<01 child m:alaUlritiOll aDd child death il:I tho:lkftlopiDa .....Id at I rd&tivdy low cat aDd...ilhin I rel.ll;...,ly lobon~ of ,i.....

Bill this a lraordilW}' p<llcor,al "'ill lIOI berulimI if rhe task illltto simply IS lhe Itxhinlof .. DeW let of 'cdu.iqucs« 1Mdolinry olio_set ol llCl'Yi<:a. Far lDlft fl"'d·.......Ia1Iy, I.... dIiJdJ\It\'iql rndulioa isP"1 of the antioa Ill. _tthic: aI bWtb can: iudf.

La lUUI.I u-. -.I ia~ all -xs."""'"u.- ill whidI IDCIdcra medical ..me... an: _IniIabk 10aU., ballb an has 00IDf: 10be tbout:hlof on!! • tbe curift& '" iJbMw by medicalrrdellionols in bOlpilab OC' dinia. 10 otherword$, "".lIh bas~ oometbi"lto boKlivelyd~li""rul by ~'p"ru I ud plllli•• ly l'Ctti~ by th~

llily.

Ulldcr such I ddinltion of health ~, 1MPftI"III poImtlol I... I ~utioa ia dUld IUr>'inIlad ",",dopaxul~ bo n2liiled _wholnc:t1M leo:hnic:oI~ II itt diop'tpl

ODe obtious _ is iIw tDOdmI mcdic:aI.....m~ _ rqaIorty 1.mJobIoe 10 Ibe ....;:.;lJ'

vlllK "".dopiua WIIO"ld'I f·mil;'" But... equallyimponIlIll f.,... iI thol doalll'1 and bwpilU,..

""" it' IIoey W'Ott oqjJabk,~aat~ ""TIll;., liU .. ou-a • wall cl bait r-vt«1ioaaroouwI. srowilII dliId .. c:llIl beptooidtd by ee;"formod IICIioOII cl lM dIilofl OW'U pamlU ;" !hi:child'. OWII borDe.

Al_ xU of lb~ IIIOJI 1'O....~rfui mc1bodl oowa""; b ble fo' proI~iU8 ~hild1t'u'l liv.. Uldlrowlh If( b-.l on ltoow!odle, decisions, :and....'iou' by ,......lJ: -

Wbnhu • __ will ban • link IIIOf'e fC:Sl.

oad • link IIIOf'e food ia PfOIJW'CTo wbetMr ....will 10 f« II laM 0Ill' PR-1lIlaI dlotct oad 1ft

_tHNalA ia;.aa.; wbetXr bcr infIal will be""-t-Ied oad for bow Ionc; .-hom .... will bqia• pi... oad orith what mix til food&: bow IlDdhow til,,:.. 10 prqlIft • dill<! ', IllOd; w""beI' 10pi)' pmiculu .nnniou 10 f~ia& • dilld duri"lone! orl... III iUne$$; wbnhcr 10 maJr.~ lip . nd useOJI on.! rehydr.ll ioo ",l ution durinl ~piood.. ofdiarthooo; whether to cbeck Ih~ child'i ...alhtS'" rqu!atly; whnlKr 10 take • child 011 Ih reeoepar1IlC occasioas 10 be lwnllUiud; oad wt>nher... when to bne _her dUld - llIc$e Ire all&cis' whid:l ho"" for I'lOn! dJm 011 whfthft •cbild &tel ... dieI, wl>eIbtt . dIiId~--u,.or.. RlUlta1, thoa 1Il;)'Illiac I doctoror • lapiralnil do. Aad wbtlno:r , be Olbtt , ,, 0 ,,","," II ploy,ohty 1ft 011 do • • , wbidt 1ft lakeD oad Kled 011by tbe f.omiI)' iudr,

Dq,.nd.n<~ On profmi<mal modical soffl= isIherd""" not rh. duld', Ii...r ~ne of dofen<:cogairu;r poor heahh and l""'" growth. And only iffamili.. IUId communi rio:l como ro "'Ihe"""l...as the active promo lOfS of health, and only ifPMcn" con again como 10 _ th......l"CS as Ihemosr imponanr of all frool·lio. heallh work.....will pracnt knowlcd.!le bring i" brn.filll 10 lhemljoorily of 1M world's children.

[0 thal itllS<:, rhe dilld survival rov<>lution ispart of I m""h wider s.bift in thinkinj aboulhealth care. World.wide, il is nowboromill3 ~lo:a1

<.hat I~ nnl 8.n....lion of advanoa in humanhealth win com< nor more doponden<:c onmtdi tal servica hUI the m um of primaryresponsi bililY fo< health rn lh. Uwl;vidul, rh.family, llld lb. <:ommunity.

For tbe child .urnval rev<>lulion, Ibischang., I

.hang. in the cotI"""tional wisdom abou l whalcorIruru tcs healTh a r. Ind who is ro be primarilyresll'lnubl. for providing it, is much IIIllJ'<' impor_tant lhan any speci6. br>'ak'hroUf;h;" knowltdj.or recll.tUque. And il is achange which is """, illSlbegin ning to btcome evident in bot h industrialized ond develaping nllion•.

[n ,h. ind\lStriali~ WOTld, man y modioalprofc:ssionala SO<: tho decad.. ahead as an "tn:I i~

did proJmiuMllwllh con proWhn ...;// ploy0

Imnri., roll iw rlt.lI'wt ojpt<>p~ ""'ik illlliwll4hka", ;1lC1'</Ui",/Y hl ""i Ni... ikw/op, on4 1nW asIh rtf>/1riwy oJ, iwJormoriJ;m, JkI'/b, on4CO/JI"' u~ iry

IJosd mlII/ruI" "'" wpporu "",hH", IW ltIporlicipolt ""'.. /Nlly ;w {m1IfUJIi~1 11Iri, ""'"htilllt.'"

[n rh. developing world., Wilh illlquite differentcin:ull'llran.... sevtt:al 8"""rnmeou ..... &Iso nowpiooeering the idOl lhal pres<1l1 know ledg.,comhioed wirh present communicationsapacily,can open up Ihe WIly 10 muc:h high...randz rds ofh.alth. And it can do to by dnstkally ;ncr«singthe ll'lwel" of famili.. th."""lv.. 10 promot. thciroW<> physical W.U.OOIli.

Th a, i, why "td",,,rifnl «»tu"';Jtg "...,..i/i~1

w l rh~ 0l1li rh "",rW oj pmIOJIri"l "Me""I",lIi. , ,...... " w., liSted finr among ti&h, basi<principia wltkh emerged from the Inl ernationalccnrereece on Prilll3ry Heallh Cat. held'l AIIII3

All in tho Soviel Uniaa during 197$.' And thar iswby a WHO n pon comminee, drawn fromprofa>on of medicine and directo... of health..nica in both industrialiud and d• ...,lopinlaarions, has r«rntly ceponed:.

"17It ou;11ldt IMr /ltol'A e<m if JQ""<lJIt (~j

...ptnuibil;1y is liJlW I" 'MJ«' 1""1, ;~ 1M ""'I,,,"llh "",Jmilffuzls 1tator '''~ """'Y/ro'" 1MptDpU1M' dtdnotr·",di., fX'WtT wirh rrgard iii /ita/til.TlrntJ"'" "w .Jfrm "'Nil ""'" Ii< IfUUk '0"'" ,lie",h.>cAtMir e""jidma alld iii M/p ,hili dnJelop tM rsAilh iwmdiorr 1M rir~' ./u>iu$~.'

The murning of prinwy cesponsibiliry foehealth ta t~ individ ual oad Ihe b mi ly istherrloreromilll to be ...n as a more Iikoly . . ...u. tobe"er heallh in both ricb and poor worlds. ThiarqXll1 Iberd"" lurns now 10 look a' borb rbepoten tial oad the danl" inbtrelll in rbe id.a llf'..If-heal, h' _ I pol. ntial and a danger whith canmost cl....ly 110 ...0 in wh. t is 00.. hqinning 10

b<lppen in the iadustrialized world itself.

Mo~ health al '- "OSI

In the ecooomicallyad~ n.,iool, it is lh,llOOring COl' of h. al, h sonic.. wh",h Iw begu n '0<:lOSr a kn8,h~ing lhadow of doubt lhou.wbether~ and more medical lechnolOllY isreally the best ....y forward rOl human health.T oday in the Uni led Sral... fOl e,,"lOpl., Ih.health indUllry is Ih, n. tion's bigs..1 em plo)'tl,higgest speadee, and big..r lrowth poinr _ 'OIl ·ing Ihe aalion a1mool S4OO,ooo million a year, ormere than $1,500 pe1" yeas for ..ery man, 'NQIOaO,

and clliJd,'

If this roloual OIpeadi rure - 2S ,imos ... m""h.II in lb••arly i 960s_ wo", rapidly malting Ih.United SlIta I healthier nation, then ""rhap:s",ch I eOSI would be occepllbk. Bur as on.Atnnican healrh eduCl.loc Iw wrillen;·

~W1Iar is SO disrll' lIi", do"' ,h Mrh CO<l11/mdicill ' " '' is IMI despilt 1M 101fm( wr /lat. SO' llIt"/y _Jtrnd orr IIIe JLn,lopw1l oj llilnRdil:o/trSlQrd "M rtt h",,1oao> ri"", lite / 940., 'Ml ;n<...-t.-., /w """/y JoiW '0 poJ",. (or iI' INsl il isU'iIk/y 'hmoght II)' Ih />NllliI: "lid ""'w)' po/icy"",Am ,,, Iwu Jaiild iii prod..., ) a ""I0'Il i~ ,h

•

I THE STATE OF THE WORLD'S CJfl1DREN 1986

Bangladesh:visiting 5 million homes

•

Or. rIIly<hI_ _ KnII'N -... was onhIr ., 10 lIB "'*'"""Ing Il(lII'tl til __• F' ~ ...._ ""1'IO&qlI "'" ,.., 000........... aulol",_""~""""",,olsr.ua

.......... 23 . ...-l....-.__...,._ 01 10.000"'" _ ..... _ ..IlIUlIIm -. AIanI! ~ MI'loul ,..__01 .. .....- _~,..,IaII...........ooo..... n..lUlXaol~·._~__01_ "'~~oI,prGlol

..__ ...4 :: .. 01 .. ' ...,.,.. _

... _ -10 _ ",*,,1" <IiII''''_'~_/'ow _ ..... _ -. _ ..... £\IIIlIlII'l

""No!" e-et1dltl' __ D\II••__of"

-=-~"""" "' ''' _ 01 ... """"",......, mosl _.natls IIlllUll medal~_.. _o!_I.now """~ _ IIlfI Bang!aclesh IV. MII.... , . ~

Cofm"ltoo (BRAC) boga/110 """'" _ II>I'>\l<Iae'" BIngIecIeslI , 6'1 me ...., of I~85. IIleoI ""~ WI!I _ ¥ISIIell !> rrollIlln ol ll"e 'O«J"Iy 16___tn.."""""'Y WId~me_oI"'decAF~ol_

HIfO.worl<rq~-.....~ Mar\.dUl .. Jle~ 01 .. elIart. _ .............. 30....- 'fIl'Iy"" _"'_""',,_-."'" '<*1_"" .. $ • T"1'l..0_.... .... ___ 1Go1ll1llll0'l1'ow __'""'" an .......-*-''IN_ flIIItdo....-.__•_ ......do: ",)).

TN IIlb'l .... I'IaI ....... !Io'n_ ..........-._.,.,..l.000....__ lI\I_ INS),"", l*:lt.._""",.._..... d __~._ l SO.OOO ,-

Most~ """"lI _ ~ ... "ft\iIllUllDn 1I'IaI QIIIIII'lO II1IlCl l)IlOpII! 10acluIfIt ..... ,et......... 8Olulu'l ..u<! _ """ ,...,--_...._-,O.-,-.....i_.'*'IO~.._~ n:ll ... "-,, _deloe.... bUI n ".._ __...,__••~-U_i•• V.-IO ....

~~,.., III r.. ,..bt:61 br ....a'lIjlI """' ....,~~---IIIlion In'~ol"" ..,.b_ IO_~__IO_r.e.,_ ot.. ..._.......oars 01 .. ..., prgper .... . ... ...... l'II' /IrIl1lU......-._IO_.._'*" .. '...~_ '~ \r8IClItJoI'aI NIl1lln "' ..1OCl '"".-.-.0...... __ Imm 1t>e00ll'0lUlfly •_ .a.calOrI ...., DI~ SpecoII """'

aJ1I IT*k II) II'MllIIlI ICIklUIclIti en iIIItl~

AI Iw$l """"" l'/1I~o:aI W"t oorne 811 IlleW(foj Kl _ I't'em WI\!!~ mere aub&!ant...It>.:>_1BRAeitptllQlTlalO: ' ~ rt _ "'"so i'_III.,.,.".,_ they.., ".~__ .. _ orne.-.;l-" " W1 __

POOf. BRAC~ lei ,.. .-.. ".••...,. (]I UW1l1 "'" ,., _ b' /Ii.d...... our""1tW _. _ .... .

I<nstWllIIoIOo'Ica.1I~",. _ '* ,._0 ....__......._9'1__.._

~~"" 1Nn_ fnIl'elj~1W'" _ ... <nil ....",..(10. --.- 1"'-hi'MIhllI.f ,. ..........~ ,. '*"Y ; ,..,~""_'-11_.,· _ *-' ~.... '" $ •~ "'" _ _ -*' 1'10I_ 10 CII ...,....,. .... "'"-. _ -.fl:l_--,.

lann of a millClitnl ;" _bidiry """ """III/iry 1M'am be anuidnd prop«liI1tIIIle /() ""r i~(\"'metI~

71liffail~" al cosily, .iKh-lechMiarldismu ImlllJII'II' Ms, ;" 11m" 1<Xl'Jed ","I ml<m' ""~,;", /ltgl,. aM 1>'"""li", 1m"" i~ I'Idc ro mI",.,/w <mrry blotdtJI alftmIl4l~"dearh """difabi/iry".'

Looltini Ir IIremltiv. Ipproodlcs, the .......writer c<>ncluda:~"'Mral UJ '"oil af r/w.., alremalim if litem~... of pri""''Y ...pmtsibiliJy for1tM/1.la IN iJUlirilllll1, ,Ite fa1rli/y, alld LV ",,,, ,,, ~~iry".

A similat concern is olsn moun,ing on , he otheroid. of the Atlaatic. This year, for . xample, Or.Jurg So:.>mml:r of &sle Uni~f$ily Tl'llChing H05pilat in Swil~r1l/1d h3S ""';\leo:-

~._ a ....w af rite /'U>"Ilt~ .. rn>tIJls lil/t. tuitJe"a11..11 fim /wr i "".,llJII'IIr< ;" medical ..,rt1iUJ i~

tkl>eWptd ""," rFin a';/I 1Md /() a~'y """btl red",_rio... ill ot>mlll """'<l/iry alld "",rlJidiry "un. TIlepw capila .;<pmdir~... 1M /ltg/ I. <tlte a"""'lWttlnll IIIII"""S rory by mart ,hall 1110'bIo r 1fI(If' afl1ui.Iwa/lh i..dicn ro ry by 1m 'ha" 5$ alldIn is"1<11 romu,r""" MlWnlIt4e rwa. Oru:e a ...."""'We.. i"im~... af Mlk4/ (11ft MIs /Iml~ f<N:1Jmarlwr 1M" medical cart -dit~ lift-lryll, 4erdiry,errlJi""" ,rnu _appel" III haw a ....... Ia'ft' e/fecl ""Iu<ilrll ani "'lI#riry rka" d«l ""'" medil:al c<m.Y., Swiunu,'" if ClIrmnly iJrr.""ri", a" adtIiriaMl1.5 bill""" Swu. /rrIJla rot»' ye<lT i" rntJical (art....

F"'-"Cl wi,b <b. evidence of rising com "" ddiminishilli mums from increasing d.pendenceon lI>Cdical 1ICI'Viccs, the industrialiud world isbeginning '0 o:rpnimen, wi,b the opponunily foc'more heallh .. Ie$$ COlt'. In <b. Sovi.. Union, forexample, a $SOO million lIW.1--mcdi.I CIIOpWgn h3Siust be<:n llunched In t<!ucate the puhlie inh.allhi¢>" behaviour _~nIr..ing on heu .r di_e,s, I... alcohol, more ex.rcise, Ind ' <llularphysic:ll check-ups. And in New yo , k Cily, theDepartment of Health hu ... nounctd an Intmp''0 cui the city'. inflllt monlli,y ,a.. by 20%befoce the end of 1988- mainly hy mean' nf amass-mr:dia public educa tion CIIOpWgn aDd Ipr<:,.....tiv. programme to try to reduce the:incitkoce of low binh·wcig!ltlIlIKlng!he poorestnf N.w York>, moIher' !

Witb the possible exception or the S<=din.vito.. Ih. gov..,"I,.n ,. of ,be ind",ui.aJj;<ed

"..,iortI are nol yn going in,,, action on • sc:oleII'hicb matcb.. this oppanunilY. Th. UniledKingdom IIId <be United St..... for enmplc, arestlU d.voting mlJdt Ie$$ than 2'lli of governmentheallh . pending to the Pl'I'vcnt,nn of dise2se ""dthe pl"tlmolion of health.

Yel the cc<morni. sense mth. new approach isrelle<:led in Ihc mor<: immtdi.,. response of Ih.busin<:lO' world. In recen, yC2ts, 11 I."" 50,000AQterican co,ponlllon, have <tant<! 90,..,. kind of"",i.e programme ' 0 inform and ,uppan thei,empl()~ in taking bellet care of thei, ownhealth.' One compan y', progranune to provide th.time and f..i~,iCJ for .mploy.... ' 0 tak••egularo:rere'" hal; resoltcd in 36'!tli 10ll'er health carecosts. Anoth., company's 'wdlncss' programmefnund ,hi' ,h .... with 'unheallhy ~f.-slyles· wereg6~ more likely to be off work On Illy given d.y.Another found i 26", rt<! oetlo" in high bloodp......... 'ID>Ong emplnyccs of,., • COD1panystan t<! on employee 'Live fo, Lifc' programme. Insev.ral . uch prog=mes, ,h . health COS" nfemployees who dn not m><>l<c b... been found tobe 3~ to W'\ 10",.,. 0'

Blaming the victim

Tbe early resul.. of ,hese new oppl'OllCh..confirm thei, poten,iaI. Chang.. in ea'if\l: hlbi,sin the United StOIcs, 10 tak. jusl DOC example,have a1read)· helped to reduce dea,hs f,om I>cartdisease by .ppmrlma..ly one-third. " And i, isnow thought possible thai a change tnwardshealthier m....tyles could push i verog. m. expectancy in the indu.. ria~zed world ,n well over 80years for both men IIId womeo - SOfllCthing thatdoubling and tl'\'bling ,nd.y', vas' expenditureson mcdinI servicc:s could not hope to do. Aoomlins 10 the o,ntert foc Discuc: Control in , he

• WbrIlor.- m• """'''l' "". _1. _ 1I<tI,~ Is ""'"~ lI1nrsI ""'" Amcri<m ""'"""""" .,...,. -lOOII>illioo_~"" ...,. . p<->r>d """"~.",_....tioo>. t.o oddirioo. ""OIl opm4io. GO ,he h<oIJh ofnnpIor<eo il1Ioo:o<IIiaa ...... fa<t""m......1O<tioa_"$~

of .... ru"'~_ ""'" of~ G<",.,.r Moron <or, r..,umpk. b .... oIIo<ao>l ,. IIlldicaI ""'" rwG,acnI"'......'0""''''.

n

UllitN swcs, ..... ,010 , tho:.-. AmaitaDIIlIIie CllII .,hirw an 11-,... iJlcreIR ill lift...~ by ro.u t.i< idf..beallb actiooIf; -1IOt

.......;..,. driakiDI ""'" in IIllIdentioB, tal<i.Darqulat eecse, and a1tin1 wisely in both qlWl,; ty aDd'lual'ty.

F.uiUlIlI: nl . bout 1M presen t pcKCfI,iaJ for~nti~ . nd prolOOli~ 'sclf·b~lhh eu,,' in th.indl»lr;~ world ill therefore justifiable,

BUI ...try ~1V<1' ~ninl bas ill cloud. And in .hi>.-- 1M cloud illhai pun;'" aU tho: mlph.... onIif~yl<t ll'Id iadi,idU1l mrxmsibili,y ..... bfth htWld .., be lII<d ... w.y of tll<iq 1Mm1~..., {..., 1M politio:aI, -"'I. end «-'ttlIl1MS III in bnh b whicb = !arid, btyond theaIIItrol of Ibc: iDdrriclIIal bID _ hieh prob.odly

iIII.ll_1bc:~'. Iife.«JkIa all 1Ocinirs. tho- .- ........., of Iife«yk

wbid is Iikdy 10 ...u _ diff~ to I

bmily', Ioeahll ;.. fNAily'1~ (FiI;. U ). In",ral R.a"l'-dah tho: ia£u:I. .......a1i,y ..." il ,......• IIi&b .-. Ibc: b mjtXs III tlloK wDo OWD DO

Iud. In Manu llu, l!Ic iDfan' IIIIllftality ... isl~ .. bCb~ familia .ho Ii"" DOI1b olIlSu. Slim. hi 19th-anllUY EW'OJ!C. the infln'monaJi,y fi le in lhe aJumswu II'lIUI>d 200 deal""~ 1,000 billies: in tbe f'OJ*I ("";lico of 191.11century Eul'OJ'l" the inf....' mortality rile .",'bou, 12 del tlu pc1" 1,000 bat»eo-lllllOlt .. low ..in the lIlOIl medially ad ~aJ>ted rouDtI)' in theworld today."

So if lbe drift for betta health il lO '*" tM...-d of .halllel in Ibc: lifHty~ or ,1M: indiridual.!beD it _ amnlDl 1M fact 1Iw llWly of Ibc:iadllll~ ooorId'l families III'C Ii";", wabcalthy Iir~y\ct primariJy bra_ Ulcy .... po<Il' .

AIIll • Wt poial., il bmNAe:i~ thai, ' .., m1 pnIicin, """nina poIicia, II'd bo$il;

....a waul ..mea lllUSl abo be P*tI 01 "rpotier _ 1lidI _ b 10 iwpt Oit llalt1l byd!IOP'II1be am,,"_ ttodor whidI iadi 'idIuII 1m:1beir Ii-. 1Jr, 1M Ulli1td Sales. for t:pmplr, if~ be a po oa...... oltlor po<altial for'adl"-baJlh' 10 ip<n lbe oIlhia """arcp,K1 10 lbe Ntw York ComIllulIXr SaMSocietr. _bidl pololcd 001 dw 1M nlll"btt olchiJdrdl Uvinl in J'O'"d1r _ probably "tDtl1 ......llil .I(} pmtll l ......M.

"

SimiJuly, lbe .,"""" 10~ ilt- byed....u.e 1be Pl'bIio: ia tho~ 01 bruabaJlh ubi.. f;:UlIIOl ip<rr """.........sal folna_hidI mar bdp 10 ahapc or lCinfora: bdul......'roodocM to poom bQIth. Stoppin&anom.l , foraampl~ may do _ for an irJdi,idual'. baohhthan ...y amoulll of """pIn mrdital techllololr:bUI is it rntinly fair 10 place all the: I"Q(lOIIJibility01\ Ibr individu.oJ irJ • lOci.,y whkh 1Pl'lIdl o••rlOll timc:I III much on advmisi.o8 ,ot>aa:o III itdoes on ro \lC'ltill,llle public aboot it. dalll rra?U

Witbou! doubl, informed actiolI by iDdividualaand familira irJ W:mt primary ....ponaibili'y fortheir 0W1I baJlh _ offen far mon: opponu.niryfor .m-:a ia hllllllll baJtII thaa fun1ler'" 1;nl OIl, IlId ad_ ift, eunU..... lIlfdie:aI,...... . ... ..ioL BurWt doa _ ....... ilia ..........libilily CUI be alJropud by lloaoe JOftRIDCIIIIIor ....mm::iII lon:a .... Klicm bdp 10 IIaapetho ti" p __ 01 rho irldmdal IIld eefamLIr.Or • Dr• ./oh.lI AUeJn.a:c, Dila:Ior olthoCn,.. for HcaItII Pt<mw..... II ColiIIIrbiaUDi......n,..~ pili it:-

Ftg. 13 OwrMnIIIp of land and clarlyintak e of food, MaI\anlshtra, India, 1982

"eoo

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~... ""'~)' fJf 011' ....~, 'ffom '" 'M i",pkrMnl" /ioIl fJf ,t."",,,,,/ ,.,Ii<y in t-Il/o p.o..a,itn! 0"",m,o", />='fII/ioIl Ir<Iu Iw7t effom 1M' /unitalJrrJralfd "'" """"I ...pomilnliljl ' 0 f'1'<l"Nh 'M1«;"1 and """"",i( wPfIIJrIJ frr IlI'MSllry OIi"~Wr',iMurl fJNl"'1'1'...."""'01</wltft', So, whih ... ""'YIuJw Iwn I~;di", 'M' "", "",iMurl .,,,1,. polK»and "'" own iooll .fforo a' ptaIItfJlu., Joeol,. /Iy",,,,,.i,,, ,lull iMl!;ci4l1fJu " "flM '" dfJ ,..", for,Itt_I",,, /Iy 'u-Ivrs, ""'Y br".",.. h"",,", """.effrrli<Je, "ltd SfJd/IIIy omp'ablt: l/wn ""'" <O$lIyud~ /ik ..Niall "m or<t>nrit>ll _ 11$ Ii.,PII~il;t>II Iqilkllitm Ilr.al ",,,,poll c.a""" J a", hfl0111)' '" a'l"" l/wl~""'~, "",,, ...., abarrdan IItt",h i, lias PI4yrd in "lflllali", 1M"""",p/lK."Nl,,,b.idtri,,, J«ifJ1 """'il...... ,.." lacili'au or'"PPO"br.latoion' 1I"''''.'labrMIdl;cit'l '" /wIlli. Tltil U, IIIrIkw, ,., >inth "",,, i",porlOllI """"I issw ffUi..,,/wit 01 III tt,1ro " I' /Wli. dll(alw", as" I« b<JkJryin ..." """npu 10 ",",",' d;-.~u

The reopollSibiHlJ of ",¥emmeo"

I.a !he developing world, the oced 0JId thepolential for indioiduab and communities '0 ,uemore conlrol OV'" thm own heal,h ise'o'C"n great .Ea,c:ma.l mtdical itm ces arc ~ery much 1...aVlliJlble. Le.eb of famlly heal,h arc gentnllymuch lower. And lIIIlly of tb. most buic problems I re more susceptible ' 0 action by famllies0JId parenll Ihan by dOCIon Ind hospital1.

In ~ular, presen, knnwledg. , and presenlcapaci,y '0rommWlicll,e thlt knowledge, add up' 0 the poso1.ibiJi,y of a quite drastic imp"wemenl inthe cap...:i'y of poor fllllliJio:s 10 pt'Ot«l the livesand normal growth of their children.

Bu, as in ,he ind llSuialized world, litisopport_uni,y is shadowed by ,he dang... tha, 'familiadoing more' migh, br in lerpre'ed IS 'JOVC'l'fltnCllUdoing 1<:$1'. For atlIOng the basicclemenll of 'Iife"yle' in the p<lOC world which "",lribule 10 poorhealth are lite IllCk of dean water , safe mi,atioo,decen, housing, basic education, land n:forms,arI"'1uare Ul<:oJtl($. And ,he pn:vcntion of illhealth is ,hen:fon: a n:osponsibili,y nOl jU$1 ofindividuals and familia bu, of govern.....nll IQdth. in'entatiooal communi ,y.

In nth .. word$, there i$ all the difference in ,heworld bctWffll a policy which IUCS the va",

poten,w for 'lClf· health' IS an U<."II"" '0 pau 00the "",ponsililli,y for poverty and ,; ckness '0 ,hepoll< and th. sick, and I policy which ma all thel'C$OUl'CCS of a llI1ioo '0 inform and support ,hemajorit y of it< people in tb. lask of improvi ngthei r OVID heahh by their own tctions.

Families need Ihe wppon of new knowledg eabou' low<Cl5t ways of protecting lire and gro wthInd healrb. But lhey a1$O need ,he support ofrommunily beallh W{Jrkm 10 reioforc e Iha,knowledge and 10 act as a channel for ,cfctrinaIlIOn: complicaled iUnesI\CS to mocc specializeditmc.s. And from gOVentlQClllS 0JId the lnternaI;" oal wmmuni,y, they need the suppon ofdC\'c1opmem programmes wbich set Ihe pro visionof basic SICl"riccs- water, HJlitation, education,housing, 10Jld, jobl ~ at tbe ....,tre of thcic sighlland 001 al lhe periphery of ,heir vision.

With Ihilltind of suppon, informed oaioo byfamiliel <:oIIld now be: I beginning Dot JUSt of Iri$c in ,he level of bcahb but of a rise in acomm unit y'l ronscioUUlQl5 and confidencc that nc;ln ,"ke rnon: co,n rol over ' IS 01"0 circums ,an cesby ill own 1Cti0fl$. And thlt is . process which isboIh a D1CIlI.I and an rod of developmen, itself.

Sclf·health In poo r eommllDiti.s

'Self-bealth· is th.n:fore an idea which poorrornmun itla are '0be suppon ed io l'Ilh... ,hanabandoned to. But Ibis docs not alter ,be fact thai' be majori, y of ,he world's poor familia willremain poor for some lime 'o ro...... And protCC'ling the growing mind. and bodies of youngebildn:n from tbe wors< efftJ<:11 of ,b.t poverty isessential 10 the breaking of the cycle by whichpoverty itself is perpetualed. This report tbcrcfon:' UrN now 10 a mocc detailed loo k a, the potentialof pte1C1I' knowlcdge for empowering and 1tIpponing parents themsclvcato prot«llhe livcaandoonnal gro wtb of their cbildl'C1l.

WhI, arc Ibe poor world's "'I uiV2lonts of , b.flCls lhou, hean disease, stro ke, CIfICCf, diet,StJ>OkiJlg, ea=isc, . holeste",1 levels, blood~sun: - b . .. whicb arc nOW pcnnca,ing publicconsciousness in the industrilliud world? What

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~ Ihe rorrespolI<li~g b'nluhroughs in knowledge which can Mlp families I~ p"'venl 0 ' lrt:allhe major co..... of dtllth and illn... among Ihedeveloping " " rid's children _ the respi..,ory inf<c,iDn$, the di:arrhoal illnesses, the communicoble disca.es, the poor nUlrition:ol heallh?

The problem!! and I"'I"ible $(IIutiQllI '"U'j fromcommunlly 10 communil Y, country to cooo,,)'.But Ibe", is • co'" of basic low-«JSI 'self-health '..tion, which have a1"""1uni. ersal rele.llI.., llIdwhich deptnd fOT mo,. On parents Ihan ondoclors. And Wf<11u:" they are po~rfulenough 10reduce by :as much :as ""If ,h. incidence of"",Inutrition, illn.... llI d early dtllth, amotIJ thechild"", of the developing world.

Slra,ogics which = already going into action..ound lhe ..orId, such :as ORT llId aettle"uedimmunlulloo. ha.e aJrndy been louc!ted Ul'OlI.OthCJ1, which could be equally imponllll,= oatye1 widely enough known.

For lhoo;e read... who = 1101 professionallyinvol.ed io heallh can, II may Iherefore be useful' 0 IUJIlJlIariu ,hose ""'I"lIies - and Ihe relalioo_ship be, ween them.

And as ,h. only lrue importance of suchknowledge resls in II heiog PIlI al Ih. disposal of1W'C'IlS, <.his brid accoun, makn no apolOgy forstripping lhal knowkdge of lIS medical ,""",hulary:-

AetiOll io prqnaoey

A cbild 's nUI,;liono/ heallh hegins 001 al birthbul II CQIIccptioo (Jdld ...0 he significanlly. ffected by the nUlril;onal "'en-being of Ihemolher duriog her O\VII childhood and adoles<:enc.). Th. lim ri lal actiOflS for prolectingchildren ~ therefore to be laken hefore andduring prqnancy. And p....OI knowkdge ...,"gcsls lhl'« btsic K\ ions ..hich mlllYpoor familiesmigh, be able 10 lake -if Ihey had Ihe neces&aryinfotm.ltion and suppan'-

o h is now known thai becoming pregnan,api.n SOOO afler pring binh rollihly doubles lherisk ' 0 th. ~fc and health of boIh n>other andchildren. ~ To proI<Ct boIh, twe should be a

space of a, le"l IWO or ,line yu", hetWet1\ onebinh and the n.1a (F ig. 14).

o h is also knO\VII Lbll 100 ~nle food Jdld 100much hanl physical work in pttglWlCY arc"';owIy dllnliing 10 I woman's health _ andserioudy teereee Ihe risk lhal a baby wiU notgrow properly iASide the womb. If the result i,lba, ,he babY'1 weight II tnnh ;1 1.... lhan normal(i.e. lower Lban 2,500 8"""""")' lhen Ih. risk ofdeath ill infancy il roughly doubled." E~n I

hand ful of .." a food taclJ d~y of the P'''lInancy,IIId a balf·hour'. Ulra resl, can make a significanldifference."

o II is a1.., known lha, immunizil\lllM IIlOIherIllainst lOtanus in PretlnallCY autumal;cally Immuni"", the unborn child. If a CQJ\I./IlunilY knows,h e imponance of ensurill.J lhal a pttgoanlwoman ,eoei, es, wll lllti_I<1l11l1S iIIj«tions, and ifbasie health ..rvices art within mlCh, lhenappnnlmalely goo,ooo infanl ~,tS a year an hesaved." If immun illtion IgWllClaDlIJI is iu", 1101I"'I"ible , lhell ,h e presence of a uained penon atthe binh - someone who knllWS the itnportance ofdtl/l hands, I d ean deli~ry sheel , and lb.hygienie cuni~g and dressing or the utnbUicaJcord _is almosI .. effecti~ in prot"",ing lhe childagainst the di sease,"

BIU51-fud.i1li

For the 6"'t few moolhs of a child'. life, thehe:lI I"'I"ibte protect ion which any tnother canprovide for I"" haby. l>Onnal hco/th and Ilr<>"'this esdU>.ive htr:as<_fttding (Fi!. 12).

It il now known th~t ht=1-mlJk contains allrall shl ""li·infecti~ agrnlS ag~illSl some of Ih,IlIOil rommon illnesses of infancy." It is also Ihemool lIutril;ou s and hygienic food whkh any babycan be gl"" n.

Bonle--fttding, by conl rasl, rrequenrly tDtlIIISlhal • baby is fed OIl a 1... nUlriliOlll m ilicialformu l<l whleh lnlIy .....,U be over..<Jiluled wilhuncl.... w~,.,. in III unsterile bottl. ...

In OIher words, ht=1-feeding mitig3ltS therisks of poverJy llId poor hn i. ne while bailie-fttding exace,bates th_ ris... (Fill. 15). And indlUCns of surveys ill poor «Immunities, il has now

"

I THE STATE OF THE WORLD'S CHlWREN1986

Sri Lanka:reaching the poorest

"

Sn l anke ranks t*)o l(ISI(lC 0!0rIIJ in IhCl'MnlIl/'Iala eountrylWlCl rIOI boo netllO n:mase <I!l~'1""""""" at........,w Des!>le an a_age capI\a

"""""'" '" IrltIe mom th.)o S 300 a _ ' 50 UInkaIIal; br<lughI lIS Inl¥l1 ~ly QeIOw 40 dwll'fPO< 1,000 ...... llW\IlS. 66% cI 11>0 POIl<J\<IlOln ~

loUIfate. an<! on """,ago . 65" 01OIl8'\"""-old$ arehMy immurozed In SeQIemt>er 19 65 Sri LaoI<a100k "" !he ctIa!IenQe 01~ lmmurIl1.8ton 10toe r"",.;"",g ttwa 01 its chikt"" _ ltv1 lwdest 10reacn WlII'IIn a ye.v,

Long-S""""",, commolme<"ols '" lree .Ido.e,"""'.kee meoieaI c¥c ano IOOd s,,h<lC109s lor _ Irl~~ Illlhe '-' (\1$/,~'S ado:e,." ...ts."... me ,...,. E..", so . anest,matea ",,"U'" at AItlabIes are DDm ,n:lBrw\109I'U. W1lh the a!tllllllan\nsl<soI!1d<nes!1ano <k!aIn,__45'" 01Sn

lMka.', 2 million clliI<hln lJnC\eI lNO arc maIOOOI'._ 10 somedegree Doal_ ~'" ""'" 2 .000Sn lanl<M I;hIlOren a ""* an<! unOennorleS menulllbl;N'lal SIan",01 many1_(Mfa

a Sn::e 1978. wilen Sri ll!flka lsunched lIS.. . pancje(l rnm~al"'" prog"".......... "'" Jnc:j.dCf'lCe at PCIIoO _ """OCll<no oougn M$ gone<lOwn by 65'" lind tneft:>deoce 01<!<phtnenu. anoJ>KW\lIll>I te\arIu$ fly 90 'llo . Over ~ one-yeaIlorrn.Ihe ,_ ilCceIe<alGd P'lQ'm is ~1!I(l1O"'"a petrnllI'lIll'I !lase for lui I'BCCIM1Ion at ... !hecountry', children welIl:>ErIof1I 1990

o The IIlIllOfiill 0Iil'fl>:>eB conIIoi f)r<>gtll<lVll8 .

I'IIIdl reacIled m e IIIan a Il'lird ol !he pDJ'lt.CaliOnby tile end 01 1984 and ..... due 10 aetlIIM!"""",,"I COYfII_ by IIII! oond ot 1985,_uMillooal '.."'eel.... available .., ......, Ihe poo,,1Sl_ . WCI'l as "'" COI"I)"" (gfUflll, 10 p<f!'V(lf'I1

oehydrauon eeee <t SlatIS Hill ~n<J"otIl1l

.......m.ctSOS oral reItyIl,alJOO saIlS 10< _en""'" MIld """"" ueatment Pr/Woouslv oblaotIabIC<>nI)r ""'" <ridwrves """ _ c""ues. c-.e WIS..... now B'V3IIabltl 110m IlIIatmllClOS anll goet'Walpracll1lonBrS _ , and Irom OOI!I' \98a on WIIll<! ooId by tnan 10,000 'etOll OOlle1S.

o Sn lBnl<a Ms OS(!<\ 1"" lPQWIh r'I"IOI"WlorinOtee/1nIQIJ(l SInce 1915 Ia ~My m:J1nour0Shed""*""" fa $UIlPIel'lOI'\8.fy !eedIog. Po new growThChar1 for""""'" 10 k""ll at I'>ame was 1roed 001III198 . and .. rome<s &lOPbreasHOO()ng bekwe t/WeEl monthS. \IW oovem"'l'JI'1 enforces a .-.t law bannong If'.e ac!vOrtJs..~ oI ~~~*~M~ Ma~~ ~w faWQfl<lI'Ig moll\IlrS Ms _ 00UbIed fO lIVee

'0lDIUtIS to eocourave b<~-!eod"'ll

VoUIIeera play a ~8'/ ,011 III Sn Lanka'sattempts to~~ c:overagoe Ido<a Ollar>10 ,000 yoI.IIlg _ voJur-. _ "'"""""'" III

t/'leIl V!IIaIIeS Mel some • •000 S1all altho S/lrvoday. St,,_voIIage os. ,Io~ ..«"""""""'Ia,a worIung low3rds d'wId ............ " 3,000VIiIagaB Many 01 SrI l ....ka·. 19.000 8l>:l<J"05lpr~ ll«I illso prorool:tlQ cnoId~ The5au1lVaOana rr«lICaI >QIuf'Ileer l'I'IO'JeI'TIII. 511Lanka AM Cross. Boy $<::001$ and G<rl Guocles.l.Ions dubs and Rol¥'l d\.ClS are aI acIMl1y-To fllL'lO PllfMI$' awareness ol _ 10 Io"lll'O"'lthou ctWdren'. chBrJce& oI l1l1M1'a1 SIllI healtI1y"....elO(l".1(, me nali(:oW tlroa<lCaSllf'lO nelW«k~ I' ee lV·"""'. ro8WSP8POl<S and magal""'"M regulor tealuros. PIlVlte COI11ll8IlieS IlOIll etlIId$U'IIIVlII oncssaoos on P81 SliPS. ClI'* baQa .erM!Iolles lIIld e.8fC198Dooks Aod", S9P\emtlet1965 ttl8 If>:ltaO and Sri l~ ""tlonel CflCI<e1l<!llm:S llII'eed To hoi..... lI'e m "_ " 1rrimI.IIloze'fOI,O' cIlIld l"""y ' PIIin1ed III~ WMeletIets on me poICI1 U5tJl! fOI lI>e Tes! MaICll _ andWlII<:tHl ~ a I/lIIMsIon~ 01 lens olmillions "' boI/l Sn l.aIllIII and~ng_

1M IIflecl oIllM1Se measures will~ 011tOYeiIlOO ll'V a new sysIem 101 moMonng <:hOdsuMvaI and~ Talung a naXl<lalsamPle 01 0'0t!I 15.000 pregoam women, 1M systemWIll follow Il>8fr P«IIl'ess -iIIll:l 1tla1 01 tha".~,..., _ 101 lI>e """I we years

b«n $/Iowo mIt bolll~fM babies ar1!:OS much asI.... 0< IArN l;lJW 100ft ~ktly 10 die in infancy thaDbabi.. who Irt ndu$i...ll' b,....,_fed (0' 1M 6....f.w monlhs of lif•."

Applrini 'his knO'O'1od8. can bring 'M majo._ity of cbildrtn in poor communities 10 the age of6v. or $i1 mon,hs in good nUlritional bealm. Sofar, 1M infllOt h.. bee>l "' leas, panly in,ulatedfrom povmy by the womb and the brusl.

But fo. millions ortbe poor wo.Id's ch~dr.n, ilis now mIl th. trouble btgins. For now m. childbtg ios '0 COOIC into incrtUing coOtllCl wilh lbc.nviron....nl of povtny -I povtny which begin.l10 gnlw "' normal heal'b and growth ." it "' thispoinl Ibl mt l.mbl. 'growtb gIl" btgin, 10 opt"nup ooween ,b. smo<><b upward PrtlJ""" ofchildren in Im u. nt communities and lh. sudd. nweighl Io&ses, frtqu.nl ~I~ and falteringIlrolVtb of child,..n " 'ho grow up in poorercommunities.

II is also al <his poinl ,bIt <»tt of 'he leas'undnstood and mosl imponalll of all IoW...:o&Ichild prolection stralegies COIIld hqin 10 play ilS"ilIl patI. Aod bttause il Can serv.:OS I .....n' andan aim and a nteas..... of IImost allth. other IO'O'COlI' acti"'" whicb pare:nlS might lake 10 prot«ltheir children in these: ";,01, vulnen.bll: )'('In ofgrowth, lb. snal egy of rtpUJr f'OWlh rlltrkingdese..... a tnOt'e detai lM considerat ioo.

Prot tclitlg growth

Th. II\OiSI insidious aspecl of child malnu,rilionis lbll most molh... do 00< know Ibat lh... isanythin g wrong." And lb. ...ry fact tb ll lh.d~lopm.m of malnu,rition i:l invilible - . ...n '0pxdial riewll and oven 10 parenl! _ is <»te ofthemain rt:oson, for i" pr lenc. and $tV..;,y.

In OIOSI cases, n......oo nOli.... lhe Jock ofadeqUlte weight gain, and m. child limply Ii"..

200

'''''00

o

Fig. 14 Infant deaths by birth interval , uneducated mothers, 25 countriesiIllorll_IJl..1<lr_ ""'" til« WJrI (IMs lhItl2 \'6InI-1OI"IQ r2-O >-"1_........... To ........"""'"" ............... 'Ik; ""....... h ~ I9no ~<rif10"""""** wilO nolonTW_

o Long blrth interval

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FIg. 15 Diarrhoeal illness by feedingmethod and income, oer-es-sataern~cI_ "'IlOI'tIII rid Goao'TP'Ql8 " Ire ttno

""'""'" .,..." 10"""~

,..,,.

Bul in itself, grn wth checking neither feedsclill4. en Ollr protectl them from disease. There-fore III only true value rcsicles in wha, <1<' ;""J!U'ClU tal<e IS a l'CIIuh of gCtu ng much moretimely and precise information about th. IlU,ri_tiona! 5la,us of ,heir eb.iJd",n.

thll the normal 4.velopment of the child, Or thelack of it,~ be ma4e v;';b1e to the "". ~nwho cue mllSt and 1211 do IDOSl to make SUR:lhallhe chi l4 liTO"" and devel0p5 normally.

The de'l:aiI<:d 1Ctillf\S which any particularparen t Can 'ake ..... , of counc, prcocrib<:d by ioclIlcil'C'llmstlltce. But =1 adYIIICCll in knowle4gehave $bown tha, the"' ..... certain kin<ls of 10Yl'COS( riM which mM !»«DU could take tilprovide basic pmu,cl ion for f"IXDIh.

Th at knowlcclge can broadly be: diYi4ed ;ntl)knowledlle about the .pecial OUlritional needs ofthe )'OUll1l child II'Id kno wledlle about reduciqthe ftequcocy and severity of illIIess:.

Breast- fed

Simple as i, ....y seem, lh. growth cbeckingidea is beset by WWl$wered qu tllKma _question.about the right kinds of growth cbart s andwtighing acaI.. 10 use, _bou, how Ihe "'iUlar",'eighioJ of all young childre n is best promot<:dand organized , abou t whether graphing llfflwtlJ istoo a1i.o a coucep' for moth... wbo may well beillil....I• • and a\>eYe all about ho.... 10 inform andinvulve milliOtlS of molhcn in tbe process:"

BUI the IUkc:s arc hiah. Fur th.", is .......,n tobelieve thai if parenll could be inYillvM in an4informed by ,be regu lar ,rowth checking of Ibeireh~dreo, then child mal nulrition could be teoduced by II mucb as halfin tbe poorcommunitiesof tbe d• •clopinll worl4.

Pnvenlion i.1 usually po&$ibl~ if!»«D" und~r

5land Ib~ imponan« of growtb and can mmdlowlDeaSutt: il, :I« it, and take lCiion to main tain it.And if any fal,~ring in growth cou ld somehow be5«0 al a much earlier Jtag~, then the", are nowse,-eni ",Iat;vely simple and rdali"ely Iow-<:osl.>clionl wltich poor !»«DIS can take 10 keep thechild on course and prevem senoua malnUlri tionffflm R'liling in, !u>d therrin litl th. imp:m""""of . egulu monlhly weixhing.

Th~ d.,ails of th~ growth moniloring procc$I

""' brought together in Pan II of lhi.1 J'l"1"m (secLifelin..: growth monitoring) . BUI the essence ofthe idea is thai rqular mon,hly wrisht gain iii theb<st single indicator of any cb.iJd'. normalgtoWthand tim Ihe procas of rquJarly re<:ording thaiweigh, J ain, Or 'he ~k of it, is an essentialtechnological aid 10 I"" mother in doing whan""is , ryiog ' 0 do anyway - hring up _ hulthy, wellnourish<:d dlild in vory diffielJll cin:uD:lOtanctl.

on wilh poor gfflwth and ft(Qu~nl illnesses. In aminorilY of casa, the probl~m of m:oInulriliondocseventually~";';hl~ - bu, hy tha, pain,gfflwtb i.1 a1nady ...nou.ly afIect<:d and tb~ task ofpUlIinJ Ib~ d tild back on ccurse has~ verymudl 010'" difficull and very mucb m<I1't u pm_sive."

The hean of the mail er i. the informcdinvulvtlmlll of tbe motber. ~'or the mother'sparticiplliion in reguw IIlVY1'th eheckinll mcl1l5

"

India:towards a polio-free Madras

•

.... indoll pt_ ... ..,.lIempl ................~ 0111," Cl\IIcl«ln Dr 19 90 , _ IIeI-tC3Ie PlOQI"""are voetW..~ e>DeI.e<lOO 01 /'lOw 10rlYOMlII~ ,-..rces '" fOIC/WIQ out II> II>tpOCHIl QI'tIU(IS This_ !lUC/'l ea ......... ...._.. ,........, ......."' "' __..~-""Tl-._ r.cilyGl MDaI_1n~~~ .._PQIoOOy........",,-,g ...._ ~01 • .,.-. -..... ......_.-y~ lIS"""'115 1 OOOOl"CIII(.~_ '-_ "'''.ilII' C1'QIlId lIJ peIiO ..III lle;'I _ 'lICItlII'II _

'MIll __ l<nl:Mon • III MicQI ftO'II!'f>......· _1I'I 19&I ••__''*' I: .111__' ....... 1.... -...., PIqoamp.:li .. ' • til 0fVI"IlMIDnI worIonlI .,---,

...... _1lIIDl ....'_. ....... -.. carWII;lI: P .........,._~ouIfor..,. 1911$T,.,.I1111__.,_..,on"'. peIiO ........

WIllI ,... ~"'" lnt!IaI' bu8l Rowy .........__ II'M!I Uno1M KO'V:lDIt> sa.... the CtoiIDI...,

rcno:l, II'M!IlIIate 1llO'iI<trY'" """""~1e<l1M,«! IIIJIY 600.000 ClOSeS durI/1O;I~NtIy """'''''... \he I'8N '0~ tIIe....cane cool ",,111_ was.-. 11"'* P"lI'3le comparoos "'*"-00~"''ll8'.1Od ..._ _

Ilul. _ QilaICilit_. /11(1_.DIQ'IIl'Il"'G'"~ '"_. oIlen .. __ ...~ N '*"'-"d TIe __-"'-_ -....00 , "-P..a """'.Q

"ow _ ~ .....-~ ...----- -.._ ~_..*-<hMllCl.,__d ..ot(i' __ On __ r.-_-.._... --,. ...-~ ... _ org;nl(R _ KhooI..-.__•.,"__,_..-coIeo;Ie

...... local"""""'"' "'*'~ ......... _

l>eIS oIlt1<l~ llr(J Rolllry cIUtll;,..-o ".'Ibiolot me ~1lI ~ Touring 1_ on POlio_e$l1OWIl1O~01~ Thenatoonal"""" Il1>O MIl . .... . _ "'"__,e,1Sdoo::>mer>la". n I*I1II _ammes r- 01mola_~ ..111 ii.,.......__ItIe .......,.. '*- ...-.ount>IlU me __,dlJyI A mIol1'8'"_ l.Cl~ IN<>1'/ /vwj on'" _ e_. 1ltoClI* ___N_tlet .,IlCkI__

n. Maar. __ocm'lllf"Ifr.'l"MI~,..,._._ .. ~"" ..... A'EliOC,.. IK.*'~n"'" lle\'1lIdoIlI• '0'" _iCe 01""""""';: -.0_10"'-"'" C 1O __' .....-...., _. '" lor lb ...___..,,,,,tu._.. _~~_*"'<:an ' ......_n....-01 __ ,_.,~,. 'di..._ilor_...,..01_""~~ A__ '__ i.~· _~~

00 WlgOo1g fllllll n 1\S111180S 01 cool".ca1-~M;I~ "'., JuIoI, me ma,orrty O! m.C/l)" .t lllklren _ . ..lIIlIf'h«! auao"Sl POIoO. dDsQrIelOme IIIWlO'OfI III i ll_. ( .... 110. 9. or!he C1~'1 CI'IIklrcwl oeceHed!he Jorsl CIl»u. 88~ ...~. _721li:o 1I'llI1t-.;I- • .",.,.",. _ lie!""'I' be J'o9' erougIIlO~ 1M hOe,~n"''''__ I10~-'''-

wro-. __

'" "-. ...~---"" Q ; d alllOo<lCl_ !UCtlo - .._Dr "_~"'-"'"

... _ graup n.. ca,_,__ ot1tI' "' ... __ _n .._._' _ e....me IIfIIIIl;I nc. ~ 00""." -no...-. "" • ..-.... oIllOA:11c • =_..... .._ 01 0II'IU'<DIl0n wi ~........, -.u ,"\09."[. 01-

---_..._..~----0.--........,_""'" '0"

Fig. 16 En&rgy content of children'sdiets, rich and poor nationsTM11iIP" """'" Ite_,toy~, 01 tho!DO<l Whd'I....,. tle _ """"" <lllyto saIisIy.... """'W__ <J11I"""""lI~-.,_-.LoI""'<lI' t ..._, 0~ n:u:i-lg o~ fU .......~ on:!,.,... 01i"<> 1te"""'J)' <lOnOiIYal o <1'ikl'. tlad lO _ tho...... _ .. INI ala <1'ikl it> It"e~ wort:l,

1,750

Impt'Oviog diets

Oae of the 1Il(J$l comman fU$OOS for thefIlleting of I youog t hild 's growth is Ihat theinlraduttian of athor foods, in additioo to breastmilk, \:qins too lale,

After aboul Ii '" months, !mast_milk alone is noloogor Sullicirol IlId other fonda mllSl beodokd ifthe thild is 001 10 bc<:ome malnollrisMd_ Yel inmany pam of the ""Ofld, OIher foods...., nOlinlrod ucM uo,i],h. child iswell in,o Ih. sr:mndsis monl hs of ~fe and, for many" whole year g_by bd'ore any OIM. food is tneo. In t1lrallndio,for exampl., III cstim:aIM 4O'i of all infants an:stW being udusi vely brusl_fed al the "ie of one}....."

At the other o=me, Ihe inlroducrion of otherfoods II tOO urly till "ie Slet')lly IlId unnecessarilyinaeases the rWr of diarrhoeal IlId othe r infec,-

Preoenl knowledge abou t when to begin w.,;w·ing w llld therefore help moIhen a¥Did QfIe I>f themaio< tlI\1S1:S of falm ing growth.

JlI$t .. imporunt is the question of how a childshook! be: .....aIled:·

In a p(IM CI)tIIm ,rnhy, the altempi 10 wean achild 0 0 nothing hut Ihe same suple food osadul ts is likely to lead tlmetly 10 malnulrition .For I t hild'i &mall Slomath tonOOl lake eIlough ofthe bullty , 1"",-entfllY foods whith Ilre the slapl ediel or the poor (1'41. 16), Th e child may wdleateno ugh to Alisfy i\O hunger IIld be: said 10 eeve'ealen a good meal' . But il will nOl ho'" ealenenough to meeI ito enagy requ~nlS fornormal hallh IIld growth...

Th e ilaple fonda of lhe poor, unlike Ibose of lherkh, therefore tu1)' a buill_in dllIger of t hi ldmaLoutrition (Fig. 16). To roun ler that danger, Ithild has to be fed IIIllOl'C fKquenl in lerYl1Swilhmore energy-<lenrc foods. In pracli~, thol mea.ostnixina fm IUd oils, and peeled and mashed"egetables, ioto the t hi ld's weminll food. Aod ilIbn means rontinuios wit h one of lhe 0l0IIteoersy-dense fonda of alI_brusl_milk (Fig. 17).

FinaUy, there is the """enl hreaklhrough inknowlet!Je l bout the importan~ of vitamin A(set: l"'8e 22). In pra<:tioe, tha' hrealtlhroughmeans that a daily hllIdful of the cheapest dark·green leafy vegetahles an help both to protect 1Mt hild'. eyeSight and 10 reduce the number ofdillThoeallllld =pin.tory infctti1>lI.< whic:h a ehildsU$taiD$,

ErnJlD"'erina parents wit h Ihi, vitI! knowledgeabout the special nUlritiona l needs I>f the weanling t hild -in lelltlS whkh ~nlll CI.D under_stand and a<:t Oll -c:ould Iherefore red""" tnl!nu_lrition and help to maintain growth.

But in llmost aU tun, Ihe oils, fl ,", and event heap veselabl.. will mean It leas!. a lillk more:apeD"". The very poDrat familia wW thereforenIX be: Ible to make these small bUI vilalimprovements to their t hildre n', diet. And for

"

5

T)'lIlc.oI _ uK_

1 2 3 4Age or child...yeat$

o

I THE STATE OFTHE WORLD'S CIllLDREN 1986

lid f,=j'~~ .. .tlfU&IIe -. __~aDd ......,. IiiljAO.tukUl Clll WJPO<C IbeirdIIiIdrca'. dLuca vi Ii", •• I. Ii"

Blll iI if _ lllu • sipiljaonl perea>-

usc vi .. -wi', IIIa1DouriIho!d dWdtm~ illbolDa wbm Ibere If~ food Ul prorick aDaclcqlWe dirt for • ,......, dIild.. 1JI • ltttIIl

naioD-widc NnCy" InA ;', for cpmpk,_dilanaibll: difl'~ ... foaDd ill tJ>c,_, «kiIld III food •....w..bk in 1M IIoma of cbiIdreD..bo -..:~ aDd.. Jw:ma; cl~...bo -= ltOt."

I.a this amu.callCl:, prc:Kll1 bIowlcd&c about_ben IUId bow 10 _ • _ chiJd could

rod"",, bodl. tilt::~ and the orvenly ofchild malnulntiotl - if Ihlt kJIo....Je<!&e -re to~made widely avail, ble.

But din it nOl all. \II~I the child'. body doeswith IhI: food 1M! 1$ taten is ilia as imPOruDl lISfood itself. And in f'C«l\' ~an, evid....ct' bas boo:naccuJIUIlaLinJ bcki.lld tM idea that I poor 'DImof food may lIOI be llle OIlly Of even lbc: maincause of child malJIUlritiarl..

lhdlKiaa: ill,,"US

~ of l ilt _ impan:Ull nl all l'f(ltfI[

odnDa!I "" kaow~ Mlooll dI.ild ",,*,,11 io lbcIT"'in';'''' l!I&t fralucat iafectioD is as impartan.• QUSC ol llll1llutritioa. • tbt bd: or food iadf."

To6Pt aD iIlDaa, • dlild's body reqWm: amman'. Bw at- asaaUr __ • '- oroppotin: - .. .. body m:c:i_ lao eDCrJJ. _~ U..uy, tho: itt- n.tf abo IIlCIllS tballao 01 lloe food Wl is QI"'" io .boOibed IDdrnilablt lot~ AJod if .. m....;"."'Otn:$diarrlloeI, ibnl llutrimlS an: dIo dniDCd ,rr.., tbt bodJ. AI the ...... tiaI£, tht , 01_ pumlI (all ~ lor doaon) is ...'IrithIlIIId food driDIt.. b all III that ways, thtthild'. lIutrilioIlIl _ ...k -r ~ .,..uol) UIdfreqllnlUy lkpltltd by illMa. 1M r=Jt can bema1JIuuitioll IUId poot powtb - __ ;f edtp.ujatIJ if /lWIkI1>k i/o ,lit "'-...

Many dnailrd Rudin h.I~ oow <klnonOl"Udthis aUlll Klatioa.hip !le1W«1l iIIncsI and mal·

"

lllllririoa, _ resaniI ........ !lao suuaud 1Iwdiai,botaI~ &IaDI:. ,cspmsibk ror bftWtQI

15' _ 7SS 01~ faltaiQ) .-. I.IwdIiIdiaI 01poor fwnil;,, "

'J1:I( rc:tJ poblml .lberd'lR _ au.er 1DIiII...lrilina r.. illfa:tiaa bur bol:h-_ mabt~iudf pno;t..... I.Iw dtiIcI III _ ...r...-tioMw1aidI lad iO further DUuiIianaI~. Or.HOIIIcilI Qhowmi hal wrinCll: kPo. .nn ad._ """ .,.,..urir ~f/«u ill 1Jn1CfIlign.,...ttiNM ......, diltbn, """ "" ,.... _ ....n:.1I,1~ -... #f iajrcriaII """ _p1DLCmliill .. ~.;14\ tN, rtIOtI14 ......... ...,.,.....,wI< ..,pd, ,.

..,..,a., 'If .....-../ rwmwr.-While dninI ..hal is lID'" IJOIIiblc 10 iml""'ft

diel ., IIId especially wnainI dicls, ",h l l Ibm atelile lo....:nat M:lion. which parents can take toml\lCt iUlltsi l

PI'VIKtlOII apinlt diar'h....~ i l1Qeu

The _ comP>Oll of all childhood ilw...." iIdiarrhoal dileuc, 10~ poo< a>o:IDIW>itia, forftIiIlple" dilld may fIOOlrllCt. diarrhoeal Wee·tioca P"haP' Iix or mon: Ii...... year_wilh ...h~ Ia$liaI foe In'cnI days. If <lie""'P'J"tII' 0(the paml li is to with!lold food and drW:, thcDdiai, ....... lIlIy 1DtIIII thai. powinachild .. ........ntber lbaa at.:lcbizI& lMNriIIuDau foe. Iou! 01up 10 4(1 daY' ill tbt year. AIld lila aIoot ise:tlOIIlIh '0 (:II"" IIO<maII'O'"h 111 bit"" "ThaI ;.wh,. ....,. ...uir;".... _ ~ tlw dia<r.!loti! Wmioa • _ of the major aIZIIS 01chikfhood lIllIh>utritioa ill tbt de . ........ -'dtoda y,"

So.".. can p&mItJ ill pooc ........Dm _lko 10 ward olf thir, lhI: Etalat threat 01 all 10bolh thc Iiwa and tb. iIOi1IIaI crowtlI 01 t1Icir

"'"""">M_ rreqlll<Ol haAdwadUo& with _ aod

Wllter. and~ hyp..ue oqys ol pr<plIriiq and..orilla foo<l, ate I.Iw 1-.> ......~ ;., whidlp&mIt:I an bdp to~t dOuthtc:al di..-- ifIbqr haft adeqowc ....pplia ol-t>. Wllt". f.....and time.~

But for tho _ ,.n, piCVCllUoa depends 00imPfO"cd itIc'omo:s and livial t'OII~tiolls, Arlit

-_ee-"""-

_ ~ DEACI1'. C*-O IS MOlIIIIEAST-no .. _ I'u.R Of' un:.

DUI'I"TI< INCREASINIl OTKII fOODI .... _

-------.:~-- - --

~-- --_.-----

15'lb ,.....,.

-_.".. --"..._-~---- ....,._,---"'.

Fig. 17 BrNSl-leeding and CItlorie Intakein the second year of life,..,........_"'_.."_,.-<$.........

• \'__ .. .,.. __ t_ ~ oan .~ . . __ .... """_tf__tf ; ','_ Ior _

anir.._ lIfId _"" Ollpply, IIId IleDCnI .... iatbe It'I'tl of lIftIth em",,;'" lJr,~ wmlt,~u.. .. rdaud 10 .., .... . .,. ia publicbealtlo whiclI -. iD wu, doeeIy rdIItd 10 lM"...,.u It'I'tl of .. I" ' ''' lJ,e.eloctikOL AJld 10..."" lM """Inll of diInboeaI~ to lMp>dUII IIId litful~ of 0' ' If'l'"l.II_ lariat 4 miIliorI. J'lUOI dlildmI 10 dieado JUt-aDd ......1 ",jlljMs _10 b. 1m iamalouuil'" ·llIltil -U ia,o .... 0ClII ~'Ilr1,

TIloI:ft is _ no QWSe for ollowi.. tIw 10Mppm. For thl: dia:o,u, ofllnl rdItdntioa......P1, Iwcb<d upon .. lbr btJinnina of IUI'OIpoI'l , mraas Wtth.... il OO'II' I .beop""".unpkmnbod by which III pII'O'Otl -ridl or poor-caapt'Olo:l their child= from tho WIlnI dfa:l$ ofdiurhoeol diMuc.

In I""'viOlU Yffi'S, this npon has dOCllJtltnltdlh. fOCl lhol ~l'OIn t. lh.......I. .. . ... """k. aod liteoral I'OIhydntion soIuti01lll md holp .0 Av. tM!i1'OS of Il10R ohhc4 million chiJdl'Oln .. 1>0 lIOVI diench you fl'ClllD. diurbocal dcbydnUOll,

Bu. ORT h. I I... spoaacular oidc '0 jl$nll~ !:val for tboot dtiIclrm ..~ Ii_ ....001 diKaly thrtlteotd by ddlydmioa, ORTroWd bei::om< lIIIC of Ihc ..... iJIc:iIj", oflooh forCIIItia& jatO tbe c,dc of iarectioa md aWalltft.tioa whicb __ bokb '-;): tbciI' 1J'O'IfIh.

TIle fin! md _ baic dcmml fIi ORT bas_bj"l lOda with ,cd"'*'u or special 'om ull.or f.oiI..w,apptd-w IlIoas ... do with iaf_i"Il*Ul$ tIw it is ilr4porwlltOpmia iDp.iDcI dlild food IDd 6Wck dtIriJl& _ cpioodc ofdiarrlooa..••

.. .. _ _ .. . _ tf .. -r d""

...., _ ' l _tIK1· _ ...,. ...·f ...., ..... rio:< ""' _ __ _ _ "'_ ,,..,.tf,...• ,,1 " 4 __ lOiPI, <fIo<tioo< _ .. __

O~T.

"

bq;nnjnl 01 diarrIoor:aI IIOl1alllritioD. ADd itbdplllO lalla 1M R.uiij IDd dunlioa ~ tbcm-Ddl.

Ben bca&&w dial'; ., illfcaiom do ruluau..bod"" apcicy ID-'-'b &Wd$:a<Id IU'ttil:aU, thoth.- of~ illtill pmmL~ oa:OIId"* • OJtT ;" tbercfan: tloc IIIaItiq Ill' 01 •opeciaI oral l'dI~ ..no.. whidI aboald be:~ to lbc dWd 10 drink ia q_Utics SIlftio:XD,'0~ ,be -... of lluid IaR durina eedW'bota.

SUdl on on! rdI~ioa JOIutioll CUI be lDICkUp iJI ,hf homt IlIilla tilllI Ialpoonsfuls or IUpf,0 lIOC orwi ill l lilft or ..... (or by ...ui... Up

dfcetivc tnditioDal l't'llledies 0llC.il .. C2/1'Ol llO\lpll

Of ria: cooiocal. All.mati...]y, pUftllfCl n "''''' l iltP~paI;~ _hcu of orll rebydnlioa salu whic:han nOW bcromilll I nil' ble ill most rounula.Eithn ...y, th. _ "'. of Ih. formula is that the1l1ucose alia... ,be body 10 .lnorb Ill' 10 2S limamore 6uid &lid IoIlUilhao isnonnally the tIK ia Ichild ' ufftrilll fro"'. dilrrlloa.l infection."

10 I ",1I,;n'y _II ~I.,. of asa, thediurl>otlI .nil pmiR UK! tbc clilld wiU ba:omo'"UJ' obriolqJy ill. III RlCb dmunswK:c&, if 11 aU~bk: , lbe pua>1 should lledt tIIc lllria! of.bcaltll WllfW Illd Ihc~ on! rdroyd...00.. a1u, lIlIOk lIpla tbc a:K'l WHO/ UNICEFlormala, 5bouId pmttlbly ... used. . ..

If Wt ...... proced"", io rolJDwal, lh<!lIilcnD, "';11_ 01childtm -taoart _ dyiq..,., 'tal wwId l'tCOOa' •• dittt'I <aWl of 1Ml.mlJDnIl p...... by llorir OWl! pumilia lh<ir "'"'......

JIIR • imporunl, thiI same pn:adun' aDsipikanl]'~ tbe olllritiolW klIICS ca.....:Iby diarrlooal m- and • bdp ... mainum 1M--' IfOW\lI 01 tbc dIik1. Ram. J1:IWdI iaTIlrUy, lDdia, I"",. llot Gambia, IDd tbe PhilippiDa lias Iho-a lhIt tloe lIK'diaA difJaaICC in...apt piD bn_ dliJclfUI who w= tmItal..Ill ORT md tbooe wbo ftR" 1>01 ...__ 70ar=mes pu _tb (Fia- II ).

. ,...... __._"""Idoydnciooo tIotnpy _ IIiII lit..".....,.

"

oaT il; lhaefo;n .... flllbrdlapno ..... _dIccti'ft onJ'l ill wbich pareDli ihl:msd_ aDrtd..... lbr impKl; fll illDaI ... I chikfs sr-tJo.ADd by bdpiq 10 mai:ltaiD DlItritiooaI wdIbcilIc. the _ thcnpy am bcIlli ID IllIiDtaiD, • 1!Itt ...... atloer ilIfco " . n 1D.... -.itil CIll N 1 force ror (OIl~ lbr doota-.d'I'inl iDto III upward spiral. ADd lbr ....CIll~.ad foe' lbr _ balk ....mod by whicb pumlSaD belp 10dcfcad illcir cIWdrca'sJrowth opiDIllhc: tImat of illnaa.

VKciH.-ptnfllllble illa_

1M~~ in immunizalion ooWftlc~usttd eatlict ill lhis rq>011 aD, of COIl"",pre""nl ....enJ of Lb¢ most seriou. childhoodilllH:Uft. BUI in 1M oomn l of . mlnh, it ..umaCyen Inaler imponance.

V..xint-prt'I¢ntablc iIlncsscs til:(~cs orwboopin. OO\lib, It wdl .. Ibreatenina I child',lif¢, also1IlIvc I bnvy nulritional impacl." llltttfon immllni..tinol _aiM these spcci6c disc......is .... I putw 'immuniDtinol ' .,oinsl malnu.';,tioa. It is likely, for a&llIplt, Ihat ......,. mort:

chiklml die of maltlul,;tinol ..... illDaI in <.be kw_tlolt r..uo.m, III Inaa of lDUSIa than onItilled by Lbc: mcasla iudf..- A:>d Ibc n:IQl isthai ........ hat kd 10 nlllritinosaJ --. ",,""hfaltlll'illl. In_ a! , . aN"', lIIIIft dianilneal Of

rcspinI..,. mea...... further...;p. '-' .....so... \llltil t.bitwhirl pool fllillflOCtina ..... lIutritiou1

dqllctjnD -ttt lbr dIiId down below dlt ItYd ofIIl1lfitl,..,a1 bcaltb .. whidI life itxIf aD bep ..oi"""

I m lll" lIi m .... iudf an IJoudoi, alon IIdp 10

lllrow lbr 'donwvd S)tkiPnt' fit poor 1I11lritiall..... freqocn. ill bcahh into ... "II:pwanl1JDU....'fll..mal ",,""II ..... fcwu iBfcctioDs.

_eaplra...,. iak<tiou

ORT ..... 1mtJwni>::atinol an shidd a child fromlIIIft thaa half ohhe ill_ • I _hic:b M M lllif.and l'OWIb in lhc: CI1lksI )"'Clin. But lhal alillIn._ IUK'bcckt4 Lbe mainrily fit <.be rcsplnloryinf«liont -ilIftctioos liM influtDZI, sinusitit,

A g . 18 Eff ect 01a RT OIl weig ht gain inc hildren w ith diarrtloea

o WoigM ooitl II> group WolgN DIiI> '" group

-~ -~""-,_. ....-~ - -.-...igrIl goln l* 0'ICIIlIll "" • •,,*,

""'" <> - - "",,- ,.- *~H _ *- =""'" <.-,- 7_12 """""'" !lO9

,~- . ~ :i»-n_--==~- '"

7-1 2 ...,.,.,. •13-2. """""'" •

~-..JI'»-n_ -

"""" -a- ;rn,-- - " :::e,,- - ..,- - ",.- 3-11.......,.. -.- '~-23 """""* - ..-,~- '" ""*>1 011liWX10

3--11 """""* 1i:12_13 ""'""'" -~- •

.........., -<,-~,- ,.- *

.........., <' - ...- ,.- - ,"""" JV.-;" ..... iII o-.x.re .... _ . ceIn O'O'lfitWWlT' lI'"'-....._ _'Ooto_oalng_ li>mpa.._- -,-----"'--'"_ .__.......ar_,_

, omiI lilis, laryngitis, pocull>Ollia, 01;10. media- which underlie 'be deluhs of more Ih.ilIl 2 millionchildreo a year and undermine 'he gf<lWl b oflIWly millions 1DlII"C."

BccaU$C )'Ou"8 lunp aJl' 001 fully dev tloped,all chUdro:n an: mere Y\Ilo=ble to l'e$jlimorydisease. Aod a chi ld wbo is weakened by frequenlillness and poor nuuitional hcallh is~ vulnor_able 51ill. II child who COOITlClS bronchitis orpntumnnia in Ihe devcloping "",rid is thereforemore than SO limes m<m likely todie from itlhanis a child in EW'Opl: or NOM America."

f or thOR who survive, glVW\h is often tc1 back.10 a IlCVC", t.UC: of bronchitis or pnCUlDOllia, foruample, a child lIIlly '- as much as 12\\ of lheproccin from his or ber body." Weakened in lhis_y, the child is then~ 'lI$Ctplible to fut1~r

infection and funher malnulrition. To keep thechi ld away from the edge of that stecpeni"8 slope,bask pnltenion api.<lst the main respiratoryinfection. is tbudore ab" ncccsary. And he'"100, there arc IClioru which parultS lI1d famili..thcmselvCl can 'ake.

Fim of all, breast-feeding offen a considerabledq= of immunilY"llainsl rc:spir:Itory infectionsiD the lUst year of life." Secondly , immuniutionoffers prolection qaiDSI four of the wom offen_d=-lubcm!losis, diphlberia, whooping cough,and Ihe respif1llory complications which oftenwait on mcasI<:s.

BUI if respif1lIGry diseallC doeSilriltc, lhell th=art also 'wo vilal pic<:a ofknowledge by whicb afamily can """eel acbild from the worst dl"cets:_

o As wilh diarrhoeaJ infection.. paKIl\$ noed tokno w lhlt conl inued fcedinJ ~and especiallybreast -feedin g -is I vital part of the tn:I.IIqemcntof respira,ory infections. The child needs bothCJ:lnl foods and tlua lIuitis. Anll if ;\$ appetite isglll1e, theo freqllCol lI1d penistenl autnlpts ' 0fto:d will he I1COC!I!W)' for the dural"'" of IheiIlnta.'.'

o Secondl y, famili.. nced to know Ihe ....ly$)'IDl"nllll of an acute lower respiratory infectionW tha, Ihey CIO,if I I all possible, gCllbe chi ld 10 Ihealth WOlker or I clinic hefon: life il3C1f i.thre atened. The ""'" revealing of these IympllIlOS, in almost all cases, is the suddenly rap id "tic

I THE STATE OF THE WORLD'S CHILDREN1986

Thailand:PHC in practice

•

W!II .. ,...d.-,,_a ................-. Th*'d _ bn:aq'Il _ _

1Oi$"'/',/I.S06.000~__ 1l"P $

"' 0.....,.. 1M ligon _ QA ICl _l OO'lo ~ _ 01 'ge~ --.uT-.l.".01 foe __ ID II'I:JllOlD llI'IfIliI"f __ IPtIClOtl.__

'_"'pnn'lIrf__ palocy aclallI!IcI.. ',11. CIII 011~ _,_ ID 1fIIOl"~,,*,_..-.lWng """'" T....01 ....... . _ lor w. 1lays as ...-- _~~). pass on IInO\floIIdge about1'lU/Ih. nutnoon _ "'tlI*"e 10"- ,.,.,.olltuI ..10. 15 houJol/lcIlOs eo.01 -., Ietl V!iCs IS 1IllIrI~ b\' !hi 0"*-101, 1uIl!>eI15 day3' ,._'"

"" .... he;l1In~ (VHVl Bacled b\' •CG"!PelOlli _ ne!WOIl< 01 heooIl1l t8I'\lIes ...,

""""..... 1111'4 -an ""'_ 10 mo:nlo< trleorgtMlI'I , SI.WY fnI aod ..a t\aSIC ckug ~eatmeol,_ *"'II~ _ ..., <lisInOuIe

lUQllIefreruty IoMI "" ch*hIn _ --.- In.- ~ mocI-l'85 , . '9300VHC:. _"ogsdo . 3.000 VHYs

ThIilrIrd',__..""'.,, '...., _ .. l'77.08lIIlillSon"'_lOe>l*IlO_......oI......-_IOClIgIIRa"""-_ 'lhl piWOO.... 'ol~ _ ~ OUII _ ' •• ' ...,.,......... __ -...,.j N __ "'."..,.."""""' ,.., ~ ,__ dP.·.."'.......... 0IIlIII'I _ -... '- _ ...~. nm2' " " 1M210 S3""0'I 19&1 ....,•• I I ... paIiD. _ .. l!M2 . ,...... 0MC:I'.:l $3, ...................... __ .:.NPiO\iii."'." 19&1 In Il1n.,... .. "'_............ la ..-1O~ , 1'I 19M ...~_.~

.II__ or• .....,......"""."i._ ...1dIDn .. 1980 . _ .. OUW''''w. no.-"...._ 3 _ ~"'cnI,IIIIi1dt."",_

• _ VHVs _ YHCI.. 1*\1 • I<ey """ .."'.... ,_ ..... _1l>Ir1Irpy to c:orrQM _

cWrydra!Dl L-. """*' ana """" _

__,.". ,$ ••'''' VlG'l<." 1m_ b.r'Ill _rwne r..a~_ III .-... MfIliIl- ooal I'IIfIo1<)'" •.. .. 10 ... _ ~ aI • ..-go etIbl!tI

-~1"" ..,...... .. ."".,.",~ more ....60'" 01~$,IJiO<k'IWch*l<tn 10IOOMIlf"* growIl'I __....-.s on~ 01.n'IIkJn CI*Ioen~ bel li I 19 72 ...,'982, OI"'Y . 9 '1> _ be ......_6<1 _ nour·iot-.d. bul boll, .., 0cI00el aro:l Douo iibio 19M.0115 _ d'lilclren~ 11l\l1o _a__ Mild mahJ\r_ """ ........ rc • IIwdIIld lli!ItlWS llIIRlIli1lOll lO.... eogr.th a1 lhli lIIIrlief_ CII7wIh~ has <>.so !leOn lnl/O<

duQId., n.........1'1 31.000~ schooIt and...-y ochOOlt/lild ""'" has •~~. 10W ,..""W _ .,-. ea«l _!lOatleInll lllllOlll>C:«l lhliClm'.:IN:n

'" _ 20.000~ vtN. opIIflIHI ....""'" _ 10 ..... IIa1 ... dn.O' ...""_ 10 -..II8ger.I ill I .. llflCl! • 7M. of~_tluy_lcoslInll_ .....·~ ifI. iltull_ !floI~w '*"- I

Qldy of~ 10-.II_9lln:l DnIQIS_IlW1 IlOUgI1l _ .... _,. .... ill • -...

aro:l $OIi;l1O"""" ill ._llIIlM-ThI!.........,..,.go 10 ,e••'".~.~ Ite _r •••IIOCl •••• "'''' " ..... 101'''~~ft___.-._01 6325......

'O'OIt on... _ ""' ...... V*gln _ .-__ ..-.y IIOCl I ,,_.... cb-.., t>r C'cgo ,,'•• ..., Lt«:EI' D _ ~,.."..._ , lol::oa b _ ........ C<Ii;;'_•

'MVIo-- .... Ioo<l ~.D-.Iw'--T1'cIIIn:I'.~ _ -"'" _ lIu;l •

_b._luuebrr..~ TheCCiUl'lWy • ....-cI 1986-I0IoII& _ 00Id_y....~-_._....... on" .._'" -..- ... ..., _ ........ 110:'"'"_-.__ "o~ <ale. ....-Jy one of Itoe_.-

af th••hild's b"'"thing, &looK with fev..., abviausbreathing dislms, IlWinK af lhe dUllf' aourils,and I dmoilll! in of the sp;><U b<1W«'Il the ribs."

In the home of Ih. community Malth worker ,or It I c~nic, th. rna;o,.;ty of ..... t.....pira,oryinftetiOlU COD be dfteti.cly !rOl,ed by in jrojonsof penicillin ar by ,abl... ar antibiatics. "'00 SOcomman and $0 dang""",. are ,h. ....pirltoryiIlD<S1CS, that lhere is now the $lrongo:st possibleCUt for makiag antibiotics Ivailabl. nOi onl y viidoctOl'1 but al$O via much ~, numbel'$ ofCOll1llUII1ity btahh work. 1'$ (_ Lif.lint>: "'eIl l<n:1plratory iDf«<inns) ."

Th. cost is aegliKibl. -less than 10 cealS pe,d...... But the dfCCl COD b< dtamatic -a!ml'li$l I~ reduction in th. p""wnonia death ra,e in onemajor trill"" far."

The hes and the grOWIh of child...a canthereOn! be lihelm ed, if nOl rompletely prot«"led, again3' ....pJn.,ory infectiaas by empoweriag parmlll with basic knawledg. an b(ub prem>uce and lreatmeal and by empowering communi ty hca.lth workcl'$ to \IX antibiotic. (_ Lifelion: Acule ....pinlory infcctions).

Finally, malarial illness must be includedamana ,he most importall l Ihrealli 10 the life IIldgrowth of child...n in scve:al rqioltli of 'hedevclopillJl world.n In Africa lion., malaril isnow CiiIUn>led 10 b< rcspoMiblc for the dtatbti ofalmost I million children I '/=. By the end ofthedccade, it is quil' possible thll I 10fF-«lSl a.nli·malarial ,,><rio. wUJ have laken its place alongside the other vaccines ill ....'ional immunizationprogrammes. But in the meantime, a dcg~ ofbasic protection is possible II ,elatively low cos,.CommunitY health wod.e... 0' villq:. "nlnotccn,can distribute chloroquine '0all molhers-In-be inord '0 p..."en, malaria in pregnlncy (whicb isd ly l\iMCilled wilb both low bit'lh·wrighl andmllemal monallly ) and to 111 young childrenwho $how sialtli of hly-fever-tbe major symptomof malaria. (ROUline t:hlorOljuin. propbylOl<is isno Ioager m:ommcnded for yoIlag children IS itcan interfere with the development of Ihe child'sown immunily.· C)

F. edi4t; in ilbleu

111$t .. impo<tln l .. the paren,,' respon$C '0any of IbC$C specific iUnesscs is Ihc kno wledge11m all Ulnesoes threatea the child'. autritionalh.alth In d aormal growth. And th. proclialsigni6ca.ncc of thai knowledge, to ~nu, is thaIlhe", .... tWo basic 'hillP whicb I fomily CII1 do tominimize the nutritional impocl of iUn.....

The lim bas altudy ......, mentioned _theimponance of persisting with food aDd Ouids,freq uently and in small amoun ts, .....n whea thesick child'. appcUte is low.

The secoed iospecia.ll1\ention 10 feeding in th.few dlYS gfter III iUn..... 1t ionow knOWll thl', iathe bri. ffew doys foU_inl l boul of diarrhoea orI resllitalory illness, a child can gain -;iht I tth, ee, four or even 6•• times ils normal ,*tc - ifpanicular In.nlinn is paid '0 feeding. ~Iture

;tilCIf has Ihere"'" provided an opportunily forcatching up on ,he numtiOllal l".,... lf«rilm.Ftxid SIlpplnmrU dun", rhis ,~"'" "' fiw !ky> i"","N/n(trra "'lIY /Ie _ of 'M """r ,ff« riw """"""f ,tdtIci", IN "u'nrioMl ,ff«r of i"fH'i(nu tmdlUlun.., rM","';"wd aM,.,.;,......1MDIt~ of 1Mchild.nis "IfMim ftctli", wi.h ..tidily dift'rtd ftxJds,abti"istertd 'lumttilwr ,,.. t!4;y "I"""r as if ""pmfflp,ilm. BMr 'M oppottNail)' ;, " ~f tmdfWri", lIM which"""';,....o Itt widely ,><pwid."

Growtll ched i"l

In al l of IhC$C ways, paren'" and families anprovide basic protection for ,he Ii... a.nd nnrmalgrowth of Iheir children _ IlOl jwn against malnutritlce or specific iIIdividuaJ iUnCSlCl, butljllin<lIh. <}"lI«gjstic oombi:lltiOll of the lwo.

And it is o.s:aiml ,Itis bocqround of possibleprotCCl' nn llro.t..ics that the imponllLCC of rqul.,. growth checking is Ihrown into clear "'lief.

Regular monlhly wci&lIinB, and th. m:or<!illl!of ,b. rc<tIltl, makes visible the subtl. , vitalprocess of the child's growth ~ dnwing • lin.

"

[ THE SfATE OF THE WORLD'S CHILDREN 1986

Iodine:protecting the mind

•

r~~ $ua1ll11""~ n IhI$ rtIPOfl",. 01 DlmosI~ ........ lQII BuI_rl'/etlecINe om ....parlSII'II 8Oluliont .-0 .... lor_ llI'ObIoo'rIll _ IlIhlcI~ n l.pIlO/Ic

1*11 cI .... _ A au.lIr 01 "'_.CI'obtn. b' -.pie, .. " ..... Jrom -..~lC" "'_'*-.g_",~De ...... -. 'ttl! IlIdr.tIng SIlI-1he....-sa .....edy -~<ri,20'3__l*lolIo Ard_-.g... ...,. ..... ilJIt,..tOIo_. ..cl _

........ ..,11> __wr••• __ 110m .........~ regG'lS ..a Ioocl-prene _ ....... __ 1ft! bw .. iOGne sew."",,,,*C. ca'l'*S ....... 01 oC , 1_ Ill '~__~bN~"'-ll"""9'.pCO'~ oxotlo__..gtIlQ~ 01 f'OIl~ gland II 1IlI!l _ oIl1'oe1IvOIIQ. __• _..., 0 ....." Bu!hi GllnIllQll dOnI !:PI \eS$eI' dlq_ 01 I(lllInedefoeoCf .~~'ecogr'IIledE_moIcI __ dIItce-cy l.fIdeI..-.- choIllloo', p/ly.

IicIl and "*lllll grawlh.S8PIlOOI Ther llIllIIlIV IlO<l-"'0 (/Ie J)(Ol/teSS 01 IlOlh~ and~

lo<:!of'Ill DeliOeo'Cf"~ n .... Andes ..fI'IIDloll<IrIca. ~""'oIln1 SaIw..",._ aoc ..-.g mm .... _ C.,-.gIl.. ,lIj....IO~_/I'Il,lrm_... CIwIe _ """"" _c..n.. _'"~01~ £-.. InBotwoSS'll.cI~__ gooIr8I ..., .. ~ 01

~....,be-''''_01'''_',

- _c, -..g pcy..., In ""... '"...,. of [...aer, 6O'llo '*Ill'*- -.. ........,.".lMlQI.ii '... ,., 01~'........._ ...... ..., .. ,.,..,.....,.30'lli __In IIogit _ of In:Iil. z.. ..., '" e..-."""*'....-. ~.. 01__..110m"""'"-

IO,,lUBtorl 1l/IlOI811't'>es .. !UCfl CO\lnII1IIS as~, eo.or-, CIwla. Bta8,[_ arodZ- 118.. hIiPtd 10__ bortl'-weoghts v-...."... II'lOII3lIIy _ ~ oct""*l ••"'I .~Q __ In oet*aI , ..........·,...-eallW.lIfO';II'ilMllIt 'OO.'" IllOnll... _ 0110__ 1.. 01~ Darn t.lcn_ll't9' PaoJIl_Gt.-----_._-'"""*zed .... ....- Il'\'"';' •!Dr_1Ddtzlng--l!'Iooql br..:l _ aq:IIoM .end-. II.IgII'

r-__ ".~_I&d'''''''

~ II) _ £... 10.hcustl ...art.1"'I1I b• PClOI~. __~ 01'"IlI'Ilb*!I dCr:IAllO oe-. 0 "',.. ___IIDn _ ..., ._ tor mz.l . ......

.."",...,.,*,-~~ .

a.I ... ,.. ... _ 01 o;One~dolor"'" hM __. ....,." ..., _

coo.-IlnM ... 1etumong 10 "'" allad< s..er..Mclelwl 00"1"'"'" iI$ h;t>e Iu1ched All IOlIIlrlII" Dgi'llII1II'm ,.... """""ll """ """ 01 • fM;t.yeJIJI d""'O 10 in11C12 moIlootl ot lIS iXlllUkIloon 0118....... 1I""u".,. """"" ompotI:S ,r. sa~ ~'"" _ .I\B$ onstaIed WI o:xhong plan! at • l>otdw cr-.ng-.. .. "'" cwr&l'(1 .-II _now l1elIIed n h;lla-.SO __gooIreI"",200 __

al .....1ronl_~iCY.~_.-IDdIllng -...a ...,. Ot'ft • """ 011nII!~'I .. _ ........or IClile ........ l*IIIla ... N """'- _ P, .......-M ".~,._~~~ 'Co:on:1I lcrh ea..a 01 _Oookeq D8c:<'*1 __ I.. .., .....

(19M~ "'" lNC(f II:aXIIt. 1<1 _ gCIWM...... ...~N~c....I-=ai _~ , ..... ..., t.cIIIng ..... producas,~ -..:I IlIl __ ..._al_<lli....c~_Ien~

whi(h is th~ child', 'lifeline ', the sinlle mosIimpom.nl indiclilOr of its well.being.

The basic aim of rqull\f growth checking is<.herdort 10 gi"" pa""ms urly ..m ing if a child 'sgrowth is beginnJng In falter. At <.hal early Sl<lie,_ chiJ,,"n can be PUI back on course by <.heronge of !W"OI-based IICtiwu jUJl discuaed. Bath<.he lechni que of det"'lil\g tho problem - and <.hepncical 5lepil' wltkb C&Il be tum 10 remedyit - ace cheop ."d ample enough In be pul 01 <.hedisposal of <.he \'1$\ llIIjoJily of pIlfents. Thol iswby Ihe gro wth cb«kina lechnique is potentiallythe g""" lest brulr. lhroog h of all ..aimt Ihemalnutrition and ilIfectiOll rom pl<:l ..hic:b hoJ~

bock the nonna! dewopmcn. of"" matly of Ih~

dev\'loping world', child""n.

"'1 the monthly growth cb«k, hcal tb workcnC&Il di..uss with the parents Iny and all of tIM:10w..coP actions now o..-ailable-whether it be <.heliming and .pacing of b1rth$, Ib~ nM:! fOf emafood and lUt io prqrulllcy, tbe impozUncl: of Ifull coune of vaccination, the: llIICthod of ropingwith diurboeal illnc.es, the importlllcc nf con·tinuing In brel lil-fM:!, knowle<.lge of when andhnw 10 Weill I cbild properly, Ihe reasons forfrequenl Iwld~g with IOap, or lhe value ofJl"yiDg particular on ention to penislent fOC'diogduring ...d immed.i.olcly afler. child', illness.

""d because it iI • rqular lICIivity, brinjingmIllbers and chiJdttn iolO monthly and predia·Ihle COIl tlC! wilb community heal<.h workeR,growth ched :ing proYida the ideal opponunilyfor beginni ng to bu~d COllUlIllnily.Nscd primuyhellth core. It can provide, for ,""""pic, •pnctical focus for the demonstralion of bow and..ben 10 make and use ... o;nl ""byd...tionsolution. It can provide I fol'llJJl fOf lhe visit of animmunization leam or for the dis<ribution nfvitamin ", supplclllcnu. Il can be the aetivitythrough wbich to supply paren ts with cbIllfOoquine tlbleu or anti·Jl""'Sitic dl'Up.1t can be thenpporI umly for parents tbcmKl _ to dis<;ussthrir """0 rotJctnlSand priori tiea.

NOI ItISI, regular lrowtb checking provides Ifilter for finding thllS" dUldtcn who arc It sp«wrisk ."d who ncod sptcial help. Even if """,n ts doall ' Ut is now f'OIlo'lble 10 ptOIect I chi ld's grow<.h,Ih= will still be a minorilY of cIlillInn wbo will

fail to pUI on weigb, ov'" I I W()- or w«-rnornhperiod. Special belp is thrn ncoded -u it is thmdear lba, the child is amply no! getting enough of'he right kind of food to eo, Or thl! there is IspcQfic hcolth problem lucb IS I heavy pa.rasitil:load, or cbronic OIitis nlCdia, Or silem tuben:ulGsil. In this WIly, the reguJu growth dlecl:ing of allchildreo alsoallOW'S otMr taOIlfCCS, whClher il befood lupplcm:nu or more Iptcializcd heal'b care,'0 be uxd more efficiently by being largeted '0<.hooc llIOiU in ncod.

BUI in the OlIjorily of~ Ibe VIlli. of growlhcb«king Iia nOl io the lCftttIing of chil,m, n forlrealmen, bUI ill the edl>Clltion of """,ou forprevcntioa. n Il is wby there is vuy little 10 begained from tbe groWlb cb«king tecbnique if itmcrdy mttIlS lhat I motherqu~ea up fOf an bow10 u ve her bahy weighed hy • healtb " 0"'''' ..hotben dra .... lJIeIIIinglesa marks on I mt:Iflinglascard befon' calling for the nel t mother ill the lin• .

To fulfil iu JIOlential for drastically improvingth. nutritional hcaltb of childl'cn, grnwtb . beck·ing needs to he o'lonized on • mon,hly basis forsmall groups of WOIlltll, p""fCl'lbly It a ntisb·hollJbood gathering. And if tlte ideo is wellundcmood lOd tbe weighing itself i. wdJ orpniud, then gro wth cb«king is something whicblboukl be looked forward to IS I time for mOIhcn10 diocusl bow thei r child ..... In' doing, 10 meetand a clwlge elpetlCllCCl; witb friends, to spend Irelue<! ...d inftll'tnativ. few min utes talking with<.he hcalth work r, to bin ,he chance to III:questions and rnsc.....rn... to pick up importantpraclical tips, to fel$$Ufe th. msd _ ...d becomplimented on the fact <.hit their child iIgrowing weD, or lOgel anc:arly warnin g and~""alisric advice if thing s are 1lOI.

hi ruch I Itt'ing, the idea ond importance ofgrowth cbccl:ing nn be und....tood by UlOIhcnwho llIlly never hI '" bern ro scbool. ."t itsamplest, undef'ltlllding the gro wtb dlecl:ing ideomeans undemanding <.hI1 I normal beallhy ehildshould be s liD ing wcilbl evcry mon lh. On thecurt, it means undemlllding thl l I risinS lin .meana I child is gro wing woU, I lcvd Iino means,bit thorc In' lhings to be dOQ~ tll get Ihe linemoving upward. "el t month, IIld • falling linoshowsIbll there il l dtfinite problem ..bleh bu tll

•

I THE SfATE OF THE WORLD'S CHILDREN1986

be IIClN on l inight aWIY &lid which I motherneeds help wilh. And;o nplaining th is, lt is nOithe moth..', iiItnt:)' or numency thn lIIIlt crs,bm ,he lim< uken, the setlsilivity shown, Ind thereaI.is.m of the adm given.

For III the dif!i<:ullia: - . nd there are maoy- thl: ro nctpl of groWlh chcd u"i could thereforestand ., <.be cu n ", of ,be web of$IlPpon which ;tis DOW possible fot PUC01S 10 ,prud under thorchildren', heal th and normal growth.

Al the mocn<nt, diffc",nt kinds of groWlhcham are being introduced in different counlri<$.Scvaa1naticns, inl:11ldins Brazil, China, Ethiopia,Haiti, :mel Indont$ia 1\.0..... dl ~nlly d",WJ1 upnational "rowth cham lfId an: in [b. p1Otf:S$ ofisluina ,I><m '0 paKOIS of aU young children. 10InlIII cases, Ih. growth chart alsocarries infonnalion abeur immunization and ORT,.booll brustfcedinll and chi ld .pacinl, alld about OIb.r Iow. "", action. which the parents of • particularnation or rqion C'lJI take (0 pl'OIecl lhm OWn

But more imponlJlt .han 1M m«honia of thegrowth dart ilXlf is the principle of 1"'=',.1involvcPX1lI In the cOlI tinUing promotion of lb.clUJd', ha hh Ind growth. And iD tha t sense thechild', growth cbart -ill Ih. hilJlds of the mother-is • "l""bol of • ch",,~ in lhe <:ol>I:epl ofhallb arc whkh could bring more benefi'l'o lhede.elo~1lII world 's childJu lban any lechnologi_aI ad"""",,_

Fim, lhe growth chan iI a prxtial symbol ofballb arc as ,be "OlItinuing Pl'OlecIiotI andpromoIion of heallb ralher !.b.o.D as lhe periodi>:IUpou"" 10 illn....

Second , the gro""b chan is a pn>nK:al ll'mbolof Ihe chanj;e from Ihe idu of beal,b eat" aspassioe recipie nt:e of set"Vices 10 a conc:rpt ofbealt h arc wllich sees parenlJ as active partidPIIIts in Ihe promotion nf lbeir own and theirfamily'. halth.

Children and world developmentGrowth d tec:kiq an thttdom draw together

Ind unify the range of IoW"",OIII parent_basedKtlons now l vailable fllt protening ,he life andIhe normal development of I ehild growillll up inI poor .:ommUDity. to rombinl!ion, \hose KUonsnOW hove lhe pDlCIl,iIllo live Ihe ~ve1 nf at leastbolf of Ihe 40,000 Yl"lllll ch ildren who are DOWdying eoc:h dl Y in ' he deve loping ,,"arid. JUS! asimponont , ,hey rould belp to prolecI lhe groWl hof OWly millions of lbe develOpWl world'. infantsand ehiJdrc,D.

Thol is why \he J't<1"D' oPPDn Ullily for Ihepro1<cUon of chi ldren is oho oornraJ to the J'<lIC"1lIof devtloplnc:nl.

O t2rly, higll d""lh ral eo, prevalent malnulrition , and frequen, illness ore elosely linked 10poveny (Fig. B ), And in lha! sense, using •

•

packet of ora.I rehydrltion lilts to pnYCIlI . chi ldfrom dl'ina nf diurboe:al dehydration roold be:.<aid '0 be: merely luaekinl S)'lllptoms. Except flltlbe flC'! thar lbe symptom aIsI'l hlppens to be: achild's life. And o:wept for Ihe flOl , hal lb"", illIIlobvious and profound <:otInecIion between IhemeDIal mel physic:ll dovelopment of child ren andtho social and «onomi<: developmenl of notions.

Any action - like \he usc or oral rehydl'l.'ions.alu or inununiutioD or improved wean ina -which protecIS nOl only the chi ld'. lifo bUllIS normal Irnwtb, .. tbomore simulunOOUllyIlladting boIh "')'lIlplom or poverty and a a _.

The aim_mel the pDlontiol _ or the revolutionin child _U_bc::ing which ill nOW p)lIJiblo, is\herdore nOl onl y tbe Jiving or liva hOI thepl'OItct;ng of RfOWlh. And on lhll basis, tMre is

•

abo . powufuJ ...:on<llllic euc 10 be made for anaU-OUl d fMl 1<'1 pUI whi t is ntlw U(IWII ot the:dispo$Il of III parmlS.

To cil~ on~ .p~ciii< eumple:-

M1'M km,-'mtI . fftcu of "",I~w;,iart ;~ ;"fa'lryalld rltildltDod 0.. O1Ily ",,",I/y btUtg "",blilWThw ;" a 17-yoar foIlauMlp "vdy of llIdia~ "ildmlKordtT {rrJt. ""'" iL''''' Md n4fnod r«01Id #r ,ltirddtpu "",I"o,riri<m UIfff f"" M '" ...." a j tJ':' dtjri,iwmd capacity, Ilf YOUI ,,,Mu, iL'.m. UJ1IlpamJ.."",, ,.., utd pnforma>lLf af co,,, n>t JlIbjlfu Jr,....."" social clasJ OM ";IIOf" .~t

Similarly, il is II.., known lbo, men Ial de.-.,Iopmtln ml abo be held bod , by poor OU\C;tiOllaiheallb .

By lb~ q;~ of Ihree or four yurs, 90'10 of 0pmon 's braio ~11s are .hudy lioked 1M physical <Ie.-.,lopmcnl is advanced 10 the poinl wh~re

lhe pa""" is $leI for Ihe r<$I of 0 ptfWJl'S life.ThCItsc early )"eIJS therefore cry Oul fur pl'Oloc.<ioa _ both 10 ddend. th~ child's tiah' 10 Iif~ mdin ri3hl 10 d~""lop 10 in full mental md physkalpottlllial- and 10 iovt:U. in the: developmc:ot ofpeupl~ .., thallhey an~ fully <:oolribuI~ 10,and brn~fi, from, I h~ ~ll-beiog of th~ir famili..md nati OO1

In man y pons of Ibe world, il is dar thaI<C'OIIomic: <Ie.-.,Iopment win l10I Iifl the mojoril ynul of poveny wi,hin I h~ nel<! few )'nft. \l7ilblhiI ia miad , • =1 ~pon prepared for theWHO/ UNICEF Join, N olril ioo Sopporl Pro-g""""",, hIS coo duded:-

" ... pnlul". ,.. ""'" ;"'J>Ol"I<I.' toa/ '" . triwU/fI>2rdf is '" prolH' II_ ""'I'lt IlIIddtwlOf""'t' of,.., "fXI,.-ari<m of yo""" "ildml ;" 'M ,"""III)pi>IlI"t$l rqiMt~ I, iJ tIrtJt , ltildrrn tMo ,"WI

ftlflllI".lIy Im4 IItfi, "",~,ria 00' of «<mom;""apa';"" OM iw", a~ "" af rapid dtwlo~~~'

HWIWI. capillll

In lhis :It'Il s<', ,h~ ptoll...,u"" afforded 10 Ih~

mernal ...d the physical d.....lopmenl of chi ld.."is ... in..-..ur>cOl in homan capital. ArId ioth~ luitwo decadca, lhere h..~n a growing lttIizatioolMI human eapilal formation has perbaps been

Ih~ nq.Iceted factor in the SUUUlc for 1!C00omicdevelopmenl. As Nobel Prize. winning economistThea Schol tz has commcoled: "/0I<1tOfeJ ;,. ,..,""'ioirtd abililits afr-P1t. ,It""', ....., lito ttJlJrlJ, alldad~ ;~ MJlftd AJWWIt.dge, /ro/4 lit< My W filIontc"""", i< pmloc' ;";/jI olld'a """ ,; brlriolu w It""",~

....../I·IIn..,.-..

Similarly , th~ World Bank, in ita lllOtW repan00 the progress of wodd lkvdop<Otlll, hu COlI_c1 oded: "FnD """,III dispou lAoI 1M "a/'It, d ""....I;"" alld wtll-btirIt of ,It< "",jority af ,.. po.>pk ,~

iJufll$lrialiud t:OOnll'iQ art! ~ ' a/iU, Ilf well Ilf a"",I~ af narional /"O'JJeri/jl. S ,,,,ilarly, ptoplt. fIIIu>an wuAd/1M alld...,,t, ...... Ijll~ ""'tri""'.... 10 aCIJU"'ry~ """"""i< "",",It" ,'

From her<: it is bUI • shan Olep 10 Ih~

c<>ncluslO<l IMI s~nding an I u<:h so:l'\'iceI asbealth and ed Ul:lll ion-and especially om theprotec,ion of rhiklA:o'. oormal growt h _ sho uldlIOl aUIDmlucally be listed Wl lhe 'c<>olUJ:llpi ion'side of Ihe natiooll ocooomk oqual ioo . For theyare 1M most ~ of invemnenll in hllllWlcapilal. ArId if il an he "'own, as the World Bankhas show in !IeYm.l specific illsJ.ance., IMI halth<In' incrrast:S wnrk capaci, y or lh ' l primaryeducaooo iarrasa lbe produetivily of f,rmen,Ihen why should spc:odiog on bcallh or educa<ioobe classified II 'consumplion' ralher lhan 'ioVCSImtnt'} ,

Equally d early, a renewed Slress on tbe imporl~ of human capilli leao;lo naturally 10 Ico""'"' for ,be special problems of Ihe youngehild. ..... HaIlS Sioger, Profew>r of Dl:~lopmenlEcoO<lmia" Brilain'slnstitUI~ for DevcloplMntSiud ies, said " I UNICEF O)'fOposiUIIl heldearli... this year. " A".)' 1tml-1nIIO ptllicy of "'"",wirrvnnll"'l or Ito""", r"pi",/ farmol;"" "'0" IWrI"';11t lOday'. rhildmL.. "",I. om ';"" a"""'fll rMId·"" Jraj ""'" dnIIlf'a,,'1lI ~-nd ""'" ;rmJm['blt alld""'" Itmr--""" tff«1J "" ,It< IoIU,. prodoclivity af, lti/dmo IIta.. is ,.. 'lUf lDi,' ado/I$. '~

BUI in Ih~ real world of """'Ot yean, lhe logicof investing 10 childltll has made Iinl. progressIIpinsl the: he.d wind of eoonomic m:essron,UNICEF'. 1984 slody of no. i",f'd" af _ 14IfaSricm "" , lti/dml documenll the cu t· hoclts ingOVt """"", .pending 0<1 sU<:h services .. hullh...d edoca l ioo in the early 198Oa. AMlhis yur'l

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mlullCd.. la panicuIar, _lrios lib Olil>a,1Ddia, PakiRID, l nM= ril, and ThailaIld,_!ria wtIicII !<lIftha' ll'C IaDt 10 Darty b.aI!tbtworld,haft ac:JojnuI. Itt -m, 10..,,55 DeW

'"ds of ....~ f.lhr Ina-'&f'lI"'tb 01tbtllomlft'tillion (we ponelll ) ,

8uI ia 1Ub-Sahana Africa,II Il1I tbt ...td ....k-. dt.eJocm' __ Ollly _ 10 l!lahbal btpD 10 Ilidt', arrym, mjltion. III "'."iIi.,

bKk '-m do< tdI~ 01...t.isI"""" and bc:ll od

Tbi:Irear , l op<Cial UN ICEF~oa Mrica'.comp!n: prol>lem$ has a1rady beaI iawtd. TbtbUlDlD COllKQ_ 0(u.c.problaDll baff beatICC1I oa Mually rvetY leJC¥iaino ICrfta and inM ullly rvetY ~PlptT in 1M world. Bul lheybl ve oC"a" beat mort 11IOVinIJy eapraKd than ia1M I'oaocompanicd """"" of on~ of Africa',f0ft1ll0ll1 novdisu, Chioua Adl~bc::-

"No """""... tnUi d iU UMU "''''' IMI picr~..of 0 ...., .....'11mdtnrtllpr. """ 1-'1: _u... '"""'" forFL•.

~Sit ~IJ " , .... ,.a. Itt_ .... w lA, frItd i~

Mr 'Y' lIIo ,1uru of" _ ...~,....a 1._bttI,.rwJI ir 11ft .. IoillAoJl ad ,.", - n..,u.,ill .,.._..,." ~fJly .. f/tUl U.

../. _Mr lijl ......l1li ......... • Iillle MiO'lICIo[""c-.WIIU tejon m~Gl_ldooI;

_ '" ftl illiM 1'*'';'" Jo-n .. . no.;,,....... •

"uffl]' Nt 01 po_e1. ...

E.... in w!lcrc lhcft b.ao beaI DO "Yo:fIlIIiDt, lht 1lI;,,""",1 10 C!CWW!lK criID b.ao_ I• cvnin& bd< oIlbr kind 0I..mcawIDdIItt till. for tilt prmcflt'lioa 01 bod! lift and1oIlI-ItfDl dewdoplD!:llL 'J1r't'1"k 01 IC!lol:j..Iadlcn~ bcaI d' , • and _ 01 thous... 01 dWdR:J:l an: _ btinI cd_Iod • arau/I. food $Ilt.idic$ fOI' prqIIaIIl IIllItbc:n IlldcbiIclrca an: bcinrI all bKk IIId IDIInlllritioa ;"mtIIlltIbly OIl lbr me.-c (F'", ll) , Oinia Irebdna:~ and immlUlization prtIIBIIlIIXlI IttbtiaI brougho 10 • bal. r. <be lad ol fIId andJPIl'C parU for m.idca.~ OIl aaeolialIOdaJ Knircs ba:5 fallc:n C'VC" in cou.ntOca willi tilt.-~hy u'Ilek ftlCOfdI 01 <:ommitmetUto lht p...ection of 1M poar.

MM

01 lbr -"" c:=pl AfrieI touth oIlbr SabanI(FJI. 20).

a A-. raI. iN OI 'h Dw ber:Il .r...-!If . ylURori<:olllaDlbnll, llacx Itt .

abIo: adUot, .... Iku: i1 iJcquallr dar 1 _

~ pull oIlbr cuth'5...n.:e,um prtII UsbeaI sh''''''"riDI1O a hah iJt <M bl~ 19701 &admy 19101:-

111 Latill Amtrica, .bne aVI:faF ""'" ina-cM1b.ut faIIrll by • rna _ l~'" ill lllally uoo.,tiltrc if frqmtawy ba l oIanDiq aiclcllCC 01.riao: ia 1Miacideua 01m:alI1Ulritiorland iUMIa, inIh~ number 0I1ow binb-wciSlu boIbic1 bcilll 110m(Fit. 11) , ia 1be ... l~ of illfanl and chi ld dWl!s,and in 1M nwnben 01 chik!rm whn ll'C btinll bandoned 00 1M st rffll oI 1be citiQ.

On ly ;n /WI, whffl: Sl:""ral of Iht lIlO61JlOPuioua nal;O<t$ h.a"" ~D .bl~ 10 ia$ulaltIbtlllM:lva from lht worn t lIma of the indll$lri~ world'$ lflC:CSSi<lo, "- pros..... in childbeahh and oulrition beaI mailllaintd IIld tvtIl

FIg, 20 Food production per person,Afriea. Asia. lWld Latin Am8i1ea, 1961- 1983_lIIPO' _ _ -""""_""__

~b'1981 4 1- 1lQ.,,.,,.'"'"""! '00OSso

"eo7~ 1l1li1-«1 ro-

"

The Code:a progress report

"

.... PO<>' <;(lImUlIly ol lhe <11'. "~og_.

bOItle-1ild _ ha'<e beer! ......... 10 be two 01__ mote likely 10 <loCI " "'laney 1Iwlb!Iboe!l who ..e~ lJINIl.fecl1ot l/1e Ql.......

&.ol 0':"1 '11 '" '0 • on !hi _ In "'*'Y ........"'_01"'" ' e .. --'d_""............... msbeen1ltO'~___~""""'_of"'"

11'0 ..... 1981 , _ a __ ........,. by

- ,. $ ... - '",•• '"II'"'"..... an:l •••-.oal ............ roe Wootl HB*l• 'lOIW adIIIMcl "" I.. ...e-ol .....·-.g 01 e-...m.. no. e-_.. _, $ ' _ (I i ...CO ••-. 10 PI'*'" _ --.-.-.g ""'" ..........." c c-. onOClU__OiII~ "'" '..._ 10 ...., .... "'00'_", of~ Ionnl.Q o:tIftdly 10 .. Iltaol: or ll'InltI;tl--IJosl ltIIan1·lonnula m;'I....,~ havII K"'IlItoi 1". Code', """" pr_ ."'~.r il T!llI ccee ta" on.,. become Iut,o el'klctMl d ~ IS~ lIP 171 na\lOrllll~. In lNI lour_ • lWl 'fC*' -.:e IN Cocle_ DIc>Iea. "'"....... ig ec_ ·

o CollI in _ .. aca.I ...~~ Ponl , Sn l¥*lIo SooneatlMe-ln _

~ - 8' I .. ilral:tl.~ o--t<.E-. r--. f"rir4. r_. a..n..~._ _ .1IIIr --.~!'IcY .....~ T......~ z.e.z-.La-=_0 <><- ,0_ 0<0 00.. _~~ a-. cu.. CMc:I~__'"0."...._ r........~~~

~. fbf._ SoooeI iJI'JIOI\- logo, VIlIl-

o Coder~ lly _ rn"""" ..om""'.," and i waltino;l '-\IlaIIIlIonE\OIMlI. Cllmetooo, cen~a1 A!ric¥> FItIlubl>c,Congo, CoslIIFbca. [OJOdOI , Ea-.'f.Cull..".,.., l'IdiI . III.. Jordan. LesoIIlO, I..IOya. "....ico.~.~. p-.,-. s...... S-. l.kN.~. f-. Ugi;Inda,~Zi,,__

o Code ... _ ... -...,. ___

New~.~. s-lon. 9,no. T_.., 'CIloIpI Y' or 5 ..

o s- ......e-·...oo ' .In_...--AusnloI. e.-.a.. Coc* IIlanIs. [l s...dOr. r_ r_,GItIon.c.r....Ooo.__Roc>.&.IVou Kcng , Ioary eo., _ .-.~. "--- Pl T-.cl

o CollI being IINdlMl by wM<lng PMtY~. BIIw.., Ilio'llllid""". _ f..,(l.«u VcIIa) DerwnlWlt.. J):'lrrww:a.~, Hgn.

aCf. ~"". Wt IWwaIl r.IaJaoM, Mali. MoroecoPanama.~. 5eoutlI AI_. Senegal,~Vincenl. l anl...... Tufl<l""" Caicos_

o NarioNll QQ<M 01 n'Wkellng ...- dilculolion ~"""JICIf_1inlI """"" 01 !hoi 111,....._1eoa.'. pooo ! II

........ ~. DImwit. [hi ' AeI>IoCIIc."o!aVM.SoIOIn 'Ufkey. V.......

o v-..y ooa. po_ell by -,- ~_.-r_ IIIipo.ak at e.--., _ II $ .-"

...... $0__ S uw,,,,,a. u.-l KiIgaoIoI

a ¥~.".,. po_ell by _.' 1 II>:-,. ............. ,(_(eolOIlIC~ IloOI"I e-

_ '_ .. ~ e--A ' _..,..__ .._....._.....-..----lNQ>--D~ ron ,W!OOed per rJO"IIh toearn ..-.cIll\1llO;ud'IOOe basic Ioocl

Pelca oI8gII d bot brIh·~ b8Iloet

Ul'ICEF IfId ......,. 0lXr orpniD·iopl are_ wortia& with pmlml:DlJ 10 pullbne icIc:IsInlo lICtioc> ill both the -u-pubticiad_. ' . of A.fricI IIId ill !be qlliom criJadiffmed 1!troI.p.m .... de,dopiq 'IfWkl (Fl&-O) .

And 10 Clllldude Ibis )Ur'I tqlOl'I, iI " .~priare 10 IIUII 10 iasl ODe ............. iii thai quietuaisis, 10 jIISl ooe 'l'illq;e, lad ' 0 iasl _ of !be1DIIIy mjnim· ofllllOlbeca with _bam UNICEFhili maie t'OCIlICt IW'tt lhc: \asl; f«ty )'Un.

11m. mocher'llIame . Mma AIlIiliI Paj:a. HerItomo is in ... on:Iiuty rutal ..... of SouthAmerica. NOI ioI>a bdatt" lhc: orrin! 011 lrainedhc:alth worker ill her I'iIlq e, lWO of her cbildml

"

~ ill tho ch..ll....,.. or~ tbc .........thai. hal boIII:Il made aDd of COIlJlnIaiq • Afnylln of bosi< ptol«1.... bda- orhicb tbc pooral

ramilia aad chiIdrm ril DOl be .uowed 10 fallAs iIlc UrWcd Sau.- Committee l1:Ir Dc, I ~

-..1 I'Iuu1iq "- ."...

-M...,Africa.'WJ _ ..o ............. ..,......., _ior _fImI1 .q.-. 0tIwn -u ..""'" ,. 6qiJI if /My ., .... --""'"..... m _ ......., -H«L F~ M". ,10<,.....,....... ./..v~_alrin,. __if' ....lws _ /It .- '" ......." .......lifjl,._ rn.r .., lt4u 11)0 NJnaIW /1-,,,, PApw ..", 1M """ 4«"""- '"

TM lim wm<h in W I $lftly M1or pnxfCtion.... th e OIrl1<qits for pml~ Ihe Uva Ill d ,beII'OWlh of ' he pooraI childn:n <on """el (4),B....I-f«din8, impro~ wn.n illl ( includin,lu pplemcnullY food for 'hOR molt I I risk),immunizalion, oral ...hyd.., ion ,henpy and'I'OWlhmonilorinl,~ IlDOtII ,be lJIOIlI ,;,01 of oillvai lable , ..,bniqllO$ for a>ttIm, lhe oco.b of bothilnn:w:<liIIesurvival ...d lhc: 1oaa·ICI1D need for lhc:pnxcetioll of arowUt. And !lo;a1lK III oftlI= mIhe put inlO action .. ...tlli.., ly loot lXIII, lhey~

!berrien pnaical oymbok, ill lhe 5dd of clUldwdl-bciD&, of !be pooabilily at copiIla 'II'ilhe wi' criJa II !be _lime. illoatina ift,mber u- monpcirI&, the: fu>ute.'"",t

'OJ &

'" IOJ i..

11m 78 79 eo 81 82 83 84 0

AsUNICEF hao arped ill its oprciaI~ OIlMnca, 1CIi\nlmm1 to ""**""' mas Da!d DOlaDd IIloUd DOl iIl~ iDa....... tbc pootm)' allddcprincil:. vi • ..moa'. poon!SI &mi ' W Sc-if.QUy, II slIaWcI _ tit Il1Ioowtd 10 IhtalCll thorlifo _ tile ...,..."w~ 01 tho .............Ilk...roo. ....IDY community -lbo childml 01tilepoor. hoWIa: ClII !he burdclls 01. ,6 • WI 10 tllca_bo hz¥e tbr leaR pM'inll IalIICk I<> ..- 1MbIcnr, ODd the IaR .....omic fll 10 "t.ort. it, isDOl oaly llDiust Illd iDbUlDlll - it abo IIlldcmliIlCl1MbclIlth ood ar-th <l the pooral dIiIdrm ODd.. copa with Ux criIiI of today OIlIy br._teeiPI more l;li$Q _ , ..... .

Abettet way bas10 be fowld. AndIinc:c MriaI',crisis is II mlOCb of the world", mal<int: .. ofArrial'. OW", both justice and humanity no"""mand UIal thc i,u= ationl! community should

Fig.21 Increase In low birth-weight,Recife, Brazil, 19n-1984' V ,a08orN,llOQt__cl-'l<Io. _..... brI1 4 1- ..... :a:c",.,,'at

"l "I "!"

t :L! ,

c

I THE STATE OF THE WORLD'S ClULDREN 1986

Parasites:the damage to growth

the~ chiIcl.........,. .......- dl$CUSSlldItll!lll ' 8llOIl can also~ 1 1qlo1c:anl_I on"'" Ptcblem01ontesU'I8I _lind 1* """..~'. grOWlI1 - ~ .=oodoog If'Ol IiIcI< or I'IyvlInI _III 8Jea';I~. Icr~. __ cf'oIlh<l

8(IaII'lIl IIl& oarvn III coo ,. , _ .._....-- t>o lIIoco_• •__ W-••• olll'8" _.i'" ._ __ olM._ '"<;hkINn. _ ,.,..... ...., CII'I _

011 re...,. eIlec:l5 olli'''IClM 'Mel~.' •• .....,. r., DIe' ._ lI'ol¥ '*' .,.~ ._0<*' .doI.9'....'••b _... .... _ ... 5 lJS _~~__• __ .~ol

..... <lr;Wlg _ ~ <lIrfWIOI ......Qi"lI""W1Cl _ 01""""" <:hIldr.-l •

o lhIl " OIl ......-...., AsI;:a-JJ onlocIS, ,000'-' peoplo,,,, __ olllle _ ',PQOJliIOn. ' --.1\1fOUl_,iB - ~ no~ III....-_-~ 2 8 ll'= " ' . ol carbo:lllydrftte • dIIV atIcl CII'I eal l4J '-'I' 10'11. o/a c/lItl',IOlII -'11' _

o~ lnIecls ....... 900 ".", peapIe_ olIeI1 e:a- _..-... ""'ong_

..... -..en. =_.• n:teaSeIl .. .1Ik <II boo1ldI-..-gIlt _ iIS __( IlogII """""'"

0 0.-_.' ... -.g 600 mf-lIOn -. 111m, __, _

_..-,at .........o n. - _ ot _.l*NlI by I ..- ,..... l '__iiCIII' ~ __

ClCUII!)IIlloll....ad s..r. 200 _ 1IQllI..__.utw .OO_Il .....

Q'*"n ..-. ,. IA''''''''' _ lind ...-..-"" ..' : .. -..",,~eggt trIO cytII .-.0 tie wi..,__1leJ.,__ IhOV CII'I Foe( -r'-. I.C' "'"

inlecI>on ~ _ .. "'-1Wl\l ctoIdten'. nt,ItnUOt\lll.--, fT>J/Iaple _mtlurd!Ins cell cau. 0t8IpoIo~IO_IIa~

In "'" long l\1li.~ conlIol entMfIJ brftI<ng". ~ 01 ooleclo, _ ,._. n lI'IeIllduSlrJllllfl ..crllI _ ..... de " . '0 c:aJro

•-.lmP<MIII_ol.....-.g-__ "III _ Il.OllIw' ..., ......

-...., -. In Cosra """" lOreo , -..,__....-....... ..~_s.afI' ~_ .._ ol _ \WldI __ I......_'·'_1IIW:WIg~...*1:_i __.__ ... I_al __

llullor "*'I' _ -. .

_.,---.y lllogII """" gg 50..-.....,....~ ............ _01'1 __ ".",~ _ can _ bit •~ 101 CCIIIW"lI.QI)' toaaIIh ....._S!«( Ill'" 0IwQ<In0ng~ proc)JtlI ..........diale a'ld """'" ...... ,....... aM enoouoaoe~ 10 ' edlJee Pl!IlISIIic onIec1!(111S byI<rll:>wno ITIOI" and ooona more about r.and'""'"1f1Q, r.".gte* food MndIing, 8I/01OItIO conIan'i~ wale< and Ia/MIaI'Y _ (lI$pOISllI

ThII _ OrQatuallon 10< ""'*'-e--won r....... Aao...... ac!rIo'e .. _1I"-' a'ld L.-.l An.-ICilI\ co.dneI•.-___ 10 -" cornrnurofy I"IlInsl .......___ arG 0'I 11onty ....... '" ...__01.....~ 01~ • """""" _ moIi : ,~brr.-.o"'__a'ld_

,",,"'- "'j ." ""~ twoIoijjN_...-e-__ SO R ., 197110 5.3"" .. "~:l9e.3 AI _ d ....1I'tIII'CI"' .0' 1IrNo", 1980• • 6 3'110 IIIn.oIII5d'~. _ .2" ........ aJiiIiAJ..'"".., _"'..., '""",,-h . _ ....._Ii _......._--.. ... Cftt.

Gel", , .- -.. u " .. hllUIlII__ 61"' .. ,..-.

bad ditd-OIl( from a r"Spin,ory inf~n andOIle from measks Or in Maria Aulilia'o eUd--~FI1T 'h buby l>:>y, I ,riM U> It' hlp. BUll.. I WQJ

<" nyi", Ai.. f«r hlp, IN j"" dW i~ ..y ImIU.

~M:I Ja",IIu. WQJ 1>&. I Ir4d "" kUd '" pIayi",wirll 1m, bti", mrll 1m. Tr', di!/i<1<IL. ir) wJI 10.......Ittr IIrM< ru- ",;Ih "'y <hildm<. SIN WQJ

" I';'hl ....v.. 'M ..,...., .. bd By .. idnigh, ,.... WQJ

sid. Sill ditdj"" /11 dDy bll!k

"I a.. nor a!JmL I , ', IIappmcd "' a to",!TJXntlm. "

Maria Auxilia Paja is ;"dttd no! aIou.. In thelast twel~ monrhs, apPfOximately IS millionlllOlhel\ like her bave been fOlCCd '0 walch th.irchildren die.

The ViS/ majority of th..riIho O:-;)olP6',* 1tIocJwegtC'''''- ,...........~

5'5250

""f~."38

38

'"5230

tseoJ F M A M J J A S O N O

..."',,"_......_---

never ..... by anyone wlSidc 'beir OWII =U_nil y. They did nOldw. illl\lly pani<ularplace or atanyone particular time or from anyone panirulu<llUt. They were lberefon: nOl f\ClII'S. Su, 'beynonctil. less suff.red, and tbey arc nonetheless,....

Thein .... lbc 'Ulenl cmctXency'.

In the llW year, rhe 'loud cmclllency" of Africahas been met wilb privarc lleneroUty and publicCOIlccm on an unp=cd.mcd sgIe, In almoit aUna<ions of lbc ..."Id, many millions of men,womell and children b.a,.. lI>IId. it deu lbo' ,heydo not filld ouch .uffering atttptable in • worldwhicb 100 . koarIy bO$ lb. financial and "'chnicalruoufCCI 10 prevent il.

That mpomc is, ill illdf, an important mile"one on rh. road to a n>l)n:: s.npjllCly ci"riliztdworld =,rnity. Forty years OlIO, when UNI·CEF was founded , there was 110 md< inl~tion lll response to the l reat 1943-1944 famin.;"Benlal, ;" whicb even l reater number'! of men,WQlIICII and childn:n los< their lives.

The inlc:rnOlional m pon!tC 10Africa'ode; pcr.ueneed thacfo... marks lbe d.....lopmcnt , in l)Ut

lifetime, of a dirre1••,n degree of Illobal coosc:illUJonOS! and COtlCC1l1. BUI if it is to malch tbe Kaleand wgcncy of lbe problem il$Clf lbell, ill lberemaininll years of rbia ~lItury, lhat =m willha~ to be ttanl.lated inlo new tI.in>co5io""

Fir$!, the COIlccm for poverty and lbe COtlccmfor justice need to be ttansJaled into I conCCrn forthe quiet .mcrg~ncics as well as for lhe loud. Forjust 0$ tbe _ l ufferinB of Arric. bO& bttnrcga.rded III unacceptable by 10 many dtizclll in1985,10 lbe unscm and unMCeSSUY mfferinBs oflIIuch larger numbers ofchildren in poor=unitics rhl'llUghou, the world mU$l abo bttomeunacetplablc, 10 botb people and Ill,'c:rnmems, ifwe arc to ron,iQue maltinll 1""8.... towuda I""'"' Ilenulnely civilized_ and pcaccful - world.

Sc<:ond, it needs the dimension of political andcconomi<.: action bySOYmWlCllts. The world-.. ideprivorc l cucrotity of millions of individuals inl'CSplllUt: '0 lbe African emergency baa .mountctlto pcrb.p' $300 lIIillion. The amounl pledlled bylo~rnmc:nta in aU'll aid for AfriClO in 1985 hO$amou nled 10 approximately $3,000 million . And

n

I THE SOOE OF THE WORLD'S ClIILDREN 1986

Population:less deaths - less births

"

FOIl1le IosIIhtee ye¥$, !he 51alll of me WoocfJCllikIfen few1 lias <leSCI'JtIe<l "'" Ilfe8kllvoogllsw1lIC/\ now mal<e ~~ 10 save !he IMlll 0/_ ... ".,., chikIr"" eactl.,..., Bul l/'IOI """"

~ asked QU85Iion at>o.llt'os !XlW'IW lora~., child~ IS '""",', ~ 1eacIlQevenmote rape! paoulal.", 1l/OWIh?'

PafadQ.iC3Ry. 1M answer IS ' r(>- A ~,.aLM;lJCIn on <::hklO8atr13 ""'lOM lead10an lMlOl...alJfl(luctoon III PQIlI.CaIJM QIOWIII;.

o Many par_ 'lIlSUI" ao- child O\laU'. I)yhomnIlll'O,lfl! c:IIil<lren Rlll"'enlS oocomeoonfl<lenl1IIal _ 8l<istng Children wil5UMIoe, IIley l(lr<l1O

Mve 0fiI0 II>e number of <:hoIctllI1 IIley lICIuaIywont. As ItIIII la'" In<lIra Ga<\(lhI sax:I ., 1983,"_ ts lIf<l_ /iIroIy 1l> 'esmcI U- /amoIies "ItIey nave f<laOOllllOle IIS.'ll/I'lIllO 01 me ITS.!iI!tlYSIJMomJ oJ"* /100 1;;N(J<etf . •

o 5eYetaI of a", key IOW<:OSl r;trategteS l<)r

leduco'>g C:IIik:I oeaT~ are also key Slraleg.es 10<r«lUCitlg bi<ths;.

Fam1y SPaCing In pOOr <:Om/T1Ur1ltillS, inlommor\aI!ly os lypoC3Vy t...oe as IIIgh """" Ill/!............-. tw1hs .. less t""n IWO years.Bor\Il soaong is lIleIelore a ke<y sua!egy b'\1Ikl !lI.M't<ll lIIId 1elluCJ1g i)tI1Ill3l6s

Fomale~3CY is lIIlCIlher powetlul <le\effI1inanlat child~ A.r<l as 1M WOfld FritySurvty fl/I:l~ rtsIng I8IrraIe kreracy abobnnOs steadily falling birth ,lIteS

Breasl-_...... also a key 10 child SUIVMII ,And a mol!leI who IS breas1·1oollinII IS eee1l'QI<lCI8d, \., a sigArocaru degor.... ~tlIecorT\;ng pregnant

o ~ at' ..!antses. OteaSl'~ otlY\ousIys\Otltlind tis al!ocl .. inIlotlitng <::oro:eP!ion lSlosI ItlllusV<Ori 100,~ a Cflild'slile can helP10POC/P<>'l<Iee nexl llnh

As OTpottanl as any ol Ine$e ir\IltYdJaI IonI<3r:>etween lalhrlg lIe<oll'l$ lind laling blftt>J .. Ihe

lI\'llflIII tact lnal !he '1;IWd SlJrvtVlll 'evolutiOnIncr_ parenl$' _ o!oonuol ......1IW I......PrCll:lQtiy IlIe mOSI ~an!~ lor tho"""""1anOO oT tamIy pIaIYwlg is "'" grlI'oW1goom_ 0/ 1*_ lllat IIley can~O'.e IIIfli'"- by !l.- OM! inlt>nned decooo.. lW'Id actiorlsI\ny\hlrIg _ IIeIpS lD roeteIlS8 tI\EIl COOTdenaiI, as'" palenl-bMed cI*l:5i.ltYlYal Slrawgoes(!D, IS th8rnfool also 0keIl' 10 __ tlorIt1 ra_r-~ In _ ...1 by It<lse co.,n.

lIIeS wt\od'l haYe aueady Rd\ieIIed a 'evolu!oo inct>Ia..........,. Na!lClllS sucII as CI1ina, Sn l1lt1!<.a.lhe RepuIjic 0>/ Korea. Costa RIca. ano:I So'l,JaPOf<lnew """" IINt""'-l"""~ 'Olles-ano!l'e_ bitlto ml&$ _ ~ !he<leveloping_lI1. Taking

""'" experiencll as a \IUIde. ~ has 00.. esIImaled1lla1 8 CO<II1Ily """'=" t>as _ its inlanl """"'"'Y~ !he las! lWO -100 ;ole. can now a,pecI inpopula1iQr1 Ie 5lal:lobn 81 8 ieYel 30~ 10 ~O"

&maier \tllIn W<lUkl~ 1Ia.... 00.. !he easePulllnOlIl/!I way, if all cllrOa Me 1tle same lowinla"l IOOIl;Iltly SOd !he same lOw borlh ,aleS ...K<!IallI !>Ial<'!. ee natton as 8 ..- """"-"d _IIpp.o,,,,na1ely 4 4 -. '- 08alt>s ead1veat - 8<1(1 1.5 miIloon '- b!<lIl$.

A """""-'110 .. enid !UrvivaI . tar110m e<acerbal·Ing lhe prOblem Ol pOpU\a100n grw.1Il , o;ouI\l1t>erelorc contribute Ie ferIiloIy <ledir>e That IS WIlylIle 1984 World f'oI:U8Doo Coolel8OC'l OIl Man:::oir1CU:Jcd OIl ns mal dodaratiorllts Slalemonl •

" r llfOlJ{fo _.I<t8dirIg. Il<IcQuaw ""m_.cIea/I WlIIef. rmIIRla1iorl orogr_. oral'llIlj'ClrllI>O<lIhtJrI/iJf. and bitltI $U8COv. a WIU8l'lMlItItiOr1 in Q>rfd 9.1T1'iYa1 COUIa 011 Oc:>'lteve<l,rhol~ WO<Jd OIl '*<lma'oe" /!ulIIanolarianand I<!tti/Iry lem>s: '

• r.. ...,.., l>I' ",,_01

"" """"'_ "Prxx _ M¥1)'_who.........".. aI~ .. ". old_Of _ IF'"I' ""' ... _lot"'""I' lI>O _ lot~ ., old • "'""'"""'" N.....-.. """ 01-. s.n.:. -...~ '"'"l"'"'9 1P>t I:> r...., "'""I'-. 1:>.-NI ..... _ _ ...

ia the _w.... the _un whidl ACricI ~pIid t.ck 10 the iad.-rialixd wuId ia debt aadilIlClQl rqJayaoeali dun", 1m ~ -.aIm 10..- $1,(100 millioIl. n- fitura do DOl laoalthe~ of the I ttlCrtSty ofmilliont or thor:mllill it has ..,hif;ved. Bill lbey bnllaUy cknlo<llItI\e WI ccooomic aad poIitiaJ IC1ioo _ byIOYffllIllCnII in bolb ~Ioping and illlhlSlrializcd n.tiool -is • rrctt<jllisile of any IOllllionwhich lnalCbellhe ltale of lhe problem

A elloi« lor 1M 19l1h

Praom bIowIcd&<: holds OUI I. opportlUli1y10 proftlc, fa- the 6nl lime, • IlIIic ...u.imwDpmuaion fa- tIsc Iiw:I Illd powtll of III 1lll:wonr. dtiIdrtD IDlI to do 110 • • w:ry J,c,.. CllIIud ia • w:ry Ibon tiIac.

x-::.I DIliooos U'C I1rattJ ~noinl 10 Iiliup lhIt opportlUlitr-1Dd with IIIIIIIC rmwblsk

-""'~To faIfiJ lbol poc...tiII, it .doIt thai _ Iboft alldIIO - parmll ""'Id to t. t illj)Owtlm with illfa-.

mlu.. IDllIllJlPOl1 from III -.sa. TIley DtCd tlxIIIpport of their 0W1I poIirial ItIdom Illd of1hcia'......u .....l rommllniry. of Ill< bcI11h ....ie.,.IDlI ollll htmcbcI ol....,.enuncnl , of the tomn>lIlIity beaI!b workm IDd Ill< IDaII lMdia, of tMIChooh tICbcn aad 1hc rdicious Icad<n, of 1hccom.munhy OI'Ianizlliool and lhe W01DtII 'SI1iO'ft

menll, of lhe empl<>yn1 and !be Il'1dc Ilnions, .ndof people'l lnO~OII 10 bolh developing andilId",ui&liz.cd naU01IL

If lbil opp,mllnhy is lum, lhca 1hc yeanab.-d could ~ 1hc~1 of 0lIC of theI tQlCSI l oals whidI maokilld has~ oct forilld£_bait protection for til< ~_ Pol 1hcbcallbaad tbc IIOtllAl de ,dOPUl<lll of III its dIildrm. IflhIt opponunity ;. _ lIkeD, thai tlx 19m. aad19901 will be ri&ht!y ........iral.til<~whidI bikd 10 prIlla:t IDlI lIIaiallill the Iwd_ ~ ol the pOII-_ yanI IDlI whidIpQided Oftf 1ht~ ol Wljlla:tdtaltdfin""";'l Illd , ...ho ....' CI4: Hily witb tlx eat

liautd .wo1llritDL, RaDDe. IDd dt:lIh of mi1lionsof ilS _ 'tll1Dt:nblo! cilDtm..

Tbl: cboia: is OUn.

---II--LIFELINES

Extracts and summaries from recentresearch and writi ng on strategies for

protecting the lives and normaldevelopment of the world's children

Growth monitoring

Oral rehydration therapy

Breast-feeding

ImmunizatioD

Iron, iodine and vitamin A

Acute respiratory infections

Combating malaria

Female education

Food supplements

Family spacing

•

Introduction to LifelinesThe __ Iheme 01 II'Ie la$l hee <eporlI onee sra. 01 lIIe lo'otIf*1'$ ChiIchn • 'Illll rec:enliiICVaOOeS WI kllOoI::lge make rt ll'"Wnle 101parenlS lheI,iSllh. 10Ole soanec- .lron'''''-a:1h worl«Q IhiI I 1hey could bt'"ll abouI adrasIC lfTOIlfaYemllOl in l:tO' chiklren'sct\aflCeS o!SUlVtVal and haalltw , OOImal (j«)WtI1 Allfle Wl1llltmll, the lIP'ead 01 ee primary health w a .oe.a.and ee 1lI'000h orcornmuruc3tions and Oftjamla·bonal capacity ,n mosl natIOnS ollfle~W()f\(j , ...-... IhiI t n IS now POSSItN 10put suchkn:IWlcl:lge at h! Or;posal oIlhI vast l118P'l)' 01PIlI_ WId 10 6UPPOfI1hem 10 I*'lO ~

The W 'OIllIollnS 01 cho;d 1lOl*lCllau IllCtIoroQUCS 10 be ", ...,"*>.:.1 ... on. ........dii 'll 10~ WId1DcII~. Bulll'lellO. ........'.-.e' ted'r1QlleS cb;I J .. ... 1*1 at eeNJDI 8Rl c:r-l beaM... !hey 8Rl 10tr'IOIl~ beaM lIley an ne '.'JeOal low alii. ber3 !hey an &I• •S rapodr_IJllIWI'l torr.e ollie I!lIlCW ll«ltiIeo'l'-. WId...... .-.ev ............ ee .... at Pf'lN'Y....., e.. by IWlllvIng pnDllIe n 1u»M'lg mare.~ 1f.OIe. ard llllIng _ abllul ...(fflfl WId theor~' heal'Ih . In W'l'ItWIIIIIQn ...meaen llI'1oI , IheliIl lIC100nS also oller a OOlliidel·able lleQree or 1lO0teebOf1 aaa-1Sl1htl6'fllll'tl'Sl1Callianoe o! melnIJlnllOfl ana inftlclioo wtocl'l ISeeoonUaI "'obICm at chilO survival and child doveI·oprneo1lo the work! toOay.

Thos roar, aecbOnS on 'ResporalOr'1 1n1ec~'. 'MalIIria', and 'Iron.~ and Y11a/T111'1 A'hew bean I(ldlld because, in~ fields 100,rocenl adYIlnces .. !Ino'o"eJQtnow ol1tr pracllCallllw<o&1waya oIllOllItlCIio'lllhe~ ancll'lllfmlll

08'0 '.onenl at CI\lidren.

~~• • I'lilS been RlPNIedty Il'lllooofll'lal~ .,.. IacIOts - Iemale tldr""""", lIIftiIy15C*:WlCI. WId Iood .......,._,- .. also~ fle IT\CI5t~ levers 101~ Ine.... 01 cr*l '-"'. AIlhough mere W5lI\i' WId"""~ 10 adoe'e. '- Cf_ _ .. (II6I,Il;h ....... 110' .......... - 101 IlIl IiIoes andI'lNr.I'l 01 Olllh 'oJII'lltI'e'I ..., dWIo el ' _ 1IItI IwyIl'lU6l alsl now ne COoII'Illld among ,.. tweak·1hfOl9'<S in kl iO>O'ltAie WhdI COI.tl CflllnOe ee' llllllllell ,tl8nl!le heal1h and WOIlIIh 01 f\IIIlOnS

LIFELINES INDEXo This symbol indicates a newentl')' for 1986, Lifelines isupdated annually .

Growth MonitoringM.muui!io:l 0lId iIIf«tiollMllnutrilion llld wuni"3Mo.InuU"itioo- ",her "'.....MOIli""i... child pow,bThe dliId JtOI'lb clw1E<h""tio<> of """benCb.dI......MOlhen' in """""',

TIl<1"""' 10 d '.

Oral RehydrationT herapyDiurb"", dood"Mo.IDutritioDCo.... of diatrboe:oOnl rehydralioo1/..". ..1>I<dia:CoutialKd fc:«linsSaf.,y oi ORTCosl. orORT

Breast-FeedingBreu...nilk'. ad...",os"Cu=nt,~

Donlon of Ill< !><>Ide

~-FOCI"'" in 111< de<i&io>IlS"ppo<tinllDOth<nW<onina

ImmunizationThe lill dis<axs11>< ..mil<>EJ:SIIrinJ ....pplyCtutillll 'he demandl",plom<:IlOtioo

Iron, Iodineand Vitamin Alrgn.ddici<n.cy~

c..... of iro<> "'"l'rn<utinA iro<> dcflci.cD<)'Iodin< Ildirim<y <llio:denViumiD A dcoo.D<y

Acute RespiratoryInfectionsARI, The problemChild ticknesoChild<ltolhl.ea o\RIRill< f onI'nv<DtiDJ ARITmti.. ARIAntibiotia

Combating MalariaRoo"'lI.11« of mal .....h"pocI of maJuioTreat"""" ol ll>l1ariaCoDlJ'Ol of II>l1aria

"""Female EducationEd...,.tioD ""d .lIni......... ind<p<ndca' forotfuosibl...plaJuliomGirIJ ill "'booI

Food SupplementsLow binh."';';h,ea..... of low binb·..ap.,Food ia prqJW>CJF-... <:hildrm

Family Spacing

~'""& ...6.. of opIciDJUa...., d<maI>d

"

II LIFEUNES' GROwrH MONITORING

Growth MonitoringIn llu drollttpilll (Da'/d, abo~, oUl$ Df driltfrn

wuJtr fiw '~fftT fro'" prollin~ ,"aln~ rririoPt,"""i<~ ,a" pmII41ItIlrly 4/«/ /MIl /lit alld pIIytical<kw~t. TM """ of"", Ina,n",itnt U pouny altdirs lmt, .1mII ""I.,;"" <kpnuh 011 """""'''' ,."'" , .aM 1DCi4/ ftmia. In 'M _nti_, Mwtwr, /ow."m ".. ,W au atJt:iLoh~'4 ripifialnlly rtJM(t , '"iocidt",. aM JrVtriI)l til lIlalnam tion - aNi inimpt><r "" cAiid Jwllk and dnt/cf»Mlt<

Malnal>irNm Iuu ....'" <ll1IStS - 4/wirick frtqw."inf«rimt. ;'11M of 1M _I u"JlMranr. 1M iat'isibk, Iowin, _." oj """""I ,"""IAMPf.'tJU loft, bt!oroa , h;/4 Iw~ _'"""",lid ~kiT "",. ,ilywrit.i.., aod .4< .... oj a cJrild ,..,..wJr e"'''' ca.",<>1. t'isibU ,h i< !a1uri"i.I'=',Jr aM It!~ ".

Mrly w rlIi", 10 _11m 11M IwIl Jr WMUn. Arrhu1/QIt, ....Jut';/;"" <II" bt ~klliwly ",i!y aM,,,"ply pm>tto.t4. W;,h b<Jsic tIdWt, " ....d """, il4ri.g <011 Iwftm Irtlp .."rbn 11Inw1.... lDprn>t., ...., child ....I• •m AI_ ,M. 100diffnrrtt f"'JfDI Jr <,w1'lJ "'" <II""" '"11> .... illIIlJtI' 80 ro.mtri4

Malnutrition and Infectionun 0( _ 10 ..., _ of _ O! ".1_ ', _ <1-.Probot>l1 .... ... " porUaI .._ of oQ 10 ...... IH-~r_ _ lIIaI~lfI<lol'l!flCWlM_~

'_lib,.., 11oo" -Pal" """""_ 1010~ ...-.; .....,_!lIan _9---".SIudoooII' • GImliao ..... r- ..--, _ •__ ol

~ Ire • C>JI\'IIl'I(lIl ..... aifncl$l~...... bOIOl• •""""~-.o.n.g dIa,!... ~0Q.600~_ ""'" Do ... ""'" <Irf n ... _ """~" .."1>"'...- 1000__....~_ ....._-""'----..-.._-- ~

___ .0,." All ; "'"'10 . _ • .......- mpoct Il"ooy".._

11'>0 _ , I..,. ...., _,.. "",.,.'. _ .... '"......- ,""'.",.~ oOfOClion oIlOocl bI'__ Theycon__ .........~_ They.... _

...-10....,~_,.._-. """bI'_"' ... '" - """""" . _ . -.. 0 """"' ......,~ ,. ........ _ ,11 _ ,"'" ....,...., ...._ .•_."'''-'' '''-''-''''--,-

A _ '" 718 ",,01 c..._ <:tJIICHO """'" _

Y-':-"'-~----' ....10.~ ..... __ """,..,..-...l>y"", _ . __~ "luc"""","''''''

g .... _na, O\OuOOSO_'" __ • drop .. ..,. _'" 20-30'li, . ._0- _=__=~-- - .,-".. ",' '0"

ThO 'lor""'J"'"~ .. lrIo~ ,_ '" ""'" ...,..__~ <:Nohr1 _. -.. ""'_ Of ..-...,

n " AI ,. _ '" ... prqacl. .......... Nd ,.,. \'01 ...-..0, ,.. -.. , 1IiaI """ _1"1'_ ",loc-"""". __ '" d'.acl O"'d ..,.,....... -.. ....,...., tit_ .. _ VOl "'" ........1onOfI1ogl..:IO"'O<:alO l'IO\~_ . 11'li"' '''' _ _ 'osP'OI<>'Yl'3l;!''-' 5"''''It'O _ ...." """""'" _, 6'" '" ,.. _ ..., 0\'11~ _ . " 01 hi 1m! __ Pre'OlIira '"___10 "" ................ lrIO """"_

~mosl__ ~_ 1 10 l~lIO"\ItIIOl"ll!,

<lumg It><> _ -. lloeaSl·-.g """'" • _ ."

-,---"""---.. __ ....._-_.________ '!!OJ

'"W,"_on~_ ..... _"' ........~, ,....-... '"- --~_ . 0_ ,_ 01 ... Mle< '" _ 10 00QI11

opooo<IOO pel" ""*' ll'" _ .. Couql>o~ cIoII»n,olon'1!l "'" lo'$l '" Iofor, _ """'__ '"~ """" ,_ Iract. _ ,. __ comnon.~'"__, bL< """"..-.. _ '" its__ IlIIOd on """ __ 1... _ 01 """.___ n o.. .-_

""*"""",,, - _ . , 1>0"""'....OW>II_ _, 1MII>IesI... i _ , .-~~

.....";,,g - ~, - """'" """"""'"' - -........._....._.....~--....... _......-.Is 01 """""..-.:: chroroc _ 11'<I--_ .._,.,...-,.,..""'!<old ....tagos '" l.)rnires,__ ' .._d _

... .. ... - _.-... ... ..IQ , ....

Malnutrition and WeaningN o< IIoowlq _ _ .. k p,~ _ .1004<, 10. 0lIditi0cI iD:, io • _ io< <no< 01 ~ld_ b;';O'Io_ _

WEANING - WHEN.. _ .... oooOl__... """"'· ctoIO.-la

_ 11' br_ ' o/IooJIdllloo~ _ Iclr .. long .. _l 10 """"' !-...ggro¥o'Il••• --.. IMt ....,.. "'- Nl ""' • "'" "II'"_ "" _ 10 """'"' In ..,... ...... 01 _ . """ """'"2. ... _ ......_~__.. too

_"' .... "'oV1I_"....... -. _ _ ... ft'''_ '' '''__•_ _-'....._ 1M _ _ '" _ """" .-._-''''*1_,,'''''''10'*'''''''''''''' _

.......... _ kI on _ ,,,,,,,",o:e 01 "..,.,...,. ...""'" 10 ' \(J ,~ On ...__ <>:klc-li<nol_IOO .......y....., ,.,.

-. u •......=,__~ ..._- __ ...._--_.._-_._-~--.._-- ,..~"'- ...._---_. ".......~_ b' "' ..__.. _ .._ _ ..,.. .....-

_""" IMIil'__•• _ .._ '" • .., 6 _ The'" _ '" -...g ""'"....,10_ T" ._ "_ ~"", ,, WltO~_ SUly , ....." _ Nl _ !ow ,""'" '"~_ .fIO< 1'10 """ <II , _ . I .g """"'II ....<.rllln".,..._ ... ..... _ "' ...... ..._d~.. "*'*__"'.... _"''''''''' lor __

,·,.". r. _ al · ..., .___ ...~ """' ..__f_ -'Ill'oo_l ~" '" _ ' __ .. bo_lbl ..12 _'3--. _ _:M' ,..,,__..__.12'10 "'_ ..£,,_ 10'10 " _ .. __ ....... bw'll_

-...; ..._-- ---...-.___- ,. ,.' 101_..~ - -------•••WEAl\'lNG- HOW"dlilol_ ........ : ""-__10__..-.....-._10_ ........- ......_---,_ -__ ..-..n._~I00""-'

...... . _ .... _Il1o= . ' _ no._.. _"- ..........__..- ' " -...__...-._ eo Col

'-'-'-,. .._---"--'--"--..g _ Tho_ III ",n__---' .-,.... "' ......... .....- ,... .,...,. ......-rr.t traI' _ lllI _ ....... __

........_ , OU _ '" "'_ """'" _ 10_"",,,...__ I0o<I$, """,",, '.... -..aI. IacIl aI""""'"""'..- _ , ~ U ~ -.00 '".......... M ~ IN>!'O Iot1ll l'Ioon. "'" II:nl _

---~---:-"' * '_.,.-...., 1001_ ' .... __ ,....-..........-..._-----

_"._..... . - ....._ __ ..., ...... G1_- ' .- ..-.-_...-""-..- "'. ..._- .,.... • _llf\OOII..,....__ ,l).' 2 ".. __ "._.__... _ ..<Uo1l~'""__ I .e .. __ ..... 11' __~

... _ G1_ ..... 1oIa "".-... "'WW--',,__,,,, "v""'" ._ ..

,,, ....... --"---"--"""-''''CONTAMINATED WEANING FOODSA__._.... . ",NoI ...,_ ~.. ...._.. 1eN .--..w.~ ..... Io "" """___ 100..., .. 110 ..._...,~_io --. _...""' , I ' ._ _,.._.. _ .... __ -ilI'___A........._of__ '"-"io_.... _ ..;do "=lol, ---'-. ' " oa; • _100 I I .~_"__

! ..,_ Iti_~"",' I., ........ ....,_ {_ _ I );

"1<_00.... . _ .. _ .. .._'----- .._",--I c, _... ••• .... .",-...._-_... ~- , ..--""...."._._-_..~__......__ • Tlo-._...._ ......<0,_.............. ..,...-._--- ~ -...._--_...,..--

.". ( • __ "" '" I . ........ _

..-- ..,--,-----..~~"","_"'00l0nI: So<rc>iIo__ .. - '""""'" '- co ,"".... ...- .._.. ~._ _---.....- _..". Nt '" 'm*""'" eo<Jo ....- tlI' _ illOraotO til 0;1_, """ tlI' lmpow'o,I lhO

.......... <loI .- ""' """""'"-'"'_.._- . "_.-IF<l'\,<N . ....,,-. ''''__~""_-.,

_" al~

.,_·1Ito ...~ .~

••,

..

T_':h<. ..." ............ . "' ... u. II _01 ,." S •.... 1' ,._.

~ .._.- ,,.,.-~._,.. c F "_~...._,---_... ......

_~ ..__ .-v._ .-- _._-_.. ...._..._- -_.._.._-""--.n. ... t>IWI......,."' .._......_.._'.----,.... -.,g '"~ _ Ill .-_.._...__ ---

.. _ .. _..... , ''' ,, _ ' Ill_-.gto .. _ ,c ", .....~~ .. ..__G1 Ii111__. ______ ... _b ,"d__

_ _ _ ..... 7'5PO' ........""""----- ,--_..__ 10".. ....__

' ..._.._-_ _........- ...._--_ -_al__'-__ """"""'G .. ____ "'''''''''''''Go ....... .....

II LIFELINES' GROWTH MONITORING

Malnutrition - other causesPARASITES

_ I/Iocl _* of _ <II _ .... warIa

".....~ _ . -.g on'" _'•...l-.Iy ...... """"""'" " \IIDI • '-"Y laid _""'"'" 20..-. _ ;n ""-*' _ ... _"'.....- """"' 20) _? e1II......... 0l ..bolo""' ... .0itI' )<:<n "... I.-_ __0-... · _----'...- _ ....._ c>::mIlOle toI nutr__ llM"lIlQonIl.... -... ......,.,... ..., <IOO'-.g .......__ . IN _ """"""" 01 "'" '....'.'1... "'_10............-.. 00<>Jl3'\ Of oaIO<... b'1ogI1' .._ uP",~5" ""_"Y _~n<IrOg«J__-..

--,-~.-_..~-_ .. ..... ""'"" _ daoi. ... ... mud> .~'"

O! ._'.<IaIy~ ,~ _ 011_ ""_ 's iron""""', ...__""" ...... __

-",,~_."

-~-""---"-- ---, _........"...•,

HUNGER AND POVERTY" F<...... ....,_V do ""'!>Ow......,.q, .,,,,,.. ""'_lOIm_...__ .........__ IOQlOW

_ 01 Iht;otll _ .... """"-....." ......","'..".". 1Iul ..."'""I' .. _a <>l "'" Tlwa _ 's lal»<.o """" IS ""'"

~ <It """"'~,"IN<. irK> l~. "9* oncomes,.... ,.,__ 01 ...~""'" _ 10... P<MI'Il'fr(lnl_ m.1i""~",,," and. _ ... 00tn"TIle __ 10 IIU'9<W d ""'..."".....,.. w .............

The po-., os ,alta "'" <II _ ClOPS .... \11""" I>j _on.......__""__A. And~_"" 1o

""'""'" .., ·tiG <:!Ia'9> 10 _ .... IXG 10 -._ .., """ >tIC ....... ... _ .. """"""""_ ....IIUt_tIe~'..._"' ..._._,.............._,-

Monitoring Child Growth

•

.... uoI .....tiodJ ........ TIoo ........ _"""" or4aiq.._"" _ booic:odricc_<UI.-m... Hlp_", .._ """'~ of dIo <WW __ Ia .... 4... ' . ..._11I, <>Ioliq_

IMPORTANCE OF GROWI"HTho !\'IOSl ........ -..,. <JI .....iI.>Jn .. . 'l"'l"1ll ""'" •

-... 0"""'" ..~-v. ,e ~ .. t>o <:lie 01""""" goO> """ .. "'-""'l ,_ """ "" """,_ ......._OCl .. ,..1lM 10. """,,, II'~ DOo>l"' _,"_....._----_.. ....",-_.... ,...

" A otioI<l...., _ ..... . ...-.._,onrl"""""'""".....- • • """" IS oot II'.-.g ..... __ ...... .,.. too.......,...' 1JSUIIIy ....... _ or loci< '" _ ,"',"....,..."A chIId '.lJO'OlP1'" _ -.. or ..... ....., """""-..__ .... """""" 0I!lfl0 QI_ .,.

_~_"'_'._ \lI ., ,..,._,

"/"" '-"INVISIBLE MALNUTRITION

' 'Tho .....,.__....... _ etolCl In or.. &.7.·""""'" _ ..-.go 1>Jl . 1OO..,..,. "" fool

or.... . . ... -..;, . "" 10---. or>d 1!"ocr%reMWj'~Io_T»ochlld_ ooIt~_

'" caIOnc .....,...,. may ""'" "" """""'" sogI'I of IIunQOtbo¥>n<ll"-_IOl>OOIl·_ In'~""_')8 _ 01 lI>I --. 01 "*"""""" <:N<ttrl *'lI'IeyI"o.I!It'llnoO-__ lI""""'lI ...... "'........ "' ..... ........ ...... ft_

- 0 _.0-_._ 'N'

" Tho """""" oIll'C"'IIl"''''''''' oot~ """""'10"""'l'bo<lY 1-11)oo...-, lI'CWItI .... .. tfIOr"9' In IXICl'I' SlIe ....... knowolo .._.AA<_ ....IyPClII ...... oIae ' 04"~ _ 1Nl ". <:niIIl .... 1\1.. 10 lI'OW~__ (;;<M _ _ 10..... _ .. _ .....

IlcIo "'" "'""l' _ QIoIIc:I<Ir_' _ ~ .. ".child In__ Ill' _

lorm 01 _ "'" ....~ _ ...... """"IIh ... child '"..,.,.. "' 10;11',"" "'" goon _ ,"'_1t>I__..d'kI". .,

~- ---..--.._----_..,,,,,,,._.. ......

The Child Growth Chart'~~......"...", _1110 -... "' ......... . .... 0''''''''........ canmol<o'~ 1I'-'"_""'lI

_ IJIIIirllllrI\I _ ... 0r>0e,., '""""' ca"I ..., ...~, ........ ""'"'11II'''''' _ 10CCt«!Cl ~ W;tn .......bIao: _ trl etokl-.g.!lfOWI' 1'I(n.....-.g.....,.-.e._....... """"" f. ,*"_ "' ........ .. "'"f"'IIl' 01 child~--~,""",-."....._c . _-_...__.....

on _01".". of "'" _ .- t.o>g .r-.. , ..t""trl .......__llWIlolI-orIll< vcr;~ ..~. fl

"'" _ 01. ,"""",,", - '" gr<M'IIl .. ChO,", ... IlO...... Oll ,~""""'''::...." Tho~ '" .... ......, """'" """"" ... _ ....",. cotOIlOOI~ " ".. _ 11"_ """" "ClII W ...

""""'" .... <lOOlw1g - """ ...... .., ........ T1'on<Jgn ...'"'II\Nr~~ 01 ..~ ~"" _ 1'>0""""'"'Ill Ull<II "'" _ OIl . Ill""'" <:I'Iart, -.. ...... ....--. .,., tHI """"",*,, W"", ,.,._""'...__.....,., !rom _ """""'" ....... ".. t<>n ..-;I .....""""*""" <II hjr <:Net",. """ in 10 """,", ""'Y CMIll""" ....,~ lNI """'0".0"'" """"'_~01

'* - "..... _ ' _ --.. ftl.. _ ..... _ .- ,.. """'- '- '..Education of Mothers

O....-tll ', ..= .... -=~~"' j ..........._ .....op I"'~ "'-.__ ...-_ kI< kal... ....- ..... ..Ib.. 01--" 11'1 ..... __ '""""" (ill """'-"I _ .... toll goowrJ" .. IiIOI.OO _ _ "" ............... Mo':I>ors_.. """'"""""" "'" ...., _ try walCtW'CI ",...""",', _ 1'01l<Im Nl "" ...... IIol IO~~__ ~.-...........nian__'I'n..,.. _,...,. _ IIol ..".., _ .. I ..... 10_.......~-_ .. ..loocO:n .,..,. •gmato' rOo IhM__00~.. IhO eIl<Jiogy 01 _ 00-'10_1N~b• • ",,~_ ..

"'" rc.o:o. '" ..... ......- a'ld """" "'_ 10 _..",.. oornooo.."" ouot> .. --. _l/ItO'I ..- '-------,.. ..-----,",Tho .._d'Illos" "'"~ ",,,,,,,,* ,, ....... OM <II"'"~ 0lU<ly prqocts_ ~ .. Iho""' I '-'11_ . como 100__.

" <:00 'Mlll __ """'" b "'""""""II \oflillI'Il _ ""' .-. ....""COd try __ ..,,",qw'IO~ ..... ~ • POSSitIIo 10 _ ..-.. lOOmlI'Ia' • _ "'''' -.nQ 11'''''''' \s • """ _ . c.""'"" '11 "...... _ _ .. on U ' Iblll_...... • ~ .....,. QCO'Il lOt """"" ............,-.-" AI ..... ...., ..... "'-" ,..__1rl'"Il1O__,• ....", .. .. _ .. 1N"'- ._<tMouo _ """"""" Ol loOd__ .-xl txauoo... -.. loOd • "" 10. ""'" Ol---'". QoJI _ Il101 .... mool '""""'"~~""'" QoJI "-"',1<:01 poogr"", _ ... II'>t_ 01 .............me o'IUlnliM~ .. .... f'u1al> -.<I~ ....01lA>'''''''-' '-""Il "'_ """ "'" "*""y ....., 01..-. n. _ _ "\s.~I0_ ...'j lw:l~ .... IlIfh<.-'l ~,~ .....__""" """""'"..-,'" ~~, ,..., .."'-"" .. ""ll<O'MlllOoCl~, is Ihe oeed lOr. """"_ '" ....., """""'" __ ""'" '" "".......... ... <II ",""""""'" <II h Uolcll ...... _ '"""" tlII_ try__ ....._. '*-'Y...- "'- "_.- ....___--

~ - _ ...----,------ ...-_,...l-o<:l< .. ""'" """" "'" homoII "'" lI10 orIy _ .. now .

"""' ''' -

BACK-UP SERVICESWk• ••bilIl '. pu-<Il ioMrioooI:rbJL<r!aIo ~ io-.1iaI1w... _ 10 .............._,,,, __ ......,..11'n"_II _ .. .......- 1I'<I'WlI'~b.

........ 10 """"' ""' "'I"""'"~ lOt lwei '" ..""""" .. . IlgrI ,.., .... ...,... - "..,., o:are .....WIO<lgI1 "'" _ mly '"__."""'ll'IIic .....noI~ Wo. _ .... imjlononl _"\Ill Ol.... _~ .. dioocio_IO ................~ ..._ ~ 10 l>O _ ••~~ ...." ... be_ • .... ...,.,.., c:a..M

of~~ ...... l"""'i' 1IUCIl. em-: _ ..-(eOI~. ..--.",-----._..

" SI>ouio Il'>t <t*.. .....,. ''''''''''_ ...~...-. '""""'" loo<l " •• I ,.... lOIo ..... """"" ...... hi"""'" "'...... _OIl~ 10 tie diol.oll,..... in •_ .. 1lI_ .., _ .'" '" "'" _ Nl'""""'Il ...... cal "'"""" ... ."..,'. _ ''''' Io'rwlg ......pIoce oj ""'"~ "'"'" ......- "'"~ 10 .....__ """"""'" 01 ""'1lIC9'_ FOOd """",,, ''' 'IS~",""'lI l'>O .........". _ _ "'_ .... _ 01' lI10 _0_ 01__"*"_ Inl "'" IIlOIrwlO _..-__In"' 11"""""".._ .... .,...,,, ..

""£_ '~- --- ,...ENTRY POINT FOR PHCft' Go..- ............. <:oil 101m ... _ 01 ""'¥J

"""'''''''' PD'1"<O'I _ e;n tpI lCl~~ '" •__ I'HC poogrom ..... _ ..,.",. ..... "" ...__.- 01 OI'«> .._ ... ..-.lOt-......oo- - """*""-."........ ' ..._-- -..-,.. ., _..._..--_.._--- --- -,-11""0 """" "...... . 'IIllI.~P."".'..._an__·...... lOI "'"~ <II '*"" _ ...... ""'" il'ICl....... . .. lI10 only """"""Ii ..~ In """""I' '"'""'" ....

"

II LIFELINES' GROWTH MONITORING

.

CIoiItl ........ _ '_ ''' __ _ lOw ' , _tlIt Doilf. I _ _ •_ .. -. _ ..-__ .....11,.... \Ie1''''_ Ie _ ....., lid t"'SIooIlo:. '"vo"'" 1 ltc _.....,

1)'·. __. ""' ...... "" "'__ ... Ioocl... _ ..

goooI> _ ... _ • ""'I' __ proydo • Dli'OIII' 1<1--......"... .._'__-__--0 ... -... ...- .......' !IO 1ailIril "' -'___ _....,_011___ _ 1

__IIt ............. ...

",,":,*,...., "' _..--..-_ ..__'0 _-"" I ; ••••__ ..== _ .... 000 .. ....00"" ""_.__",,, ••2 __ . .... ....... _ 01_ __ "" I I., 0lIan"" . ....__... .. .... ...._-_.-1_ _ ..... _ ..

.. 80 (11..-_"" __ The_ .... : •• • __.........---- ""_........-..... __(II_e--_-"...."'- --------'-

Challenges

_ ......-. .. 10., .. _ _ 11.......__ I U , _------ ,~"'--_... .......--..--0..._'" ..........~__""""_'*IP"""_ 1 .. _ ,,:< 11 "" __ II _ -.. -"""" In . _"... .... _ ·0 .... 111 _

""" .,.._....~-I ' ·On . own "'*1"1"" "'" tloeS .... _1Qt.IIO/' •....,....

_ . ""'" 0«1 ..«t ,g" _ ..... g "'0 ...---. tom __·__-...q1IaoIol.olue 10"""" ~ loB. _d>oIilr""...._""" ... r.gtC "" _ nICI><.__ l>r ................... "*9'" ___

•.....,... lot '*IP"""" ..... -... , _-_..._-_ .. _ -___.._ .lho__ ___ J

M... trwdb_ _

\lOlIOWo b IO-tO"Io ..:I _ lot _ _ __

_ """"" A_ Ilw.....-._.._~lot __... 2 _"""'__l leog01 ""__ ... I •.......,.-----_...._.._IgLO" ... .....-."" _- -- ----~--- - ,_..,-

ALTERNATIVE METHODSMao.loo. .... <ii, I _ . of ... __ .. II _ •__ 01 : ...~-n. __ Iot .. _""""', a_I _ . ..... .. _ II~_""'''._'''.ouoCoom,Ol_ . -VO

... -....". _-..gIl .. _ ...

.-..._- ---... _ , _ Ol e __.... n.r ._..._---_.._--....__ _..._...._,-... ......-_._.-__ --.___-__ \lOlIOWo -"'_... .... II . ..__

,.._------ --...... "'" l..... .. f'<Il _ _..-_._--_ -_...-90 ........ _ ._...__c. "'"

-_.._---_...-.--_ _-....._~... De- """----"'.0__• Of .... '"","'_ ' ....... _ -.- '...., .. _",." ._--_ _ Ii> _. ,.... , _ .....-.v """ ..'Ow ..._~__ t __ ..

OUI'C'«I _... "".., __ .. "'It' '_ 1<..__01_....__..w ......._ ...~__II......-..

....,------'...COSTS OF MONITORINGe-.. ... -........ ~ _ _0010,," ,I..".- t ' ~ _-.. " _......-.. .....-.-..-

'T'oe .... 01_ '__'9 _ me" ...... .-..tw...,. _ U S 1002-50'0 _ .,.. "'" _.............. ,. .... -. ........ _ Tho--- -_..""" ..__..-,_aII_ _ .... _ ..= . _ __n._ _.,.... 0';••-_"".... ..._ _.._..__...__...._.._tooooUS 10113 ..103:1_...._ _ . _--_....__... ---_.-------_... .-----'....()I .. .. , ..... _ .. _ .._ ..

..... ",---.og.._~ ..",-.

.... _ .... h • .-yl"!t' r",_ .........."OlI/*'!I_"'" ell no _ 1Il __a.... ~ ...._I_ .....__0<' .' F•• - .. _l00.IlOIlWOOOll ...._ De...-c>'o _ ....__ III. roo ....._ "" .......,~ .. ..- ---.oil' 100 ____" i_" __~_'"~- .-_ ..__ ...-........--_ ..._--~_ _ ,I"

•

n- .... _ """*""" ......... """'"-. II>~a_ Q8C!I

ll"O'....... no -'II woogtoiog ....~ "'*'"f'!IStIIlOO~_out n__~...,_""' . B.l __

"'"1"'" \III 0..-01 ",,"""'.... In~~_~ n.e__01_, '",""'"**.... .. .....,..._OO ·dO' 'N '. _' /Io. "O" ........., llO......ofgtOWll1 moo .........., 001be"""""""" Ie>' .. ..,.."' ...I"" """"'" "" _ II> .... """ .,."..,...,..EIotIo<... ""'"ItW'Q.., <1IMIIIIO'I _ ·10-1_.....,._""'lIO _ ....-.. _ ..... may... ...., bo

_ lOSS <Xl/'iQliQIIOll, .. CI.O'~"" . an! lilSJ_ .......-- ""'"" \III~ n .........-..,..,_ ifl/rllSlrl.Q.<e"'~_",,- -_................,,--"- '-"-- --"-,~

Mothers' Involvement'Tkt< IIH ..... _ 11 0'''''' _to _, .. obOlil:r of--"_aod_-"_IO-....odtk_oIpIoniq ' <W4". poortII .. . ....."

'Olnl """"" -""'" _ ,."",.,...".,..,. _ ." ..m Ina "'Il'"'fIcanDo oj ... gtOWItI ~ ....... ~ •_ ""CUll "" NI _ ---. _ ..__, .."'""'"\I\al .......-.-l_'~ '" INIdIM ,nor or _~ moho>__"'''''~__ ''''ChIlfl

"D<lIo llIIl*otl In~ _ Ihrl """'I'~____ flO<! __ ...... _ ...... ""'<:Nn,

E...., IPIOo!lI' 00Iy 53 _ O!.,.., _t>ocI_ ""'""'"~ .. oclw>oII<1G , _"'" __ WI '" "'09'...... Ge_ 01 .. """'"" __ to _01 1:I'IAItIl......''Tho _000 of Pr<llOd~ .. _ CIl'l!wTnINt-. .,., ....."..,. ,... .,..". In N PrOIOC' ....,.......",.,....~GNo1S_ mN:IIOntlltlOlll r... UIiIl IlI' roo....... tI'III />'O!IId • '01,"","" .. -. ,10,, 00 """"'I'IalllKl'*l_1lopo n .... CI'IIIll'.gr<lOl1ll .-".......~ WlI -.. _ "- " .,,, d'>oI<!'._ 10lo»>oIr INI Chill' , _ ~ ,

r ,__ 0.. __ , ... .- _.__.- ,. ," In i __. """'" UNiOT """ MlI'iooO , ~ _

IIfO"l'G' ""'"' ..-.:I ~,111O~ ocaIos, __...,... _ IJ\, PO' """" of..., .-.go _ """ ... Ino~GNo1Sancl._OI?$OO~_61 PO''*" ..- ............,- - - - _ ...,-'II>"""ll" _ ~ 11'10 _ ~ _ ""... _ ..OQI_ .. ...... l .b__ '" 31> PO',*"ollno , ~5"'"""" cI ..,."....- ......... f19'Ior__....._'!"'" CUltanl~ _ h

,.._.---- ,..;,,,~

.-........ __ ...._.~"""

~ n • 1'''11''''' """"-'" .....", ""Y oro Il""'" ....II'<rWItI cwtIO r , •cI N .... ... dN<~~

...._Nl ...._n....~ ....... ...... '1

_ ONr__ --.gN .......... ..___...., ""_~ lir'Il ...__."'-"'- - ,-"""'- - ,'" ~- ---.-.-'.''Somo__....,...,.,.,...,__ """"bI'.

.-may tie lO<l. .. 1$11 at........, """"' "., CInC.-. -. .. """'" -.os .... l ~.,.- lQIlW1I. _ may Do _1qI ~ I*' CUlI.-.J......~ twng 00<<10 .. _ t1ol1O llul".,. .. .,..,. _~"'Y lNI_o _.....- Various <¥aIuI ....- _ """"" lhol _ ,...,.

"""" ... -.. \ ""' ...... E..... ...,.., _ "'" _ "...'"bI'_I ..._~ Do _ _ Ill' """"' ...., h'-_ ....__ ....-.........---"- --"--_'I"· '1n 1lo 0r Ek..,C,~_c...w.nlloguro

In .... "'_ ......., _""""""' ..... _elll''''''''cn..n... ....,. lOS 01 lis.,.,.. "'"" 2,000 r~ ,..,.".,.. In....~ s.. DnooProgr.." IoorQoI .. !>''''lI ...... cNtb, II..... .~ .. ..."'" 1>:>'~_moIIws ., ,,,,,,,,.... ., .... cn.:, r-uoo..-or-...-- _ ..~. Il'Ol' '__ " !>"nIl ...""""as II ccmor~ lor ..... """"•• _ ..• _ ...._ ,,_ _ ..... _ ,..err_.- ,....

The Growth DebateCrowUI cUm .... ....., _ ......... elli"' ................. "'"~ wariol. Ihn "' ~ , -""",,lr lDI <k _ ..-lioI of cIoil4...o bo ..............cou ri•• .., .... IoIenmIooaI _ ...H<I.. NonJo"..me.. 01" Eouope.o. elli_1

..__ 11'""",, 01 ....... """"''II """_.,,,cnongr:o In -. .. toglM' .- A.....__ CI'o'Cl'1 ....__" . ' __~ atIOuI __ _ 'I......."'_.... ....,;ng . _ ol....,;wy,..~~ <T'>(II:l """"""' ... """"'""'" 10 11''''' - ,,_oIogNIy - ........ f>o\' _ .."""""" '" ..-

....... grOWI!'I "" - ~ ..-"'" """".--'-il:_lO<l"''''''''''''''''~__.....10_""__... _...-.

''''' _Ie .......... atIOUI YItICtI"O'~ ""'" _...,.. ol Iho "01d t"".. .... ....... "".... 1><-. ,,",, __, .. ._ ___a._ '..'

" Tho~O'I' at noI grOWI!'I_olS ""~ "'" • ' I n E"""" ar<l _ ~ .......ooiII' .. t>o_ n ol _

""""' "..,.... ..., ll\@y ar'.1loconl"""""""5UgllOSIS1N11re_ o! P'""""",,, _olcl>ldron In-..ca.o'llriloo"""" noI _ ~ ""'" ..... _(IS _ .,.., II'1IIPQ<t"' _ '" '''''"' <>01\' _ P',......... ..cMI 1O__ ......-41_ -.-"""""'" .. 01 _ ~ _r:ohIf INn 10~ ..lIOOII'__....... '

--"'-"'-- '-"-''''•

II LIFELINES, ORAL REHYDRATION TIfERAPY

"Tho<e .... boOn.__... to_ ......$.tO In _.n__~._.statatrOl

10<>:1 """"'" _"'" tr>o tUr-.oI__hom t:-lg _""........., t_" ....<liIkUl .. __ IlocIo<.- " ..~ to ...... tI10 __

"""'" ;>'tIO(Ill hi """""""" "'_ by """""'" _1IOI"C Ma'lw ._."' ", _.. _ , .. -. otognl hl weigN. -.... _ -_ ........ _._---'.'

Oral Rehydration TherapyDi="-I diMaM ;. 1M1ffiJ'''' rilllU Jlilln ./

chitdml ill 1M .u../npi", u:qr/;/- 11M oJ'no 1M <lIit/<II_ ./ <lIi ldlto<>d "",llto/ririlm.

11w ".....",ioft of .n,,1T"- tkpnuh upon j",.pnImIItIIll i. ullrn IUpply. Ja";/IIn.m, aMh~.

B., i. 1M ""aoli"", 1M _jtwi<y cf db>'h, fromdUs,il,o.,.1 d.lIydm.Wm "'It ~ c!lNply "....."rd by"",t",hydra,Um .1Impy (ORn.

DiarT",,"' ;"J«IicIu c.... 1M body IIIIDu ...1"aM win 1m,,, ...... ,I.ly "'" be rrplllfflJ - k<ulu.,UI dtllydJ'llIUm. ORT is I""d "" II•• diJuury IM Iglwase fFt4l1y illtU<Wf 'M 1Ioody~ ,apacify"'" bforh",1".1Id wain. DriJtltiogII ", I. M 0/ ",1... ,11ImUlind WIlier ",It ,1Itn/_ prrtJt1r' liPId IR;lI "' lIy<t",.,w..

Prt-padulgtJ " ,01 " hyd,oM ",II< (ORS) call",,/y db..." 10 Mil.\. Hu, 111<1lIi"i 1M ~"""""" iklbk 10 <Wry JrovstMIJ is Jto'lIlW01yf frtniblLSo _ oy ORT rampaips an III", cOtUtrrmui", """odi", """her> '0/om/all ddyd,o,ill" by ""',,,1ttnulIu>/d rtIIUdil1. - JlKlI Qf $Jlf<1. oruJ ",/. "".';"""riu w In 11M _pi.

n. rom""", ......ri<m ./p"...." ,'" _Id """ is10 wilhMld j"'" OM fluw d.ri.., 0 dUlrTlu>to.1alUX.l T1It Jeknl;}ic ""iorrale jl1r ORr, OM jl1r""ri~wd /«d;.., d.rilll. _ OM oj",. _diarTlIDN, "'"Jru.o ..,ahliJlotd /xytmd dow"" rlteM/ittif' ""'" iJ 1<1pb1u l /wr "'IJWW,. i~ 1M /wlldu[parmI> '" ,1""IMy I.v-I.... "'~ (mlI«IIMi' d;Id,,~ again!! 1Mdlhyd",r;"" OM ....I~. ,rir;"" raw by rhildluN!d',....., «''"'"''''~.

•

Diarrhoea DeathsI C'Tho __ IO<IIy .- ..,_

lI'd< .-"~ ,,-",,,- _"""~_ !lI' ...Plogo.",,_ dl.rog ""~__ ....1 Ihey~"' bo -.:WI"'" ...... """'" .",..-0 at.. _ " _...- ~ '" 11II in the dO' "»''Q 0I>.ltIIh0S. aM "'"sucn.".. IfIaIl _ UP", 1!>-20'""' ...... '""'_ollilfl~ aMI oliar~ _ ~.-1t>D!IUI_"' ... -OIP""""' ..""'.__in IIIcl """" ""Ilespreaa III """" 1e!llOO8Ir Wesl I'.IrQjin \963 ..... '96< "'"" In ". " -...., •__ ,_- ......--_._, ' """""",.. '..

DEHYDRATION110I... iii.......... de _ ..~,.._ .._ ..,.'--'UIWp-. 01 _ _ doc bod1'

Lr'lho b<XIy """""'Y _ in 1I1e ~.-

~ _om 0'_ ..... -.. T b<XIy ""'...,..,. -.. __ .... (00JIWl11l\rOlql _ __,

..........., _..-.,..-....,"'.._~ ....-""" -_._ _,....-• 001~ ""'ma&r. ....,"""" ,.".."."""""" '"...10<_......_".... ....".__ 1__.,.._

'on. lo<goo~ loss .....11<..., _ ltom ....b<XIy .- In QOllyO'otion, Do!hy<lratOO' __ .................11< _ ..... it lI''''''' ""'" "'"""""_T ......___a _".-. lI>o """e "" ,.,__""...... ()ony<l>a"'" """ ...., "" ......... bI' """"""II, ......a.""""m'....... _ ,

"llo!>joO''''''''' <ICCln _".....,.. _ ~ _ ....

..""'-.--""'-_.-, """",,__0.__..__ ...,,-

·_ 10 llet""" ol_ ..... _ _ I<I__"""""", I _, ..... """ POt'*'! __ ... ~ .....~~ .

~~-_..,~ ..._-_ _ L .. , __ ,Hl

MalnutritionDWrtooeiII dia<_ IX •~ ",_ .. _triIIoo;.-I ......lri_1o jto ......_<~__.bIc..~ a.ooI d<.tk _ ~

" 00itrrI'I<l60 .. • ....... _ It! lnO """"""" '"~ ill _il>Oo1 1","" tloli:i1uOO l'1O ___ ... _ _ 10 c.-I<I_ ""'"_ . _ _ ~ i>. CO'IWTIOI1~1<1_IIWS WId ""'"I~_..-j!tom """ Suo:tI __~,1k>1 is ... I ""'*QMlII ...... ~ ... t:"\!' !UT1b<>' 01_-.. ....- .. cr"", """, , '"'" " _....._......_...._.

_ ..O'lNln" _ _ ''''

'0f"0' _ 1'IaoO MCO<OOil •~ _ pOCO...._ ....... WId.-o__.. dioor_ "'.1l0SllllC1l'0'e >UtI' "' Son Jcoo. Coolo f\Q, lhe __iloO.",," 01 """"""'" epiolxloo ....-on 09fCI I2·59 ""'"""

-~~---"""we.gIlI.",,----'I pOCO __ ....... ...- Ie """" ___ II>on " """'-"l be _ "'"' PO<>< __...... -'" Il_10oao,_~ Ct>eo ...._ ....~"""_ol'.0'9_"'ilOd12·23 """"'" in .......~ _ ..... J9<OI<l8CI~_ _ d'Mbon_Iho-.g1 _ A~

""""""'__ ......_ ...,.,. fwOolfIl .ogol WId"o-...c _ """*" woo _ , ~_ 651; _ 1·10:<_ _ • __ """"'"11' .. ..3 8 _ 1'4* """~ 65..~ 10:< """, "

. ~- _ _,,- --=-" .__.... ......._ .. ... ... .' ... ' .-:I

Causes of DiarrhoeaMo., ........... p...no. .. diattho• . TIlq oro _"'-' ..I__I0 ..~ b _

THE PATHOGENS''DiotmoooI _ is IISODC>alild """, """"'" 10:1 ""'" ..........,..,.... """... " ....-.......~_ "'~~Iv<>uiIhOUlIl>O_ _..._..._._-_..-,....

IO<Ill oJ Eco__ Net1tl oca, 10:< .........,., .."."""""""- _ .- .... ' IVltw.. ",....,."", SI>QoIo__",.., _ .&>rnoneIP /)1lIII1lI'lIl~/)1lIII_

fnl~ ""'"' _""""""" ICo<:ao'l>\.l UOf'~.:lIo ............~~--.~ f>a._ <:of!, ....._ ,~ .... SI"lI"'b""""", "-- --_....,__.. .F_ ,.,

T RANSMISSIOS' 'W__ ' a ..,.... ill ...... _ .... co~.---_........--ag.oo• _ _ . 01 lte • .......-.on 01 , _ $I'OQOIOe.-..gonoc f rot _ _ ~ .. !>I ..........._ ' OUIOS. """"oo__ ...... 01 <:f>OlI<•..........-_1-.iIf__ (o>:l'IIIWW>\JuP" '0.000(: <ri_ ,00_)"",,-._,_'" _ 1lellIIco'll _ """""" t>v oiI>od _ OJ-_...........-,.,...- -""""""_ ,__ l\>vl! _ ltIal OUCll " ""0 •• ,, .. 011_ 10_ 0 _ __ ...:1-.........Ono _ 1Nl""_ _.. ....~-- --"-,--,-_ ....--_... ..'-'..,THE LINK WITH MEASLES

".r, _ _ 1IluCly," """<ft 5,115~"'' 2 VIIagco",~ -.. _ lOt . _ ._lNl_ and _ _ 1XI1O .....acl..,...,p.ClIlv 10 ""'"'""" ........'Y ........ Irl_,_~ 01""'_ "'" 1lwIy-tv_ ...........--""--'-- ---'"--" " '-""

Oral Rehydration0...... _ 010., ........ . .. "" ..... ,.., _"" ..,. 11<~"1Itioo Ikr>JIl' (om . -. oIdrooo .....,...k«I .......... 0( on!~ _ (OKS) eo • .010_ 'no ..-.1} 1ldI,.It..... ~oil< Iou. .._,.k",-

" ~A ,__ 10dill"""'" oo GO "'"""""W 10__..... '*'11 ...--.. __

"Ill"""""" co,,,..,, _ .. .... temu ('heme_ 1,"'''''''' lIO lNtlr.il_.

lb) 10 CI7fe::I <JoIr/.h_ Wng'~''''''' ClIft"_ , Il" "SOIl _ . OAS .. "'" ..-.01_ 01 .... typo ,.... ,,' .. o:llI<l .". WII) .,o;l~,

(Cl 10__ ..,.".,-.IlOO 1-,._.......o! '0'" OJ ".". 01 .....,. _l by ,,0><Jr<IUII~ IllS........, ......... .., be"",," ", _...., _~"' ..-IO_ "......._,....--_......_-_ "'O!'lCff_ "'., ,..

" "tlou! ~O·9 $'io 01__10 _1lCUIo> ""*"a.am-,~ ..lanIO. _ bo _ ""'" OAS _ , .. ..._....... .. _--"".,.,....-"'...,...- 10'""" """ oroiii', ....""""""" """"""," '......., 10,_....-. 'IIP'lII' •"" .._ 0''' • _

_ _ nna'__ '"

"

II LIFELINES: ORAL REHYDRATION THERAPY

ORAL REHYDRATION SALTSOral ~h,dration Jails are formubted to replace the nutrients lost during diu rhuca:

11" The formula tor oros recommended by WHO andUNICEF conlams.-

3 !> gms sodium ctllondo29 gms IrlSOdlum curate ulnydlalc (ot 2 .5 gms soo.cm

blcarbonate)1 ~ gms pola$SItJfTl dllcw10e20 gms glucose (anhydrOUS)"The aboYe lngr cdaen1s arc dissolved II'l one litre 01 dean

W3tCf 'NtK) has rocently recommended a cnange 11'1 eecornpl(I lO formula , IcplacIog 2 _5 gms 01 sodium bicarbonateWIth 2 9 oms 01 trISOdIum Cilia te ditlydfal0 The new lormulagIVes \fie packets a longer sholl life and ISal Ioasl as effecllVO'" cor recllOg ecocss and rBdUClllQ stool vOlUfne. Packetscontainingsodium btcarbona:o are stili safe and enecwo "~I~ no Ill , _ 'I'l lloItwrl!><lI lMt

I r 'Counlrics stl ould t avo 00 heSilalJOllln contlnlllng to useons-cearocoeto . which IS hl~h l V enecu-c III the treatment o fdehydrntlon However. becauseor usbcuer stability and evengreater olrlcacy. WI10 and lho Ul"liled Nal lorls Childron 's Fund(UNICEF) now recommend t:l<il coumnes use aro o cocceOR5-cluato where leaSll)lo r..s In tho case 01any new drug .Coun tllOS cIocbflQ to uso QRS.cl tl'ale stlouIdcare tully monl lo rI~ performance d tJ'lflg Ine Iirstnew rnonltlS ollIS rOUbno LIS8 "

~"""WIiO f~~CcnroIfIt<y_ owe0-.... ..,. M. 11(1 5 19&1

" Gll.lC06O IS IOCluded in Iho soIullon princIPally 10 holP theabsIofpllOfl of sodium and fIOl asa source of energy OrOlnarySUlJ3l (sucrose) can be S!JbStllUted Jet glucose ......thncar eQualeftcacy. lhouQh IWICe tho amounl of sugar IS nooded.In08eSInQ !he amounl 015Ug3r In ire formulaas a mo.1llS 01ImprOVlllg palatabil,ty or ImeaSlrlg lIS lIu:l'ItlYe value ISpolonlla!ly dangerous as 'I can worS60 the diarrhoea ••

lhu""""'lI'II' tJf_ ..__...~ 0'>tI""'Id" _......../'f. •iI*Jl WUfl/lllG" .... ",,1Vl/ lIIfC. 198J

" Thepresence at coraes uoi In ons ISparllc:ularly Impor tantlor the troatill ent of dehydrated chlldroll. in wtlom pola sslumessoe In dlsrrhoo:l arc Iclalively high, Studies rave shown lhl'llurKlerl'lOUnshod children who hevesultered repeated bouts 01dll1l1hOCa are especially lik€ly 10 develop a blood level 01po l0$SllJlTl below normal It roo potassium IS not replac eddunng rehydfa!lorl."

r/1lt~d~_...,<It~*')d'~__o#Vf •,ollIr1f 1WC1Im~ _ ..~ 'Ntn . •!l33

Tho World lleallh OrgarcallQn has deve loped a S81'11toaulomallC me3SIJ,ng and pactung mactIlne lor 1hc pl'OOUCbOr!01 $lTIailef quanblJeS of ORS Of fer usew/1efe laohtlus are notSUItable lor aulomatiCproduc:XIfl

I l" Th IS machine has boon designed for easy 1'Iandl1flQ. aI'I"llfllmUm of mallltenaflOO. arid lor use unDo! dl Hlcult chmallCand opera\Jflg COOO/tlonS. A PfQ(OIype 01 thts machtne ISnowoperatIng satlslaclorily In ltle CAS production raol,ly 8t IheSlate Pha~ccul;ca1 Corporahorl 111 Colombo, Sri t anita "

1'0'''' ItIljIr..",.". lCIt CorIt'Cl' Vi IlQr'tllloUl~, l .....-m1W""""" .. ~!t"~' IMJ ,JnIl 198~ 1'M (}/crJll('~ r:ll

EF FECTIVENESS OF ORT"A r e~ lflw 01 22 .559 p«!latHe records at IhA Statc

UnIVerSity Hospi tal . Port-au·Prince, Haill . Indica ted a morl(lilly01 35% among 9,434 pat iwIIS hospital IZed WI th Oiarmoa anddehydmllOl'l 00'11'19 lhe PCfled t 969 -t979 A pl'Ogmm lor Ihe

"

management 01 Intantilc dia.lhca (based on a nT) wasestablished at the UnlYorslty Hospit al 10 1980 , Morlality loll to14'Kl dunng !llU l'ISt year. was 1.9 % durin9 l11o seccoe your.and has been less than 1~ at-co January 1982:

..., W PiIl/oi /OI1d lll'..... """"II')iJ'I""" pi doo,orn.w 1ft /tlillnQ'''*l' """""""-, /ft H••3I~~tI:\II. jo, FI/chiOId-lc;.". _.A/o)lll~j"'A 1~_'lJII_oI_""'_r_ ... "" 0mI ReIMI'."II(:WI n....;j))I, LS Vl 19.'l'f

" In a number 01fcsearchSI\.Oes ltIo usc ot ORS lor trea'lr'lQdehydratOdeh,ldren alllle commurl ily IeYct has dBacased thenumber 01 dlta\tls Irom dlarThoc.iJ as much as tlQ.60... 0Yf!faone yem oonod "

' ''''".__............__ <lt~~hir.lJlI' •j/JI'IIlW-l()lt.IoIClJo-., ~IO IN3

Pteltmtnary rflSOOlctI '" 1980 lor the M llonal dl8rmooalosoaso control programmeIfl EgyPt found thai early retlYdraIIOJ1 bY molhors With a sail and sugal milt mace at 1IOlTle,backed up by ORS from hcalll l cere providers, reoucoc prescnootdliid m()IWlltyby 40% anddlarrhOOa-specirlC rTlOfla ltlyby 50'll),

S<m.,.,..,~"" /rof" II a Mol>;" ;M "'0(1 l>/tIon, "nw,I'-"/ (1,,""''''''Wl llJlIi lIIudy" M,, ~ I1YlJUII/l Ot:JtlOCI 1980 ". Slrm<rfl'll.~ lit'll ,,*lI'ilJ/oIt\1IIl1IlofO.......~ j ~f:I/OC ' M,..1ty 1lI~' "')'PI I fIR '

" A programme or ostrrbonon o! oral fehvdrat~ packotswas establIShed by the governmonl In 1980 In 20 01 tho 8UCosta Rican municiPalities ThOsach ets were disl ribum Irooot chargo 10 mothers ......ttJ Pl'eschool chlldr<!fl 11'1 tna 20cxlJl:!l ll' l~ IUlI I1lllrMClpalllJes. lhe resolt, alter one year 01operallOO, was a 50 % reoocllon 01N'llant diarrtJoea coaes IIItho 20 mlll'llClPallbeS, no Slgnlllcanl chatl90 wasdelOClCd Inthe rert'lall'Wng rnul'llClpah ties wtle!e the IIl Iervef1tlOl'l was noteHec ted ..

I _M*,""'_01~ __ .. e- Ib ~~"' >Of6'IV I!JIJ:J

UnAnother outcome thai may be 'expec lod' IS that OATprotocts a chlld 's nulnllon In Tfurd WOf1d chi ldren dla rmc.,alone accounts for 25-75% ret:m:lallOn 01normal growttl overA yea. W,lh 2-3 years ot repemoct growth arrcsts due 10octscoee 01dl3ntloa , ne Pfobable thi'll most rnalnctauon weceiect in SUM !YS Is related to d,arrhe,.1 , a COflCIUSlOOsUp(JOrtl.'(jby fOn glludina l studies in Ocatemala, Bangladesh, MCXlt,:O,and 11m Garn~ :l. "

"'~t""r l"'Il;/1Ilflf''' o.,",,"of'Iy(/I'aroortlllt''' 1III' ~.. _;Jtrt"'IIJ~..1/1'..,_" _ I"",...-wb IA«:E~ ""-'I' ! 945

'SUPER' ORSReKlIl'dl coatinues to Improye ora l .-ebydntion salts. aadncw forms of '5Ilptr' ORS m<l1 500 Dbecomc pneticaL TbtCWTeDt ORS formula I"tmedia dcllydration but doa DOtshortCD tbe dura tion 01 tbe dianboea or rcdu Ct:tbe ¥ollUllcof d.ianhMal 510015; as I res ult, motbcrs somctialts ba¥edifficulty beli eviq tha t on!. rcb1dr.1tion worts.. 'S uptt' O RSC<lD both I bortCD tb c diarrbota aDd baln tbc Rool ¥ollUllc:

rlToo Inl&rMllonal Gentre lor Dtarmooal DIsease RosoaretJin Dhaka, Bangladesh . has develoPed a rICe powder.b.1SQdDRS WI th cksh!1Cl adva ntages over lhe currenl glucose-basodformula. Because of eherlllcal reacrlOns WIthin the humanbody . rice-bllSCd ORS reduces d~1rrhoca volume by :' 0 '_,- thllS ellectlvoly treat ing the diarrhOO<l as well as preYCflllflQ:lc hydla llOl1.

$IIrr~"i/!iI¥tJ ~<inT WH G,~' IfIHI II M MtJl1 "~",,I- lIiI"""01111 ''''')O''8/lp, "' ''' IJ/r)',. I arlt.·lH t Or.ltl/>I~ t!ffl;> 0Jnd ,\ M Moll<!1110(1 !lII'W<lf.~ t1HS </w<.. ..._ ~1lW .....>111 OJ ""'!I',"" ,'noo.t- £l.oIeWI <It1M 'MI(l . , fJ'II'4

Anomer adVantage ot rk:e-based DRS is that In milnyooveloPlng counirles rlCC IS Cheaper and fI'lOfocaSiIy ayallablo

_"-9l' r""'"""""e, """ ._"-"uM<l~""""""'""'--_:11 "_ 000 .. ..,.."""'.""'_ oaII .. _ . ....""", • •_ _ -.y-.py ...._in~

...a__ "'" ' . '0 """"""" "" "'""'""'", buI ___ .. PM' _ ""'........... <lI _ ....

"". Rooo .. <:/wlU """"-._..... gIUCO<lODO "'""""" _ , •• _ w ,.......... _"'- ....-,~'-'".-- .......-......... ..... ..... --- _._ _ ~ _ _ . ....__r_..

'-" -'"..- po.. "''O-'''''''Il/l ...... ~-""",._" ...

_ 0lld0<Ig hi ....,., ..,.~lO~ORSI~ ...... Cala.<tJ__",__

....... <10__ ol OllS .. _ .,"".. .... -.,....,_".... ~__ n.o""'1l"'4I__ ...._d~_..,..,_ 11' I>ol ...... _ "'"~

_ , ..... "'" b<l ll'O<CI __ OIlS ""',~'".....- _ to' gIuooa n.o ....OliOIl ot11-..-...._ 30'1._""'"__ lIW<l_, .... _01 out:ul ....~ WI<l 4 9'1o~ ; ald ............ .. DRS _ .-led '" _ """" _ 43'1.....(~..:l 36" .... !Po<¥IOO-<1CC P<lI"'l!< ~'"" "., _ _ ... __,_o ~_.. ._-- --_ -... --- _ ..--_. ...-",-_ "" .. ,_'....ORT AND MALNUTRITIONNwdI ..~__ O. T _....II<CI .... ~pacl of di.I..- III • • Ilil<I', ..tri,;".ul--"F.. ...- .. .... I''' , ... T.,.." Eom>I _ _"".. -.""" ,..,. tOy • t-..clIO de.>IhO ....,->.-" I:ul.,. imDkl_on

"'"~ '"NIly_""",,_in. _COfIlI'O"'""" _ ~ Iho...-- Chb..~OHS_...... 0.25 10 0,5 iIIl_~~ _ In

""" " ',"" , Ia 0ltIlllli _ """ _ CIl1Iy 1l\IlIoIIi;)l1l<t>'IDo. Tho ompocl __ on __. ...0

muIIPt _ .1lP'>W~"" """"","'" atOllS ..Iho ",.".,..... Ill"""'"~ ....111 _ ..,.,.., to"""lnICI -.g """" ..,. """"'" ....... toocl .. ...""""""'I oonod, ",...-, 01""""',""""""""" ""'I' beono01 "'" """"~ .... JHllI"B"C ..... ol~ ..."""'"'""'" .. ,,-..on ........._---....... ._--..... • "C" __ cr. _ _ •_ n ... ' .......

"--,,..

Home RemediesWho. OIlS _ ........ _ .."Iobl<, ""-~ ....pnI_ .'--'-- Ialoou·m..........._

"ORI""', au"'_ .. "" ka:m'"_~..... '".. -pteI:Ifn(l-, ""'" """"...".,....,. - ., ","y.. ...__'.''''diaiil''' TlwIl ,.an _.-I.,...-"'" .... 0'<WCI<Jn '" 0fIS .... 0> '...... """"

,"' - .. .._-_......--_._...",..,.,.. - -,-TlwIl ....-.0 ,_ .....,_..",",.,.ORI """".

__ or <l<tlY<h1oOll <lWOi<JII ' ... _ •law""'" ..... _ 0Wla. _bOn"""""*'lllO_01 bo _ or1lOllY ""'fJ'ol "., """'"~~Farly __ '" ORT_ 10-"'10< ",,"..-...-....loA... _ place. SeooncI. -tr om -w.....,.1ha *"''*'"''_1OCl ..."."'_ 0\1 ........'" ~oI'jto 1ooS, ""'" os"""'to"\I, lo<a '" _ • ..., -W """" '-lIn:l ...."""...... ...., ......- __ """ too __ l'I1a.l ,~. lom/y O>tIO<1 _ os..,.,. .._ t>egins......,. be lha; __ .,..- ....k .... __ ..... _ '""'""'-'l <loII'ljodr__ ,•

....--_.',,,,..._- ...--,... ' - -''''"," F"""""Y 19B1, onlI'2.3" oI500 _ ..__

'l«J __ {In'' Slaw~~. ",,"_InCa,_I ... """"""" 0fIS .. """'" """ 2. .. ely""""",""".0-..1'* _ . ' 8'to "':.00~-...... ... 1Il'l' '' """"': 3'" '" .-PO__•""""""'Y _ . ...., .. """""" '" '3'1> '" _ ..._ ..... -tr_~ ..:::.:;.:::-'"':.=,.:;.,..;..., .:.:..-::"...:..."'::-------,_ -ea-a. ..""' ,__ ""'_ ,...

" Tl1oo • • __"'_,_" (al _1oOIl __"""," 01_ Nt ore

...",....,....- .. .... """"'....,..., __ lOr ..."""" _ lrO<1"""'" '" ""'-'Ie _-. S<.o:I1~ Ol•"""" ...-00 ~om _ ....... . ..... .....-..; a lOly b............ ...., co,*, _ . ..,..".,."." _ . oncl •........ '" IJfuCOOO - ..... .. SlIIr<:NO _..... can _ ..._ "'" '" _ "' ",".--.0: I-.ey _ ....y""",","__Ill","""" T.... _.. ....- .. ...., _ -... _ _e,g.•00>'1«_,__ .. __ .. """" ......,., _1000.- "'........,.-. ..,..,..,. -,--"'"" {til SolI _ ""'Il" """--- co I og 01 __(ace-! _ """""'" ... r- """"1 .. • lew~_OI__"uoccl .. oIace"'__ d foao ....~ '" """"""'"'lI .... .-..un__ """ .-.", 1IoCao!l(lo</lOl CosIs,~ ......._....,_~"'_OIAIl__._10"""""'" _ .... ,..~ N .... or ·oM.., -..gaI'_.. !too ..,..,. .. """" -. in 'IL'CIl _ "'" _ III~ 1oOIl' too~'"

' .... _..,..,. - """ oed __ 1&8II'r"'" 01 __ "' ....~_ ..ORS~P<JIZ!OO<.on_~ ......_..._ !<Ir '"--. III """"",__01..,,..-.,_,,..., _ """'"" too ..- 01 .... """'" '" _.- lei_ 1lOiI'>jdo'__ """ " o;tuo..,.,. ......., N>~- --"",,,,,,,-."

lM_.... . . .._ _ _ ........_ "Ol""'" _ -. '...ProI>lrniI e RI,jIII """ MIl """""'" lrom -...0

....",... - __ "....".. ,.... ""-'<ing !tom • """"'" """' ...OI'*Y .... _ lNl .,.., IhO__........... bol_A! _ ....... """'__ ....... t-. _ Tho ...~ _ . .-.g .... MgeO'f Ol ._ '" .... .., • oeo«> '" _ T~..,."., ..-..,..,..." - <loy . ..- ... ...,.-

"

II LIFELINES: ORAL REHYDRATION THERAPY

ooees, pans, or glasses to measure water The lhlrd involVesdt$lubutlng 10 each family a eestc spoon specifically 00SIgned IOf l1'lOtl$lJnng the dry logredlenlS accurately

"Results WIth these mroc approaches have boon mille<!Usmg ellhor Ule P1nch-and-1Ocoop method or ualllg 1hclrownhousehold containers andmeasuung ImplementS, someof thewomen studied In Bangladesh, Hondufas, Nep..1t arl(f the USmUted solutions containing excesSIvely high salt levels.. Withall three tccm c oes some Nepalese womeo propared esoliOllScoola1nmQ so IltI'Ie santhai lt1eyWOl,lld tc rneUecllvo 101rel1 ycl rallOll

" One dil'lculty m Ilvatualing the flndlngs of mixing andmeasurement studies is thai no dolilli tion Or acceptable resultshas been SOl lorlh Is 0110 oo ngerously salty solution In 100eccecaoe In a community-basadprogram? Onein 1,OOO?Isone solution In 100 With an IrlCtlectiYilly low salt level toomany?"

OmIIllIl~_......-.c;r/OlI'Ib'I;IIt/I'lIIDOII_""'" """""',.""~._ t /Ill? ~Aj,n rM;'

"The SVongesl conclUSlOflIO emerge lrom Slud lCS01m illing1$ the Importan<Xl of Clll'etul. thorough, and Il'lClivlduallnstnJC\Ion In Iodonesla most wcrren who had hea,d 01DRS bul notfOC(ll¥9d persona l InstnJc:IlOn did nol know how to ITlIIlsoIUtlons oon ectly from packets In lndOncsta lew ol Ihcpoo(llo who said Ihcy undefsl:ood !he d&rec\JOl'lS on the DRSpact(et could Il'l lact nllll the soIutlOf1 ~openy A few lTIOI'ecould IoIIow vetbailOSlrUCtKlOS accuraiey Allor the lechniQocwas actualy demor6lfaled. howeYu , l~iffly a'llllllCed !he DRSsoIubOfl cor rectly "

'(Jl4l~_'-/OH" Ib'~"""""'" ~' ........ _l.m ... __A(rlIM:'

Continued FeedingA common ruction among parents is to withh old food -andeven bre ast ·milk - during a diarrhoeal attack. But starving acbild wbo bu diarrhoea ca n cause malnutrition or exacerbate nil til1l malnutri tIon:

" The cecoer manacorrent at diarrhoea in the homo alsomcludes. along wilh the administralion at OnTome pl'ornolion01approprl,lle chIld leading, bolh durtllQ and flt lflr a oantceeececee. 10 provent excessxc and uncomponsalod loss ofnulncnls In many SOCIeties the ceeot's ,cnodIal response 10diarrhoea IS to WIthhold food and Iluld. includmg breast milk.III thO mastaken beeetthat thiSW1U stapthe d~rhooaand easeThe Sll'1I1n on IhO 1I11esTlne TnlS ' treatmenl ' only adds to thedettydrallOl"l and malnutfllJOtl caused by the t~ne5$ "

Tlw__fII__..attnl~.....-..oy.,..,~~ ""'CI, 1913

I I"AI children ol 4 mar Ihs or oldor, who naVft beenweaned, should be offor oo solid load dunng dlarrt1oea. Thebeslloods 10 grve31'0 those :hal are e.."lSiIy dlgesled (suctl asboiilod fiCO, porridge, SOUPS, milk products egos, fISh, andwolk::ooknd mo.1l) and thoSe COI"Italnv'IQ potasSIum ($UCI'I asprneapple, batIanas and coconut water) Some la l Of oil mayalsObe gwen EII8fI!hough:he ab5orplion of nut:nents fromlOOd is lessened duflng DIarrhoea . mosto l lne TlYTnents wdlbeabsorbed 110m these toods .

" The child shoUld be al loYoed 10 eaT as much as he wants.Food should be offered oll en (5-1 limes a day) dunngdiarrhoea, because Iho chtld IS nol likely to 001much al each

94

lime The ctwIdShouldhave at leas! one exna leed a day lor awoolI auc- lho OIilfrhoea has stoppocl ,.

r.-- """ __ til «uIII __~ lOt'.__01'_~ WHO, 1985

•.A recent carelul Sludy Or young cl\ildron In I1angladesh,evealed mat. on everese. eachchild soncec 6 8 episodes 01diarrhoea pc!' yea'. Addod up. \tim meanlthCy had oarmceafor 55 days or I ~ pc!' cent of the year Such chIldren Will endup sevcmly ooprMx1 of nourishmenl it they ale starved arinetlma they have (l lllr lhooa. AlUlOUgh dioes!lcn IS lOSS cneenveduring diarrhoea, mere is stili a signi fica nt arrcuot orabsorption of nuulents."

KM, 11IitJi1 1l'1lJ W A M "'1f1'"1!, "(;ar,y o ,~" lJiIlm"....~,110 '5,_r>lJlJl1911~

Safety of ORTConao ra is IOmetimes ezpreued abou t the cfan&en of usiQltoo mild , a ft ill oral n b)'dntioD10111.0011, cspecia ll)' if pveDto the vUf )'O\Ul&:

" 'Il!hIloexcets Of! I\ulcl and ele<:trolyte melabollsm conllflUO10 dcbalo the relalMllhoofcbcal ments 01 each f\uIIj compo$Ilion . espeaaHy itc sodium concontratiOn used IOf youngchlldrco, II ~ lntefesbng 10 note \he 'Mde rango 01sod ll.1ITl tMlhas gr.oen i\COCPIable results '" S1IXMs afOlnj I\1e worldThose uSlrIQ higher ccocenr atoos 01 SOOIUffi (90-1?0 nl8Q/ l)for treatmont 01 chIldron advocate oHel'lllg extra water to thechild, while lhose report,rlg lower sodium (50 80 1TlOQ / 1)generally adrnlt these SO!UtlorlS are too dilute lor onoceverohyOratlofl 01 severe diarrhoea espeoolly ,n aduIIS... Evenyoung dnld,en or infanls requne a l1ighef sodium level dUfingrohydration 10e.pano Olllrace!lulAl f1ulo and ImprOve Clrculabon than in the lalQfm<llfllansnce phase when more nee walolIs rec urec 10 onset obl igatory water losses... 1 tie teceotsceouuc Workmg Group convened bY tho WOf1d HaaUhOrg (l n!~a1ion 10 ellllm,n8 Iho composilion of oral rot lydratJoomixtures tall thl! evocrcc tluavlly lavoured a sodium level 0190 lneQ/l as op timum for a solution 10 00 uS(.'C! world wide "

.,t,,,F/IQ RorIIJII/llllfl.-.... _~"'. ·,()t IJlm/ll<1r-.o ,." ,""""tII'"'Ill ..-ot*...,.,_ n tl H JrlMlftIlfId r H' JrJ/fIff9 /"'d"~A<.MlIlc.. n ...,.""fJ(If)jIj __ "'~I ""*1_ >IfI/ , o•.lorI,t

~"'-, IH I

RehydrlllJon lhefapy can usually be achieved orally WlU'1ORS soIullOfl . except In cases W1Ul sevee dehyd,t1 uonUl"lCOfltrollabie V(lf1'\I\lng, or anolhof sonous complIC.1tton lnatprevenlS SlJCCOSSIIJI oral lhefapy In lhcse cases Intravonouslherapy IS noodcd CAS soIutkln is also Ihe flUICl used lormSIflleOance lherapy Howevef normal dally ItUld reQuitemen ts must be orven as IIulCls ollower salT concentration e g •pIaln waler breast milk, or diluled IT\Ilk feeds ThIs ISpartJOJlarly rmportanl ll'l 1Il1anls; due lo thelf large SUflaoo areaper kg 01 body 'NeIgh1 and l/'lCIr hIgt1 melabollc ralo. und8fnormal conOllions !hey requlfe 2.!:l 11l'l'1eS tnCIIe water per kgIhart 8OUIts,"

"A ...- Ib' fll: __ aI .,. _ ""0 . ,,""(Wf 1O/ CUJ/ 5H V80 i'/RfV "

D A ,ccenl study III Egypl touncl UI8I morhers IT\Ixod ORSWlltl gteal8f accurllCY If a standal"d container was Pf'OVlded.and recommeoded ltIat " wt\Ofl the pre-Pilckagod lorm 01DRS Is dlstnbuled 10 PillionIs, II would be 01grOOl value to

_ ll'-:tuoIod """"'"'""'l <lIl'l........ -.; "'" _

inolNeJonI "

",-... -- -"--"'- "-"'- - - "--_... , ... .'-ORT AND UNCLEAN WATER~ .... SIUdy"" .... n .... e...-. ... _ ..... """

Ol"""'ll OIlS _ 1ha1 .. I1Cll _io-IrolI" 9/...."..,,_0IlS ....-.__""*'_oncI~II_OIlS _ "'""" _ woII _ lroo _~"'__.... l'owD1' __..""'"'*'"' _. W'<l "be _--"--- -_ ......_ __.._ ft

...._--- ,--", -_..'-- ---" -"On .... c.o... 01 ... ..- -.b'mIIICtI, ~

,,.,..... ,.. _ . "..., I>t..- _<long "" _liOO 01..-" (\ 1 ORS _...,.., lie ",""",OIl "'.............~b'I' rtIOOll"'led....- in _""'" _ TIoo<fI _ '" lei .......-don! IlI<lI II>__ lNIl_ .. "" r$ ~!IlIl ",,', ........ III •.. .... r oloriJng-."(21 ORS _ . o<a ~e:l, ...,.., 00 II'<ll<:CIal----"P I •~ bO~. oncI ORS__ 10 "" _ ..-_-"'-',.. .._--_..--..-_.......- ...... '.. '~.. .,

Costs of ORTIt _ krt 01 OIlS MUlIJ .- 001•• rr.. ~ ..."-"'ai-o _. Ia Ik _.-. ...... H _

b .. ...too«<l dlelt " po_ by .wilcloiof, .. 01T>'O f,.. ....""""""'''' _.,... 118_ ""g, ___

_ lIII' COO .",,,.,.. S~ =-"" "" .....SO.Sll _ ORS n""'"' __. ORSOlWI.. \IMIn~ _ ""'_ """" ""' ony"""""" - '" I'ogI'iy - _ ... ..__10 "*~!IJoIaI>I' ,."..m_.... ......__,

..... ....,,.,.,.,... - ....:>. ,-• ..., In~ __

__ i .... .. ~"''''~~!UJl ...,., """"'" """ 1>0 ' ''"''''' _ to< V.--. C>l4''' ~. "'" '....«1 10 __ wolf,....-.. ... _H_....",_~_......__......--_.._-_..

_ __ ,_ .. ... "'''' ... .. .. 1,-'_ h use 01 CR> may~,~" moo, -._ '1Imo"'''' _"'_OIlS "' _...

\lle IOnlI Ie<TII ~ ~""" tor_...- Ol_~.ORS_~__"1llO _01"", "" ......__""'1'""-_..~..~-....".... ""__... nutr-. "

'::-;:.t-.r= -;:~;::t--_.

II LIFELINES: BREAST-FEEDING

Breast-FeedingBreast-milk is the ideal infant food. It is more

nutritious, more hygienic and much mort econom~al

than any breast-milk substitute. Breast-milk alsoprovides a degree of immunity to infectious diseases,as we// IJj having a cOlltrauptiw effect throughinhibiting ovulation.

bt poorcommunities, the bottle-fuding of infantssluJrply intreasts the ,.ok of mabnmirion, inJwionand death. Yet in "umy parts of 1M dewlopingworld, the incidence and duration of breast-Iuding is011 the decline and soles of brttl1t-milk substitute! artrising.

MallY flU-lim affect a mother's decision on breastfuding: tlu adwt and example 0/hospitofJ and themedical profession; social att itudes and levels ofknowledge; dif ji£ulties encountered in breast-feedingilSeli j pritt, avoilability and promotion of breastmilk substitutes; employers' policies and governmentmategUs.

For babus who are breast-fed, the weaning periodis 1M tiltU ofgreatendiJtlger to health and Ii/e. Lilubreast-/eedi"& good weaning maw hea'UY demandsof Ih.e mother; but knOWIng when and how to uxan achild could drastiallly reduu child malnutrition inthe dnMloping world_

Breast-Milk's AdvantagesBreatl-milk's advanta ies include a perfect infant d iet fnr meearl,. months, some irnmunil,. from infecti on, and a degreeof protection apinSI conceptio n:

LJ " Breast-IOO in'Ianls call ihrlve C'VCfl under untlvglenlccond ilions In areas 01 c~tlcnl8 PO'Illrly Tile anji ·mfecliou5p ccertes or human mllj( account tOl' \he very h~h reseieoeeof lhO nurslng mlant lc Ifllecl on in general and In part ICular 10dtarrhea In depnved lropical 8fflUonl'TlCtlts, mos!II1 lan ls growadequatcty. even if lhoy have cxoeoeocec lotal growthrelaroa1lOl1 Of were born prema turely , as Ioog as they 316keptat Ihe twcasl during the rlJ$l 4 to 6 monttls of ~le Breastmil<has UI'llCIUIl mmunoIogIc, nutntJQnal. psychosoaaJ and economoc benehts ..

l...-......... ·1N~oA to"__~~-"""_

__--v CInImI ......""" ~ " ... I

PROTECTION AGAINST DISEASE"Oneol lt1e creet arguments In favou r ol b east leocling has

!ong boon its anti·mfect ious ecnoo . s -ceeuee infanls davel opfower bactenal and vuallnfactlons 01dlgcst.ve and rOSPlratoryorigin than bottle-ted babes. The bott le and tho teat are targretlto r sources of infoc tlon than the breast . parllcu lany fOff(llll llll,,'S hving undel doflcleot salutAry conr lilions The Immed i·ete con8urnphon or molher's milk (from Iho breast to thocnlld 's moultll . wllh no handing, aVOIds lhe prohfet~IiOfl of tooQClms present on the nipple and areola ot the breast and !tiepcoctJll1lon of olf1cr germs whICh abound In the 8flVlfonmcnt..

" Above all, rrotnee's milk prOVIdes direct protection ;IgaillstInflICtion" , arc gastra-Intcs tinal Inleclioll$ in partlcctar Thedisease rate lor mtecncos is also lower In breast ted nowoornsIII HIe wealttlicr classes thall )" u cee fed arli fiCla lly "

(I.M~-... ~ fU_~..,." ..".."', c:n.rn...,.,, .. r~ "'" 1:l8 1U ' .0 I~;>

Bceeercn in iooe and canada lound that 81lrliclaJly 100inrants were w ee bmes more likely 10 conlJad diafl'tlocalinlO(;\lOnS and l'MCe a... likely to suflor from respira toryinlcclJOnS the twO maKI cecscs 01 lnf3tl t ooalh as infantswho wt!I"8 br$lSl -lod (see table 2)

AM_~~IO ·~. ..

_ Itqla ... 13lJ.':nI-l . 0 111'2

Table 2: Relationship between method of infantfeeding and incidence of disease .

Numbel'" of cases of disease in 24 mon ths(NOlA CANADA

AlIment SF f<F SF /IF

-"'"inIaett<::lO!1 57 109 42 9BOtJbs 21 52 9 86OietThoea 70 211 5 16Dehyci'atiCn 3 1" 0 3PneuTIOI'lia 2 B

SF ".. Broast·leeOOg, AF - A1tdioel loading0tUwl11 rer~ •_ _ .a.u..."""- Ar-. 19IP

Droast ITlIlk Is !he best food lor mfAnts, and no subs l lulOfood oxactly duphcate$ rt Sluc!es oi breas l mi ll( and broasrlocdlf1Q show mat

" 8 rOO5I milk p'<MOOs some InvnunologlC3l protectIOn lorthe Infanl"Breast rTll lk best senetce the Intanl's nulrillOlI;:t1 needs" Oreasl- feeding cos ts ess than feedi ng WIUI substltUtP.5."Because 01 Itle Immunological and null1t1cllal ad vantagesof breast milk and because prflparmg substitutes properly "dlUicull in mucn of lhe develOping wOI'ld, breast led Infant:,;are less likoly to deve lop lnfectcns or ma lnutrition" Breast·reeding protects aga lnsl pregnancy , a1ltlough me!engttl 01 lhls ceeeececnve euccr Is not predictable." Many olhef IK!vantages havo been Claimed !of breast-

feeding I3nglllg !rom c cse emollOfl8J lies between motherand d1l1d togroalcr Inlelleclual at:llllty in me r Nlc lor the breastled child ,.

~_og, ,.,.,..wi -.w,. PwoMtl '--'"~_JfII) 2._~IHI

II"Coroc:iuslon:> dra'Nfl frtm mvesttga!lOflS at Ihe re4atlOflship 01 Inlanl loedlog mode 10 InfOC!JOUS eseesc outcomeshave generally been lImiIed by stUdy desogn probloms, byunslaled 01 mprBClse de rin,tions 01 feedi ng modo Itndoulcomo{s), and by lack of IflClUSlOll 01 aSSOClaIl.'(1 - andposs itllcCOIl lounding - teeters If' the analyses Nevertheless,the WClghl 01 the evceoce IroUl less eeverccoo COUlltrltlllslrongly succcns an Inverse assocmuoo between breastfeed ing tlnd overal l mortality, and between breast-Ieeonq anddi,urhoeal·rola tod mortality and morblOlty In the high-risknewborn, FUlttlo r studies Bre noodod 10 charactenlo nJorocloorly tho nature and strenglh 01 theSe relationsh ips ."

,lIwwIn M ./dSlln, """MlIWrp_ ,m,ess -. .~o1I'Ill..r.c:1oCU O'lfMlI-foolll~ 1lI'_"_"""ll rooll'll'Ui PwdoIlI'QI "" , . ... 4 UilfI 2~ 11/11.

CONTRACE PTIVE EFFECT1&__........... ftIlobk_al ......... po;-Ott _ ... _11 •....a.Nt _ lr~1",1 , d -.~~ ...n _,., id,raItl<....... 01 __ apjoo' k<: j. pt<pUI- a ·~ .......... u. ••_.n:..;, .. ... .Oft ..

......01'"- bUdo, _lUdo" .........~..,_

............. _ 01 ........ qI aod lo<aldo,........,..l!<tw;I~(lo:llIyS~_,__•....,

......-__ho_oI..._ , ",_0I1hoIOngI< I .-. "'" iD<Igc< ....... r.....,...-...:l~ ""'"*"_ 0IIeCI Of -.... _....., ,eoogrv,tCl<l trr , ..-... "" .........._.t_...,. ..._, E~_ onIy~" ",",,..._

"'- ~..,..,.......---_....,.-~ .... ....-,.......""""~."""........ 01 '""'""""'" """"""'" Tho.,.,.".. ""'"""""" is ......_-.g ....... ...-.w _""'" II>~0Q00tICI .....~ """"" " _ -. DIll N , .... on~_ ~ " "__OI!omo11' __- --._------_ J ..... .. " 'N'Il ··__~._MWI\I'l._......_oI"""""""_.-.-------,............ l8rWy.- <><:aning "' !""C"""""-. ....or~ ill ....."""' ''.....'__1-_'_-_------ - "" ... ,- '-"'-". --. .. Ghar>o __ 10 ..... _.-.g, ...."'Mdy IOQI'IIoorliW:y .... -.lei...,...,.. tly M _ 00'>, _10.. _ "' .... r>M\;0I~ oIIo<:l '" t><_--.;....., _ """''''''''C .'lIlliCaMIS-"

'..._....._---"'--.. -_... """" "", -_....- ....-,-'...NUTRITION

1I" n. ...-wca ollUl'Oln ..... la ",tald-'SlOmIl......... 11>'"11" _ _ ...., """""'"ra.ot """"'"" lUIng 1M """ ..... -. (II'1ft. _ Ny ,.."~ "'"""""" !or..-""""'" '" ""'""__....-~" Tho _ ~ ....... 01 "'"""'" _ ...... tool 3 106 __01 0" __ ""''' ''.-dtrr .._~_01

<NIlIW1>Hf> 1IwOug/oDl.( .... r"""", ...sWII~~_",

11>1I a.- _ 01 SonIa~ CooQ,oo ..- "'"only ..... leo _ ......,.. dumIl "" IorSl""""'" '"._ lI<.....~. bill"""' ..... _1Oml__""~__ltv.... pro.odo<I1I'4Y '-" .t.... _ rem Il'O ""Y ..... ".,.. 01""' ''''' __ "1Il_ -loci .... _ AI.......s. ",---_..__ .._

_ ...... _ 000:oI_ ... . "",_,..-,~

PSYCHOLOGICAL BENEFITSI IlrlJO\:l~~ 1$ a $Ir1ll qu> l'(Irl ""'* Q!

........ _, __ .-.cl'\rO~ ..., . ..."' '

ll<:tMUl """'* IIrCl <tlIkl .. .....".., The molI'e', ~ ....""'" 01 """ .... ..",.., .. ..-._. or_.......:=0 -"", n'IllUd\, ....,. sqlI~. __ !II' .____..._ ,,' .... , .~ or o<_·

-.g~ - -... - r-.g ..,....,....,.

.,.,.,....,l>'ll_.~ IO"""t>onOonll.___ po",,1ioos, _ CIlIIiINIll'OlOClIOI1 '" "" ....a,

.._ .jof.... _fl!oO<1 ,,_ IO<laV " .....,- '-"*'~ -'d•• __ .,so : l ' _ '''''''''''Il ..., I>oncIong _ _ """!lOI'II ... _ 1lIo< ".,. .., II Il' _ ...... ..~o>Io<:Ooo<d _ . '" ............,...".__ '" bo"Il''''IJIeCIO_ '~ a 'II arn<:o'III__..-.r."""-"",,,",lhoro 10alSO . _Ir>::t_.. INr dur...",.. _ ·IooItong _ .n _ _ ~. ... _..,.._01 ...nino_.0riI' I "'" "'"oro JPOI """,_ .01)0""'" .""' ,..~ <:NIl•• _ ",,0,_ " "'" 25 ___ In'" 1'1 .............~ ... -""""""'ll,_""" .._' '''''''oigolk:atllly_,32 "", ,,,,,,_ 23 Por '*"_ ..... _ ..........10_·_ "- <:I>ICI.

"A rorxtt'O .....". 01 XlC ...- ""IJOOOIO"'" I- .~ .. ....,., ~...,.".. """......_ .... cari'In ....... _ . arod or_ Ihor> "*'-lIl'_ I>r IN """'" _.....,.,..,. ..... __ lOCI """"""'"- la.... _ 0 I rosutQOI\OI> oI .........._.-.g---_ ..un, "'Il'~ lI:*loolC !II' _ <JIt>ln _ ....a1 _

' ''l .. ........- """"'.- __ lor -. pIanno:n_ «11.a11OI'S ACfIJOI' 1ecl .. 1NI0<e0Sl.1I:olOn\I" acdirong....- ........~.....-. AI ...._-. ...(Iillo """" ,.., 0<..... . _ ... IOlUIO W I",,*,," _ .......- __ """""""'" ..., IhoI _ ...1Mo .._ "", _ con ...- .....-. ._-..or.bit """'" ., _ _ ,_ .olel __ 10 "'C:tOI;$6 ..

"""'-"""* - """ "-' ...-y - """""'"".~ _ ._ 10-. In «><.<*- ........ .. III<:nIOCaI .. l"'-"'li <:IliICl _ ,f

__ ....0(1- __.. " ...

,~

· ' to SouIn _ "'" po"" "", 01~_.-.glor 11_ 'e_-_$hlI<JlIY _ .aso_la lO•• "", ..... 55 10otIOLl J~ "",,,,,, 01 fir5l _

'"In Tl'oaoI_ _ '969 or" '919 .... ....-"11"...-11IOIIol ........·""'*'l_ !Po _ M _ - t"", '2.~IDS < _ .. "", _ _ ~..... nllO 17 ~_ .._.-

" toT_ ....""'_ 01_""""""1>',,,,,,""'".............,!tom SJ .. '866 10 &0 .."...., .. lsao llI.owng... __ .., _~ <l«0lI0n ol twas/.-,g 01CI'Iob-on __·tod~ 110m 1' .8 _Ie a 8-" la< lII3n 5 POI'*'! ol __ ..,...,...,., """""'ol_ _ lBradl, e.ty~I._SotI_

~~_."", lor -.. ............ .. ".,_ol _ _ . _ &0 _ _ ."" lor

• 101'O II <Ill """'" ••...... G _

-~ ....._-".,•

II LIFELINES: BREAST-FEEDING

Dangers of the Bottle10 dcniopinc countri es, babiu who an n:c1ll$ivc ly bre astfed a re mo re likely to s lIn' ive thaD those woo are boltle- fed:

" A stUdy 01 1,700 womer'l In lural CtJilc III 1969 and 19 70found lhal postneon,llal dealh rates (between ee am and !he52nd week) were three lime hlgl'lCfalTlClOQ Infants who Slartedbonis feeding In !he Ilrst threemonths lhan among ecee whofecerved only weest m~ OUlIng lhal lime. Because the 1f1lantsWCfe less kl«lly to be bfeast-led , death rates were hlgtlt!famong chtIdren whoso mothers had moderate BducoIlOn,hl(»her ecores, eene 5arlltallQl'l , and prooatal hoallh carelhan ;vnong those WllIlWl a conlffiSl WIth the Influonce olSOC1OElCOllOn'l teciceson moftshty In most studies

" A recent study In ca 10 under ne aosoccs of lheInlomallOOal Fer tility Research Program found tho! ch.ldfcnwt10 _ e bieast·led for 1~ 10 20 months had a 93 ceeeeruprobabil ity of SUrviVIngunlll l 'l8 brIm of the nelll ch!ld, whereaschildren never breast-led 01 breast-led for Joss than tnrcemonths h<ld a survival probability at about 64 cerccru.AIlI1CLJgh the educational IOI/al ot the rnolher also mnuercecchild sui'VIval, the romencc ot bfeas[·!eed lng was greater, andlhe lowe, the rrctne-s educallonal level, i re mere in fluencebreast·leedlng had Among children whose mo ttlOlS had noeouceuoo, eose broasl-Iod lor 9 to 1? monlhs had a 30petcenl hlQher SUl'VivaI probability than 1tI05e~ beest-teo.among ctblclfcn whose mothers had at Ieasl. seven ,.ears 01sd\ooIJng, the oneeoce was n percent."

"'-' ......, IWJ/Ol\' _ ...... '*"""' ~,....,.

_J no 2~ _ a.e.- l td '

SI\JdIes In 100J oountnes In latin Amefica and tho cant).ocan -FJ salvador, CoIombla JamaICa and Drvll-haveshowf'llhatlfllants breasl-Ied 10I1css Ihan Sit monlf1S(Of nol ataU) were sot to lourteeo tlfT'lCS more hkely 10 de In lIle second$lit mon ths 01 liIo !han babies who were breast-fed lor Slitmonths Ot mcec~ t ..,. .JotJu wrny " MI<//lI ..." /OlIfflIII:In llItIIlf~Mld lllf,onf"'-" Itt N /-ft!Irty~ (eIJ ' , NIJIOMtt "..d /'ll1mMlOWfQ<1ucr'::fl """"","-. 197B

A study 01 9 ,66 2 newborn babies delivered arne Oa!jlUIOGonerol Hospi tal and MediCo, t Corure In the Philippinesteween 197 3 and 1977 to.Joo a sllollg eoneeecn betweenbleasl feedIng and oecrcesec lTlOJ'bidity and mortality(see !able 3)

~1ia!I N H U- ~<l!.l!UnD_ "'eJI""""""""",.--y...,~ .JlUl1iIJaf r-.w'~ ....'a ~'982

81easl fedMlKed·tedFormula-led

Total

CONTAMINATI ONAND OVER-DILUTIO NT o be ll$ed safely, infant fOlmula req uires access to a pUle",ater lupply, as well as mean l of s ie rilization and ldrigerauee, Mothus mUlt also be able: to read and Il-ade n tandwritt en illltnlcooJl5, and bave l llffid en i ia come 10 buyadequat e 3DloOUIIIs 0 1 the product. When these condiuoQare not mel, tbe: RSUlUI1J milk solut ion is either cootamiu ted ee over-d illl-te:d

" For mllllY people '" lhe dcYeloplng world the hygl80lCooodfl lOl\Sneoe:ssa-y Jot tIlIl propec use ol ,"Iant IOtmuia JUSldo no4 llXIst TheIrwa fer is unclean, the bellies arc ditty, thoformula IS dilulCd 10 make a btl 01 pOWdeIed mitk laS! IcogorIhan it should Whal haooens? The baby IS led a oomamlnated mrxlure and SOCII l becomes dl WllIl diw rhoelt, whichleads to ootlydrallon, malnutrlliOn, and YCfy allen donlt! ..

_~._ " I"" '_ Il/ " l7l;:lI1QII ... I'''",!'l.Jl/lI''''''''''''' ~ ~_,.~ ~ lot lY(lllsr·~'II '" ItVl~ A"'*"""'~Clrot.l'!fI .... !5/~fi !91l."

An Indonoslan sludy sampled ~3 milk. ec unrcos trom bottlesbcllng used 10 lClld Infants In lour mlllernal aou Chi ld hca l1hclinics Tho !lndmgs

Ooe- third were Jess lhan 50 % 01 proper strength and on lyha" wotc WIthin 20% 01recommended concenlratKlrl BCCOrd·ing to \he maoolacluJer's label

Milk sampled Irom feedrng txltlle!l 111 1tw1 climes was htghlycootamlllated by faecal OI'ganl5mS, WIth only lour 01 53sampIos haVIng rewer thal"l 1,000 OI'garllSfTlS per mJlJllrtrO

S-tool ".. a..- -.oJ _ "1lac:foNJ ___-.Il/_'"....-.v~ """""1l/11q>ClI/~ >d X AiJd 1S6Cl

The CostsBrea st -milk bas an ene rlY COlt 10 the mothel and ilIbelefoJ'C: not 'free'. BUI in cub terml it lepr«enls a veryconsidelable saviag 10 the pool compared with the buying ofinfant fonnula (I« tabl e 4) :

Table 4: Cost of comple te formula -feeding for aninfant :2 months of age, expressed as a percentage ofsalaries for selec ted jobs in different countries.

""""'"' MIniStry Junb--- ,""" ...ff .....

""""" "....... ra '" 21..... 9 10 8G...... ,,,.. 27 ' 2 '0~ OO I88tll 3> 51 2'--- ,. ,. •-- 28 2. ,.Sri """" 63 45 '3..-, • • •T_ 32 32 14T~kBy 21 21 ,.UK (LoodonJ • • ,Yemen 17 13 11

N Il~. 'Modt",r~il'IfIIISF/Ioc:fO'l_"""_W'II/~" &lImI3IIIIi1<1ton:~e.-~_Y~~,M.nnIM-*W.JooIr'd1l/ lropc:,i~ .... 7IJ. no r5.~ /9192 _ _ )'IltlIVe:tlidI':n, (1nJ1/ I1Jr<1I11J1101l, /98'

98

"_ '-*'"<1__""'~""'_.. "" "........... IIUCOloW1ll. D\Il _ OI... _ ...... flIIlIlIO."_.....b _iUa""" <II trIO __, o:toafI'. rft'lgonl_'-..,... ""'l'. l>UI~ .... COOl .. _lc>o<Ong_• "' . W,_ • 1Il _USS20(l.S300 "" ....!ItsI _ .. WI> """""" "","""",,", <0.. ,........__.~ lNO """"'1""0.., .._ .....

""""""" ... roo '....."Poor~_ may __ 11>.10 S200·l300 • _ ""__ I>,.0 .... _ may ......... ._ '0_~. t...- may flOl _ """'-QI' lor_ .. mo,_ . lnoy """y """ .... ""'" """"' .. """" _

""lIlOul """"~ . ' ''''' moy....,., _,..ogar "''''_ ... _~__ A ....

<1>1>'>*1 oI_lMClI<IlI"""'*l _ltII COIlIO\!le!lmoll'....IO_"'~ __ ;" .....~___. ..."" __~ is~"lCOf",- "-------_ J ... ,. __" • •

Mc<J<XI " Tho _ogo~~._ on moik or_lor """"""'"__57 20 .. 10':1>" WID__ """'"" III .. __ Ib>SOI'oCIIOO~ Ire _ 0l,l0 ITO"IrIIy _ (V 3) __

SlI 00 .. 3~"''' II.- fI'lOflItVy """""" "" .....or_.__IIl .... -.l ~

"""""" (S5Tl_ 56 ~ .. " "',, ""'" 0'I<>'lllII\'_"".... .. tomW ·,_ " ' ....... c.oo-,,-. ,_ _......__ .•_-- ~ ....- - - ,,-_ ...-,-

Il''''''''''' , "'1' -. . lIOnS

"""" """"'" ",.. _ " _ 0d00"1l """'........... ,.,.,., _IO_...lI'_\QIUo.. _, "'" 10 lI>O """"""'I' ..~~ l o<lal'"_ .1l'>.>IhOII~ ..... MI bAoI~~_.~_""'_"""01~USS-OOO"'*'" Nldo_~_ n_otICl

-.y~__ !O~_.""""""

Sl?O _ 10 "'" l!C<>I'OI'I'l' .- ..., • GOt 01....,...,...•• """"~ fIIlIUflII u"",..-. •~ ..ana """"" in ll'''''''..........., ..... ond~ ""' ..,_..

....,...---_...__.-- ~.-.,-_ ... ,.. ,-I . ,~_ ..~__._dln"'\I ''''

ICl <II I>"l»$~--.g • • .-uIl <II ... fDIl'I\OI.II ol .sucl<"'Il ",. It<l '"l!M1 No _ .~"""". .. _ _,..._,..... .... l.><:l ~ """"'9

.. ""'" .... rnor>I'\' "'... ' ..... The COSl ...~ 01-... 600 Ie IlOO "" 01~ POt <l8I';o_ <:011 01__. _ 01 _ .~ '" """"'-.,- - '''....-''- _'''_--- """"-,... ',""' ---,~

ENERGY COST TO MOTHERSB",,~""'_I..."l''''''''''' '''_~_.........-. _ I. drmos""& .- ...IKI>lioo,.,..,.. .. ...,J1.ra..r, uol__tljo 10.._01• ....-IboouI_ ... l1Ie _ .....~_,

• ThI__ oI....,......_""'<otng"""""'•.,......... """" ""• ..,...., lOw ""-"~ ... ..._ ... _ ~._~an."

........ao:>ot'/-. SIMI .. oouaIly _ .__

-. opo1I'IOIIC. "'''' • dry ..,., ,....,.. ,-__ , """"_." _ 1IIOl .. 0IlICla<Il "'''''"' _..,.,......-. Sho .. _ "' ".,. cine ... caoo 01.~ _ . ._ <lol...."".,.. I....., '" ,..,"'~_ lOr", ,,, """"l'O~ .""" ......~ ..* <;ogr... .. t ...... '" lacI • ~........."._....._...

~ l: ' ~ ._...,. _ . __ _ _ ... oJ ... . ,~

l'ro'e ..~_--.0001. _ _ "'" 01_-mI< 0Ulpul an _\Il' __~ ""'"_;w _ lalls t> ..-.oily lOw _ """'""

-...... In~-.... """""'" In ...~ In "'"<l!y__ ... ........,"'_011~_........., t> be IIlI<>JI lSOO """1/00'/. 0UIPiII__..~l90""/<l8rin __AI .... _ .. ".., ""~ .....".. lAL9Usl-SotM _ 1 _~ -av "'""" _ ........, oriI' '200 _ /day, Aver._ aup.oI """ _ III oriI' Obaul B3ll "'11»/ ..

~ . "'- 'l..-.. ... ...-"'-- -_.... _ '.....-...---~ ,..,

Factors in the DecisionM.><y ......... pa., • P"'" 10 a _,', _ to brent-10<4 lie, cllJoI ~ ... __ ....liaJ ..ioI. ..... -.. 10 <lit..- of _ _ .. ...,

" " _ " _ .... _ ...~01_ .......... __ Ilf<lOOt!lI' ---,. '-"" ... ...Old .. " " __ '-""Ii

" 1_ " do I . ...~ .... ..... tlI _....". C<>,...... II'''''''''''''D tlIl>\"IDOd """" Iaog _...... ..."......., '- _ ..., ""","" ..,. "'" Il'O"'"'!l~ .. ..... .....,.".,. .. ltw<l _ toUt""" !My""..__ow""""'l/ .....,_..... ...

~ -. to""", _ -.ca ~I!l_ """"'II. lIIOUllII' -.ng ""..,., _ alii ",.,. 18IlIII1 1ot ........ I'll POOPlo•..., 1IId... """",,",*". no. .. _ !I)' • ..- ono_p-<XM:Il:<I1lI ....~J'W"t8tIy_._

..." -.. Of """ _ ... good ..........., """"..... ..- ClOUDl 1Ml lIOr """. <JIll ~"'0I<lprlX"uet ;0 good """"4' ....... l>OOy. ... """"" ..... _ "'"--' r_......__ ~_"'-'-- '-BREAST· FEEDING DIFFICULT IES·l.a<k of,..;.a.';. ........... ei by_ .....100__""'.., J<.diq _ u-

AWHO 0lu<Iy" tI'....-~ . ,.....~-1Vlgary-.en. Et!IioI:>I, "'!l'N, ZOinI. CIWo,~, hiI'l _ 1tIdiI - tQflClu<loO.' __.__ ...a,__..,.rut .....,., ......" II'dot'lIol<l _.-.; WlIlI

......... _ .. It>' """"~__""'"" """"""

....""*"I_1oC lor. """"'__ I~d_

"'"' .... """" pooo;tJfI' """"""" l>j wturlII!aoo1<>"I "'"" by .... plo,,-,.p~.,_..-- ",.,~._-",-----"' ... ..._.. ..._-- ....,,.'"""" .. ,."

•

IT LIFELINES: BREAST-FEEDING

MeXICO " Responden ts who regularty bottle-ted ITlIlk orIOfmula o led the grCilICSl reason 'Of 1101 bteaslleecllng wasinsulfictcrll bre ast m~k ... Othef reasons reported by molhofsfor nO! breast-feeding mcludod breast protllcfns. InconvenlOnce and refusal of the llltan i to suddC the o eeet ..

~" j -'u lItld~ J J.......... ' 'l <:mlll'llC .'''''' _~~ ..."..,.. -.,~ llo.'l.__ " • ..nf__r-'. J/JIJnII d T'<JPIClI/ 1\ld.1~q >'!If 28.Or:tn/n' / !lIl !'

., Women are losmg the art of managIng A successfulbrC8st·!OOdmg relatlons/1lP ~,'h Iheir babi8ll. BreasHoodlllgbec omes so unnalW:lJ tbat they find 11 d ifficult 10 coco withproblems - pain or soreness of nipples, breast ol1QOfgemen\and sucking d,fficullies of babies lJullhese problems can besolved II mothers understand them and have the opporlUnilyto learnhow 10 cope. LikeanyoOlO!skill, bfeaSI·loo<!lflQ has10be learnt. DUI 101 many women. il has becomo easer 10 gIVeup bt'Oasl·lcWrng than to persevere in it "~~....... ·1'htIP'U"o"'O"(lI_~,,

'lie .- DI hi """"" .~ '"4o./on1~ ""-.

""THE COLOSTRUM PROBLEM

" Breasl-mllll1Oi1La1ly appears as coID:slTLlf'. a COflcenITatedycUowIstl fluid measunng 3C4)l'OXlmately 2S mI dunng ee firsl24 hl;lI.q Thesmall amount and strangecolour ol the I'I'IIlk atthIS stage Tnl$IMClS many health woncers ana molher!! Itlloleeling arooous that the mothe"'!! own mdk fT1IOht not becnougtllo leed the baby, eecacsc of ees. mall)' women resort10 pn;llacteat or supplementat lormula The result IS lesssuckl"lQ and lherelore less t:J'oast-mllk supply InmanyC89C9.Il1lS PfOO8SS ends In breasJ-teoc:llng being abandoned altogethel ..~~_ r!lll~ Of _ I /lMdlnll ..Il11l lll.1.. all!IG _ _~ 19114 o..b1l l~ "'_IlI lt ]

LACK OF KNOWLEDGEM eXICO. "nesoooocms wete coencoco as to w-otncr thoy

beheved lofMISwere healthier II lIloy were brelist-fcd or fod aaubetinne fOl' broast -milk. 52% of Ihe sample rllsponooo Iha tbreaSI-milk was belter lor tll o child's health , 2"% believedmilk 01' lcemularoode Infants healthier w/l ilo ?3% tell tt1at whalthe child was led mado no dlflerence ..

_0Ill01\I1C l-v_ r.-.'J 1~ .kmtlmlC'_'"""IIIf;1OrlI .~ __'. onb'lI~~ '" . ....",.""""o:;>n __ , .b.maI 01 Im(J<;II Ptol.ta/rICI.. ~ 2/1

""""" ''''FAMILY SIZE

" in the C39C 01 women ..no formula-fcd. fafTllly Slle mayhave been a oolCmllnant In the leedlng deCISIOn Montformula feeding mothers had from ltve 10 10 etllldrCr'l than didbreast-!eedlng mothcts The demands on ltIe rnothen limedoe 10 IaIgc lam:ty Silo and the COI'lYef'llCflC 01 aIloWIrlg anolder child 10 boltle-Ieed the Inlant may t'ave fMde fTlIIk or100mula -loeding 8 more IIItracIlve altefoahve 10fhese rnotnersPert1aps ffiOI"e Importantly, the eHect ol a gf OOlcr number ofpreglllll'lCleS and childbirths 0fI these woman's health mayhave contnbuled 10Iheu l~or1ect Il'l8bllrty 10nUlse !tie mosIrecently bOrn Child "

~IC 1""'_~ J ~ 'r (l(lflO/rrc: _ _~~ """"" .. ..- /IMdInlI """"_ ... ....'IJ.w...... _ '• .I;lu'm/ 01 TI<JPl;III~ ..." 28,~19Il"

lOll

GOING OUT TO WORK" lactatIng women whoseemployment req oues separation

Irom ~r mtants lace obstacles Ifl many SOCJC\JcS Managinglac tat ion undCf such ceconstancesrecores a comple_ laskleQUlflng haoo oKpression 01 milk, usc 01 Intant tOl'mula orCOW's milk, Of usa 01 a wet nurse. Among tho $lrDtagl8Sdeveloped by employ{)d women are WOl'kmg at horne lor theIitst few momne: worklllQ l]e_lble hours, part Il1ne, 01 shortershift S, eoo breaslfooc:tir'lgat m{lht "

It'm~ ~"" r.""!11 "'~ l 11K! G<<loflt~ , '",lOlS1 l_1lI "'.'lW)lIM'-" CCfll lla<rJIlI'11.10 (QJOffl""Ile<' , Siudin k1 f ..rn/)'f'lNllwlQ , oQj

17 ' "' ~ , "'IlI" l iM l

" Wolklng women roltorate that breast milk 1$ 1/1(1 best tortheir chlldron, bul haveoct yel beenabe 10 mustll r the support01 sccc w In ootall\lng a longer malt.'1"My leave, 50ch leavecan be VlCW9d not asa prl~iJcgc accorded 10 a working molht.'I"as an IlIdlviduat. but as an esccseco et me lUll responSibilityof the entire communlly to uphold lhe need lor mothers tobfeast-teed their reecs- and thaI because of the manyadv antages thaI human rrnlk can ol ler society A WillI,Ied , 'Nellnourished. neallny Chik:l is lIfI eseer to any soclCty Ma IE!fl'lltyleave mosl bo COf1&ldofed B socer lcspoosrbl~ty thai ISassumed rn the aim 01 [)fOOUGlI'Q a healfhy young generation."

"".. r Sclpa 1,. -.bg<s"oI....-....,.~_ _ 01 _ ~Ootim rd55/56 IHI

CULTURAL ATTITUDES" Unlof'luna tOly the West 's eX3glJCfaled concern W1lh

taeaets as sckunloo,ects ISoIten rcecoo upon and adopled byoIt1efsccetes Whon perceIVed prima/lly as sex symbols. thobreasts rrcst be 'doceolly hidden' -whICh 01 course makesbfeast-leedlng ,1'1 public places dlUicull

tbiolJll llellw>q .... I &_1C.Ollr 8t1n1f.toodo'll wi to>_O<'b'd~AoP. 1987

Supporting MothersIf mOlhe rs are 10 be enc ouraged 10 praeti H breast-feeding ,there must be a supporti ve psycholnllical d imalll, sta n ing",ilb health worhrs d uring aad afte r p reg nancy, . ndext~ndiJt& iDIO th e fam ily an d the mo ther'. work_piau:

U"El\8mples ollegislalJon and POliCIeS mat support breastlecdinQ are maternity Ieavo. breaslleecfjng 'breaks' al lhcworlw lO, allowanceS slitter cast! or commod ees- lor [)fognanl women and new memes. llextble work !ldle<IuIcs lornew molhefs. rtlOf1'1Il\O-tn at hospitals/maternity Wards. ChilOcare at the workslte, and a na\Jonal ecce 01 mafkelmg 01bloastrrnlk SUbSlllUles, As the number of women workingou\Sldo lhe home ecreeees, ImplementanOl1 olltlese types 01jXlhacs CflSUCStha I women reee.ve support lot bfeastleeo.ngfrom Ihell health care [)fOYlders and Cl'Tlf)Ioyefs

GII,eo GitlbDtll 1.---. __~ ,\,Ighfs

n~, "Of. ~ "0 J IH~

ADVERTISING INFANT FORMULAThe lDtenaational Code of Marketing of Bre. lI-mil1 SulntilUlU, adopled by Ihe World Health ANtlDbl, in 1981, . imsto prolttt and pt'OlDote bl'ell5l-fee ding aa d 10 reduce thepressures o f . d vertising 011 mo lben to boUIe-feed th eirbabies:

I' "'oI~199" "'CoOo_ ..".,....... _ ~ """ 01 !he IJ\ill ""9C' .. \ 6_ A!ortIot ,. """""*... ,..""" .._ """""...... __ e- _ '"""" """"'" .. '6_,~OI"oasl_~",,"_-"""'"

"""""' .. 13~_ ......__ 'NO' ,_ ~,.,."_,,,

HEALTH WORKERS"""_d _ , -"'" """~ ......-.g ...,. only .... 1"-_ "' .. _ tIUI""", ll'I~~...,.....,., '*'* _ tnaI <loIOO<Jo_ tnasl~ s;,.,."'""" ""....., .. LJItWI__.._ .____-..-:1._.. 1__--.... _ ....

__ .....1Ia<l_'" _lKillIOO-.. ki<oIl''" _-loo<l .... __ ..... _ .. """"' _

""'"'" ..,~ ....~ 01 """"",""""" ",, ....T/Id__ "'"' __ mo, -.._ or_ ·r-long, _ ..... be MIl -.> ""*' """"'"_.--"fWvCll"" ... D' """ ..'" pi""",""" "' ...... _.. _ ., ..-.._ _ '-long In ......

"""", 01 ........ -...~_____ Ireo_oI_Ill-_..-_--.......,,""""",", ill _ . ""_ ..., CIlol(l _ ..,.... on<!__' ........ ' W' , "" ""'*"" _Inl.>nl_ r 1WIII iht:oo po"""",," _ nelp...., __ ,.._. 'OIl .-. _ ... __""!'.~~ -....g.., - - - '- ...,..,"'"""'" _ .-.g.....-- 10 ......... <:af1 -"'"

""'"""""'""""",,,'"'_ s.-.._,.... """""',-, ,.., po- '" "'" "'" ...-_ or..... " :"' '\1 _ 00 """II'" """. _ """"""II Ihe _ 01 _ .--.0 .........ru • .-.,. '" ....-, • '""" _ 01___ ,_ """""'" io .,..,.,... "'_ .. "'"losI •_ _ """ oob<w>g_.~ .... _oong --.00"'__,... f<lOlo.<:<I<l ........-.; .........~ "' '''''' A__ ~...... ".... '" __•• ~ tw.....-.o to U'" '"bOI:Ie-~ E-o<I, ,. ""'"'" """ COW' , _ '" ""'"_ """"" _ ",,,,,,-",-, 01 r..asl""'" ... .., _who• noll"u9\i .,. ... _ III ouoJt T""JoIJo<IOiI"'_....,;t> ...~ _ .-"Ior """ Ill_"""..... Qo1I1 .. """"'ll _ only.,.. _ rn;ry__M

~---....... -~----- , ..,.-..--,..,"Sd'oJoI~ l1<l<1 """ ...

""""""'1\' .....,.., ., be ....""'" """"_.-.0 ..,~, ....,. bIl llilO '" """' _..., """"'" .......m • ..., .... r:<_ ,..,__,

'~ .. """"'""'" __ Ito '"'*"' ..'" """"""'""octmI lor.....o<:y __,.. ""*"igo'lO<Illllr

".... '"""'""""'" """ ------,.,,-"'-,,----"<>:>l/!gas, and ..t>.., .......... ...... """OCY ""'- ._.- ,"'_ --'-"'- --~ ,.. '...EMPLOYMENT

I ·'T,,"~I-on<u~l;gn I' Ol"" PIo"""" .......... _ " aeIIin\I Il10 InIornaOonaI _ '" _

......", """'*'lIand" """,,",",~ .."'_.'" _""1' ''' baooc"'""'"' riVN and " """'" ""tI' .... 0....._ """" -.... '*' "'""*'Ii .. ""'" .. ma....-.ly_'*' _ ~ ~'I _ . ""1"""""'''"''''''''-_"' r:<~_._ ...... _

.~ """ "'-- - '"~ """" ...,. _ .,.,.,....,.,. 10 <b:> ........

0\I0In0I ....... """"" In 19'19. ""' ~ --' 01 "'"_ In. 1Oo'9t ..... .. l\raLII --ml'1i't:.- "'"taw~ _(CtOCI'oosj aI ... _ . .... _.- "" _ .....- 01 _ ..,do,.. ITho_ollabtw W local _ ,." """'" r:<0\lf3m '" Il.m ....__ T_ "'11' " • _ .-- II All COTll*_.-to ll'OY'dII ,.... .... III '-'"' _ _ .._ •••• <II '""'" 2) Wf:<Ioom """""'" _ "'".... lMiII~ In )(* eo POI'conl '" .. thOm _ 60_ 01 ...._~_._ ."',u.'III. .,

"""- ,--_. __ .... ... J '..

WeaningF... . "'" ... 01 "- _m. _ .....-10 00I0o&0o oldliclo., to __ 01 • I:"""iaa <I,nd. If~ W)' loediq io 001 _ 1atI""..o4, ""'" . ....'..... foll """ __ Ia iaf.m... lo.....-

P, """",, .. """" _ ...... ..-.-. 1IlOl _ ·1aO_ __ """"~ '" __ 1tIo ...... _ 01"",. "'"_ ,."""" 01 9 .... 2<"""'" """'*"___I..-...,. "-''"'''''''il--....0-_.._.

'"l 1U, .. """ w.o_ .. --. _ '_IIl IS~ ...... "'" • ""'...-..,. only -.roo 01...._ ~ N ... ", """'" 01 ~ ..

-~""", --_ .......--~. ......_....-...,---,.'"""","':.":.:r--'*'~. _ ......on CrOW1I\

'"

II LIFELINES: IMMUNIZATION

ImmunizationFor as liuie as $5, Q child can bef ully immunized

againsl six of tht most common and cllzngtrousdiselmS of c.hiJdhood. BUI at preunt, tvtn thoughmany countries haw stepped up {luir vaccinationcoverage, fewt r than 40%of t~ /00 million childrenborn each year iF! the devtloping world are fu llyimmunized againsl all ormost of these diseases. As aresult, almoSI 4 million children dit and a similarnumber art mentally orphysu.:ally disabled eachyear.

Many developing countries Jace serious supplyproblems with immunization services. Technologicaldevelopmenu art helping to overcome some of thesebut management capacities needfu r/lIlr szrengthtn+ing.

Immunieatian isas much: a question of demandassupply. Rt ct,u evalUil lUms how shown that cuverogerales could bt doubk d and in many caus trebled ifparents look advantage of existing immunizationsmnces and if thou bringing their childrnr Jor tMjint oa«inalion wtre also to return Jor 1M secondand third.

Demand for immunizatitm can be increased in twoprincipal wayf. Fint, empowering parents wilhinJort1lation about immunization can increase thedistance wJrid lhey are prepared to trawl forimmunita tion services. &cond, making seruiasavailtJble at more convenienllimes, closer to people'lhomes, can reduce the distance parents need 10 travelfor immunization.

These slrategies combined would enable immunization to bring about a reduction of up to one-third inthe rale oj dealh and disabili fY among Ihedevelopingworld's children.

The Six DiseasesEa~h yur .lIIIost" millioa childnm ill dI~ dn~lopi,,&worlddi~ aDd .. ~v.in1~AI number ar e mnataUy or pbJlic::a UydisabJ«I tIlroup 5is vaccine-plCnotabk diH:aKS: dipbdleria, pertll5ll5 (wboopiq cou~). ~taIUl5, lD~nlC:5,polio.1IdI\lben;:uIOlis. F~w~r tho ~ of illfaDl$ io den lopiqcouotria ate fully immuai%ed .pinsl .II-or eyu. most-ofthese diH:asa. F1lI1herm~ om y lIbout 13" of ISIOdltrlilIrthilly na:iaated. widllttaDllI 10:loid, wlUcb also pr«tdl dltatw-bonl .pinst KOUW I~lplll-dl~m.io killer diwlIWill die finl moadl of life;

I 1" 01 every 1000 ctuldrCl1 born IflIO the wodd 5 wiltgrowup cripPledby pclllomyohlJS. 10 die ot neonalal totanus, 20 Ole01 whOOpu'lQ cough, ana 30 or mcwe dIO 01 measles or liscompUcatlon!l These diseases, along Wlltl diphlherta andtuberculOSIS, aro the targets 01 the WOfId llelll1t1 Organll.a ·lion 's E>c pandcd Programme 00 ImlflUf1lzatlon (EPl), and

102

bolWeen a Quarlel' and a thMd ollhc wor1d's c::tllidlon are nowprotOCIed agB1flS1them .•

r ..-dD:l_ lMQt _ 23 '~ ,,,SMEASLES

I I" WlthoUt ImmUnt1atJon, vl"ually 100~ cree children II'!the developi ng WOfId will contract measl es betwoon ee agesot sil'. mon lhs and rr ece years - mo youngesl inlants boillgPfotocted by maternal antibod ies Tho ago at whICh 0 cMdbecomes Inreclod vanes With scca rnrc ecooorotc ccrcnore'where mee Is ovorcrowdlng and poor housing, i t nemlly occ urbefore one year 0' AgO, in better conditions the disease maynot slrike until SOllie nne In the scccoo vear or eve« Ill terCornplicaliOflS occur In etoct 30% of all cases, Iho mostimportant 01 whICh nl ay eeo 10 ooecrocoa. blindness anddearness Those are more Irequcnl and more SOVOfe Inmalnourished children who may have case ralal.1)' taros ot10,*, Of rooo In lhe deVelopM'lQ world, measles is also asigniflCllf1l cause 01maJnull'1I1011 and oarmoea Overall, II isestim ated that some 3'l> 01 children In clevclopIllg ceceeeswhoacQUIremeasles wi" die I,om It Of trom Its complications ."

11 /1 t_DI. \'lIccnt~ .... {II~ "'~ "~IrISI IhC _'s",*,," __...........-.~'_r9ll.

PERTUSSIS (WHOOPING COUGH)'·An 3CUlc OOCI8J\allnlectl()n il rlocnngme respt,atOl"y tr:lC1.

whooplng cough IS very contagIOuS 1I1 1heIirsl week 01 two01inlectlOl'l The spasmodic coughing Of 'whoopIog'/l'lat characeozes tho (I1S88Se 1$ leadily lecognlZed a nd lasts one 10 twomonlhs. Per!U$SlS IS most severe '" cNld ren under Iiv<! months01 age ana may lead to dea lh through poeumoma Of othel'coootoes In veryyoung children, there IS no chaf8C18listlCwhoop so the ceeesc may be dlrflCUlt10 recognize."

__ Wort! r lllCloiflillW 01 f'IbIt ,..,."~

"..TETANUS

D'v retanos is caused by a toxn of t~ tetanus baCIllus andcauses pain ful muscutl'lr contractions and genemli~od spasmswhich In severe cases may reach ue larynl'. end resplral orysystem, The disease can OCCut at any age, but ISP<i"'cu larlydangerous dunng tho eoooatar period Neonatal tetanusresults from lhe con tamination 01 the umblllca l Slump byunstorlle methods 01CUlling the cord OJ by appl lCallon to thoSlump Of maltCl' such as cow dung Of mud The intec tednewbor n w~1 lirst 00 unaoe to suck and !hen be unable toswallow Of breathe Some8 5% of UIltroatod cases die In thejlrst few weeks of Ille "

RII '--' ~~_d",,*,,-,I'll- ",,~_""""I~ _..-. /b:lI.,..r-. t9Bol

POLIOMYELITISPolIOISa wal esease spread by OOlItaetWIth ootects, tood ,

01 water contamlnatod WIth el'.creta In a small ITIlOOIlty Ofcases , polIO Icad:s 10 VarytOg degrees 01 paralysis and,somebmes, dealtl. The0600r Ihc mid at the time 01M'l lec l.on ,the morelikely tho Ifllecoon WlMlead 10 severe COf1SOQU(lOO8S.The use or polIO vat:ClOOS In !he last twenly years II'! dcv8Iopedcounlnes haS markodly reduced the lnadeoce 01 polio ,however , i15 relalJVO Ifllr00l.Il!OCY has lecI 10 IaXII)' andoccaSional oulbroaks among !he un'fTVTlunil OO

s...m...,.,ttl"!~ WorIdr__dl't.t*l_

~",,'9".

TUBERCULOSIS (TB)11''''_ .. ".. .... "i..~' 0 _ ol _"*"" one! _ , Tho _ .....-nb!w (lI~ """" n

_ ..... !tOO IlQO (lI r..e .-. • fICIl ....... ...."~, l>.ll~ . -.g/1I 1i> tIO"""'" 30,000........., f."".""'00 .. "" __ Ii> 18 __.., Ii>--_ ..........,. ..---,~II» _ """'" ol alo<n o;oftol fa ~ _.,......,. ia~ .... ....-~, III 0ffIca<:y n__.... "'"~ l>.ll ;n-."

~"_--...__.._..- ~_ ...--.- ..._---- '-'-DIPHTHERIA""_ "'*.... 01 "" ..... .,_ ""__ ~ol __

-...ol ""' ... _ ;n... 1, . '11 """""",,,, 1OO3ay~~__ .. .., .."... i'JIecl<ln .. "'"-.~ """ olloel "'" '-I .. r-.... .. ..-_-~ ..- -,_.._--,-

The Vaccines

SCHEDULES..-......on -...0 " _ W Noo boo<,-'"-. .... """ .. \OI1ocl1 "'" _ """~ _;>_ .., ""'.- 01 muIIt Dol_ .......Il'IIIty_tr,NI_oI.... _

~a_ ..... ;n""' Me o/ ...._oceurs_No "'"" 01 ""'_ M!IIXlCloeO ""'l bob. !he -.s"""" ....~~ ...", .. - "'" ooon, "'"~ "'" ~ _ I\' _ will ""' _..-. w ............- . _ . .... ................._ _ y tol_IO_.

" f~~orco;orllQO~ 0/0_"'""' .."" "...,..,., _ """'" _ '-' how ooon.... <ri! ......, Ii> • _ P<WIl Ii> tIO\lO' • _ .hrd, or Ic>.n> qeIO (lI__ 10_ ..........lion 01 __ """"" _ .....-.0 .....--"'In • fiI<oO !roooI<II' _ irMIurv.>._ .M-. "" •"- -~ -. . ....... .............., qo::Io ..

---

D,.,,_, ~1lt'IIdl

So--..a ~, Ill;''''--""'-""" flIICIII:n ..", _

......... ilq.o ,I-.....

,- - _.-.-..- FItno9 ........ ..............~"~b<llilrlls;knI 12-15__ ~ ....

on --~, I'fml 0_01 ago.'" _ ol4 _ l'<l(t

___!O.blall\1l--.o,_.g;.oe,.• 4-41....-.,--. ""__•......... I1*'<ln1I 1M 00<:0'lIl_d.

"".. a FiMlS_0I""__" 4-'''''__io~_<Unil""

_ _ d-. Tho"-al"-al_ ..... ...,..-...0.

I ...... I~edo , FoI:rn 3 _"lIgI,•.-01__lhil_oIafJl(t(Jt<l<'>o&." _ ~ "lIfI--..----tliWo;J-'-- , ,*...n_OI~_lroIdo<oio...._-........-.,.-_C_ _~~~

_,-.a_~ ..tq .LJ •......

T able 5: VK<:..... _ Dumber and tim.... of cIoon, adJoini.,..tioo _tho<!, otld 'Iabili\)'

_01 ~al37'C

0;000: free", <NcI.-~_..,..., $:lIbII u3-4 _ '" 37'C n '-' _ bJl nno!"" ....."...,ood .....- --"""" - ,.

II LIFELINES: IMMUNIZATION

pos:sbIc. lOcally. childr en should be Ifllmunl led as soon as1hoyaltllln the mnmum ages (seclabia 5)and.stloUltI receseSUCOCSSI.... doses at !he 1Il1C''lals st\own l lowever. cIelays winbe IflCYltabie tllmfT1l,JnlzalJonscannot be made available on atleast a monthly baSIS, and p1annefSwinooodto use scheduleswhICh best meet Theil 0WT1 cecoretarces

" lmmUll ll a\ioll of woman c t chl ldboallrtg soe IS;'Ineuecnvemeasure In controll1l19 reonatattetarws In areas where mostpregnant women seek prenatal care early enough to be giventwo c105(I$ 01 tetanus toxOId, these sfloukl be spaced aueastlour wool<s apart, Wllh tho second dose at leasl two weeksbelow delivery, A third dose should be given I'll the ne:.;!pregnancy, and all Y chllclren born during tho folloWing livevears Will ro prOlacted ..

"."""'''''10'. WQItl 1Ilo'W!l/lOl'l ()l I\Il)k I~ "-Do;t"'-"'!l

""THE COLD CHAIN

The 'COld eN"n' ~ the name givon \0 the systemusod torslorlng and distributing vaccines m a polent slate from !tiemanulltCfUror lO \I'Ie person being lmmUrlllOO It IS a supplysyslem whtch 1$ parllCularly cutcer becauso vcccoes areS()OlIOO bY heal

The Expanded Plogramnc on Imfl'\lJl"llla\lOfl has tlWlvacanes These are 1) POlio, 7) measles. 3) dlphtheoa,pcr1U$S1$ and tetanus (OPT), " ) Iuberro 0Sl!l (BCG) , and~) totanus IOIlOlCl ern lor women

SlOE-EFFECTSAI with mos l druP. \'I en Dn oc:asiDu llJ kaYe uDdninbletid~R«tL Attordiq to llroe World Heal th Orpa.izatio...bowe"er, the beoefits 01immuDiu.ti on far oUfweip tbe risksof ad "etK rUeUOfl5:

" 0Cspl18 the saloty 01 the vacolles usod In the £PI,compllcallons do occur Although theil rates arc dllhcuU toeslimalo PfoclSely, It L<; kllO'M'l thatlhcy are far less frceucruthan the cornlJllCatlOOS caused by me oscesee themSOlvos."

"Tho cleclslon to WIthhold immunltatlOll should be tak(.'flonly allet' senccs consoerancn of thepotential coosocuenceslor me IndiVidual child and the curl1munity

" It is pi'lrticularly important 10 lnunuutze children sufleringtrom mAlnll1ritioo I ow-gmde Ievor. mild r6splmlO1'Y mrecuoosor dlarrhooa, and other minor noeeees should not beccoscercc as ccoueucceucos to ImmUllll iJtlOO "

bfIco,..". "",I """~"'Uol""''' "" _'" _ .. I/lII H'f"WWIoi)'~~1'IIooo.:c"I1 ~ !>9 "" 1 .......v ' 91f(

" Parents should be warned of lho common side enecis 01IOlmunuatlOOS, 0:he1WlSC U1ey may suspect mat Immuni1:atlOI1S cause 'al her than protect BgaJnst mnoss In some cases.eeescs vaCCination produces a IT\IId levereasily controlled byaspuin and a lash wtllch may QCClJr 8 to 12 days aftervaccoetce Aeactooos 10 eral po/io vaCCJnC, lI'lCludirog aparalysis SImilar 10 poIiomyelltls. are very m,o - perhaps one Ir'l

every miIhon OO$CS neG vaconahon 'MIl causea small SOteto develop at lhc vaconation Site - the SOfC usually~altel' one 10 two months . Rarely, ltlIS sore WIll bocomc 3""--" In the caso ol OPT vac.anabons. lho rl'Ul treol.l8rll'eactions ase Ievct and redness. swelllng, a~ pam a1 the Slte01 Jfll6CtlOfl The per1ussrs component, '" l81e cases cancalise severAlneu,OIogicreac\lons, somo of 'o'oi'l1Ch are severeThese $(l'I(lI'O ,oacbOrlS, greatly publicu:Cd recently, occur farIes& hOQUllfltly than senous side elfocts horn the dISease ItsellIn UnimmunlLoo chil(jrcn

" Mora COmffiOl'l than side E-ltects of vaCCltlCS are infecllOOSatld absceSses cnusod by contammatl!Cl r'IOOdlOS lilld sy-

104

oogcs Wt* ffiOI'e hequantly resultlfY,l "orn Illl8CbOns givenbv1ocaI IIll6CtlOfllSts or folk healels, Ihts problem can AltO0CClJf'" organoed heiAlth Pfogr3mS Progmm peI"SlOI'Wl8I shoUld bourged to roport all serIOUS SIde effcc ts."

_"llMI ~ , •.(1&_' ()I f\de j~ "-"*""".198~

COSTSCompared with the cos t of trealmenl of childhood co mmunicable diseases., the C081 of immunization I• • mall :

" $everol sucee have calculated 1I1C costs pel childprotected or death averted. These studies gene!;llly show thmmeasles. OPT, polio. and BCG ImmufllzatJons are highly cost,effective Immunizations oro substantially rtlOfe coet-ellecbvethan such ott'ler Pllblic health measures as providing CurQh VCcare or sale water

" UsIng EPt C061111Y gUIdelines, al'lillyses were maoo 01ptogmm costs Pel' comple tely protecloo child (OPT. neGjlnIndonesia. the Ptullpplne5. and ThaJtand Costs 13nged tromUS $2 86 10 S10 73 and sccmcd most dependent onprogram oroanlZatlOO health cere InPUt costs and p<'ll)UIallOl'lacccsSltlllily

" EP1 planners estimate It1aI deVcIoprncnt costs In starlingup broad covet"age immUOllalion programs IOgethef Wllhoperating costs once !hey ere underway wi. total 55-15 pertully mmuntled ctlIId In !he 19805 , Mota than hall thIS amountwtII COI'lSISt of personnel cosis. IacIllDCS, and aperahngexpenses The 1es1 01this amount wiI be eeoooo IOf vacones.cold c;:t\alfl equipment. and lransport3tion rPI plannersbell8Yll thaI many duveloprng cccmros can suwtv D8fsoonel,0011"05 and Q08latlng expenses, but that cX1Ol'I\(Il fl;l9OUl'ce$WIll ee I'Ieeoect to pay lor !he taller Items In the poorestcounllies, lhal IS. vaCOlles, cold chain &qllipmenl, andtransporl Will nood to come from externAl donors "

1fmIl-. WcnII...__ <II PulJIIc ,..... "--'"

""O " lmmunilahon mone of the most ccst-cuecwe measufes10 reduce childhoodmortality rt uamItself pro....des a powerful)ustillcauon 10 proVIde the necessary finanCial resourcesFurthefmore. the resources required ale nol large WIIQestimates e et II costs US$5.00 to $15 .00 to fully Immunize achild. and as IntO lll s \4Onorally comprise 4% 01 less of lhepopulation, a natlonal rmmunil alion progntlTlInocould be IullyImptemeflted lor an Investment of approximately USSO1'0a 60 per capita"

HII ,~. ' 'V,1CCnoo ~1b/II *'- tJI rIliIfIltM .NOf'tIl>/Inl· . ... l'roN<:'*'1",,_s_. _ ....IlImncn'r""'. flbr:la:lob~ ' .!IM

Ensuring Supply11Ic tcdulica1 aDd manquial difficulties ill placio, i.trunuaiulion at tbe dbpo5lll of parUb aDd chi ldnQ an: fo rflli dable;

" To organall , orl a continuous basts. lhlllr1YllUf\ll8\lor1 01severat m~lion children dunng !helf first year 01 tile whclhcttI1cy be In CIty slums or desef1 camps or mountain villages ISiImanagement problem of fOflT\ldabie d1menslOOS. Add to IIWIdesPread W~ler8Cy. inaetllquale loads and transpcwl sysIems. nsing fuel prices, budgets!)' cutbadls, lack 01elec tr\cltytor cold slorage 01 VacCInes. and ovt!f·S!retched healthservices often reaching only 1'5% of the paputation. and we

STABILITY OF VACCINES' 'Tho~ II!~ _ _ ~~ """,<l'I'O<l

E_ _ fQI ""'--"_.,.,~ BCG._'O.M _, _ 10 loghI .. .... .. 10 I>OOl _

_ <:on lMl """ rro<d'" 31'<: .-<1 we _ ..<ObJrod goass _ 10__ ... -.. ..-01 uIlr_'¥-SonDo IlIlIO, mDIl '"""'_ ~•• "......____ may till _ .. 3 1'(; !or """ _ In.1II(:r~ W!I~~""""",,,no.._01 .......... _ ... T.. _ ;Omore_1O_ _Id_IIt1I:I~."'_"'~'lOw_"" • ""''\l8'...._' .. """,,- • .,...SO"""" ~ . .. II! ...", 0Uf0II0n."- _-~----_ 0''''' '...

n " ",__,..._01__..... """"_,_,_~ !>oingPl<l'tlOOClIO.... EPIbyVl't'O

or>:ll.t«:£F ....... WHO_dol'-'ll_Io_"1110 1 _ •• "-,, OJ 3rc """'~""'~A.... """"*'1Jt<>n.lI1eY """""" ""_oocl_.-:1_.-""'ll ""' _ .. .......- """"",""" _ ...- - ---- '"'''''''' ' _........................._E_...__ _...tIII~ IO_......... 60'C,~__... . _" ...... So.. ...,.,.,. _ till _ """"",*,"

~",--- -,,-::"''''''':::::_....."._'_M_ .. _...v-. ,,..EQUIPMENT

·'T... QUOIOy ot.... """ _ ... _ ....."..." _ "*'_.-, hoe """ ..... COICI_ .. _ ..........mo1'"' -... ...·CI:Ir"""-. "'''' ..,__......<>l 02 'C T'" """'" """ ot , '*""" CIUI ""

~ _---.",..-.....,.._ , ",.. b '...... _ . ""'u....cl,... . kwl/'GO......_..._- "'''''''''_._--,~_ IO__""' ... __ '-'li__"""""'""' ...__b ~OI_,_ "' '''*'1_ '''__

'"Tho "'*"'_...., o:toocmc"~ """" noI.....,.._,IO __ .... QUOIOy ...... _ ...

..- n.. mcol ..,..,. _otI_ """ """,,"b. II!

... """""'"". """"'" n-~ <ha>Qo c-.. .....,&<PllOOll 10 _W'CS ....,... .. _ ,.., IIlOlII! 18:-

" .. ,... oOIcl "" _ age ...... pariod '" ""'"q~ 10_"'_"-~--~--_ ...._ '" "~. '1'0>

NEW VACCINES"'__ot__, _ _ """""""",___ _ ~ _ ..... .,.,""'W·1..... ... ' " _ ... _IO..cluDo

.......-01 _ _ 10..""""__.....,CIo<'ml EPI _ ....._..._--"~ ..._.. ....-._.- ...-_- ,...,HUMAN RESOURCESL.odo. II! 14equa1< • ..·1 _ ..~;. _ II! .... _om- -.....1_ bl'1brI!I'l:

"0.""" ..._ ,*- ......-1"...~_,_1l'PO''''''''''rrt_~_1ogdIoaI~_ ..... ..... .............._-_......... _...."'*' !tlIlocl..,lM;l Nl__...-nborI 01 $!On rQI""'" __......P'OlI'_, """ "'"' ,.,......, .......bOM """liIol t>o..,oI:D1 0Cl talO gMln '"~OI...~ .. __ ... _ """"""'" 1Olt>Cr ......~ , _ s..,..._, I<I1lIl

...,., ""' ..._lot... _ ,"1 ... _

_ ....__ ...0 'I'"'''''''''''The "*' ~__".. lor _ ....,_.....---'"Tho ~_ 01 1 7.000__~_"'"

... fPl .......".".-.-II<.O ....__.................

.., ...~ neWill'S""" ""*,,IOPOS00II1tlo,......- ,___"""""""'_"' 01

--..,---"""''''' """ ..... ...."....,...".".,. '......__""""'111"""" n... .""" WtwIcl_~, """"'""'ll ....,....._ ...01 ""' EPI .. 1ll!2. icIono_ _ 01_..-..- .._.._---_ ..--Il' _

H"_. ,__ ~ _ _ . ....'-'-'-'-'-'- ,...,

Creating the Demand...........,..- ......... oo""""'._ 01_.'"~ AWHO_ OI6 1 __1n3 '_ ... _1918_'!Il:I31ounc1 ~_

_ ... .... .... 1twtl lJl>T 's-' __ ~o ....,<arI\J"lIl lrOI'1 ,?"" "Sorw!goIIO 6O'lo 01"... ., ..... _- - -""--'''--''----- ......- .._-l':1i""' "" - "If'''' __" <M>.f _MOTIVATION

' 'T''IlQII_ <lI ,_ _ ... '"' _lIwcl_OIDPT _ POI"" ." I , 10"'"*''''''' ..."""""' hIS "'"~ co Ill .... 01 <\ll<lJtIing _ / 01... '""'"_~ "'" long woilrtlll ..... 01 _. ""' ....... clIlM\I ner W>l1'iM",,_._-_.._...

-~- ......._._- -""- -,...·f .. _ C'ot'Y .,~ ....,,,,", 01 1l'\lO, l'Ie~,..... .... r.gn, _ "'lreOIonwiy.." <011 01 .... _ ......_..~ """"""""'''''''''''-''''''--,__OI............... ""'IJIlO'IC\'t.->g '-_......,hI""" ... "'._, OoIwIwing .--....-._,,,...__ ,-.,._In.~Il''''"'''

SIrOnII'1 "... .. 1Id 10 _ ........ _ , In ...... . ...... lot

'"

II LIFELINES: IRON, IODINE AND VITAMIN A

~. lew will lra ve! more than a lew kilomolers 10 a hoallhcItnic In order 10 ob talf1 VllCClflaIion "

UlnolitI '-' ~_""""-ll:It>tt......,_...., n "-1ll ""' __' -"' _ arJCl_, ~F1ulOo """. 19114

TAKING UP THE SLACKTaking up the '.hlck' between available immunization RI·

vices aod the proponiOD of children actua lly immunized canbe done in lWO wayl :

"] 1)PrMlslOI1 ot me servicesat a coovenlunttocr nlcn nearue residence 01 rec ipien ts aro at a con voniel11 l imo ; lind (2)acuvcororncnon ol lhe service being osereo. When lmmuntra11011, lor example . Is broug ~ll to the rcsoercc at a lime o f daywtIElf1 vWagers arc notln the fields01 et the markot ecceptaeceby 90% Of moreiscommon Comp,lIatlleresultsareobtallled i!immum2alJOI'\ IS offered 31 coweocnt assembly poin ts whieharc not 100 dlstanl provklod s-et the program IS well org8.rllzedalld promoled Roma,kably h'Oh levels Of acceptance havebeen acncvec when oducahonal and promobOtlal methodshave beenNllaglrla llve. "

~t,"""",-, ~__. .. _ .. ()It

....,. ,...." ..." ...~ ... -.11". "'*"'"~_

_ .... ~r_lliIo!4

Parer11srlCC(l two lypes 0 1 IfIlorma\JOlln ordef to be able toullh1ermrnunoalbOn SE!MCCS

" Genef al IfltormallOl'l rog8f :Mg Immunlzable dlseascs. thebtlfll!flt!;C/lldpOSSlOle StOO enects ol ll"lOCtJlabOOS, and tho needfa repeal ccees, and

" 5oecllic rotes , wee .and locattons and cIcar direct ions Oflwho shoUkl come lor oactl ImmurllZahon SCSSIOI'I

"Parents and otherS who bnng chlldfcn 10 be lmmlnledshou ld know the followlng• whJcn dl$OOSCS the Immurnzabons protecl 898mS\' thai lm

munIZatIOnSw~1 no t oroioct aga inst all ceeeees•• whidt ltge groups are to be Immunized and whVother age

groups are esc'ooeo.lhe rcoe lor repeat doses.ltlat Immuni7.01l0ns are sale and tbat 8l(lO ClfuclS Iiuch astOVCI, 010 Signs that the vaccees l'lle WOI'klng 10 bulk! tho lrchild" protectlon: andtnat vaccin es do little or no good once a chilOtiasccmraciedHIC clscase."

..,. ,.....~""'.., W~ r~a""" at F>iJb/I(; 1III.1IlIl "' ''''''''''~1911'

ImplementationImmulliutioll eewen~ is m05t eUttbn whea offered aloll&with o ther , mutually rcinforrinl; primary bulth care (PHC)$e:rvic:es:

" While Jrnmunll8bOn seMCes can be dellYlll'ed alOne. they31'e besl oeIM!ted along WIth ether serYlOO$ needod byd\ildronltl 100. Ill's! year of lilc. and ty prcgoanl woman the pcfsonswho constItu tc the PfKlOtY groups lor pnmary health ca resetVIC8S IfI lhe deYeIopog world In add'\JOll tothe fllOOIloong ofthe growth 01 Ihe child. the use oj oral rehydrilllOl'l to Irea ldl8rrl1oea and the prornobon 01breast-leed lng , lhese 5eMCe5

106

may Include mala rl8 treatmenl and proptlylalllS, and COIJllSOlI.ec W1ltl respecllO C'.hild spacing , no lntlOfl d lJ"lng prognancy.weaning, c lean water and san ltal tOn ..

Rj l ' -"" 'E~~ ... l /Ie_d ....~,~ 198-f O>:fQrO'~fl<ta 1geJ

INTENSIFIED STRATEGIESn lnleflSllied Sllateg~ have been developed In seveat

countriesIn an oHortto raise immurnlalfon levels mow raPIdlyThese inci lido

I Accelorated Implemenlallon or c ll is llng plans2 Use 01 periodic rounds ot Intensif ied act,vlty3 . oeeenenco 01 one Of more days each year as 'NlIli onal

Immunlzahon 08','5 ' , on which children In Ihe tarae l agegroup are nn mumzed

Some ellorls have been ell tremeiy successnn. wh ile cioeshave had loss Irnpacl lhan cesreo. POhlical commi lIT\OT1Tlromlhe hlQheal levels has been an eeeeonar ChilrACTllf ls l1C 01successful tmplomenla tl()(l~,pohllCal comrm ln'lClll bY II·self is Insulliocnl Wllhout coocorma nt managcrl8l . tech mca land logiSbCaI support . To have laslJOg impact, Imml,ll'llL8 ll()(lPfClglamrTlOS must be oanof the goroctal health Siruc turo~~ I.... of ....,_~__ __~-.,.-..71-a~ rM .f _M ill rfNl5 /E1'l1'GEH115/ 11

SURVEILLANCEO " lmport8nl .ncreases IflllTlfOOritlallon coverage have cc

curred IT1 mosl deve'ooIng countnes dunng (I)c past decade,and ecee oceeses are now being aceelefated In several 01them Although many cccouee have surYOlllanco Gala adoQuale 10retleCl disease /flCIdefICe trends. lew OCVI:lIODlng oou nees have surve~lancedala adeQuale lor Pfogramme management soveaeree data , drawn either from Itle country itS awhole or from selected areas , are needed lor U5(I by EPIm8nagefS at ali level s."

1fQ)cVf (II "" f </!iIft(1ad1'roQr,""""" <IrI ~,lIOtI J*1I»I __.......~>2 1 -2bQr_ r98. ...~ WMn, lJ;~b /l- I ¥/.

(l( NI"/ I/

THE COMMUNITYlJ " rho Dil rtiCIPo1 11Q!'l of commomuos as acnvc pa rl no rS In

planning, implementation and evauauoo ls cr lJ()ial tor itesuccess 0 1 jmmunlzancn programmes. and IS a hm damentalstrategy !Of the developrnenl o f prImary health care as a wholevet commuT1l1y Involvemen1 etme lccet level. lind lhe scccess01'soc lal marketing ' 8pPl'oach6s at nanonal kMlI , reqUlrOLll<ltlhe health seMC8S have tho ca pao1y to make an adOQUllICresponse to the oemands whc h lhcsc actions gc OOfa10 Unlcsslhe logi sbC support nos boon well planned. useB may respondto appeals throug h communIty e eccs or the mass rnod l3 onl y10 lincllong W3lltOg Iinos and no veccoes al thechl"llCS wh ICharesupposed 10 be p OVldingserw::es. SchooI leaChers. reitglOlJSIeadets and other opw'IlO/1lcadcts o l lhc COfTWTlUllItY need 10beIrrvoIved $0 as 10 encouraQll a lull u t~l/abOfl 01trnmuncal.tlooand otI\eI' prrnary health car e seMCeS~tments In !hcs(lareas. 1'!c:JWcvef, Will need 10 go hand In !'land WIth IfwestmenlsIn tralrung and StJPflMSIOfI 01 the heal th SIal! "

11" ,...-- ""'-"'11 ......_-. ~_rJJ.. .wr ..1~"_.<=I'IIbm, .....,.,.................._~.. r........fU> . I!illf.

Iron, Iodine and Vitamin ADtfirinocia iN My ..im>N",t'MoII ,,,,,mm.u 16

~;,k "lit! ofdt4r. au diulbilil)l OJO""1 (Mldm i.1M dn>tl~", "",hi.

/"'f'I'WUtI """Un' OM dild", . \ d~u ",;/.lptCiji( ci"I4/II'. Imd "" 0 0/ ,,,pplt/flt1lu (1m tit 1/highly ='~f!«li... _ ... 0/ pro,,,,,.., <Mldmo',/iflt. "JIll Ilnlrlry fTOWIA.

F« tumplt, i"," ,,,ppkmtnll ",. pt'tlltIIl.",,,,,,,.i<z; io</i., ,,,pt>u-..,. ",n prn!t>ll ,.,;r.. alldiTt/i.""'; "..J ..",,,,i. II ,uppk-.." ",. punt• •blind1ltlS, <m4 mJIIU 100,. ditlrr/wt"/ IlM mp;.allny'./«""''' _1M ,........iJ1 <,,~ of tIm/. "mlJnl 'M' hiklrno of 1M dtutlopi.., world.

Iron-Deficiency AnaemiaW_ 10 <I0oI. <-..u..n. ,........ .Ioilolfta ......p«...., _ _ .. Ito. d'Ii<Kao<' __

A -'I """'" co 500 _ -'""" ..~""""""'" _ Il>M C/wIa _ IhIl ' S'Io_llf\lU1Il 130........ ..., ' - 00yl0t>i0. """""""• ..,.. -.. ""'"" """"'"hOO ",. "'" _ _ QrlIanir..- .. _ 01.,......_~_""" <OIACltlt

-.:oobe<l .. '_'' W","""," "" -..eM 01 .... ..., ..............- 9''''4>1 "'II "'9""' .,.-- _ g«II4I00>0n;I "'"" ""'"'II~ ,""" __o'r__ 01 ..... _, .....- _ . _ in "" c:aoo '"_~ 01 """""",,"",_ol_

" n.. <lo1iIy~b' _ __ """__ " "" last_ "' ~ '""~ """"'"". Thoo ..- eMr><Il tlO "'"' 1:»' (lool-...t>ul .._I11_,...-;y"""'_,_ 11&___1InIl '*'Nt<aI-...-CIl"",....... C<lmII""'" ..... .--.._low_Wr1 --. oroJ/or!rqlonl~-..

~-.- ...._---~-~-_.__ .._-.....---"".,"" ~ ,,'.,

[ -..... toe ClWIIdO<_ '9' ol """ "''''''''"'Y ............ lII»Ia01 dUlCG"" __ IN,.......---_._ ~--_ 1i\lO,__ 'II '-'1\1 OlIO, """~__ _ "'''' • llO'\ICI.OOIIt ' 'oll" ....,_ ~ '-' _ """ _ 200-

~50 ........ -=-> """",, lr<rn """ ""'<:lin<)' ......... <J! _ """"""'toP«JbOlJll' Ilb:>ul""' -.-.. " OOy.....,.....,_MlOul 500 __.......".. 10 """ 00""""'" F_ """"~ ......_ *' _ 1"l"CI'IIY b6"<l .. P"J',Il'lInI -.."

-~-----__ '....

"('10 -..., ~ SJIIII!I' 01 """ .. _ .. <:oPO-._..- llI' _1l'O"'I'- DIo'Jrol"'fWsI_-._""" .. """" lO """' ...... _ . E_ ..... """"'

to CBM,""" _""'_........ ""......"or fMrl """""• .......,., .... _ ... III _ .. .,..'"_"""'or~_or ..,_"

. _-~ ....... -- "......~..._"" ",,,,EFFECTS OF IRON DEFICIENCY

. '~ .. III _ """' IeOdlO-... llUI ... to'""', • 0001, _, 11'__ or> "'"~ one~ t>eI1avI'" ...-"",_tolll_E_ "'IJ'V""" _.........,. "'" _ cI __ '" 1lf(tg<\8I"C\'.__'-' ........ ., ""MOIX>01UO _ ...._.... 01...._...,_~_~·,,- ..,..._.._-~- ~-_._--.._----_.......... , ,-0""'- """-...._ ce_~_........ooIogoCIIIlI.o>C:IiOo'I _ -.0 <NICOmO. ..

""" 01 thOWI .I ............... "..-... -.... .. _

"'Il """"....:......- -~ _,-_.......,,-,...I IT_ ,0<81"1 ....- " ~ ..... (0l'Pl .......

_Me<! hI .... _..,.,..,.."., _""'II "'"~~ "'_0\10 I:foI<lr<f't... , ...-(--- --_.._-.o".- rt-.,"

' 1lII\ll "'"" two"""""~_""""lhaI."............ -,"""""__... ". """""""'.""", ... -... -.oon,~. or_ .,._I<>' .......,." "",,,-, .......bot _lid t>,....00_...----,------""",----- '---_..... "'. ,...

Causes of Iron LossJaf....... "",.lfibot< 10 ..... _ .. __.......

__ f ""l_ ""I ' Ie. _. dcpleot _ '._.-INFECTIONS AND PARASITES

"~to . _._q _ .. """"""'___ .._"",..,~,__Ior

"'" _01 MlOul 2~ .. "..,. ". "'"__-., . ..tlnI>nl, _ '" <lOW:!..--.. .. _ lOl!lOl'ng It<Im.....-..h.~."~__ " _ .. __ or.

__ ........ _ J"'."'\I _. _ """""'.......

I'UnlI<:n --.. ",.., ....... """""... " . " Ilj .--.; ......., .... (>:;nO'_ .,..", _ .

_ C"'- -._~... -" ft ~.

'-"'j-~"'------'..'" .. h .- .... """""' .. _ . """"""'" oror • __ II> .. dIro<:tI' __ II>

,.

II LIFELINES: IRON, IODINE AND VITAMIN A

hOClkw(lH11 Injection There. 1$ also a strong associationootwoon ~ I""f!mla and mil lari9 "

t I~I~""', 'PIll "',....~ n.r ''''"'1IOI'af 001>/,""1~, ~.I "'~>q ....... _ " wu _ .... ut ",,~il.:IIlIo IflIor,n.>bQo'"~lJJ_ oS/~-.:s c..'li'lt'/)' . wY .1.'>, no;> I US"

FREQUENT PREGNANCIES"In Oangkok. the pl'eVOOIOO of anaemia ,n pregnant

women doubled aller ttle 11'1lrd pregnancy and increasedfiwllold Ittlet the flfth Pl'egnarcy "

r~ rllol~oI~_ ...__ ..~_ ..~_nt ....... .-.~ I IidlI'I sa-:. 00...". "'" 3.'> m ;> '84l'

Preventing Iron Deficiencylron-d ElicieDC)' anaemia re lulu from poor abSQrption ofiron in the intestine as well as inadequate iron Intake.Preve ntive measuru may take ll<tvera l form, :

I I" AbsQfpllOrl can be locreased Oy changing lhe oet.but itns approach is Il lll iCull lu p ecnce owing to oatl"l'l hAbitsIIl1d COSt l hefe arc OthEl( mothods of provenliOl'l; lhO regul aradmlnlSlJallOO of an won supplement BS a meocoe. and the8\JrJIhon ol llUl'I tu a fOOClSltJft _. Research ISbeing camed outlI'l devcIoptng countrIeS on Inc poss. biIily 0 1 addllJg iron 10oornmonly used soces and lIa\lOUl'lllgS s.x:h as sail !ish$8UC4t Of sugar, but II 1$ sMllOO oartt 10 say whether Of not thISapproach wtII be successlul In many dcvclopong countnes IllSImposslblo to fortify food ....'m won. consequontly , heallhaul hotllleS distribute 1l'0fl SI.QlIemonts N'l lhe Iorm 01tabIots 01s.,.,~ 10 the groups most e t ' lSk. I e ChlkJrOll and ptognantwomon .

£_ rJM (}eM_ \'Iwnn IIN'........,.;W~" \1olrtl'1_ (b:;JIw rSM.

uesoes moascres 111 5upPlern0l1llng and OI'lllCtnllg jcccs{fOltlfica lIOO1, IllS Irld ispcos.1t'l e to ocvcioo general measures;'limo<! at lI n~umlQ a neunooatecn Sllpply, such as• llugrncn1ing lhe availab ility ::If pro teins 018fl(m..11 orig in,

IrlCroos lng the ccoecmcnon of vege table tocos rich Irl(ron,such as groon leafy \'CQCtables and beans:IlllprOVlng the llulr,tlOfl ooliCllfion 01 lhe popolatlOfl and ,0001/8 All, looming to mOKe bcl1er use 01 avwlable resources;

• lmPICWlIl!,} lhe distriblJlIon of food If! the farrnly gtoup so thaIhigh fISk subtects fpa rllQJlar!y prognall! worneoJ gain ac ·C8S$ 10 l1Iltma l prolclns WIti' 1I high IfOfl conlon t~ .loom S ~ _ C Rou-.«l ""'*-"'11_ . 0IahIt ...... ,_ no 13.1 INr

Recofding the 'esullS of it piIol prc,x;1 In rural lndta, theau1t'lotS observed

[f" Poor 10 the usc oi oommunl ly hea llh workers foranaemia SCfcelllrlg and nOfl and 10I1C aCId dlSlllblJllOfl ,anacfflla was VE!fY common 1'1 prognancy , bClllg present In66,*, of 64 1 womon deh\l6flOY belween AUOusl 19 77 1100January 19 78 FollowlOO thll lnlr(X:Iucboo of screening andtreatmen t by lhc community hoalth workers, the prevolenco uf811a8111111 fell drama tically, being pra~nt in on ly 20% ofwomen dellv~nn{l betwoon MarCh find August 19 / 8

" Thus, the result !! 0' using communlly l .ealth workers lo rscreening and treatment were hlg lli)l satlslac:tory Tho cost 0/e.1c:tlscreening test wor ked au f alless than one US CClll (0 .06

'-I108

" In sum mary , ou r experiCrl(;8 suggests tha t , WI1I1eoec ontc!taming li nd llSlrlQ appropria te leclmology, commu nity hooUhworkors can ectoon lor anacnua In praonant womerl and glvoSimplo lroalrnen l , provide adVice Ofl l1utnliOn, arc makerelOfrals lor more In1e!ISI'iO eoaweot as IllCllcated . Mo!8OIICI ,they .1pprOClu1e being given an opportunuy 10 play $\lch enIl11pOi'lant role III malemal iIIId cnlld health care, partlcu 'arlysrnce II enhances their credibi~ly and pre$11QIl m the (,,'QITlmuruly ."

l.IItlt9Wl_~ l..w.plDM ........,.".,-nonIO....""",_' \t\'WtI,_~ "" s.., , I~

Iodine Deficiency DisordersT byro une, tbe hormone produced by tbe tb)'l'o id cland, ilessentia l for the physical a nd mental devdopment ofcbildrCQ, and dependenl on iodine intake. Iodine defic ienc)'disorders (m D) include goitre a nd c rctini5m:

" In many OIOOS 01thu world , mAmly In mountainous reg ions ,the soi l and water are very poor In 1001r18; if the populations InIht.!S6 areas are dependent prlmarlty on !he foods produwdlocally, lIley mtly 001 eeve enough iOOIl'lO In therl dlCl

"ln an alfor f 10 COInpenSo.1l0 lor thIS dolicleOCV. ec thy rOidgland I,Ifllarges SO !tlat II can utlh79 lIle available iodU"Il!moreClflClOllltV and produce enough thyrolllllC ThIs palhologll".alcriotgemefll of Ihe 1hyr0ld gland is known as goiter, wh IChceseas as a swelling on the lIonl 01 the neck ..

... _ QllifU' oJ IftII D "'*" ""*'-~ 1ft"'*- ~N.oIIMJ~e.:..-""eo.ou.i;o/OI1"'{ACC/SO'JNSlj

Tho tul ly deYeIoped S'fnclrofllo (01100) IS on ly lhe mostobvious marn feslallon In a whoIo range 01 oevetoomOl\taJceeocs prevalenl In gottrous COfT1mUfU!lCS - exceesscd ascombina1JQnS of retarded menlal dell8lopmcnf, heam'lg esab4llties . spooch disorders. rlOUI'OrtlUSCUIOI abno,mallt~, COOldmalJon detects. and poor pI'1ysJcal growlh I he 111010 severetile coro dcfic:~lCy, the mo re froqlJt:1l1 IS endemic cranoIsm,"

'/ r",,, lHk'ICmK: UOi'rt1t h' ocrinI' <fI!"""'~ _o1V~ l,lII<'d'""~ 1 2~ 1 983

" It sooms thaI In severely core-ocrceot area s lhe IOdlr1llstores 01 It1e mother's thyrOId bccoee more doplof@(J Wllheach sccceseve prOQlllJrocy and laCtalloo , and I"oOf lhyrOldaccumulates IOdItlC more avid ly It IS a nold exoeoooce thatthe scccessee ch lldrCfl are usuaDy more relardod and l.-laltyonI'I' c rcUns are born: ·

JllIMt~ ~_"'*__.'"<.t_Of'''_....-...-. . AmoIllt lll:Mcw'of~"" J . 'Bl3

PREVALENCE OF IDDThollgb fIIOltly limited to fIICMl.ll ta iDOU' rcJioas, Iodi nedtlide~y affects lUKe oumkn of people; .

" In 1960 , Kol ly and Snel;lclcfl estimated lhal tnere wefe200 million gOl11QUs P6fSOOS work.1wlde Twenly years laterMatovlnov ic 's flOure lor tho less de'lC\op(l(:l wglons 01 tll0world was 329 mi llion, and IhlS IS probably an unc!erestlmatoAs lor ondomlC cretrnism , it Is 1I11poss ibie 10 make even nnilllcJhgcnl guess Thoro mo said 10 be 1-<' million cro W1S IrlCnina alorllt III some Soutll-fast Asian tocal ltles , up 10 a thlld01 the population may be hypothyrOId ..

"'It>'>' enrur"" g<WtI lQ ...- llL"","OO~ ' <MICAH~r;J~I 9tlJ

CONTROLLING !DOlo4lM 4<l!<wo<, """'"... .... ... __ .. low -"

"~ -vlo """" 01 _ "" can 00000 ....... _~""3-~__ 001-'8_""""lO)al(l _. 10< Il'*'II/rj C/lIC $IlI'YIOOS ..,..8<1_~_.......... taI\l>O"""""'IlOO. T"'~<n<la

...,01 0lIlIr.. _q OS ",......... _ """" 50 '0- lbo'S , =_cn ... _~ .-..,,--

I J " IOOn! <lOlI<.w>cy ,,~_lO~llI'_

"'"" ...__..-_ '00 """ 000 mo::o 1M'_, PO< <la, ."..". at!<at..,.....,. Peto3oc---.<II • -... ...-~ ., 11'''''"' moot .. ,,",, , ._....,_ol..-<vIgO,has_~

In IOmt ................. \IOO<l -..to. tIul • ;0 • ___"'lIIlP'I'''''' ' "=".I ponocI_"~<QllIy '"........ <II ala" _ .. 10 odd -.. 10 • I0o<I• .,""""'."..,... l'»s '-' <lono""" _ .~ sail .-.... !'1M 0<01<> .". _ mosl~ _ """

~-""""--""-"'llOO"Ig"'-' ..- _ .- • " JIy """"lor_al

.-. " '_ "'"'_ """_ <II _ '" o-e ""I,"""'" ".- ..._ lor heO 10 IcIU' __• ""'"""'"""'"" . ,,,..- No> -.g _ 10 ..... """ .....__ lPI3l • ~ l>O """" '"<>dy _ In~_.--. 01 soli .. "'" _ <It _ "'" ,...,. ... ,.....,.,

llOCOuIO or lI1e ocalle<"" """" _ IIiCI _ DlC 01 \till

-"-~."*-~,,,"" _ bOO1l$X1~ II New Ooonoa """'d) :i n ,_ on • _ ..,. " Z...... •r........ _- ""-,-"~ p"""" _ nuor-, •""""" _ In 1982_ "" -.co 01 _ _"""" 01...._ ""'*' Ihe ago ol 9 jMfS _ ...... ..trMy...." ..__""" _ .... -.....__1rDm

1912In,",,,,--. CO"Ilt<'le<l ....... 16-_

woo """_ sail" ....,.... , ....,... ""'" -... """"_ ....0 ... ' ..~ _ in g<llli'lll,l(! _\:IlII<O...~,., .....-...oTralOlol . ........ _ 01_ " 131' "'Il """""__"1'"" ._01 ~? mon" -_8_ ",_,,__,,_,_... __.. ..._--'-- ,_...,

Vitamin A Deficiency~f&_Iee<J_.,.. _ ..._ol_...• boot _ tritiDo _o. .~ _ "'__

PREVALENCE"~- from "'" Co\xJll lor ''''' "" - .......

\IOfIOl -.,. _ tl\'."'" 01~'la"" A.. ,.. " .."'" -... ""'*' 01__ --. """'"'9~_ ....... ' . .. ""'"'*;00, ........IOt~,. ..,...... "'" or "'" _01 ... ",_"" ,.. _ .. _

"'~., "'_v_",--""".__~~_I........."""" _ onon. _ . .... "'1, III "-_ __",., """""' 1O<:IIatS__n ",.,"'" -... FO'~. __ .~ ........_ ._ 'M\I'l_""""" A. """"" outlOOlvIO...... "'_--.ngloo<l .._~ .. _____........ d'>II<l.,.... .- _..._...._--'..,I 1'"\'...",.. A~I .. .......-. "' """"_~.....,_ .... "'""I _ S .-. -.-. <:!liIInn may""""'*'P...W"., .. ...., _ eno-- 01 -. ... " .......____ ... comooI ;,,_.. .,..,_ol-..~_.

------~--_.-..'-,._ ......~ ...""'n A _ _ /I'e

___ lor '''' 1>1.. &-" _ or ... "" ........ A

""""""' .. ""'''_ "*.""*' ... _ .. lIe!.".. ..__ ... "'" """"""" cIlolIl·. _ .....-,..-, ........_ol_A_in ....__• .-8ol!*-... .. "'_11'__..-,g__ l~""" .. __ AJ _ ____ ...\to'I,,-*,,_'*Sl AlIor 8.......,. '" "'" .... d'oICI__ , ",,~ !<>ollongO ""'"--"'-"""'1:<"'-" ".,-- ...._.--_..-.-...._---,...INCREASED MORTALITY RISKk<nal reteaI<~ _ ........, ..... 1Ill1il ..~....1alo.. _iol04. oriIII _~, -..... ..... ..- ""_tn.......... -..--. doildfoo:

I " """'" 01 3,.81 _. CIIob.. "~__ " 1... """'""" ,_ ..,.,....~ ..... ""'"....... ,. ... ... ._ "" _. ~ _ .... _ • ..-.1 .....,... _ 11'.... 8 10 '2 _ ... .... ..,.,....-.........., .."""_ r.lMoIoII _ . _ """"""'.WIll> "'" ........ '" ""'" , . _ . MolII ....",., A_ev woo~ _ 10<1 '<Olh """" 'e'lo "' .._ .....__Irom'10 6-. "

---~---~--_.-.-. ,-,.- '...I l1'ho _ .""" I ~ IIbOIound 1'01"-'" "''''_ _ W IlI_ Ilo ., "'" r__, ,"""""""" _

d1or_ OJ lW<>I on! ..... _ "" _ . 'u« ' ...... ol

....."... """-...-........._---------~--_ ..__.--r__..e--_ ... ..-,~

"Thete .. I _ OW,""~it~~1 _ I __ A """'*""I_111_'''..... _ SonousII'_ .....<II.. __~ "'" _ A _ DoOr__ -.... ... do"",","", _ .. _ _

«IIanI...._~I1aI"-'__......

-,-----~-_, _ r__'_'H'

PREVENTION£11_ ..-;-. 100- riwoWo A"''''1..", Ii< .. 1oRil1i.._ -. diorri"""" ri...... A copoooln 10 pte"'_ -..... ...... __ , do .1ioo_.U ..101;..1,....peoo;.._-

,.

II LIFELINES: ACUTE RESPIRATORY INFECTIONS

" Vitam!n A rontcauon has begun more recenuv In Onatemala (sugar), India (tea), and Ihn Philippines (monosodiumglutamate), Previously, several ccunues werc torhfylng cerealproducts . c.q., bread in India and corn flour in Guatemala.Miu garinc IS fortified in most developed countries and inseverer dovclopna nat'c ns. Including Arazn, Colombia. Chilo,Mo~ ico . Peru, me Phillpomes. and Turkey."

"A year 's supply of vitamin A in capsu le form coots onlyUSS 0. 15 ucweve : the COSI 01 dc1ivcrirlg capsules and ofany I(.'quired mtormanoe support must <lISO bo taken intoconsc crauco III programmes in Bangladcstl aoo Indonesia.total costs of dcl lvDrlrlg vitarmnconcentrates 10l; tl lJdrOll ill riSkare less than $0 .20 a year tor each protected child

"Even less cxooneve. In areas with tavccrabc growingccoouioos. IS the addition of dark green loary ~t.>yetables aridothor foods containing vnamm A 10 the child's diot This callcasily be l.lCCOmpllshed et minimal extra cost, "

;(e<nnI'""..n'" " ,">POOl rKl >JI_ '" 2 /IlCIW),NI.1I"" , lrH"" ",1."..-.lJ !.91l1

Acute Respiratory InfectionsChildren in lhedeveloping world get coughs, colds,

influenza and bronchitis as often as children inindustrialised countries- but their chances of dyingfrom ehe infection are up to 70 limes greftler. Thedeadly alliance of malnutrition and acuterespiratoryinfections (AR I) underliesa thirdofall childdeaths,and weakens thesuroivol'$' chances of healthy growthand development,

Few developing countriescan providesophisticateddiagnosis and care for the 300 or so dIfferentinfections that make up AR I. Yet the lOll of deathscan be brought down, and at very low con.Immunization proteus againsl diphtheria. whoopingcough, tuberculosis and tbe respirawry complicationsof measles, Most ARI can be treated at homeprovided the child's momer understands the need tocontinue giving liquids and f ood, and especially theneed to continue breast-feeding. And both mothersand community workers can learn to recognize thewarning signs that Ihe child needs antibiotics ormorespecialized care.

ARI: The ProblemARI is one of the leading causes of child death in the modernworld;

O " Acuto respiratory lnfccucns (Ani), diarrhoeal dlseasesand manrutntlon are Ihe prmcjpat causes of lnness and deathIr1 children in developing countries..

" MoItalitjl trom Ani In developing countries IS3 0-70 timeshigher man In oeveiccec countnee. It has been esnroated Ihilt

110

about 20 per ce nt of infants tern III dc \lOioPlflQcountries fail 10sUNi~e their fifth birthday, 3n<1 that ono-tourm to one-third oflhe Child mortality is attrlbuted 10 ARI as an undertYIIIQ or acomribUllflg cause.'

H<u;r;~ lOtCOt' I/(Jlgf ",:uIto 1/t5j)/(,11c>'y " '<lC~ If!a>rIdrCn",~ .""" 1/"'" II pr.1 lJNlCCr/WHO ~~l rmnT', WHO.T 9~~

Chitdrerl under nve account for most of thodeaths from flR I{11'le elderly are also ~ulnerable}'

U A review Of data nom 86 cou nmes on five connnemsconcluded that about 2.2 mlltion deilths are caused by ARIevery year

1'110 mortality rates III UOb'BS under a year Oldare highest inM,ddlu Amcnca (rww ly 1,500 per 100,000 population),tollowed by Africa ( ' ,454), the develOPIng countries of Asia(1.2 112), and South Amellca (1,110) In children between coeand four years old, mOltality is tllghost 111 Africa (467 per100 ,000) and the developing coootnos of ASia (;.>U4),followed by Middle Arnenca (149) and South America (113) .Mortality rates are lowest In Norlh America (8 per 100 ,000).

In AmerlCtI, Furcpe arid Oceania Ihe reiauve Importance otAn i as a cause of detl1h declines as children reach schoolage; but II,,:; Is 110t true 01o ne-to-tour-vear-olos In Africa andAsia , where ARI contmues to cause 30 % of deaths This i~

cooetstent WIth the faCl that malnutrition mtroocal ccunmos ismost common around the age of two

S/Jmm,1l11C<f /rom A lluI<> <Jrd !( I I'O IiC " c'We' I""I"I~ ''''~

in J.,cfJt><J:< ~ ' 1Ml,'W ' I"."'" <IIJho MK>. t'I)! .~6 ' "' 3 , 1918

Child SicknessChildren in deve loped countries contract ARI as often aschildren in developing countries;

I r'Accurere data on the rncdcnce 01 ARI areuroneo. butccm munay-based lonlJltudlnal studies Indicate that It is veryhigh ever-were On the average, a child If1 an urb<!narea hasfrom live to eight attacks of ARI annually, WItha mean durationof 7·9 days Most of thL"SC are me less ecnoos upper

_......_..."..._.... .........._ "' ".-"n.,~ 01 .... l>I0bI0m" -.0 _ .ep_"'"' ...._ _ "__ iOJ1I_1ho~ _1Dr ..... of _......,. IrIO'y _ 30 '" !>O'"CIl """'""'"__......... ..., 101030'4 01"""" ""' ,...... . '"_._....-.._.._=_.

~-_ .- ,""""-....,,~

U " '" __ 01 _...".,. _ .., ....~"'..... ..... \.hIo<I~, • _......., "*1__ """",",""'b__ olol~.

_ one-<>olI "'01...-. l.\JI>cf_""" ttacl_"""_......."90. """I' ·~IIOI~

"""" .. _...., bOlO,,",," ...~"-".. """ '"' _ or>cI ... Old. "

""__...<1__ ... .., ....,,~_ """" IWO~~__........_~"" ._ .,_M._ .....

__ _ n,.. hOd """ .. mD<O _ "" 15... ol .. r IO-....". .......~_'*"" -..._fllt_.......". _ -llQ'lOoI ... _ ......._ _ ...._ , f\eopo'OlCO'y __ """" <:<lI'I'I'n(II\ W'1'I\l"." """"<lrt_. _ --._ """"~ ..",,hOl 'lWfI'_

---~---..._,,-- --_ .._~_._..=-_........._.. ".... ._.1)' -1.10.. _ ~ "" .....""""""" ol _ _

.,. """"" 01 <5....."" "'...,_ C8u<p"o v....,. Infl< _ """__Iron...., "' .-.01_.00aMMI__"" _3 ""' aonI 01.casoIol _ _ .... 0CUIIl ._aoy.-... 35PO' oonl 0... ."...__,__8£1_

oI_M<Ity tIIf<:lIOftI,""" 5 44 _ lIOt chCl__Tho _,..,..."., . _ . DteOOI_""'. _ ........~lla<l ...__,_ Ill ..._"'...--'1"" ""_ "'_.. chlt>on_ 1>,..,'.........__ "'" ........... """ _ . _ _ lIllO'~ I 5<lel'S • a>oIOre" "'""" 1IlP''''"''''1I!!r "" .lIa<:M PO< _ _.... IO <>lII't ........._ _ "' ... _ "'_Cl'ilb'cn1IfC • .-.:I ...._ _ ol ... _ ol _"' ...~ .- ---~_ ..._..'- ,.....""",

Child Deaths~. Oft .. fat 1""'" ,w. '" 4JloI I.... AI. l ill.....10 ' ;0.,

U'"t "" _ lIa1> 01 "'I/'SIl>'811 _"'" l orn n l\len1....... pnoo.<no<"oa '"__....""'11 ..__

lI>t ~and~de'> r .)tI"~ on <:neSfLO:tll ..... 1'toI!opnoo... """""'" '...... _and '" _ \~,... oiO _ 2' and 13 _ "'llI* ,~. INn

""""' ''' ........., ~ can bu __ ""'" do .. ""'" """"'".......... """'"as ... ....... "" _1'1OIIOOly con<OJtIO<Ill\< ... Pan~_~"""...... _ ..

.... '* '960s '"'" '*" 'ltlOs. .. -... ...., lIocillt.&IW,""""" " r'. tm>s .....~ *'<1.e.~, ~ ,-. -.010 ..Oo.oo!>oe. ear-....,~ lISA 1ltopo•• IOty__ ..~"'.._c..-_5(l._ol .. _ ..-... boIow5 __ oIO.. "" ' . ..."""""_ 1.... _,_only ,e.z, ,, "'" <Ie "" :'-•'WJoOoo • "'" ...-. .. ."..".., out!<on(,J ' ''''' """'""""""' ' ''_'''''.. ''''" 0'IId _ ,....'onou ""'" ~ Ie> , 0'\ '" II<><QIIaIo "' ...go \S(t<JI>Onl: lrMt"'''''' . "......, ..... Z.~I ....01 _ -... "'"""""IIIlIioI;InoIio. ..., lI8a~ -... ttl! ..... lIlaIiIV ..... __'.1Oa le>1lI_ ' 0" '" ~ _ ,"""ol~, Pal>ua _ Gur>oa """" atoiI'Y "" __"""'" '''''1IIOrY .,"".... _ .. ........oM ....,_.... 2~'l,. llIl "'.. reailTJetll~ .. "" ,...otloOI_~ 1O\ on O<l """- • _ ..... '" flo _ . .... <;aOO

t:>l/lllly~ Ie> lIS .,..., . " ..•..... , ' G .. _ .... _ .. _- _._.-.....- .....' HJ ....,......,.... "I

Causes of ARIOver JOI",,- <.... AIt,

It' 1110 lICUlI"'"""""'" .;,;_~".,,'-._ ""'" 300__ol n- _ "....1lI _ _ """ ..... • .....,...-...., ......_-,~11>0 "I'PO' ____ nets _ """" aIIt!clOId~ '" ~,.,..",

.... ----"'~ "" ....", .. ... """""""_ ._ _ Ie> ~_ _~ ............- ---_ ......_-,- ytyW, - , - ,~~-,0CUlet!<""""'" _ ~. '

........-..._--_._..........- ...- .......... ... .... ' '..I 1· 'Uor<l _ (pnourncn;oj_ 1hOSl "-cause'"

_01<l<Y _ ~ .,...,. ......-. .... OldJlMo _ . ......~..I/:ftAolI_~ _...... • 1>lOI """"""" •__,"_d • _--._..... """,."""- ..",. ,

Risk Factors10/.0 _ .,;0,,0........ w. '" ".1 bee klui:> _ ..' MIy _ 1ope4.a.. _,_ !he ..cliIolro.·. _ ."" ........ ...... '- rio.... <7<1. 01-.mao ..,j h.oc-t _ ol ARt:

MALNUTRITIONI ro-n.. ._ ... ol ,~ 0lIo<;..,.."

""""" ..".,...,.. 101 """'Ol ...".,....". "" All• • '" """""'"'IfllPOi'la/lOO fl ~I\l COLIlIrleS: looo twIl~ _--. ... asoocir.... _.".,..,. ""'" -*'Y .... .."-_"_d_=_._n _ _ . _ .,...., _"",

,~

'"

II LIFELINES' ACUTE RESPIRATORY INFECTIONS

" 1 10. CI10IcI .. 1"""" .. fI'IiYIj' ..- at....~,~~_ ,_at<Ity on"""""" ........ _ lor "" .. """...,..,.,.. '" oomrt_ "'*"*""'".... ...,. .....".- IN . 0::000 .... '" ,""",~ ..~...., ....__ ......... "'*""" _. gtOrIOt '" lI'* .--n... .. oloo a....-..~ ...... '_m.-~ """'- "' ~ '"molfaJlr"""" In ""'" .,.....~ '" tile"""""" <:v<:iIOI~"'-._ ~.<loIfIaJIIIO"' ....

-- ~-.. Tho _ GI _ """""' "',.,., ""'I' be _ l>I'_"""'0l<l<'I~ ..~ tI'ob'en can llo.. r-q, .. 12 POI '*"-

'Jriltl~is _ l>l''''''' _ -. ...._. ""'""" 110 ""'" "'" 01 ... _ ."".""""'9" ..._,••01 _ .. "--..

. ,..,. <Io>oIoprnonI '" 0Wy t>o __ "'".. """'" .. ...- '" ... ..-.... '" ....~.... .....,. l'lt cHcl ...:IIIn """'.- ~ os """"'" aIIOI..-.. <IlJ<I.... IO....... _'" "cD:I><C>gr "",,,,' •............ ...... on r_ II ;,n, _ I0o<I.~-vY , ..~. ....., """" .....,_ Ile 'caICI><lPor""""" r be~ "'-""'""III __, .-_ ..m."""""""''''_ io!e<:...... .-----,"'-"'-- ,m"",." ",

LOW BIRT H-WEIGHTto- binJo.~_ .. """ doUd'. rn-.hilitr.U·'_ OI ....,.,,_ o\ Guil """

b'\h_ .. . ..... _~01_"'~, ....-.. • """"'" ."" _ ...~ 01.-.,... _ ...~ ... i "", oIlnl_ ___"'~_AII""'_~InC<>slaRoto. "" _ oIIOi1 _ "'""" ., CtOG' .. """'_ hi..,....... ol........., "'''' ..... _ -. a ~B'" <acluaO'I...~ IS PDSSil1IO ~~ II'IC IaCI~ ID / --=_., AIlI """'-"'Y_'~'D"'980 "'-- --------_ _ ""(fIOC""" " '.

(101 ,.,,,,\.bOO /'SO .....~ .... l.i\oIooe onf OOll So.«M> )

Preventing ARI_ .....-uoI ""'....rotdiD& ""''' .Iaoc .... .....~ .... ioopocl 01AIlI :

IMMUNIZATION_.... ... .-- .......""'" - -"",,"1!'I(Irif, _ /WI_", eo.ogI» _ ........--....~ .....cncaotr P'I-_ l>J .............., _..-..""._-MEASLES VACCINATIONM ....... . ~b iI , 1oo _ _ b, .......·"...,..m..........., ............pit •...,. .....pIi<oOo""II flooc:w....,..,.~ ..."' .. _

.. .,.;g;.,. ..... <;a:lA' <luring "..- b ........,.. .,. ""'"_~ ..taI ..~cwrMr...__•

'"

..- .. ....... """""'- a>ry~_ "-I'1<:C<U1l 1<:r _ , NII ""' _ _,_...• """P<IaI -..po .. Ug;If'IOt. as nu:tl .. ~ 6.. '" _o=mno ......... __ •_ _ I<l t>OOd__

.... _ 9 6"'" _ .........,."""' .._ . .. """"....,, _, ,............,.,..,. __.... - r.., :

INI_>I _"''''' ''_• ...-<y' '*' 000 ". ....._.....,. --_....-"...-"' ..... ,,,." " ," . _ In _ All ,"". ~ _ ,*""""" """

......"..... _ .. 31 "'" DWJl 01 619 __ In_...., ......... ttUc.- Cl _ T_eogIll "'""..,. of _ cI>Ilhor> _ "'*'"""""' ..... _ 28"..,.. of...MeI< ..~. "

---~-""-'--- ,"',,,,,,,,,,,OT HER VACCINES

n" Two'*""'"" """"" .............._ ... .. .... """"'.l>JI"""" como! ..... "'- bo a<No<;aIO<l .. prWnoIy earl- ....,~....,..-... """'eoa'"~ ....._._.._, l>JI_ y.. l"U'Il ohIdr.. .....,. ........ --.. _ <Is _

_ ~ " yeI_"' ''' ''_Ill~ .,!I'lt oooe at<lIUlnI. -. anlIgonC sMt""" itsIfI(JrI.Iorm-... l>ll ~~ llOyO"Id ""' ....."'" aI~""'"~-"...- -----__.._....._-_......-- ..., ,..., ""......"....BREAST.FEED(NGI '~ _ oro tI_ ~_,,1''':1'''' ''.~ '" .... """''''''1 n et 1< ""-<ty ..1..-, _ _ .... ........""" _ """

........ __ 01*"""~ "'"'~ """'" ..-. ..,... ... 1><_~ ""'" ..... '""" ....-~---'- ''''---'......"'...._en Il> __ ."a c.- _ ~"l tr1l~ ..__ _ • """" .. IoI<8IY 10 ...". ."" AH .. \110M .......__ ",........ - .... .- 2. ..~"" 1~.,...""""'lI

Treating ARI

HOME CAREn"~ I .._~ ... ..,~ _ .. tile__.. .oR __chOIHn .-. _l>e",",-,oJ~~ hi _ _ WOO1<ert...,_ om _ I> _ """,0Ilf\lI" __..I--'.a.oa.a. _ /oJ1I "lOy ........ .....,..,......,~_ "'9'" _ ~ .. """"-9 ..... 10 bIocI<od""""'" ..... _ br"""""ll ~ ,.. _ ....... ""'"•........., __1<0 01 /oJ1I. _. _"""~ ""'V _

.....-,., .......01a """'.,.,."."., [Un;I fJll~",..,. 00 IX>'Cn.O:l _ "'"~ 01 iQ.oOs Il"1O'_-_..._"'---~

~ - - • - <NQt""'" - ...,'.I r' ~ In on WI\Id'I IoocI ........ ,.~ ......_ _ID_ .,.""*"10 tooa,H---_._ .... _,---."" ""'",,., J- I ..__ "'" many_ '""'II ~ dioIIINn_.....-en _ f¥ 1:Xl1alu. tIu. "'" ....- mJSl 00__ """'"__IlIl(>.d .... ....-_1nclocloIi'Ig"""" """"1OlmusI t:eSCIUgtlI TrIllS """'" _ tlGuCllll(ll'l_ ... _ """'"'*" IIS<>Od '" "'" """_'0"'"~ ..

---"-"-- - "-,r..:-- - . ... """',...., - --HEALTH WORKE RSLa oatioIlI "lih d .... -., --.~\ooe. <Ira"" 'II' .li<~ kJ_~ '" Alii .. plok.....auilJ ...Itb _ 10.. ill k_ ... ..u. 10m aI eat"< •

doild -d.:

11··..----...- .................__"' _ .et>oOl, _10 til _ 10 _ 01 ".. ....... dIilogf'>OM ..... ...~ Kos .. _ .._ '" "'" or<'WY <:ani _

_ tno ""*"~ ......._ ... lobar~

---~-''''-'...,... 'OQ"''''''''t "m. _ .. I~ """ 101..,.tJlI""""'" "'0\1'_"""

... .... .....m~ ,..." ot . --.- ...-.. lIIaI ..... ..."""" bI' ...._.__ .-.I """""'"'"__.Yot ~ .. r>o _ occess IOI1!1DcM 100'_ wI>d1"' 1llI"'""""'" _ ,. "" .... ,....., 01 -.aIIly ,.,.,.. . .......trJOjr$"-"01_ "" ,..._.-II "'"CCIfMU'<I\' __ • "" _ al _ lo< ...,.........~"-_.._,,"---_.._- ._,"",,''''''_''''''.Antibiotics

I Tho "'lllene_ 01~ 1Ii<J......... InCooIil AICiI_. flI<!Ut:lIon .. All """,",IV""""'II.,r_ot ol>::>ul 10'0 _ ' 970 _ ' 980 -.....(COIIOClII\' __......,~,ana _ ... ClOlIQI'Il... .... __ot_..-._ .. .,.,....;oon).1"__ __

_<X>,.......lIa •-----_..__ _ -.. lHJ """"""" 0> ".1, "1'..-01~,,_ .... " ~ '" <>'ICloCe lot

.......... ~_ -...... .. 110 I'o\iI> """"'-- _ ..

.". <:all The-.. 01 IhQ lIOSl ..... <lrull _ II""". d"""" _ ..... <>:l<mUliIy _ _ ko"'- '"• """ _ III~ ..__,., ouc:ll 0101-'fOI _1 01 _ lJ<o _ad as_ ..... CI'IOIC<!."-_ .._"'---- ~..__ ._ .........-..- ....,'.HEALTH WORKERS ANDPENICILLINe-m..,;~_ --.... .... rant!)' . _ .. p..p<ai<lIIio ,"_ "" r... """ .........' ...... "'"........ -. Eqorioo_ III "'" N_ o.l """"'" III\aoolia ............... ...;tlo niaiq. die, .........1;e,I "'"

I I" DoIaiIo<l..."..."., 01h~pr"","",lo• _ 0--'11 """""'" t> _ !omoIv ......" -...di/q>oOIt~ A..- "..".__ ...- ~__._'*""'OI_ _~_ _'"_ ., '" Iht ....... _ _ .., IlIw"ll 01 "'"___. FamoI\' h••llto __ -...... _ .."""'""';J _ .... <:Ii'>iCaI~ _ •.-_ _ ..,__ .. _ dIIllo 011 .... !lOIOl '"

"--. _ """""""" t>!P""" al>Oflll>lin"-an:!.., 10 ..., ........ t>.~ D<J(lt;l"""""

h(T""l__",_OI~ 10<1 .. ".._"' 0.~ I""oenl~ '" .... _ '0'" !rom~,_ "'" 10<1 tIl.>1 """"" _ """""""" _ leiN>o ............ ~.. ....... "__ _ _ _ Oo<t .......

.. _.......=--'----- "--'- ,...PENICILLIN RESISTANCE

I ,"rn """"" -.. "'II'!CIIMI ,.., __ 'llI'.." ,..,.,'*"a_ ......_"y to ambooIo<:s -.0' 'V t>." _""~ '- """" ' '''_ 9'1__.MoIl_._. _ 10""""""",, COU'....... ..... .. "'""l' cas<IS'"""-'Il .- • .- _ ""'.... 'l 01 "'"_ _ -"_"-01_""-'11__ .... _ _ 01 ••_ _ "' _ 01 ...

_01."",. '11""-'11-""'" .---""-"'--_ ...__ ._-n.....,_ ......,-TREATMENT COSTS

Il" lhe ""-'II"'" 01 '--.0' ....... "'""' Alit"'.. ___...- '" _ ."",..,.,.. '" _ • __ CW 12~

~ . 0 ..... _ 8 "",*, ."""",lM>Iy. lor •~".,... '" .....,.,." "' 1_ l.folK:Ef _l • "'"~........, INl '"~ ""'""'""" ony _. ~ '" 10...01 _ ........ ~ _ aiel.... _ ""'" U" " "-_.._.._---~"-"_ ._l"'U"~-... _,-

'"

II LIFELINES' COMBATINGMALARIA

Combating MalariaMalari4, r,alUmi,ud by LV A""P.vU$ """'I~il",

;, lift< pf I~' ddnl ,,,04 ....., ikbi/i/aring diwua*_ /1/ "",dilld. l~ """'Y dntloping "'"~'''''''t<ptril>/Iy til ''''fli<:al Afrj(", il iJ """ oj1Mfiw "", j~

U1UIl of illjlllt, oltd I hil4 1IliJrt.21ity. l'rt1fM"1_ "'" abo t<peci<J11y "",lflmIbk, Jl<lllil:~Ia ,ly ifalrNdy ....1"""risW

OMri", 1M Wit I9SOJ /wpn r/11lltiglt "1<1, ....1aMll""'1J ...... bo wmpk",/y muJwui. BIl' lilt dism#Jw rillU IIlDdI: a .p.nae..".. _Iocrtlt, t"rgrlyI«lIlUt of 1M uptJ\Sl 0/ ""'''aUlia'", COIIrroJ p,...111.... ,'ndt filliuly, f7"lJ'i"l milra,,", '" ......., ;..ciJn "_ ,Itt """'1"i_ witH carry rlu diseim,and ;rr<real;", Ii"" itrollu in lilt /MI' ""porIon.of , Iu _ /aria fK'r<I$i,...

lAltr-urm ""or"" of ....!.:Ina dqJtlrJlt "" d,z,>tI«I;" lIA' oj i lUtfl iddls, ,fUrl,,",,i,., 1M ..osqwiro'J/>mdi.., ,..,"....... au ",i", """'I"i,o lit'" MTot1U,,!III rrfiflk10lS /II p.oI<e1 b""'.... fr- , /111, 11</ wi/It",...,,,iUltS.

'I1uu _m 0 .. • i,Mr u l'<'!Ji..., whicallydiffi(fd~ or Mtrlr. In lilt _ II,i-. Ilrnvglt, ",,,,11mOM cltildmt can lit ptolt<uJ.i...,_kin.., 0'00""I, il IIwy ,II. ziWII ,...,.,.,"" d"'l ImlllMlO' '"j>(lT1 oj W1Ilml/nil)'-bcIud pniMry /willi ca.. aflitoi·ria

Resurgence of Malariaso.:. .... . ort, ,_ IUloril .... ...._.,.0 . ........- lId..l ......... 10....., dn'ol<IPo& ..-..I<., __<ioIlr .. '"'Pi<a1 AI,,",",

U~ 2.<00 _1'<'>IlIo -)uol <N« nail "'" -'<I"_""" - _ M .. oounlI .. '" ..

"""""""""......" .... '" """-""'- .. ...-.;,_ ........... '" _01 "'" lOP ~ '" ontInI """ cniIIl~ Tho Wo<\O _ ~.__.. f"oal...."""'" """'" .. .,.., _ ., 01 "'" "'ClOt .. l!>O.ooo ..-.._ ..... 1MoI:IIly. IIIOIlOy """'"ll 'J'Ol"'IO ..........- ---_ _.._.-"""'","""'- ....., ,...

rr """'Y~ .. W......,~ <lO "",..... tho ............ """*' _ ,,_ta... 01""';'~__Pol'" __ "'".....,200.....,. pet_ ....,. .. _ '*" 01 lhO~ , !>II" --. 1.000~_ ...._.. ~ ""' -_ ..a,y _ ,.. ~_..._'._---_r_,...'"

Impact of Ma lariaMaIaRo 10~Iy ...- io 1aI uoI .~;\olna, riou.._,... ......' ; .........,., _ _ ... ... _ IIlrir '=' duioc _0<1. Malulritioo_10 ... _ .. .

11" MaInl in """'-'" .. ,."".,....,. ............... by ... """.. ._ ~ -"" ..... II ir_.."""" 01 """_01 ...._"'__-P_.P..-...P_.orP ....... . _ _.~

~ by _ . _ , _ ...-ing Tho.....,..-..... .. _ ......,. h""" ...., ., _ . oooor<lol\l '" Iho_01_11'...... ""' _ '$_01 ............ ...."""""'" 01 lhO inIoclion. _ .,." 1>1_ 01 <:oncomo\rI"", idllKM .oo..d1 or _ -."_.._-~-_ ....~- ""'"

,~

( I""ano"""Y~ol N~ ._ ....... ""'*"" _,"Ion! -. .. _ _ ..._ .. __ f'!oananI _... _ ..... _

_ ~• ....,. 1t-cy 01:1 """'"~__.. ,.... . 10 12 _ hir , _ "'"'""""'"Sl.d'l_...'*' __--._.~_NI,ti.. "''.<l,' _ .. '''~_.~_ ........, Do"' OI'lIIn'IOIOriOl .....opy I.bw llIrIl ....grd.. c:r...".,..., <II _ ""'" lEI__, ....

~ _io orlOlCa1lOn <:am<:aIQno _ .- "_to: .... ' ''' .. 1OCOtdO<l .... ...., ,.,..;gr,..."-._------ ,- _ .. _ _ ... <>, ' ....1 1''\.Jllo mony_~ _ _ ......_ _ ..... "'.. _ sc.._ ....-..;_

......... .. " .. ' "'10 ..... tnlocI><>no rd...."

....... WJlnMCII_...tIIiCl<..__ ~<II J cia,. <II taocl lOr "" od<.IIt Tho oHocl '" ""'" 01

......"""'" - - - .......... . """"""'" <lion_ lOr fl'IIlnCu' _ _ ..,." low _ ....., low

• ..., ...." .. _ . _ <fl!I<Tm .., """"'*"_......... ...._--- ... """""' ''''.- ,-

DEVELOPMENT OF IMMUNITY11"'" or .. ...-...:• ......- pXlpIo

wI'I<> ..... ..." _ ",->-.."_IO~'''''''..........rv"' __"' ......_~""".... _.,._ ThiI_<II~~........ .- ........., -.. ""'"_.. _.""""~ II09<'t '" _ . ... ............ COlI _Ii_ .. pw_ .. ... _ """"'" _OIl '*'"""""'.Chb-en .,... !he lIgO 01 ~ loa.. ......;..........,. '" _ ..." __ ...- """"""'" ltoDgftIO\eIIl lOt .. Ir"r(Irl;:clOy 0Tl(I n'IOIlOIiI' Ii f«Ind _1l'O'C ",.... .._, ... _ , ctl!Idron CWO" 11>0 '" ~ ...._ <lemi:rdlrate _ _ .-.. _

~ _ . ........11)1 lite "' "'1>"'."'""""" I~ 10 i;I(l(l(Jn'Ie __ 10 .,.,..... _ 10 •_~ rd. .... """"""" _ S. .,..~ II--'II filii .._____ ...... e..-. .. "

-,~

Treatment of MalariaWI"'.-. __ ... _1IAil:!'_.......un """ .p,,,~ fr<en oa4 ....,. ;, ..,.~--U·· I~_"'*

....,..... fin<,~_, III _........-. '" 1""""'"Or! olIly '"~ Ilo:IgnooiI _ ., mal<o_,_10 __.. '101<

""" _ ~ OI'<Mllle~ II!.,,-._1Il_ , ,_ •• _POtIol.wy ......__ ., 1MlI'/._"""'"_ .. on,... ...... ,. '" pioriIy n __ ~._"' ......... "'""""",lie _ .. ~""<l"'_""""_"""IlfO'o'ISOO" III _ ""'11PI ..... ";,::;-;: :-:::,~,_._'.'-~....'''::'==

-~-.. ...-"_..., ... .,_'...11"MorIaJoIl< ""'" _ ...... IlIl "4'; I'Q:\"""'" Il>llOsI

__ 01 IIIL. 11>0 ......... ,. _. '" pr<M<lo _,a<loQu;IlO ~""'.llor -. -...-.. • __

..... -.... 1l'OIOOly.~ - - '.... -.g <liMIOI> ,'tII101 ...".............. 11. ca"I t.laqll"'....,.,... using ....__lI1I<Iull" -........... 5ho <a"I Do Ia.QtIlI>:All ... 1".-1 _ !llnIIlPo........, . _ ...... __ ""'"' early dI<eeIooo> ....,_ '" -..~ ... "'" _ . n-. WIl...-

"--"'~-_..... ."""""'"""--'"....""""""'".... . _ 1CI .... loy"",,,,,,," on ....__

~"'_"'..""'_"'donoeal_,•ouopr>nod "'" __ 0"Ili:it-.....,~-..• •""""""" to_._ ptOQt......... 1<1 ....ut, _ ....,.~ 01 ....- """""- II!""" '" ....o. "''''''''~'''''''"''_'''''_IJiagncois ...., __ llW<IP"lOll -..... IIy__ ........... • «"*l be,,",,100 WlIOglll1M _ _ fll/'IPOIIon _ .... __- '-_b__" __ ._.-:rr,...,- -,-PREVENTIVE CARE

\1 '"~ prIOI1'" ll'M ... _ """""'" iIP'IlIOO'd __ ...... _ ""'""'" !IA pr<>lll'\j'loctoc_

Iioo~~ Tlotnol """'~ ... _but _ rN.oDll .... rioI< 01 low l><In-_ ...., _1lI_ rhO "'''I' '" et1CIO<:e •~. 300 "'0 "~~ .. noCCOW~"""""'lI .... _In.,.. 0CIa\lI """'" ..... 101 .., 1hII <;M ""'"' _ ........"""" """"9' I~_ I>'OlWl' -. ""'" l"'"Cl- ~<:<;JOm'OlnI\'---....._ __[TilASj. _\CO t¥1fII!!'IAIOtOll _<h1Id_~

' '"I''''~ "Ill 01 -)IoCIIco ...... '..--' • JKll' .....""'0......... """" 0ng<I0lIy' _ .........1 ..... INIllao"l ~ In .., ..-no: ""'" """'*l tlII~_ t¥ U """"""'"" ......,.,. _, io_00 .. _"""' -.nlaIgos fi'>lJl' 01"'dIy !I'<OugII .... ..........-. 01 <:iOo<oQuooI .. ___ ~ _ ""...,......."".,.,.. . ..._01_

-. "'" yun '"~ Is~~. In...-coo. ~_""''-'__.........

..... ll't>IhiII"'" OIl • ""'" .............", 1*"'" 01-.lho<lly. ...~~ Jlre'o'(Yll!l>o do. '~'e~ 01.<fIIkl'. _ ~!rom __~ 10~_...-o'Q 1hI_......._ e"OI"«PIO __ """'"Ill __ F<>.<IlIy, _lo "'GtiI'""""""""(r l I mop ""'II! at h l*aooII), """ !CW1;-Vm

-... ""'" .... -- '" "'~ '-">Illy ....., .._ I'-.y_a~ .... -=- 01~po ....... "--- .. _-,,- ._"""".......,-"""" ,...CHOICE OF DRUG!r·C»loroqwII _ ....... fqI "'- .. __

iI'uyo et "'" """'"""'"' _ . buI .-01 ,_ ""'""""1""""'" "'-" "'..-.... _ II """"Il"-""'" _ ""' ....... _II<>~ .....1OIl ....-... EJ<?t -..-.. .. """""'V__",_ .ot-. ...... .-..,. .. , ~~ ..__ _ ,,_ ._""CV_CI

_...c,...u '·-..... ~01"'-_tlII_Qrl '"

-... ..-. 01"<1 "..."" f«>m ..".,.., _-.~'"I<lo , "'"'"_.~~10_~.., .... ccot.~ .....- ~"II at "'- Il """'" __ ~__.... _ ...... ThoPItC _ ~ .._ """," . -......, IV'lOIl _ .._..._-~-_ .... ~_ ........

,~

Control of Malaria'-..... -..a _ _~_ .001 ,,;_ "'" Ji08. 0001_..ill .... _ ...... bree4i11~ Ia ._.. w.""a_ oI~_..-.. .... _oI

""'"'""'" ...... ""'"""""II _ . _ ..... -....,,,,-.01-.0 _ .W'..,"'" ..,'" _ <IlUCa_r.. ""'"J'"'\I 01'- ""'" .-(100 ~" I 'Ill o-:ll...... .. """'*"'.__ ..'" _ I ""'" _ 01____ """'"01"''''''''-

to_ _"""'__...... _ 1I1i ",,, ";.,, hlOlll'k><Jly 01 ,._~1fII_ 01"""'""'"~ or........_,aII~"_-..... -..:I """ .."""*_ '" IN__01_, ' " .. WllIoi """"""" I. g ""'l. "''''''''''"II1Il_ .__"' ""~ n-._ . _ • • ...- .... oIII<WI ..... on'**'_-_.........-__ ......-..".,..,..lIinc:II ~ reo,;,.,.__ lnIorn\atiorIlDOUI_n__to_"""_---_....._,,_.

_ " '''''_ "'" 'N>

THE PROBLEMS\ I" D!O ... oI.-no lor h ''''''''gc<QI 01..-... or'_....... 1<011 01 01_11 "''''_

.. """'-01_......... ""

...."'~ ......_'11 .., ""'"""_OO;Jll_'"

II UFELINES, FEMALE EDUCATION

....__ ......._ _-,.,

............... ""__ _OII!!(I.-x>-'I .. ""9OiIO'o, -. .." _ ........,...-. WI___, ...utIr>\I '" """""""" e<--.g 01Il'1O_

" Two01 .... moo! _ '*-"'_ ......ll""ll'I_.Inlf\'. ...__". _, .Ur.,.l0 .....•_......-.-., ._.1h>"" L"~ ' ,

.. ...in_r:-.......~P~,IO

~ ......."'_._--""""_.....- -_...... ""'- .. ,.-,~

RESISTANCE TO DRUGSn.e _ Iooportu' 01 Iloo _ ~... Iou _- ....~ ................,o "Soncv ~ _ lW1l 00lItI0ll 11> ..... PIll '" _ II _

Sour> ""'"'"'" al .,.._ '" ..... 1~SOS""" t." lioog" !I>e,~.p, ~, : "'1O~-'lIlI_"""" 1985. "-' _ WI J3 "-'00,_ . 10 '"'" ...... none QIlOO ,...c W,.., .......-" -. 01"<1 11'1~ P~ "OlI.O'oI.-.on. _..,... ol ...-. '" """"""'"' POr-'_oIwhicn ... ~ _

-..... """'_ 01 ,.........",~, __• cannl flO"""""'" or<! Il"'" • _ """'.~~ "'e ..__ ""'"""'I Tho .......... 01 r-.nl PO'_ ...~ "",,"!lOl ,- " .-. #"011 • lo I _

"'..........." """""'" • .,., - ,~ -..no ...~e. p I~ ..... criI' par_tnaI _ ..., -. 10 1>0 --.t 10 _ ......_.... 11>0 _ 01, : ..., 'IflOl*l '"'" flO_ __WOI•• 01 .... <lou; bull "51'101 lor ......... U".... '" • _"'II _.,..".~ II> _~_ _ '-"""_"''Il .__ _ .._ ._lI'Qj',"''l,I

-....,' .RESISTANCE TO INSECfICIDESno ";k>r ..01 ... 01 _ .... 10~ Iw<1<...........tue. la ...,~ "'_0,,,,,n" SOlC<Il~IS• .,.., I......~ .. _

..., Ie Illod _ """"'" 0>011'''' ''''' " "'""Y <>aoreTho~",,"IIc:anI.. • ,...... _,..._...,,'"_,~~1_"' ...._ .. ",.,._ '- -. '"<X>1od 10 too ._ 10 """ '" """"• • • ' • . 3~ .... .-..tonlIOOOT,'I"'__ JOIO~ ~ 10 _ . __ ........ II""'l at•__. ....~,__«ICClf<*l .. 'O

-._ r"-"::' 10. Il'w~ """". "" -.woo." ~- "----_.......- - .., ,,-,~

-- •• ' ' " - , .,. '"~. lhough•"',...,. .....augto -'"

11-"T!1e -. 10 C!IItoge '~ itJseclo<:;do.. ..._"'_on_~_-.__"'Il "" orIy "".. F bul pa ...lOIoclaI. oc""'~ "oI ._ _ IaoC_ ".-.. b :I' ."' NClOI;rnO """~ ..... '" , , ... _ II!IIITPdon ... ..-.. """"'" -. .. -.... "" _ arm>oor.ming__ n

___"''''_ ot_ ._....:r-""o_ "''' F_

'"

Costs

TREATMENT COSTS~ I" ' F.. ......,... -.,"'_"' • ..-__ "'" "'*"""'*'" <:eel" '98~ '" N <lo\.oil -.lei

'" l.lS$ 0 ' 9 $omoIorty COOl ot lui _ '" ......-oI ...... ... ~-oId"""'" "'*"-""";'l.lS$ 0021""" _ l'" _".., ...~ '"~ '" _ per ..., '* _ ., lapoeal """'" II eboul.... n.... ... _ <lruG COOlItw N _ "' " cnoa-'O~ -..Ill De \lS5 0.08 lO9'll canI<I llOI _ ,~ _ "'"" ..- _ ~ .. """""",, ....t ....

""""" _ "" "'''' JJ'rIllnVlllOn _",101 rtOllO'aJOfl__ map COOl ill "'" "'" ""'G, ...,. N -........., BuI",.-. '" l_ 10 ..

.--.g PHC "''''''.,.". ... "" -.... ..~ """'"n_ 0''91 ..- be incluOoIl .. "'" fwOl ...1

1lI0UP"'_~"~"""'_ "..-- l> """'" ""'"*"'"- --.:I ..... ....-~... ..... .,I>O~ n __ 1l"oCCOl.... __.. __ ,, """,","" 0

_ ....,F...PREVENTION COSTSn·..., ogrormooo " ' F~

'" l , " _ ' -=!k>do "l'I"""Il !X*'........... mapCOOl .., ...............~1llOI>Ol>eOI~ "' _ ,~'""'_'"IllfW01g "'" _ ..., DDT75'_...._ _ '"

....-. ""' ... ...._"""""" ""'" '"~ ""' """"".""" .._ Gf*_ """""'11 ~ in .O -""'il""" ,....

..... COOl "" ....", .., ,-"""" 1>0> t<lon__ .. ...,...IJSS 1.'6O.OOlI, Nt .. U$$ 1 S per _ . This -....to~ .... COOl '" 001 . "'1""Il~_ ....._ "'*aIInll ODIIS, _ per ,.~_ _ ,,_ ._<H:t1'.....,-""',...

Female EducationR<>m.d i~ ....."Y COUMria l40ws Dc/uH,,",IIl"

limo MllJ.WrI hi,Jr intI< af j .-.k 1,'IfflJQI a"J I"",In'fls af i~/Il~1 1/1Id child _ w/ily.

Ir Iuu """,llY lw1IIWMmtd, Mtotw', IM'I_1tlil=llJl i; _Iy ..~ iruli<;a'<1T Ilf rt-I /if,iMI. l4"J"rdJ ~Ihu ,""" /I !«1lJf', ;~ irs """" rigJr~ ;~<klmfli"/Ili "nf<lJlllI..d ,}'illl "'"I,.,

Rtffltl rtWJd •.."..If lIul/ this <lmj",.ou"" if~lIy M.. ' ...... Fa, fr- bti.., l'Wt1y" rtJf«ribIo"I 1ioi"l ' U1I1dan4, ....''''''''1 .011<,1/;"" ""u <U /I

PMMpl ;~I lDral ill rtdwillf 1M ".,,,,t:wn/If ;"/"''' 11M <!riM dn.iu.

17w _ hallimu Ii ..""" ...._1 bi""";",,, tDll.jmpnmtti eJrild .".mool ""vt 1101 )Oft bull ilI"",i""'ui bydelailed..-rrh. Bu, il isIIlrwytka, ,"" ,,Itt MM«l'iq,r of girb is ..... Qj IN 10m Ittal,.i..vw...."u ",!rid " tkutlopi"f «nmlry ran _4

Education and SurvivalM.ul~ ....s-.~_ pool _....,_ NO< ",,,. ,,,. "W I ........... '" __ ud ...., .......1iI:r .... .-.......w, "-""".mIl..... ....lool f-Jo _ A1cMlat: •......., lid4. Pnol_......c.ldW<ll "' ....A-.Jiu. N Uli."";.,...... --'>ed .... _oI _.~ .._

''F9''''" _11>0 I&eOc.... 01 GIIono.st-...,_"",,"u_.,d>O:l~ l>r~of """""' Tho..owllOo. 01~ """'" as '"Ito b"""""'" "'.. no __ .. lOr _ ",ltl .....oIOo,

~ .., .- ..... - .. tIigIl lOr """"'" "'" ""_.""-....,,~-

'"Figloes _ I 1966 ......... 01 Groale< 1b'rItIay."no<!OOJ! by ",. __ __ lor __ Studieo._ 1IJaI "'" nIin I'I'IOrIl*Iy 'afIJ _ ~,.., no-..:alI<ln was__ "'"'"""""'...,..,.. wIIo ...,w' ; I l oIo' ••• , .....,\iIIeINl_ __ ....1'1 «Il.oCaIO'11>ejO>Cl -....v_

''rl . lk'!oIod _...." '" 115""""""" ""'_bI._ 100<..". _ ~ '" i!e. _~ _ a"I' ""'_OCI _C"p""''''''''' '" We. _ . H __ """ """Kl'_,.,., .....gonoty __ "'"" ""I _It>t Ge<>e<. 0.. , lO g ,...1-... mq,o _IlOr..- .... ~""" inl......... .....,rnorliIIir; ., """'"__

_ III _...- .. Ngn, """""ala

II'<!...,.".. 1* lIMO """ 10 mo<lOIalI ' Kor... oo. """""~. 10<.<~~ I>'IlI>ot"t """ 10 H --.. .•

Jt: r;.- '_",""" n__ ..._..__.__ .....I . """" cloorIt..- ""I !hot rroro

educale<I1he ..,..... ". _ ...... <:OaI:ObT111>01 toe<...,... ........ 10_...........""...-._.-... ......_ III _ bOm 10__ """ no_ 0CIl>j

""" ..... _ lI'IMI 'C'" tIO<" '" """""" ... ", -. ... more~ III Od , £_ J1~ lOw ....,..........-_IIOl '" 1'oOI . ""'__ 0fIK'l CIloIo_lY""""'II""...-.atIJI1 J1 M .. .. ""*"" _1hOt'" , .......... llduallIlil ill I"", "'"_~ in..., mo<rololY Il\'.... ....mo.'. -.oo._ ...~ ol l'lO"""all _ 01_'I' _ ".1>:> 01 ...__g:<IUI> 10 HtV- .. .....,. ... ...,.... ,NopoI_. 26'" <II """"""'<10 not ........ '" "90 .... ... io in So~ _ .JOll'_I!!II''''''' 8... <10 not_. • ,_~"' ol "'_'" "" I e ,. 01, ".,. __ 10 ....'*'" _ '.<><lu::oIloo1_ ... _ '"'- ''-_ PO..... ' .--"""'---__" I.OC(I" ' ...

A ..........~ Il\' ,.... ill""' Cb>O-. lOrOio_ o.se- _en "'""""""" I'lO $OogIio"'"'" "'-""'" .......... at ....., 10 not. "1'1oQlll1lO.._ . ....~.. ...,..., _ 1'1 "' ..-1_,""",,,,_·,__ n...Wing...-y""-'IJ!' Unoos in~_ ""' \91"·l l____- """".... 01 ....,...,... """ ....

__"'"' rroro~ '""""., _<:Net....III _ _ jUB 1IduaI_~_ .. ""io ..., io"' at """IIO"'Il_~ ..

_ _ 'M> _ """" ..__

- ,-''''on... W""" f.""" 9.ovet """"""'" _ .. ......... l1li"2CIlL'*oOS _ _ ' 912 ..... '91\0•.'_ "'on!_ .....,~ """""'"" eo ' ... """ Iner-'ll"""'""'"' ... Comer""" lor """""",, """"'" """ ...._ hall -... "'*'Y« 11>0<_l......"...1<110>.._.......~-

••~ ID III 0III0:l "" ....nl om<WlI'. _ has •\IlMl_ "" "'" _ '" marIOlIIy. OlIOS """ 10IorI fo'_ ."' _ ouosinComonJM. '09 1* \OOO "'*"....« ...-.co.... __ "-' .. """"'* 55 at~001.<:0100 ...,.... "------------,...1*' .=-.... _"'25 _ .._...... OK ....... \'R'S <II _ esIImOlOol .. ___""""_, lit ... _"90 at41 ", ... _ ...._ . .. """'" ,.... fIIIoc:If. 01 """'Y _ . 1<J(><lkX»... ' ....... ""'""""" _ -..:!lOtI _

25... lor IW""'. 1'oI<istor1 PI ............... So L_,

... -- -,---~,- """-=-~_ _---_ . n'_ "" .. _ _-'~

An Independent Forcer _ ~--.. '-' -..moo> ..., .... _ '" _

_ ........ - "'_.. IMr\Q-....'01.... -. . __. .. III..... ''11M. in -.c:ong_ 01_.. ..., "'*'~~ -....-... l>"lMIIllhO _ - ..... ' 10 be_aII'~. "''''''''' 01 2"........ .. IS COl>"Ilrios..- trIO!. .._.at hi"""'"~. __ ...., <:I1Ild """'*'f_ ..-......,........__i ... '------_... .._-_.__....",.

'"

II LIFELINFB' FOOD SUPPLEMENTS

Ftnw..- • ..- l>y _ ., Well A!nc:& .....

~-~· 'T""' ........,. """"'" <>,It ..~ .l'O'101 IN~...- ForrWr I'fop:I 1>1>0 oto:l~_ IIgnI 01\ IrII"'"""""'" _ <I'oICI~ ...-.I oduclI_ <II ......-. 1I"e\' __ ~~i1"'..yo

.,..~ """" " " •• "' ....... """,*", ".,....,...~""'"" • - hi _ """""""'_ ... _ ..• 11'<><' b' l/OfIO<al __ """'" _ tuI """" bo.......ino<l.. "" "'-""" I<:or<:. ""'" rigN ...JC,- _ _ ... _w__--'-"""" .•-" Thoro """__""'" -... I*IS 01 """"""" """"",,,,ate~ ....... _ I_ 'I toW:aliOn and "'" _ ".~ 01....-a.- or .... p;.,_. "llno... tog........ 01 ,.., ' ....""''''''' "'" t'I' HI.QO _""",.. "",,"",,_ al ~...._ Domogr.",., """"" (CELAOE~ .. _ of ..."""""""' oc ..,....., 01 <:!'.ad """"""", , INr" """" It>ol ,.,.. 1Wca hi..._ ret.>loM __ .~

"".....,., ..--. InC(IffIIl _" _......, (If\Qo>to 11 c:o..o-.u _ . ... ".,.,.,. ..10<II__.."..._... ", __-..._ ",_<11"I\'_100fl(>-lII'lIl1!lll '":<I01d'*>'OO wi""" moltJe"J ... _ 010 .,-- --_..._..---"' ''---''''~ ""-"I' ., K<o>ro an:Clul«l 86" 01 N _ ., """'"_ "'_'961_ 1919 10__

- I' iOI¥. .... _ """"- r,,1t !<.II' U'I. .. 1rII_""""*'I' -., _ 1962 un:l 1919 may ... '.._ '1lT .... __ .. _ «ll.CaIIO<> Tho '. ,••0;' . ...

.., " iiUl' ... ....- Ie tIIl>'~" ""_....... '.........""" .... ,.....-....._---_...---".....'- '...Possible Explanations11M eu<I ...... 01 Ill< «1_ oM

_ ....11I bo lion ~.... iU"""'od l7. d<WI&::<if"O! ..'..-' lIfl<M.lhI$$, _ 3<lOlll ......., <J,.,_"mill c.i/ "'"_",'. ,""""","CII....-" A-.. "'lU_ . lhol ..__._~ 01~ ... """""" .. """...,.01""_" bI' , .... oao-....l thw.- ............,. 10 <10 onvf"oorlg """"__, _ _ ... sno.""",,_ .. ..--.Iho """"" _ _ ..~...-.. '*"'".... --.. ho '9'0. nol.l>O<ln

" Thole l/orol ..",._ ,.,., may Do _ ..-....., "'" <lit.. l'O(I _ ~ ... _ ...., ~, ....,..

IOCOII' 'lIf'\O<'Id " """'''' .... to<:I NI ~ ..... Do_ .-......,

"' ...,- ......,..,----~-Il\os •..- .. 1h01 ....~ .. __ ll'oa1lI'cnongos"._-"' <J_rolI__~~ ""."..,.. ""•....._--~--_ ..... ..1IWtA\IlllllOOl*l__ ~, ""'" _ oc;I1<>CIln,1 '"'

'"

~ ""l"l"l1too 10..._ ,...."..,,"'"_ IIIlII'lllY do "" _ E~ .. Wal~ln<a .,.., ""Pl'C! ol oot",,*.... 00 -... _ ~

<:I'Ia!19OI no! """ ,.. acluc:aIOll IlUI "" o:lIIu<IOO 01 .,.,.".--" ~ -.on '"'" 'Ii 0 ... '"~ "'"__ _ """"' _ 10'9'0 --..... Tho __ ...._ __ It>o...-. "' old sno •""""~"'_"' """"""",,,,10 "''' ~, 11M.... """"'""'" '" iikoII' 10 '"'""' ...-"1.IIIma...... _ ,.... .... __ -.:I "'""'"....-. '""' .. 11'Io" ad> ° <lot tor le d~ ...~c/"Cl~ __ ol "'~_"'Do

dMIIed 10... o:tIiIInn: ...... mov _ .... "-d. ...... _~_""" ","" ""'_~""" o_,,," . ""C """-' __.. . _~__

_,__... , ... . 'H,11"_ ,-..__ -;; ' -.

...... _ ol .........,.. oWc.oIIco ., _'" IO! <Nol~ _ ..-. nt<oI, d _ Il>:>,,;/'IlIhBI _ 01__IUOlO '""""""" ol ....._'._0 ..IMI1g Tho ,."...0ll.CaIlI-"""' rnlo b' _ . . .. '-.- ",", .._._.,-,...,-_.._ ..,.__ _ .buI-.... _1._,"""" ~.. II>w! _,,", "- _-.-, .... """'" _"'<100I ...... ..-..,_.......-.. F<U:aIooo .. oaod",..".,...."'" _ ' .........,__....'-,"'"""-"'9'11 ...10_...",""*""'" .._ b:>:I ... .. tIWl_ ol

"""'"" Tho __ infkloQceollho _·.ocJ.......... ..1110 ..,.0 _ ......... """ ..... _ root """""'""_ •• rc...-dYllI"W'lI'l'_·~""'"I . ..""'""'""'" _...--.. "-_1 ......... _oTiO/laIlIy ., ....-_. _ """ IlllnIIat>ctI_ atO........,....._..... -.0-_"'" ._ 00(Jl,Id nol CQ"IIor .. greo1 ..__ t ~ttlOl ~ """" ouweoto ..... d-. canbo""'""""'" _ .. ,..,__ per_ 10 ""'''''''"'~ loocIo'll• • \U)'

~--.,--........""-'-- """-----_.......,.. ,-

Girls in School(,,_.'11 __ ..."""" _ ... "'"""""'"

llCIl«IlioI lot '...... IP>e __ ol ""'_ odn l101Cl __ Cum; "'" 1*1 ol. _ , 11IO-"_. "" • _ 110>'O - .....,... "' '"""" Nn <IOulIlorog.. _ d .... ""'" .. _ ...., ........... llltiO,..".35 " ol 09'd6-1 , l>O\jol1' "",""", "f ' 919 .. "IIu'e_".. 8C11o _ ..,."..,.,. '"" I.. ~

__ "'" _ _ ,_ <>*0'--'"""!loll__~ girb" Pc!<$OU

'"Co.ft"""" "' ..... __""""","", 110 _ c.II '" ...

bCIl$ agocI 6 '" 11 or." ImllIIY ""'""" WI"""~ 10""""of""' .... _ "'.-- .... )'N'$ .. "", _.... - _ QnO ., _<11_ ""

_ .....'__ 10_ ""'__..... _"r~ 0g0inIl woman .,__••

""""" b' I1IgtIoIr ""... -.,._.... mosI_ ....... '""""' ''••1Ien __ __ me ,....."......, """""'"...._............- """ ....~~ Ms boon__ . ... l'OI __ "'NY"'~,

~ f<> be _ more<:o""..~ ,.., me<> _or>__ .....n..OlIl<riy_"""~_ .....-. , _ '. ot*Iy 10 a..o-..:_ ,.",._ ..0"''',,"'''' _ f<>~<lO~..-

N1lWYo .. ....,,""__ _ ....----_ _.--_ ,- ---,..,, '$onoa ' KIl , _ _'_la'~agell6

10 , , In1IIO~'\l""_ , .., I "'"""""" ....._IV __.' ltIey _ ...,.. 20OJJ.[J~ lX"'1S.- It.-~ _ From '960 10 '~IllI._.

.....' •• ,_lorg;rio~'-~_",

,a. lor l><>vO "'''' ' 9110 .. _ . "" 00-._ 6 '""_.....~__""'_01'" i • • ,.,~ ...OOOIl'<>Jll_ " '960 LoI .... "' _ , , • •_01_.~_"" _lor l><>vO-.. ..'96~"' '' AIf..... .... _ lor QO'\I iI _ !IllI' _

Food Supplements0.... of lilt pri_ ro..... of i"fo"l tko,. if low

bi"h."";,., (LB W). & /Ms lI.>tif.i", In< ,,,,,,, 1.5/til", 0' birr. ou I. ru Ii..... """' Iwly '" dv i"i"ja"'Y. 0....~ of 1M 20 ",ili~ W W b<lbils60nr_. yrar (1" i" ,lit nkJpi", WQTId.

17rl ,~;"Il<ml";h ''''' 1«"" 10 LBW if 1M""" lItri ""'II kwl of " . I";,imt. FlJI;JI1 l11pplnwti" flIT·o,·,.u/t ' f'rrgruutl u.",..,. hlrof! bmo ,Irocott '" lit•jf..,iDt ,.. Mlpi", '" ".-.1 LBW i. lIWI'Iy

""InIMAI L8W if ....maid m,. ]1J..I!n 01 i'fln"

tkollts i" ,lit tJeDthJpl°", WITIl4, 1-' '''PP~IJ i"fJ<Itfft1"'Y ' tlUld lit (1 (K/fIIIfjMllewr fo, '0""111 im'll01child IIMI,. Illl4 ,,,,,,,,,,,to

S"pp/crterI,a'Y Iltdi", p..,..."'..... flIT infa",.01111 rlrild.... ""'" IIw palm/wi '0 mill« /IUlI." ,,;'....... m./ /lu:ir 'f1"ti~ it "ill (1 /lUll .... of dLholl.

Low Birth-Weight

.... ~1rJcan""",. _ _ '" '~I~ I ..., -.:a .."""...,'l9OI' _ go:ta• ..., Doyl ' .. . ..., • • ra!M _ l>!JM"""'"" _ . .. _ ....,. '~15O 0... 01 "'" ""'"'""7~ '''''''''"-..~go:ta'_~ .. "'"__• ....,_ LoIgono<lIl .....~ ..... _

_ ....... Doyl ., _laDo< .,"'" """"""'"_ "'" homo, Go<\<~ 1....., more ....... -.;pro._.... .... _ llO7O- , .... to.elgiOI _

-",....,-"' y-.~.-.""""' ~ l<;u'<l "'"' goo:ls """"_ _ _ ch«I ....... _ .,.""'" l"l .... 01

~_. lor goo:ls-. .... 0lI00 '" <io;fCOPrJI oOlI>l """"""""--'O<:Nli:l"""' .......""' 10 -.gIIl-__ ""'" r....., ...., __ ",.. ""....- o! _ In _ "'"" <td ""'" A tn( "'"" 01_ ", Onono """'" .... -om "'" 01 .... _0)-"""",""""" _..,.,.,.. _ oc:c..c>oo<l ln~_, _

l>I '*P<>g1t\Oo' ..-. ...~, ............ co.n ThOIrUoing~~~ """ .. """"'"_-.;e n_......_..._,----_-.~--_... ......._'...

A 1983 ,_ ",. "'"__0<_,,,,,,,,",,,,......_ _om 110 "'"""""'. """""""" "* 01 "'" 12'....'" 1nI_ """" ., ' 96' 16....__ 2G _""", """"l'W'IG .... ,....,,~,500gr__~_"""" .. ~ 101>0 " countr.. &v 'ogooo. ,. _ 01........ ""'" "'" lIorIPHlcigIO ..... 31 , ,,, In~ _ ......(P""Oll_. _ . no. _an ... SO LMIk8j '9 1...., A _0U ll'lo ., """"'- '0. , ,,, In "",5 8 """"' ........... _ 6~" .. Eu<aoa- -,,,,...-..,; __ ........,_to _... >11 " ........

'..". _ -V' oI "_'_"'dlO_, "'";IN\'__ ., """ _ "'"IIOClS ." troa Inl~.• 0l'QnOllo 0000 "" "'" -. """ _1II3IUII 01""-, _------__ """"""'" or" Il1O ffIOIl """""'" 01__\O'....." ....f"'~•• ....., ' , ., ......... _ ~ DWj LoI "" """""' _ lOw llio1rl WOigI'II .._ ...... ...... .. DO!>JloIIon _ """" ffIOIl~__ 01 "" "'- aI ~ 10.............. "'_~lI'''"'"' ~. ,

"" -,; ..._----,,_ _ _ _ _ ... ...... J •..,

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H'

II LIFELINFS' FOOD SUPPLEMENTS

-.....,.-_ __._--~..."ro"" ,_ ..... _--..- ~- -_ .._--~ ..._-,

NII_..s...._ea-lIc.-......,.... "..""'_....."" ._ ~71oll

0-- _1'lII _Dc 110<1. _ .. _0"•• fA..-. -"......... ",--. .......,.""' ...,..' ., . .... ",.,,.,"' _ _ 1>\' •• iMOo'~__ol ... _ _ 'tl1J1_·_....0lI0Ul ' 'II .. III bO'l'l!I .. C/IlIqul _ _ ... .., ""_ ... 3''' __" , ,too i = : II9O(TSC.t.l. •""* III l'IO !$CoO. _ _ 11'1 ......__ _ ~__ -.....:1>1< 300.. ..1_- .. Qooo

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............ _ _-Vt Wo ••_ __..~-__..-.ot _ ...... --,....-_.....-. __.._..---.-... ' ....._.-~ ...._.._-.',- -------_.._- ..__ ... ..----- ; '- -- --,......._____ l.8W ____ $ U _ Tho _

_ 13.' '*"-" _ ........ •• (3 •~.., olilMIal _ "" • '. , rn 3 -.- .... III -._ _ IClo The

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MATERNALMALNUTRITION,_.,......_.._== ...... I.8W_..." __ ..__"" .... _ -.gill. Dol .._____ LlW __

_ ... 10", 1~ - ,* .... . _ '*_,.... .- '-_. -..t _ , ._ .. _---"" ... '.,.'-0...-, __ _....,,_..ueq _ _ ___._Dnlg_ bl I ' .~, .-_.._..--.." ,-_.......~~-_ ....._-"''''''s, ... ......._ .Or!e_l7r .. <II_ .. .".._lcIl

,.

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- - ... -""""'" -.gI'Il~ - --."- "" : .,,-' -<aII"'lI ~., loo<__ •-'- '- . ~""_ ....._.- '... _,--,....INFECTIONS

"".........~ ..~----.- ".."_,---,....,.-...,.., _ . __I . Iloo" .... ,,*_.' ....--- ""- --...... ........... """-_.rqw.....-..."... U 0 _ ... ,... '""'" "" """ __-_._ ....._- ....... ."_ .011_:100, _co""',....-.- --~----_.•.A..~AEAHA,-._-_...... " .........-._----_ .. _IIJI_ -uN"" "lI " _ "_ __ : ,__8$;'.CO'$ ' ..2."lI ..... ••_ ... ,_01 ,a~ , toI_. ..._al __""""'.,_~_01 .....__. _ Bl 1.__ A ' _*.. ..., r.a .. _al_.co_ __."_._ -_.._.--_ ... ...,.. '.'

FREQUENT PREGNANCIES.~"'- ....., ,....--_.--..

,.., .--.----""'"-----,~-..__ -.-...._co' ,..........._ ...-----------_.. ,,--,-___ __O'-ol $ ,. c, -:l __ -'._,.- ...,-_........_ ,"' .... _ ,0 __ .. _ '"_ -co e1t __ .. _

....... _.. . COOl cw l, ." '0------.-..-....~....._0I11o_......... ' 01 _------.,,--_.- ., -... ,-.. ....-.n.. .. -._ "' _0" ._ IP "_01_"""".....-...,_ -"'- ", - -_ C4 d __ .. OICO." ...__01 ... _ ,_.- -- --- ~-._--.- -.- - --.-

Food in PregnancyE...... _ ohlrio&_oipik..... _ lkrio..kal..... _ .. tlPt 10< Ik Itoloy.T""~"" "'.. ___""'" "'" . ,. ' ........ ' . 'II """""",,, .. ltIO

"""'1 01 """'_dln'Il~ '' 1>j ....... _ '''''''' '''In____ aung~_t>m

_ ,rr., .... 1hOI_ .. ,.__...__...".-.. .._-..". ,~-

,., -.. 01 ""'""'" , ...,...".. -.-,, Ihal~...."'_~

"" lPWtI .- .....ognonoy ... ..."..,.. !lim ............ .""""'" _ _ Wi 11 4_ "" __ It'I __1 __ ",",,"__aI___lrom~_"""""__......,-"'-'--- ....,.,,-- ..

-~ ..- - "--'"n. _ ,1IU"F"""_ ...... ....,.", ..... -.....,llUmiI"'".... ..... _ .. l>'ognonoy ."- to__ t>m_l ... ... !>OO <:IIl>iM • <II'\' .. ........, .....,. fI'IOIl....,..,,,, "---=-"- --- _ _ .. MIl....In. _ "_"_QOo< _ _f<d ....__ l:OlI _ ..... 1011'''''''''' <lI ..._ .,__.,.., ~_lD2,500._.. ..... 1HI11'_<lI_ .......... ""' .... ...",., <lI POOOl_"" , lhoo'llI""d ...."'~ll ,5..,. I"'"'"=.._ T__ ' lWlI\::MIogN _ on....... or_.-elNtl.... ....,g" <lI _ 110m to'" _11'_ .. '"'-' - -......._ -...= - - -" _-- .. _ ..,.., ../>~ __ .. ...-. _ '. .. Ior..-

__ n lOur Guo rroa!"" ......"""'".. _woU>....~_21 ... ... ,,"_1tI<OrtO'Ig....~~ NIl 5,000 _ dInno Ihll""'II"O'ICI' "'" "" ., . '" .. .... 11'_ '~I""_"_1.0,000_ """" TM _ a.s...., _ .... """"'" <lI _ , _ ____ I.I_III, or......, e_1l....~ .. ..._In"""'~ _ ...... """"""11"1 _ ""'" ., .... """""'" .. ~'" ....._ ,..d l/'<II:O>_ ..... 10 lOur __* tMn "' ..........-....- _.,-_...... _,,-

. n:::: ..---...... -"'- ....._-.,."-"- - "'"WOMEN AT RISKr.., ""'"* ........,..... on:! ..- ~ 10 ...

......-......,. 1000 • ., "..,...,__ "9"I'Il'"__ ...no "'~~ largo! .".PO"9''''' to"...,. Theoo __ ..... too _ '" _III

.".

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...ogn<rq " "" ,''' to"" 00 _ bI_lor--" Tl'd__ -'""" II. _10__nO!

loo.otfwlllO"""' ''

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-~---~-__'" " /'" 'HI

COST OF PREVENTION""-do .. "" _ ........_ ca.Ii:l III~

ow...", .., . """'" ..~ _ ~ad_ bdI.tIItdarIIs to~ flI\riIoI r....." ' one! .,~_ ................ ,......._ 10 one! IICIaIOlg-., lOi W(lI lOi ., yOl.Ii'I(I-"" _ airIs. I Iia$..., _ , ..lOll. lor-. h I ",,01 __ ;;, lluo_<:oulO SI\ISty .... ....os lor lOIl<l<lOIII __ Osngl>'III"I""l IM>u;/' Io<:oIy _ lwl 0'0!l<:C1S Tho_bOt.........,. ,_ -.1<1 WTIO lO IOOuI 50,09I:+' <11\', """-10 10 INI " ,00 .-10 .... 0'0_._111, "......., '" IN! """-'__ 01"" .. ,,,, ' ooure- 11

- ~ ...... -_..__"'-'''' W,,", 'H'

"n- " OX__ <lI WI ISSOOI_ 00_""'__ ..~__ ono .... tw\II _ .. ....._ ~ '" color"' ' '- <IU!Irq 0'0ll'1II"',_ """".... .. _ oI""'inIat1\ T~_

'IJIl _ 10~ """"""" 101 ond~ \Oft1"""""'" """"IbI """"~ -.c;og """'"~.... _ ...... No~__ ".,."..,.. corti to< 1111..... 01 .. lOW....",. .............. _ 110m to..-·--,"-- "'........_._----,.,

I r '_ ......~ '"~ ..-.:I '""___ II WI __con 0'""",," _ , Ip. cd'"_ .. 10 _ _ ........... M . ... '...".I .. ........... corti "'''II'"'IW: I .. _ n by 0f'iI' """..---. nornol\O hi ........... '" __ .......... ,.".,to _ It'IPQO!'_-."'""'"'"' _ _0:.,'_~,_."."""",,,,~-.I _ _ ""_10to .. oonGlo m<JO\".,.__..ay cI~ morIaOIy ..h __

" TI'd . .....""". '""""""Y .... -.I _ ...-,_ • con DO 1''''0",,,,.110 .. an~, ..-....- - - "' ....... _ _ ~ r<Q,oIOIW'lm'Jl'II!"Il eI'IorI,~ """"'"bI_ ox~.~.....- _ .......__, _ . ..... to ...rrorl1_"

... 0 _ ..... $_' _ " _- __"'MI'''''

'"

II UFELINFS' FAMILY S!l\CING

Feeding Children.... , 1 _ ' lor_' " I ,__ ...... _ .... ....,. ", __ <aN

...... ToM ..' _ •• _"' "" ' , _......;, .......,.,., -... 010001 4pl...,.-.. _ _ w~ 4ilkoohI

, r "S<.QlIooIwe.ry -... .".."".,.,. ....~ <II __ .....II-.g,_"'" _--...... ,_Ol. oor9o ond _. M " ....-_ _-_ -.............. '_"'_""llo_""""~ II __ Iho _ """ '" /IooI:long "- ...

...... 111 tlOi. • -... ....... ..,.~__OIY_...._01~_.... '"~ ' .. II Tllt ·_,.....'.,-, ....._____Ii>' ~_ll"IIlNIIII\t._..-"'M· ,oe..--- --_ ...... _'m

IMPACT OF FOOD SUPPLEMENTS OSCHILDREN____, u··___ ondlYOldlO"'" _ ""'_ .""__ n._",= ••_ ...____ ,.........0:. 01 _- ._--0. _ ......_ ... """""'" _-allr..... "'. .._.-- ...... -___ -=--w _--._ ...... '••_"",L'llO.''''_~"'''lI'"'''II ''''''''' ' __~ ~:-lIo."__-------,---.... "'_ ""' ....-...... "'9 '.111_.....- .-.; _ 0Ile<:lS on '"

-.. _..._----~-_to ._'.. ...._-'.''. '" ~ ....,o__••_oJ lDiOll .. """"_ n.. ••-._ _,"_OI..1Od_'Cd -. -....-" •• Tllt_ __"_9""""__""..,.-_ ol ..... _ .. _

• 4 •• -n..o ...,. ..... ' ... __ _ • ....-. -,. .., __ .. tIOIlI'

._"'----"'--"--__...__~r _

FOODSUPPLEMENTSAl\'D HEALTH CARE"-I f ._~ __.............'"

..... _""0__... ____ -..-...... DfCUI._......_........" ..~_11:> _..... ••_ "'''·0 '... __.""_011 _ ...__--"'""-.,.._ "'""-.............lO.it"":=......- ""_oII""_C- .__ ,O .._ 00I0I0:y _11:> _ .....30 Par 11:> .... __ Suet> ___ala -..:y. _",,,*",,",,"'--'__ , 011~"""'-'OI' ~-.._~ •• ... _'" ,.. '9'l _ II> ....... U'j ... _on! _ oil •"""""" ....... ,.~_..

_~__" __...u .... c..._----'-'_ ... ,.-- .-_.-COSTS

:=:;:: ' :~:..::.::; ;.~*;;-~ -ii' _j~".""__1IP_1oO.._' _

____"'''"_011$'0101130 __co _~IO_oI_ ....

l: .

_"'... •...........s-._·•.••__"'__010 ,,,,,,.. ~ __... _.0 1_"_,,,,, './SI'=-o"lll ~ """'- be _ . ....... ... 4 0_ "'0_01_-' __ • '_ ... - ........ $ ..._. ,--"""'.'.-"---"--"........_ _ .... 11.......... "' -..... 10 """'" -.-. oil i 11'0_-._._------"'''- ... ,....... ~-......... ........ fIOrlltllOlll'WO_m.t____""" t<I\ICIWIO .... __ """"'I "" ."",_~..,_""C ClCII'Ilr_ 10 '" _ rn:J ,.,.", Illci.oI- .......,----_..-___ 0 ' .. '

'"'" DIIW:ac7 01""'" .lIIs..... ' _091 ......__ • ..-..._. _ ·1"". __ .. -....,..-.~ '•• __ '" ........... 9"0'"1" .. __lIj._ .... _-"""''''''Do_ ...._'-4" _

_ .-...... -.w,_IV9'I ...... __",-,"' ._"110'_..,. .. 10""_....0 . ... , • __.......__.....=... So ,.... _

-."" •••• • __ .. . co •____4 <"",",- __ 110'_-.c """ _ .. "".....----..-- _...._ _, '''''''''''''''10 1= -... ; •___ ........ 011_ ____ ..... ..- ='_011'" ..__. ' I ___.$am 011 _ - .,'.' 011... .-.-. _ "" _ .... -.co ....._ ...........

- ...._ _ ...........,........1J"U'llI; "" """'1'01

..-"',...,. 1l"1 "~IM~$<>~"'IO""""'" ""V 1Noo.... "" <ItICl_ ... """""",_rei .""""1·'

_ ._""... _ .....;""n_c...___ .. ,,__,_, t l-,......""""',- ,-

Family SpacingNUllify "",filii,,, is OJInI "fIln1ttllll $iMply /I

.....,,... of /KIp..!u';,,,, rtJrI'rol. Y"....", if rlltre """JIO " .... 'h illf <II II wo,ld 'popl<w,itm n plo<itm',,~UIIIwld >lill bo II flIlWtrfMlllnJ "Jit>ll rIM furfa",liyp14f1f1i"l '" " "",Md of i",pnJ<'iflf ..or.v. <md rhiMliN/I. ,,"" mJuciflf jilin, IIlOTloli lJl "Ut...

TM """.. ""....",... oOld r14sfly IfKlCN 1M (Irtf

IUlIfCin ' " II """""" :. <kiJd.btari", <y<1t, 1M ...."...Itt, .",';,imwl~ /Jotc..- dtp/tld _au 1M"",W 'M rUb 1(, rM Mlll,k oj IN>,h ItUHMr liMchild. /11 /'PO' co_ ""i,Us, IN UtI"'" _ ,."ily "'..for hdlllt, """" wi,hi" lIN }'tar of " pm :i",,, hiT//' UlUJU1/1y /ltlwtt" r"" OM fou, ri..... 41 hiflt QJ II><""/rn IJon, OJllT all ; 11 1...",1 oj """ yta.. or """".

III prIM/in, Irowrotr, ""'''Y w ..... do nor Mttt" lil£r ,II< _IU '" 1M fruJm. '" dt<i4t II. 'M" " ...bt'f (It 'M ' (>Q<iflf of ,/tel, , hildrnt.

E1Ilpowffl., Wl>IIU'1l !"i r. flu .,,,, '" 'II "'. ,"'/,!lri, ""." I m ilily coll fd ,lin_lOft Mttt" J",,,",r~

imr-r 011 b<J,J, 1M lIM/Iiior_,Am a",j IiIL f'W'1.lind '"m.....<MIIUl 11/ Ihrir child.." . III 1U"'OIlIi""" ;/ «n</J aIJD cmrlrit..,., I. a rtJ>ltrilnt iNpopwlariolt """",A •• ,'"

The RisksTIoo ..,...;"" a.....-, l .e._ .......3~, ""'" 100.< boTIo, ......' two -._

_ __;d ~ _

__,- ,_0 _Qno__'00,

I'> __• Pr\ll71o>fI<>e5"., ""~ .............. ~"""" _ 100 _ . 100 '*' 100"""I' .. COO-.'- --------.... _,__ .t,~,,_ ....INFANT AND CHILD DEATHS

,..~ born10....,.~ mclI'o!IS ...~ IoI<oIy 10... ""'" .... t>cm 10 _ ogocl ?U 10 JO IIato ~om ...._ F-V S<;wy (WFSj"""bnQ 10~-. (;()I,nl>"'""""" _"-'agoom lO moIl"<n

"'"" 3~ run a 11'_ .... 01 """"II twII' COIoa> I'"'' ,.,..t>cm IOJ'l'""Il<' """""'" I'> _"". .... -.., .........,, __ "~'""'~_"9, __"-,-,-_._....----,-"'Till _ -.... .. '3Il<l _'II ""1Ile"'01 <:I1oIkO'or> '- t-' _ lew .. _ .... pasl eo __Tho ......,... 01 WfS oat> .. '- COtllr_ 10 • _

~ 01 this ,ola"''''"" "" Mo """"""" r>oIocy-......... fIr<l<>Ilo 1'> _ a1. _ t>om _ _ __ I ...~ ".." _ """"" _ ...-., 10 '"""" _

""" ....,.,..,. ""'" 110m _ .... 10 """{ ",","", -.", 110m lo<>ll __ 1101.< (II ...,..-.l""""a"""'" .....,., 01 """':I'" 10.....~ llIf"o:loy I'> """"<:<l<IIltleo. _ bom _ __ ..,~'""..-.os "'""" ...... 10 "'" )'lo" 01 IIWl_ I>Ot!I _ """ _ ..- TII<l Mor/I'IU ..~ __ """'" at!<k:tO ....., ... .......- __.-,--_._------""I" r...., a :>e ".,.,.... ~""'*'llOS ....t ....~ '" • ".." two ,.,.,. ... .,.....,.,.t>1I1 . ... "'......~,.IO """ """ "''' IJ'C 001 con"?~__ and"""" nan .....- ~ In, ~ .. __ '",..-01''''''''01_.'11_ ........_I .. NI Zr<l 1O , 2'l!l """'" oIlOe. ......" """l3IoIy.... _ ,_ by at __ >0 P<I""'" In n _ .......0ClJiII\' 0X0IIlleIl.. I? "--,------...._-,...

'"

II LIFELINES' FAMILYSIl\.CING

_01 .... _01 ..._0'__..CM:l _ '''''''' 0/ lXIOl oIlOO$ Nn 18 """"". ,.. ...,.. .....,., _ """'" lOI<dy ., "'" ., 11>0 ... """__""" • """" "'Ilh In_ 01 ~~ _ or-."_..----- ---_.._._........_---_......,.,_ ... t>_,_

I " f ..., flCOU'lVJm~ _Mat,.......",__

... """" ... tJ~.,..,""""",,, .."""*.............. 01_ Ole ~ 30 10 s.o IlI!f oe<1ll"q>er Ie>' dooelI' "**'-""" ""-- -- "_.-.. -...._--- _.... " ... ,.,"""MATERNAL DEATHS

'-""'_ ""'N .......... _ _ ot<lct ~""""...." ......... 0I1l"'Q<1UC1'''''' -......, _ely """"'Ilfwd ..., _ ""'" _ 7~ """""" ..--.; """'_ """" ... , eoort _

" lJoaI'if _ ~ (u<:oo'" "",~ ondlrt:m.......,.,..,. ...........,<_-. .. "'"1unilIl_ ...,.,01\'"""""'"' •...-.onQ lour" ..<l~.. _ lIof1td

'ON< ",,",_ ""~ ""'" __ ..._ ..." """~__w~, ""'-_lOOonnlIOI ... c....... _ .... _"' ......... ...,• .,.".. n '_...... ,-=_....._..-_.-.. ""'-'-,- ""

I<iol ""'r .... """ parity, t1UI ...., """""" 01_l>oIlt>S ....... OIl"'" on....- _II> ' In~....., . ""' " • • lOt _ . -.. Ill""~_"' •..,._""""' .._...-_'"0_.--."'_...........__ ...-_ 20 ...... _ _ ._ ,...

....... bt _ Thus. __....,.. .. w-.;W '"_ ~mo,.., be--.__"'-'WOOl ....._ bI/'tI ir'IWYolI lOIlIl 10 ,,;g,. _nIII """'" .-----_ _"-...__, "O n_'...

! " 'Womow>. I<>CI. "'" -.. 01 "'<;l(/\IIOIIld ""-~ -'y ...... - """ "'~ -~r_.,..... - '"'Y~ .._ .... ol ""'_ Inr_ _ ..... ,..... ........... ~ PO' 100,000~__ 10 "'" "" 10 \,000 """,,""' .. Po"ts '"AII\clI _ I,W

"Nol "" __ ..... _ ', __...~ "'I'"'" .... 01 IJI"V...... IJ"O"I~-~ ., _ -. ""'" -. .., to Ito> -. ol _OPIa,"_ _Dul lWI' 0100LnlOtgn _ .... """'.""-_ol "" ....,..,.,., ..__ . A-"'""on_ lhO_runru '"........ oo ...". - on maI')O ,,_ c:<>o.on""'-wof~_"""'" '""__ l.",.ca11j'~ ""'"""""" on"""" _ __ _ ...... lie._~ '" tlr""",-.g 0Irl00 ~"...

<)<10 ............ _ UIIIlIo _ . M _. IIho ner'" ....... 11'- .._'_r_.-... _- ....,_ ..... ,...LOW BIRTH-WEIGHT....... _ .... w",w F<nitity _, poial to • l i. tbel.... _ inc _ .PKiO& IlIld kro' ~'"'Pt

··'..,__""tno_ ". ,""'''-''-''''~ .....~ OI......-.g MII'/ aIlOCI .....~

'"

~ '" 1nI_ """ """,,,en _ IItl _ ""'"00lIiCt'I _ ll<I'NPI Inrlllql t.... n.... 01 ..,.,..,.-"_ -""'---- ,-.. " 1 ' ,,",

"Spaoongof 1000-. 1wO oo-"¥__ lItoCauIOo ~ """" ""'" weq.tI ..... poor«.....1IO'l.~ n:lJIlIng • __ 01 _ lolI<ll'll

Of """" ... ,....... ' ""~ "'"""""'" ....,.,.,. Fromn..-.cv 10__...., -.... llOm o'lIo tarot or ....,..,....... _ ""1*'0"00 """" """"-. _ 1J'Oo'1l._ """" 01 ocaaomoc~ l.ooo' ooc>oeco""'"'" ",." __ a/Ioolo, M tom _ ..... _- ,__ ... ......

___J .. ,, _''''

MENTAL DEVELOPMENT" O _ ' OQ ..-. ................ ...... '~!CO

_ .... !WI' weogN l ow IW\PI weogIII _ ......_ """'" ,.." _ """'*'.... I .... di......... '" .........""""'II -.... ~om POOl _---_ _-_ _ _ J .. " _'_

'As ""It"' .... _ ..... __ ",., ....",.

-..n', -. ..... .-.. 10 ....",. ""'" <Ie_,...CI>oIdron on IaII1" _ ..-.I '*""''''' !>Om <:lose I<lyClhOI_ , bo!I'~ d ' ' ""'_..."., t _ .. . -...,." _ .....,"'."""...... ~ ""'" """"'Y__ .. _ '" l.:I"QO.....-.01 on ScolIIIr<l, Et>gIard, r,......., .... ,....lnIOO St.1fl:O;"..-_.__....-....,_..---""'"''''-'''''-_':'''.- ,.. '

A, ..LIlly on ",. US ..... 1GI'ell ..~.. _ 1 _ 01 tnIl".-... ""'"""_ .._ ,-Tho _ OBI -.. t"O':IOl>W 01 _ . , , """0<l<XI0I:0"" ,"' ....... ThO <IuCIy......., "'"""' ~......, _ -...;Ill .. inlil'\l$ llOm ""'W if'II(ltYOIS, '"",.

"""", ...,., -="'9 .... • 01 I:><*>giwI """"'" "'"""""*"""",'" di......"." __ .... ,.., _ An~-.;_ _...__.._ _ 01 _ ~_on __-_.

.......,--_..-_--_...._~. ""_ ..... '...BIRTH DEFEcrs

"e.:.-rong _ , ... A.c1I' 01 US ...., QItll_..... <IOfo!<:tI 01.- "-"'<lo-.-0 ...,... """""""_,,,.,.,,,...Dom """". _ 01 l"e~ """ _ Ilo!O<:tI __ """"""" _ tom """_ _ ~,-----_ -....__.... ,,- ,...MALNUTRITION

"SI\ort bItrI ...,."...~ Ie __ on_._.,,-.gon_.... I10_·'-ding F _.. ~....-",,,,,,,,,,,...h;I..,!oIncl~_, MIIOO'IO""""'.. _ NflI'. """"""""0-' -"""-..- ..."""""' ..as~ ortIO<l,.,.. """''''''10 0f\0lI..- o'IIaI1l"'~---_-._~_ . "'"'. 1Il<ol)' 10 ... 'MlIWl .... --.v '"'__ ,..,

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Ell!

II LIFELINES' FAMILY SPACING

'1 Q(_"'_~ .........~ -.-*v_.,ar....-.. c:o..:-... "'Couf\oo. ... _ . bd> ....__,~ "' ""'""',... (Ol~ '*' _ ., ..... -..._ ....' t1'J. '".",....~__ li60..., 19 / 7 I>omsolll!'lh_"9* """" .......... """"'II ...... _~ tu"';l1I» _ """"" inln """'""v''''IOIl>l'_ liOpet<O'Il- ..... _l<l<l oI l1'1lO_"_ION t/IO/'9II "' '''''''''_'''' _ "' '''~SloIoo,..-""'I '" ,.. _ "' onl.YlI motlaloly_ 19&).\910 .._ .. "" 1lCI..... ocnc<If'IlIaIIM 01 _ ....,,-,g-."' ..... !__.... ,_ ,-_.__._ _..-__ e- ..__,_ _ "",-

- ''''MOTHERS' LIVES

"..~ .......... 1Ddoy, alJOuI 5 6 ...... _lIM lN _ lOO.OOQ 0CII.I<l bII ._ ~

-- ..... "' ........... - """"'" ...... yeatS...... """ Wi t ,'"'-

.. _""' ...... 1 M""",,",," tolOOul_ "' ... _ ""10 ,~ ...~~.OOO__,-~ ""~_ol_t.<tt>a---,.. ",-- --- -- ---, .. ,, -,-FAMILY BENEFITS

'100 "'__....... .., - ...,. ..lI' omolI .....,. of \'<U'lII~ """ _ .~"""" .. h _ <II ..... ~"...., .. """""" ,,,...-.... """'" """' lor ead'l <:l1ol<l IO"..,...· _-""'II -. '" 10 COftI b • _ cnoII;I Hot -'___ or. _ .. . phyOocal"'"", ~ _

_ ~ "'.""'" lot i"" '"od ..... SI>oorog ""1 .....___ .. mor.loocl_ fo<"'~ ...,_ "'"__""'I tlO-....ol_ 04 _ "''-'".,roe _ ,"s-n, _ ..".._ "' __..... ........... .... , ....._'...POPUUTION GROWTH

-II'!-'''"''''"''lIm.. ""'" _ ..... oICNV••luogl•• '1/ '" "'" """' -..cI""' ", _ ......TM~~.Il_ ' i. ... lIUl.__-.nty""_,,....,.. s.nc._....-ol__coJcI/)I """"""'" .. ox,*", .....,.,. 01 dto..._,.. .._ol"""' _ ......._ •......,....,n p(lpo.j;l\Ion lJOOO\I1 t_~ ...... .-rr

-,~

Unmet DemandI, ;. "'- ....-.I .... __ '" iopQo&<OUIrie> la••Wp Jaal6<s k<o_ d 10~ Iop"".......... _ ,, _ _ 01_ ..

..... ,1011<1,..:''WO'IIl~ Su:voy ,.. """""'"'~

10<>"1 ""' ","", ...-..::.0"'" _ .. "" • ill """""._011\' dnI a. ",""" ..-anM~__Of 'M """

".

MGo<l_ . Fo<._~_""' .....--.g_ ... _ .. """ _ fIlll 1l:"1 ......" "" mote..-an __ Z. ... .. ......"." 3~" .. Neoal. ~~ ..e-a . _ GO-IO"" "~_

..-.a:'--_....-''-- ~ ...._....._ '_ 'H' '''''''' _ _ rOU

r l"'/lwou ',lIell' NIl aI Ino _ ~ .. 3 \"'""'_ l.-.p __ .._ "" ............ _..... _ An 1InliI'M " \e<ao:>lfU ...."'......., aI aII _ ..__"""""' ..._I'O'01I1 """'Z 2 10 1 3perooot, ...-.g ...._~ __ L", . IO_"""' 31_ 1O ~3 ......n__~ lOnI'/ ,o-l~ per canl aI """'"" "" flO<__ .., """" <;:IW:lran

'"", _ "'""""" a1__ llI'-. '''''"Ill"''."",J-,6 ;" 1O ' ·S .. _a1Atnc:a-,------ ---_.....

n " ", _on ~""'". ~ pIonnoo ""'Il'_<:anf"<lI ... ~_ Of' ... __ ... .-.. I.L_

oomoncl "" IIfI\aLef oi<as g4 1an'o1y I1wJl~ 10 be !ll'O...... 10_10 ""*'ilo _'._ot>ooJl ,..__, .. ,.,"" ....... '" 10 ......,._.. ..--.. _ W."""'" 1'lIO _.,.,..... '"...,.. ......... ""_ ..- 1_ are lOw.......-- ~ l>ao._._.. <I\Oflgong _ ... ""* 1'lIO","""",.,.,..... O! ...,.. •_ .....~ 10~ Thooo;l .. on 01 _ . W_«I'-_ Of.................... "'~_<Mrd al "--,, _ ,,I""""'OO<l1a<:l8ll<ln _ "",,"1IaIal _ . ....... """"'""'""'ll, • _ ....., ....... ...~1 10 ..,..... a 0lr""II_ lor"""""""'*'" u a .._ .........._go. 0t'C<>"'" "'>bl aI WIlr""'-' oS e o! .0.." "'" ",.......... Ior""""'"' .. I'lIl _ """'abILIy 01 lor\Ie t,orr-." II1II1' Do.--....l Thoo..""..., .. """ "'.... """""",,,,,,. PI01'CU1IorIy .. """" "'...,0IlOO r-.. llIOnnOlII__llr<lcn;,, _ _ "

""" ......- _..._-_.__ ...I l " AI):)uI 95'" "' ...~ .. .... do._ ...~M"

"""""""__""""" ""'" 01_ _ 10~1lIa'WWIll _ _ . IIftI'!IIty <OIl"' ..-.... and COliIIl_ __ 0as<>0L0 ~ ". tlIaI

__ ora 0lI0Ul 300 OCUQIO< ""'" dO001_~ n'K)r(t

'"""""" ..... ...., ott ""' _ o! '-"I'~.CIiBllyClUlID_"re_ID Il$VlCClInIlleCle . ( ...-,~ _-......, .

_ __ .. _ Ol n ·'....n··._""'_......~_I0_ _...,.,. Oil\' ...,.,. _ . "'" ~"",.Il>_ r__

16 iIrlIl ~8 "'" 1.000 _ ,_...., "'"-',_.. 26 aM ~O .. "'""l' «lUI'IOeI. ...-..... "" _ o!.,.,.....,."."., 1Il .. '" <a<ol 11>._ ""_ ..... 010\lOI- _ ___ """"';T""_ ..... ,,...

"w"""", .. """" "'"~ or- ,.._. ot __1lI ""'''iOes _ """""l .....1\" <n'Oren "' _ . ~an, l _ ,""'" PI __ 1 , ZI .OOQ __•i "'C'd WllOtI1JlIy _ _ .. ....._MIO"'" _II> of "'" <I1oIll _ " ",","", ,,_ ,'.... "'""' .!lOn'I """"~ .!110"'" _ "'" ,._ ",., ."'" an

_ -- -_...... _-...,_ _.. ---""".._, ...-, .... _ ... <0._..._~---- ---_._.. .._..-_ _ r- ..__, _- -,..,.,. ' .... ' ..- .,-."",,,,,,_*c I><h

... 'F _ '""-' ....... _

-...-P.....---=--....._..-__ r- .. _- -

'"

---111- - STATISTICS

Economic and social statistics on thenations of the world, with particular

reference to children's well-being .

s ... "" lI>t .....-. of infon' ..... child """,&1iIy

COUSTIlV (NUO( TO TA l U S

TABLEs

!:Ba$jc I"dic~ton

IMR I I population I I births ""d infan' and childdUIM a GNP per ""pill ( I life c~pt(:lanCJ I J adulllilC~n IChool enrolment I 1in"""'" dislribu,ioJ>

Z:Nut ritionLow birth.weigh, n b,.ast-fcedil\i n malnutrition

I 1fwd prod=ion n alorie intake

3:H.aJl.bAa:ao 10 w.,,,, n immuniO<:ltion of child"""

n immuni:ration of _a.rt n life expectancy

4:EduutioaMal. and ftmal. ~ l.raq I Jradio m:eivcn l1primaryschool cnrolmut ""d t(llI1plotion n occondlll'}' ""boo!

enrolmem

S:Delll"l"'phic lad;.lln"Child popw.ati"" n " " or Srowth i..ram ""d childmortality I I tnld. death rate II crude birth rat.

n fertility rale l l urbanization

6:Eeonomic lJIdic:alO<SGNP pcr C'lpi.. 0 annual Sl'QW\h rales 0 iD601loDn po••rty O s" v<mment upend;,u", U aid I debt.

1:Iluk Ladicators fot Ie.. poplllOlls CGWltri«G«l<taI -. 4m

......- ......F........ r.. "bioi 1_1

l:I<toi'iom/>I.IilI __

S ... 00 nrimom ia u.r..., ••" IOIn,. " I< (";d'; . ""'",....)

T.bk of IMII io...-l dilf.......... by """''''' 1970-1980

New Index of Infant and Child Mortality.....-... or coIlolIoIaIIOn ClOt 1."'-"-' NIloonJ!"'o-'"~ ft tN::U •• !'DOt~ let__ • __ .., __my .....c lII$ _ 011

...... rod chlcI ,"0,*'

AI .. Ot\r or .. " eo. .,.. _ ........,-..iII\J _ Mt d ..... "0lIIOI,__ . .., lNC£F '*"led Xl tullI)OI'I ..~

NtUonI~ DMIoon II />i1llJtli" .. 1hII ....~ .1""'",,,,,,, HI of Inl"'" rnonaJjly ..n·rnaleS In!~ These_ e ctI'1"ClIereclln 1'82..-_ leO "' Jht SloI.. d .. _.~_Iar 1983 Io_~ol"___• tiel' ..n .... IlO\l."-"- lie__•01 • """, '" <:hill ,,0_ ..,-.., ----"' /.."''*,-

In • • ,-.0* 1"'. >. o;IIia " ... raM, rIlOlIr1O '-' ..." , _1CIltt .. 0lllIh '*1,000 Ch*:I<tn IIQelI '''' __~. n. ••"'"... lIenotJW\aIOI Irom m.l "'*' b' !toe ",1/11'11mor1AIIty rtIle l,*,\hlI1* 1.000~ bIrttlI), TM mutllINlI the two __ CQJId not be -,. COLP,..;I

IIICl ...,sec In -""Don. IIIlI::aLU IN OB"OI . ....- 101 ,.. C/'OoCl-=ro """.so '-Ue."'*~,.,., bIltw 1 .. ~ i,_ • I'IIIMl__ SIlo"'" ..a m 1 _ 01 _....... ..., cHll --., _ If>:! .. .....,..0 .,-now_w'",' ,.., ...... __ I!

~_bNk1l_. I.now_~••..... torllw '-*IO_•.CO'...._....,._ l"O _ <II mortality '*""-.

• • IIQllO<l lha l ItIOI .- 1000. 01 inlBm aroo CI'IIdrnonaioI'1 will be liClOPled l:!)'OOU'm_ lor -... ..,...a._ • ..,_ ..... __ <MIl' h _,lew~ so 1IIaIi.,-,_,. IN__ form

.-l ""-' ......,; ChiO n....' Fa..., ctU>___ __ 01_",= 7 ....... rdchlll"..._. _ ..._

,.

01 .. ..• ' ; -._...... ... __

.. . ..,b oI_ I.~ ...

.-..-·I~ OI'I......~_ -.. _ tcr ctiIIl "olaioOl)

H'_oI ...~_ ..ChiO~08llI ..010.... II III CQ.r.ilI 01,.. --'<. II nowIllPNft _011I'0Il ' 5-.n/anlI.., cr-.. "'...'MlIIIS curlenl!y dyWlg ekfl year, allI'IIIly" 5 millen"'" _ 1hII _ 01 1 • • h9"er~ man " ,.,preyICtISIy-*' """""*l -" _ rJ/heI lIIarl ,...... dtIlI'llor fNf/rJ 2 ) inl.lrll __ lIWll1eWllap-"'CI-. • PI--'Y ......,. '" IKI ,d'lIkloiNll lor...., 2 ..... __ '.''''''IQ 1;1_,. "' ..... ' •.,_.... _".,1""*' _lor...., S .... _

__ -, ......... _ ' ..., ol_ ..._.$ .... prqKIIOn 111M N ICItIl ol_ ""'" ..-.:I d'IIkl oeooh ... 1IlIlrom III<;ut.-.T

le¥lII or ,) "*'" l;I.-ouncIl 0 "*"" III'IN.-.:I olINc:enIUIy Ol COI.A"IoI. ~ ol !he pufIXIIef O! UNICEFS<CIlIlIrtIo'll <:OI..O'lIr\'.e~ '" !Ile ... ol CIwId IIlJMvIlI..-.:I" I'Cl)II'IOlI~.1O~"..P'OIIC"'" mill or......._ ..-.:110 -... ""',.~ or........, QlDOIII «00'''' .............. _ no.... . 10_.__-...-. "'__mid trIOIIIIky l'1,...-.:I ol .... ........,__...,......-.:I__ ; ~ : w:..,__olr-_-_.. .,--,~ .IS _ or inl.lrll _ alIIcl Ata... fill las 11 ... ..-.:1 ol~""""''''' • •1OClIY-MlCUI ~ 3 miIIIOtl • year T1'uI "tnc.l. _ro:>w _ lor..,._ 30" or.. "'llllll laro:l ctlIId

<IeIIltoI, • P/OIllCIll(l, III' !tle .-.I 01 IIlI _ tuty. 10iCCllUI'Illof ",.. 40.. ot II ontam mel CIlIiCI__.... -. ~ _ .. _ 0'U'IlllerS

~ II" Aka. N ....- IlIiI:n ,... III c:._,,_"'~ol_"""_--

Index to countriesIn 1M tollowiog tables. COUIIIlles are llsled Indncet<:ling order ollnlam mortalitl' ,oun<!ed W It>It""",est 5 InIIIecase 01 coumries .i th a lal8 01 50 lMaltlSor more per 1,000 rive tw1hs .cocwes withtile same rates areIlS1ed alphabellca8t'. The ref9<ence f'\lJITIbers indical"'" !hal order are shown In the alphabeUcal Iisl 01COOOlroes below

Al{jharustan , G_ ee Pakistan 30'".~ " Hail; 23 ,~~ ",- " HonOc'as es PaPUa New Gulnea sa

""'" to Hong Kong " '" Paraguay 80-,~ es ......,

'" """ eaAustralia '" ... ae ""'..... "AUSlroa '" ...... " ""'" '"-- za Iran (lsIamic Rep, 01} aa """"" '""""""' '" '" so - OJ

""" " ,..~ '" ....... es"'"~ ra "'.. '" 5aIJdj Aratlia toBoIi..a ae ,.,

'" '-" "-- sa """"" " Sierra leone a&.. " ........ 99 Singapore '236<J1ga'," '" - '" """," s'""'" F_ " ....." " Soulh Ah::a "&,~ " ".m..... e ,,"0 '""""'" " ~~ se Sri Lank3 saCameroon. U "",. " Korea, oem. Rep. 01 es ..... """"" '" Korsa, Aep. at as 5_ '"Central Afrocan Rep, " ,- , sa SwlIZe<1and '"""" is lao People's Dem, Rep. as SyMn Arall Rep ""'" " ,-~ n Tanzarna. U. Rep oJ as

""" " Leeoeo ae Tho.., "e- ts "'"" " ''''' ..""'" " tibyan Arall Jamafllnya " Triruclad a'ld TobaQo seCosIaRica '" -,..., es ,.... sa""" '" "'"- • ,."" .,CledlosloYal"a '" ""- sc '-'"," as

""""'" '" "" z ussa as"""'""'" "",. ss Malllitan<8 is United Arab E"",ales ..,.- ee MaUT'WS sa United Krlgdom '"''''' " Me.ico ra "'" '""...... "_. ,. _.. s t,,- r ""= " ,-- ea

F""'" '" ""'- , Viet Nam sarreee '" .."., " ,- acGerman Dem. Rep. '" ...- '" Yemen. Dem. arGermany, Fed. Rep. at '" -,~ '" ,-~ erG",~ " Noca'aQua " "m ecG,_ '" "'" " Zamee 50""',- sa NOgoeo'ia aa ,"''''".. """'" 5 """" '"Guonea.a.ssau " """" " .-.

'"

TABLE l' BASIC INDICATORS .---. •• .-- - ~ .- --- ~ -- - - .- _. -'.-" - -~ .- •• - -- _ u __

---- - - 1;'': \",' - -- '::'~-- '. '. ,_,''' _,n---"'"_1<IIIl- ,. ,..~. &1,0011,.._ ,~ - .,. 1& 41

, ::-_. ,.- .., 'M_ ,~ .. .,. ' M, '. ,.. " ""'",.

" "'ff;' ~,~, -,- ,. ,a " ' lIIlS' - .. 11111 •• n~ ". w

- - .., ,.. .. -.. ". " .at:P~ 12 1~' ". ..., - ,. m " lOOfl~ - .. 35/" " 111, - ,. ,. .. 3 UI1~ •• " "m "~3<, .- ", ,. '" ,.u,u. ,~ " ..~ lZ, =:. . ", '" " , 51'/1! , ,. ., "/111, ", ,. " ,~... ,,," "" 33/".. ... '" ", " -,. ". " Jel" ,

"_..

'",,, .. ' '' /«1 '. " 'S- /l' 11, . ,

" ~ .., ,. .. 2n111 ,. " I.,. :1.0"," ,.. ,. .. u,,, .. .. , "/1'..--~

,.. ,." ,. '" - " U l1. . ",

" - ,- - -, 110/5 ' .. " "" 11''' '''.. Goo • ,.. '. n "" '. " .~ ..." - ,. •• M M / ,<o ,. .. ." no~ ., N

" =r, '. '- " 1i~ - " 3"" .".,oo ,.,." - .. ,.~ ' 3t l't• - ,.- "

_.. - .. .."," ._- ," - " ~/2 ' ~ • ~~ .-n ::.u ,. ,. ., • 240 1N'I ,. .. 00/ 1' ,.,oa " "n '" - " - ,.. - u "rn U I/;oI , ..... - ,,, '- " _no -. .. 30'/12" '5/$1 " ".. - '" ," ., ,..,,,, ". " 51'a'- '51"" - ,. ". .. ~;~~

,.. " 1e-/ 51" ..,., " .." ~ ,n ,. .. ... .. 39/15 " / ;>!;

" - ,~,.

" "· /3. - " 2""'0- ~/43

" ,-",,_,.0- ~ '. '. " '·m .. • 5'131 01/ 82.. - ,. ". •• ',0'11'" ,. ee 311'5 3113' • "" - ,.

'" •• 023/ 1112 •• .. ~/" SII / '2 ". "."__"'" oOl

'" '" ", , 100/ 2116 2.1\1<>" • <S' >?" 11'It' ". ..." =* ,,' '. •• < U, /64S ". .. ~?3 0.. ,,' - " lo:1/tO •.~ " .,.• J---. u "'"' '" ", ,,, '" 10003/100 .. R"/3" . ,n oo· ~.

• - ". .. no, ~-;- - U WH ,n_ oo .." -- ", ,.. " ' , StU ,.. .. ' S/ lO "',~ • ~• - ". '" " .- ~ .. M ., " "M• Y:::" ... ' M ." 72'lI1l :14 - ~ 116/41 toll'., .. ..M ,~ '" '" , :lIOJ74II ,. " unl ,eo-n.'

i$= - , ,~ -, -'_Tr'S,2Wf - " • ,or ,~. " "..~u ""''''

,n ,." -., .. .. w = '"m" fI.\:" ,n '" ." '''ins, ~ " !>t' /V' '~"ff " M

" 'M ,~ ," .. III .~. .. WI'S '101"1 , .... '*,.

'M .. '1'12' - .. ..no , U /II(I

" - • '" ", .,., ". ~ ".. . 0... --- M ". " 'SC/2' a.;~ • &,./W',oo~az.. - " ". .., "' I':sa ~

.,/ " " .... = M '" ., ~ "/l11 ". S113~ ,oe l12.. M - '" ' .S3e/"1 ' 2'0 n " /50 '05ft5 " "so - • 'M " ""'1 - " 19/sa ' 00/" " .." - M .., ,,,. . ...'/115$ - .. /ilsa "II HII .. .... -- M ' M •• 1.1 1"'~ '00 U

I'~,.. ,- • ," n no.. .~ .. 1211100 .. ".. - • ,. " no ,- ..

~'" IW~'OO• - • , ~ .. ,11m .. • ~,w r- ••• =- • •• OO • '.~J'U ~ U . m TOf/tll • •" • '" " .".. 'M " "11' .»1121

• - n •• " . " - .. I ' ..., M"D:' • •• • -~ n '" .. ,It!o", ... a .~ '00''' ' .. ..• * n '. .. , -- ,- M ,,,-" :-""60.- n ,~ " 1:1411' - • 0 ' ° ' 1' ° 1 • ••• n '" " '40'" "" U ..no . no• -- "

,.'" ;~~" ". • " '118- '10/1 05.. - .. ,. ,,,. ,- n ... 'K_ , ..

'"

,-_.." .-- -- ,. -- --- - -- - - ,- _. ,_loa-"- -.. .- .- - --- - no - -- -- - V,. - - ,. - ,. ,-,- ,_,ta -" ,u '" , 4" ' t3lll ,m U .~ "'''0' " •" ,m .. m~ "N " .~ lU/1 10

" ' u " _m '" • 77'/1" .,. " "" '. " .,~ 1.110 " '1m ''''1 " m• '" .. " StU ,.. ~ ,."",.-- • ,m ". _,a ,,~ - "''' "~--- m '" .. .~~ "m " nm '"- " '" " '''''''ll ,- • W/~" 10$/' 00- " '. n, u·."fl 1."0 • .~ 1191'" .. n- -'N " m" ,. • .- 1~lta1-- -1:0:' • • ...." 22.Qnll'-T ,- • .,. 'lJl' " 00

n ~ ~,. m • 'N ". • .,. ''''''31 .. m, ,

~ • " , 'M3fU' ~ • .,. ,UIl1) " ~

" ,- • n .. '''~1010' ss ... tlS/lw., - .. ,,' ... ,~- ~ n ... ... " .., - " •n .. m" - " , ,.'"

• ~.,. " m .. '73'" ...'. " m,. "'Ift" • ,m ,~, 110l1l1/100, - " I'»/ SI 111{10:1 " •" .- • " '" Ollm - " ",.., '..'" " "u - • m '" ~m ,.. - U f lU ' M"O< .. ~• _ .....r-_ .. ,m " l' , . n,,,o " ~". .m

" iN :" • ee •• IU,,, "" " ... '07 ,'01 " ~• • n .. "" ... - _m .,." .- n ,. m J1~/>J "" " .,. 10"'00 " •-"-. Do>o "'" 01 .. ,. '" 571/71 ',130' • "':88 " r /" O'• -,..... .. so ,. ., m~ r 0'0 • ' 01 /1 011 " "m - .. • ". '30 / 17 '.- " .,. ,.,., " -" = .. .. .. -. ,..

" &3"/lH' "0/.01 ". ...• " eo " "" ". " M /72 "."n " .." - " .. sa r 3t:W ,- " 91 /1/< 101 " 00• - ae rs .. 2••10 " 118/1 5 112/1 01 ,

"• - .. " 21) : 5 '0< "$1 ' .5SO" " , ,~--_ m- " " .,n ' 2.7&O Ij' l3T 7.'110 n 10tl .O' " ..

• '--'- " u " 11/' tm " Am , n1" 01 " ~

" ~ n '" ," :1.,/' " ... "U"O ". >0'A - n ,.

" _n ,/.- " 13/S!! An'A - " " " . n ,.- " r '~/'''',.- .. • .. " " 0 ,~ " ~~ '22/ 113 " .,Ill> e-~ " ~ " 10/2 ,- " w,. '04/ ' 02 " •,w-. " H ". ..n 1.'~ " "'" ' lllI / lliO " •'.- " " •• IIO"~ ,- n " m 100 " 110,..- " H .. 'on ,,~ n

=~'110"110

'H~ " " .. ,6/1'11 , " 0' n "1"05.", c..e: " H '" ~n •.- " , .m'0'_ " .. .. '. n .~ " .'" ' 02 / O!l,H_ " • .. ". "" " Hn ' .n' " •,ot _ _

" .. " ! ' I ' ,m " r ' 04/nD " .."0_ " .. .. "" .= n , .m"':'" " .. •• m /o .~ " HM '0'/'0' " ..'" " .. .. "'n ..~ n , "'" n •"3 __ ....

" .. '" ~n ... n , . '"" 0 ..... " " "" J 1l1/V ,. "0 ", , " ..

"$- .. " ", ' An " olIO " , 'MI 'O- " ..".-.,r....... .. " '" ~" " OlIO n ..ht ,o , ~.O!> .. •'" _1(000 .. • .. M .- " " ..".- .. • " n " ,- n ... '11'11' " •u._

" " N O M" ..m " UUUO " •,1(1~_ .. , •• . 101'11 ..... ", ,o,ml2 " •

'2.e- • H n. ~" '2"A n , '01"'" " ..>n_ • "., ,.." ..- " 12~"

,,,,,. " ..11' .. • " " O ~/I .- n "2/'0'' 2'~ • n " $. /1 " $10 " ~

100/'0' .. "'n ....... • " ". "111 .- .. ",., " •,,, - , .. " $1/ ' ,,- " , " /100 " .., " So« .."' .. • n .. $ ' ~l '1.210 " ,

,:;~.. ..,n _ ,

" .. ." ' '''0 .. , " ..,n_ • ,. .. , .~i?t~ '0. ' 00 " , " ..,,,- • " ..,. '0110 " , '00/'00 " "'"

TABLE 2: NUTRffiON••• - -...-. ...- • I' ,. ... .._...... _. .- .--. ..,~,.. --- -- - --- • ./- ,,·n_ .- •••- • • " -- ll'0I ... _ ('''''''''''00> -,,~ --- ,,,!-'., ' 1>$-1" ,..,.,* .~

~.......-_ 1_,00)- .. • • ee. ~n " • •• ~._' ~ , ... ..• ..

,. . ~3 '~ •• n

a SoMa l ""'" n ... .. • ee N ..• - " ... , ~ ... "s - .. , .. N, - '00 ' •00' " . , • ", ,- .. ". es- 6(1 ' 1'0' " .oo ",~:.. ,.. .. , • .., •• •• .., " ra .... ...,. .. •• ,

" .... -'- " / '0 ' n •00 .." :=. .. ... ~. ... " '/11' " '" '".. , ,... c.w- A...,... Flop "

, .. .... ~ .. , ... N.. -- ra1>O . ~, ." ~-

ss N .. " .. N.. .. .. .. " 30":'0' " .. ..... - '" "'" ,- W ... W S' ' /0 ' " eo "'" ,-~ ... ... M'

W~~l '.. .. ..

" 1lM ..... M .. .. .. " ... "sa .. " .. " 10 '/3" .. so .." - .. .. .. 17 ' /2' ,

" .." - eo "l ' /~ ' sa ... .... - .. " .. <\1 ' /3' • .. eo" ~ .. es- •• 30'/3 ' M .. •.. - .. ... • • ... , .. .. •••" "",_'.Orrn fIoI> .. •• sc- W , '" •" - " .. .. so (;Z ' I IO ' .. ... •.. - " .. N " sc-zs - .. .." •'" _ Ilel> oll ..

2" ~'6 ' •• ..." ::,- .. ... ... •• .. .oo.. ..

'3 ' ~ "" r.......... u ... .. .. .., ..... - " 33 ' /S ' " •oo sa

" -- .. " . •• ee - Z'! "I2S ' ". •• ..... ,- , • • • , , .. . 00.. y:;'G .. ee- ... W ' 5'1' _ .. .... .. '00 ' 00 .. , .. " N::t---I::..:.~

" • • .. J. .. ..." eon--, u Roo '" .. .. .. , • .. ..., ::: , ... ... . &/ ,. • .. '".. ,

" " .. ' Z' / 'l' • " so.. i:I:. " es .. f, 00 .... ,,' ree - ... ". .. .. ee.. Loto,wI .......... "" -,,.. ' Oo/S>

.. ."n ~ , ... ... ". ~ .....~

ta , ea ..... , ... " . ...> •• rza.. - .. ". " .. .... - .. ... ". " . 71'/3 ' " ... ...

" ~- " , • sa ."" ,- , " . " . ". 6<)0 / " ,." ...

" """ .. ". ". .,. ," ...

" - ... •• W 29 '12 ' ..' "" =- " ",. .. JIJ '/2 ' , .. N

" .. ... , .. .... - .. " . 31' /1 ' ".. ~,Roo .. .. " • , • " ..eo '. , , "0 ..,.. =-*1:.. G<n1I

" . 6~ ' /3 ' • .. ..." " ~f " .. n..~-

.. ,.. ".. - , •• ... •• , •• ." ...'"

,-, - -- --- .."" .~ ...._- -- -~ ---~IOJ'I- ' ..

~-- -- - --- ... .,- 1 ~23_ -- ...- • • " - rro ......- (,",,·,t . It.'I -..~ - - - 117&-'_ ,,'..,- I.'.,.. ,~

" - ~ ~. W ~. 500'/" .. ," ".a ,- ". .., .. "" ,,- " rr .. ~l ·lti · " ~.. - " " n , '" ".. """" " ". ". ... , se '"zo -- , • " .." ~NObRop a " " ,

'" '"" - ," " " , • '" 111

"_..

" ~ .. ", ,. "... -- ", .. '"---e~ • , ". '"n ~ " " sa .. U ' /l!' "

,. "."f"_.. eo .. se .. 00'/ 3' " ". ,.

n ._- " w:,· '" '"" ,- " .. n ee " '" "." - , ,~ '"eo~'*'

.. n .. f '. '"" • '" ,~

~ .- " .. .. .. f ",,,

'".. - , .. .. " " '."~_F__ , ,.. £ • ,

'" vna n ec .. f", '. ..,

aa 1«<000. Dom. Ilop. 01 ,'" ,".. _ , Roo '" • ". ... ". , ,.

'".. = " ". ... ". , • ". "." • " . " . ". r '. '".. " t.. - r ' " '".. - " " .. ee 4 0' {3 ' • ,.. ,.... ~ • , .. '"~--\:.") • .t, ,M ,~

~ ~ IflCI TotIOgO " .. " , " '"" , 10'fl ~ " ", ,~

a - ,. , ," - " " •• .. ,

" .. '"," ...... , , .. ...",~- • .. eo • t o' /u' a ,,''" :t::' " .. " • f '" '",ro , .. .. " ".'. S::. .. , ," ".,.. , ,

'" ''"'M_ , , ," ",101 C<coco , , '" ,"1<)$ .... , , .. '"109 _ _

• , ". '"''0 -.. • , '" '". 11~

, , '" ".'" • ! ," ,,'11 3 _Dono .. • 'M ",1,. USA , sa " • , , 'M '",,~- s , ," '"116~. roo -. '" e f '" '"'" """v «:<>g • ". ", '"110_ , , " ,~1111 _ ,

'" ,"120 u...o Ktv>Om , , n. ",'" - • " " , '" ..117_ , , , 'I '" ,~,n_ , , '" '"li'Ooro'n.>tk • , ,, ' n.11' . _ ..... • " , ," ..."8 ...... • , ". ".'2' _ ....... • t '" ".120 _ • ... ... l

.., '"..- • ,n "., ,"- s se- " '" ..,

TABLE 3, HEALTH.- .--- .._- ~_. -- •• --- - -- .-,,,0-,_ ',,'·IM:! -- ---'. - - .. ~ - - ,....,.. '. '.v... __

_ 1_ 10Dl- " ~ .. ~ ~ " " " " .,, .- .. .. , .. , , ,

" ", - ," '! 'O " .,, ~,- 'O ~ ee " .. " .. ", - " -n " n ' ~ . ee- •• ae .., - " .. a n ' sa ~,

~ " ","

, ,"

," ", - ". •• ,.

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.," " se - ". ". ,..

" "" - ". 'O. W at- W , as "" ,- w •• " . " . " . as- ... " " "" '-- " " " ". " " • ,

" .." 1104_. ae " .. , , , , ,

" .." - ... ... ,. ss- ". ". " ". " ".. - " .,

" " eo " .." - " .,

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., w " " .. •~ - ... ". ... .,. •• ". .. "" - " w • ,.~ .. "" _.- " "" '- .. ... n ' " . " . " . w O' .,

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TABLE 4' EDUCATION

• • .._-,-- - ""'."0"" -- - -- ~

&000 ... , _

. ' ~ :::I - ,.". ,_. - ,-- ,--,-. '_'M3- - ,. -- .,- - ,,1>_,'" -v.,., IIIgll _

_ ""1_ tClOj

"'8- 21"G 38/" " :le/" ""2 , .., """.._. t3/2 3O"W " "" 31S~rzO' ..~. .. " /5r - II,. 1"/6' " 1</6 " uvs-a _l..... ' e/I "I" on 30115 '6'131' J.,.~, .. 23." 0'• - 4211' ' 11n .. ~,"5 n ,s, 01 /31 " .ns - 2' 11 3S, ,, " U / I ' .." , , 21/1

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, " ...,. -- ". " I . , , 13 ~1'2 "~3 ,".- ,.~ " .. .. , 12 2/91/2' r

'" 1&1,:. [)om 'ltla

... " -" '" i 10 &/I"J I ,'" .... " -.. .. I S' /IS.lo' /ll' ,'" "W .. r , , r". .. "0 " - 00 "

, IO'C."?a 1 ,'" - II ' !lO " ••• ... , 10 112/9' ,,,' ~.r... Roa" tl 030 " .. .. , .. 3/0'/11 r,n :.::..~ .~ " - ~ : n , , , U,'" :.: " .. , , ol/flhl ,'..=- .. " .. , , ,,~ .- " ,. ... r '2 7'F! r l"" ,," - >l.~10 " -" .. , HfJ, 21.1& ron- ,,- " " ... , u ,.. 110 ,on ~:._ .

,~ " " " , " 1"'/22' ''01' n ",. IUM " " " , ' 2"I,u r l1 l'" ,,n -_... .- " -" " , " I" ' I!> ' ,,'" - ..- " " "

,'0 'h'I!I ~

,'" - ... ..- .. "

,. , 12 1 ,,,U ,'" - '2010 .. " ... ,

2 ' /1 0 'cf." ,'" ,- ' 0.10(1 .. it ... , '011" I~ '

,,.- '0,110 <, " , , , t

'"

TABLE 7' BASIC INDICATORS ON LESS POPULOUS COUNTRIES

_.. '"-- - -- -- ~ -- ,- - ". - ' - "--, - ." -- .- - -- - "' - -,- -,~ 'N ,~ ,~ "" ,~ ,- '''''''I'U, - '" ~ .. "" .. " :19 /': 1~/", ._- '" ," .. '*/' ,~ " , ,, - ,"' ., , .~

~1';~'"".,,,.

• - '" '" M "" 8:0 " 112/10\1, - '" ,. " "" ,- " 63 / " "'''/111• ~ • '" .. 2'1~ •• " SII ,." '01/'., - .' .. t - .,./..' ,• ~- " ," .,

'"., " "'" '31 ' ll '~ '

• - ", .. , ,~ .,",,,. ," -- ", ., , "' , ," ... ,--- " .. ,

" " / <2 r

" ~~,...., .. , - , r

" • 'W .,'" 2' .2'0 " ~1 '15 " '0>/'0'

" - • " .. '0111 ) .•:>c " 6.l"/63' '0'" '00-

" - " .. .. '311 ! 10..,0 " " '" '"'I'''" " " " .. 11/1 ,~ , ..',,,. ","''" -- " .. , ,- , r" - , .. , ',- , ," - '" .. , ' HO , r" ~ , .. , - , ," - " " .. '31ll 0- " 9&/ &1' ," - " .. , ., , ," - " • .. M' ',- rz r ' 01/ ' 0.

" - " .. .. '" J.UO " ... 9BI~

" ~ " .. , ... , 1113 "/ '02 '

" - ", .. , - , ," -- "

., , 21.1<0 .- ,, --- " ", 1./10 ,

8>~.'" - " " .. ." ,,- ",

se - • " .. '" '''.200 " , 01/''''" -- .. , - , ,

,.

General Note on the DataThe _ ClIOiiGol., ... IIIlles .........,....,

lI\l' ' ..... ...-. ......-...Dl _~kd .... _ ",, ' ! ...,<11 ..".,.. .....t'>e~__' -. _ r.,.._trom.......,_- __~ .. ,..ISOI*o.., __ ,$ ..._.__ Dl : .., 0ll0:>Il go4i"i.' __ Dp .... ._ooibIo l-"- '-'" --.cY___ _ I e~ »1"......, _

_ _ 1'lI;) ...... o/IocloII.... .._.... tlJ 15tior UM!Id N.1IIDnI~ '--. .-_"""" ...,......,. --.....___ III t« -. "'" __ on _ lrvm.- t.NCU __. AJ ood! UNCEf !ltlclgIlIcI _ .. "*""<l .... . 01 Y

The ... lot """"" """'*I rates. IIIe~lanCy~ bIrl!l liIlI . cruoe ClD/llII rate, eIC • Il<lI IlaI1 or mefIVUIIr on al......... """ 11'* IlOo"""--by "" IJ<'iIecl Na!lOm~.bOn 0MsI0<'I T'-__ .,lematlOf\8l e&lomaleS or, .-~,

b.r>cl .. _ ltIQF II' .. to .. _ DlGN' ~ _ <JBoc:.l clII $. i.'__.._ _Dl. __ ~ot

-.g _ -.u Il'f' .. Wor!I:I Bor* _ N

C/IgIod , b £mG ,.. eo.-"'i_~.....- .,.....,..~ 01'*1' co or ...,pII------... -on 'W3SlIng' a..__....... • WIlen! h

fv,nI _ II> any • PM III "1;lOIlM'f' ....., llICIled .. • IcoIncIe

1n~_bI' .....,.__ ..__- Ihl Dl .. tnI8nI mon&oIy ,..,IDI' 1983, 111 ..tes __~I0""_5.. Ihll ClI2 III <:l,I\II1lfllIJ WIIh • I81f 01 so or 1IIOfW, Inco..tn1I'IIS WlIt1 rates tleIow SO , __ aw. ,,\ISIJMy.t/lltly _lItlenSrOOe ..... !iorI lyI1em, 1ho 1_Mvft _ ""-""IIo!(l 10 lIie nearesl ....,

Signs and explanations~_ "' _ .trle..........,.__ fIlf

hllDur lMH (inIonl lioliillil,l~ 01~~........... 1Dt _ ~ Tho..- ...mo:kII ..-.e 01 • .-e. sol •••_ .. 0fII&0 01~ ,"" COi.i0Ill'_-.___ oI_ol_ .\Jeel1WlQe Ile r-..._,. ..._ ..... Dl -.g mAo_ lI\l' .. """ __ I)I """ .....~ Inc-._..

_at IIledaa lllllOl" '* _ .IN mollCClij_jiDi~.-l _ "ll' i11 1IIlI_. _ .IN alIIl

01 II IIlIl ....~ by "" _ 01 .. IilItN110 I ,• . _ .... ...~-._0Ivw,

........ _ oIllQ1l' · IlKIn,.... .,.n.. '> __

.. l)IlltIlem 01 -.010\>1 .. 11Ir'c.-" c:lloca 01 IIlIl..-.lOlJOMN oI ..--... ..

I 0WJUl ~"'IIlIl""''''''_ "" _

TOlIIIla '. • • • • " a !JJidio:wlIs. IixIInDIl: ill fle _ Of ,.. _

•c.._., ...LNCXr .., oIIcII .......

W l_....-hIlI .. _ .........,xy LNCU .__..._ ............

_ Dl IlW _ figureo WI ..... on 1'1\1 ,..~-"" by IlW UnItW IQtIoN ,. :~ Iolio"_on In_ -.., ....... ..._~_ ...I~..ttmot. t _ ,...... IlW ..... .-.1IonIl ,.....

,..

~t

f"

.!,.

I'

,,

,~~~c~~_~oo~_No'~.~~3_~~cl"!.acc~·~I~aa~~~c.m~mc~

01'0'.-'1

~~~~~~~

'

c

c~cc,

"_

_

~

~

~

~

~

~

~

_

~

__

I

~

-

-

~

~

c_

0

_

~

~~~~~--~~~~~~~~~~~~~--~~-~-~~~~~=---~~~~~~~~~~~~-~~~=~-

1"lll!'I'III,III"""I!II'!I,!,!I""I'I!II""III,I!'1'll',III,lia

U,

Ud

u.J

UU

he.~

i"u

nk

R.JlU

U!h

,i&.h

Uh

l~ll!

l~~l~~!llllll~~l

ll!!llil~~1111~~I~!1

~l~l~ll~

1'g~

~lii'

In::l

!mU

'"I'

:0II

Ill

'e"

1,ill

II

~!!llji!liJlllll!!llltl!!ijll!I!!II,llljllfll!JJJI!!!li~~

1

11o"

c:-

•-.

,o

:cjll

o•

•II.

I-_

!~nli

,<~I

b''1"1"11

,."",.,

I'"

11t._o..o..ooco....o..

:Il_

I!h

r"EE

UlE

;IEl'

IfIII

1IIIilillllffllfff

•I

I',

unI!.JUuliUdh.ll

N..§

i£;

....:2

,

Table 3: - - '9~~= ,0<011 - N/1J , -~...~ ~,

~"- - ~".... - ~"-~ - ~"- ~, ,-..._. - "."-~ - ~"-~ - ~"--- ~, ,-...~ - ,_...~ - ...... ' -~,~

~- ,-...,- - N/1J'-~0_ ",...,... """'"'" ........_ '980- - ...... '-~=- - "."- ,-...- ..... ' _5~_. ~_ .............. 'No~ - ....... '_5-- - ...... ' -~

~ - ..... ' _5- ..... ' -~~.. - N/1J ,-~- ,-...~ "'. - ...... '_5::::=: ~, ,-...- ..... '_5- - ""'" r-e~~ I10Il - "'DO ' "~- ..... '-~- ~S- ~_. - ,,~

f::.""It~"Ra> '" - ~"- ".",- - "."'.... ... ... - ~ ,-~- ~, 0 ...- - ~",- - ~"- - ,--- - ...... ' - 5

Table 4: e,:._'--~

, Y79

--~'916Educatoon - ~'.';::::=::'" "11- '911-- "-- '979_.- -- ,91g-'- --~,g,~

:l:;Smlo_._ ,g11--- '916

~ Soror<Iary .....hO . ' 975

-~- -- '979v......" Porn -- ' 913- _.~ '97<- --~llHS- -- '976- _.~

""''''= ,., ~ --~'9/6- ,.

~--,~

'--.11. '''' .. _.~ ' 911- --- '912-~ --- '91g~~ ~~-

'9111,-- -- '9/8- 5 ....,_ '978~~"""''''

_.~ '916c.....,. U ReI> '" :;:&:,;';",0' 19'9,... Ig' 6I_Al",,_ -- '913~ _.~ '910- - ~--

,~-- _.~

"".u -- ""- Sow _ , ImllO:T"O'II '918- _.- ,gl1- --- ,9n- s.cadory__'9/7,- ~-.:-,g19

,,~~ '0_

~_.~

'"- -- Ig , g

'"

~" ":W---- .------ .Cos • __----_.' liS...,'liS...." '4" IS.... '0·" ..

Table 5: ,_ ... ",,_.,_~

DeoliOQi'-.c: if1dI(:aTDr.i

'M',M,,."....,M'...., ,M'""..._ '0·" I'......._ -"I''40 _...

......

-~--~-----~--------------:":1- I ,.-----~-

-=- -----~---Gooc>,,,.'_-~-00••" •• • __l';N>"..----=GIll' V-r...

-~CNP_r>-"_Goooo.... . _ .....----~~.:f'"

-~-Go ._.Ga ....--8.'---~-,...--~-

,-:::::- '"------E:.-"-r.:

Table 7:....9.....,~ ...P'l"o·---

Table 6:EOOllOllliC--

,.

DefinitionsInlan' ........ .....- .. _ot

IIIortaIil} .,_..- I _ 01_ """, .. l OOO """ l>n1O

Inlont ..... _...-01_01CIIllIl _...- 5 _. (II

IIIortaIitJ 0\10. IlOI lOOO . '" .....-,ur. I""__ .. ,... .-b<:on

Eo_lanc, """'"" -*' .... d ..- Ieat _ , ,.,,,.,.,..-,. fI$O.$~

.... "'" ".".. st'_ '" """""_at ". ..... 01 _ bof\

CN<Io _....,.,. ......... "'" ' ,000-_.."""R.I,",

T_ """'-"'!I:Ier Ol_lholWOiJ<lFotI lIItJ IlO tIOmpet _ . ' _ ..... "'_, No 10". .........-"'11

_ , ..., "",",,'on01""'" •

,,~ .,..~----__ ltw>~or_",,_

.. Wootiftg 11'_ No1 _ ....,__

1_ "" ,.,... .om ...~_ utrIIlOn ): ""'..., 01,._"""./!oogN

" llQ<>Aoon ia.~_ " ... .. ...._-I<w./"ol,tll 01 "" li"oIoC SloIOl~_ c.,.. lor _ 510...."

--~

Adult _ .. ""'"""" _ lli .....1,/1«""1' ''''''' ...., _

R.ol.,

,.

GNP: GIooa -... ..Odu<l ...........GtI's POIC3Pt3 ara ""J)re<MKl ..""',.,. I....- _ -. GNPPOI ...lIIl1"M'!' , .......__ \1''''''''' , l1l3I _ -.

_lid ",. fOo'ogo , ...., ... 101M~ _ '" GNI' "'" COP"II.,......... ,,__b"""'"

_01 ........""'..._. ....._--_.,..,......., ........." """"""'"""_..

L....: <lioI "... _ l"<I<>lo<><l_.... ,..,.-,00.: 0ll0aI 00.. : ,'j. . <:8

_ .... _01."....010_

SIIat"' .-",. .. I'I9'aIlQ'lI oro_'O'l."_c_ ...., .. ...,.,.,..... _ 60 "' ...

"'"""'_ 8~ 01 ... .,...__.""._.s..-,.. ",."0;0 ..",,,.__Ior_,

-.y 1»<> _ ,_ ....~_....- OI__El .olmo," _"' ....... __ ..

11.0.- Ih>rl:>OIonll .. ,.., .-__ Ior _

...~'" ""'.... ....,.,. ..-.. ill 1hot _ """ 11'_ ""__, Tho "'" ,_ Is",. _ !UfUf .. _ ...,..,.

.. ........... _"""'''*"'0 .. N

.-ago gro.c>, ftXIl<eSII«l ;l$ •_ .. ,.,. lOlII .....- '"_ in lNl • 1I'0Ull•

C/'lb... _01 .... _~ e<lI!IWIg re !lrSl Il'_ '"

PrImary --..- - • ' ollySdlooI:~ lI'IaI _ If\ dI,.oJ COI<W.

Main Sources10''''''''' u....,-.._

ChIld llMooMOI'IIl l,loolM ..........1IIonaIIty: _ 0I'h<>:l

P" ',.....,: 0lIICf ...,u..... _

-~-

Io'..t ~

C_1IN1he: _..., lNCEf

Aclult ..- No.."... f_.L.II«Kf" S<>«!lI!Il:..., CIAnI

0t00riU_ ~»E8CO)

RadIo lr1iloCI N>ti<n EoM:o_-...... " _r.c_ CI./Iu'ol

- """"'5<:_ LO-.lOCI __ EduCaIICnII.

EIM_t..... S<:iorOtfic _ e.-.a~: 0Jvant,f."",,!U'lF8CO)

_ . Wono1_",-,,,,,,,,,'-*'\I: IW' OOI """ Wono f_fr....

Child lNCEF 10... __Ion:

Utbatl .......__

P i d ....." !lM:ooll

D...iep",.. ,t e..:..e"c.0Ii0'I_.....-: D. i. 0100" (o€COI

'"

Variations in Infant mortality rate (IMR) _in countries

l~'" _-0- GNP PI' ca.ou. U. __ IMR101 ;I QCll.<lIr)' '*' gMt • m--.g~. 01 lI1elil""I01. ... """"It'(! PO(lfer rural "'- !he preyajIinglMR Is~ c:cnsIde<IllIY _1I1e IIlIlionaI average~!IIe IMR It uMNIy ""JCIl1owe< among!hose"'!II ""'1* ..... oJ_lIOn OJ """,""", Stall.toea on!he (lI/fer1lllCel in IMR .....,.., countr'" "e lhe<eIofe_fY11UIJl)lIo,"'ilI 10 !lie na __

T~__.. ". __ 01..-..01

tI.R V8I\IIICn """'" ClUlIneI!I

_ A. C(IlJr\'W'II 2 10 _. !il'oO'*S h -.ated

-..... al~ PI' 1.000 gnp.-..on 0CQ.rI'Wlg "'_ ..... IhoIUl iI _ lhan 2S'Io Ill 25..._ . lI'Ie __ -. n. _ '*' 0m,_ ,", 10 __ 01 0IlC0'IIe -.-. 10I_1lO"MYI.II'owogIN~oI.(XlUI*J'1gnp ' ' .. "'0 ...._--...c.a..ar_r._ ••a c

I ' .. B.~ S IO '. _ "' _t '~ d ... 0lIlNy 1 I"'P'- MIg " __ "'_.'5001*1 000__ l OO lO l.i.so 11;1 19• ..." te!lIIlWI SO TN, "-" C3fl De00"_ "" 10 _ '" __ -'Y"o '0

" ....""0' ot;l~'. gnp-" '-11 _-.....~ .... 01 .= ... -.ry

'"

......, !n)m 00U'\llY 10 CXlInIY.~ .. ... c.Mor!he _ "-,,e, mail ing a~ nollO lIlawconc:luIiof-. ~om ...... dtllnnces in l!le IlgureI 1loII.IllllIllibIy UI8d . IN Oila C8Il bo . , ""IlO/WIl compiemem to IUlia _ no~ IMfl _ ages

" • inIereIMg 10nore"!IIe~ at1N !nl ..-.r1IN t 1I>ot ".ee 01"""~_not~

on "" _.. ""'"*Y _ nu.-n-.. Itld

v_....... IM\tl Iow -.rr~ llMIII. S/lOW •.....", gI-* __ 01~ Ihan iI loIIncl 101__ .. loeb loboa:o lit Nattns.-____ " Ir .,,_~ 0lIw__.- ot vanous __ .., .....,...."'*".. ,' "r-dIlIo.' ; _"hW_ ~-*- IhII !he """" .....I'rIlllI* IN~ ... lliClOlllMt' hi! cNCI .....__• and ..~ II> ClCII1 nogn and _ .......

" ..lilli ,~ In faa.. " .. cNCI"..lilli, l:¥'" _ . .....-.. 01IN__of " ..lilli,

*'<l .,...• sc. III... lolb'lIl'"s 0tiIfl Nl101 .....IOOl< In mote _ SU!lIeCt or _ .._.....~ ,,_....... . I'w:lI*' __ ....DIt~IO:nr-___.a. of _Nil ..__ - __ aID

..-,.. ll" _ .. ""~ e.: i .. ...., $ II, 1Iof'l_CII ....

IMR Internal differentials by country 1970-1980In _ ... og _ 0I1 93~ "-Mia _1«11>1' .... UN~ D!'4oon

"""- ol .........-_.. .... ...,.. -25,.-.. .... _ .... "-_01_ ",--~

..__.. .... 01

"-- -- ,~- ~-. ,~-25... _ ,- - ,M_"9

~" -~-- ,. • • •'- " " • •- .. " " .. " " •~...p eo .. • •" " » " .. " •- " " "- " " • •- " " • •- " .. " •-~ zo ss " •~~,., ,, • " " • • ,. •s " " g .. " •'- " aa •,- • ,. • •,- " .. • •- " ~ " •- " • " • " " •- n " " e " U "- - - " " " •- • • • • " » •'- " " , • " " •~

- e " ~ •~ » " e .. .. •e " .. •"- • • .. "r• ... • ," "- .. • " .. •- e • '00 •

=~.... "'" • " " e • Ii "e • •- • , , • • ,. •"....... • • " "- • • .. •~ • c " ...- • e • • • '00 •.- " " .. • • .. ..~.t... 01 • • • ..• • • • • ae •- • • " "" • • .. ..=~ • • • ' oo

" " ~ • • " ..- • • • "~- • • • ' 00~ • • • ,.

, _ _ "-*I's..-So>.Ir<e ____ ....... _""""",,,__._~

'"

Main sourcesImmunization leadsthe way-,.. :""

, -~ .....---.......w . •-...y ,!1M !E{ICU" ~'~/2J

~ - <II ... '"-- """"woo .. .._ ", WtOO 'INS (>" 1<U</'I/ l,

3_ ...__ c.. ....~_-.... .. """""'--~~--.....~00... , _ .. , ...' J ' . 11I&3 s.._,_,-*,,,,_OIU'I"._"-"'_...~."'" lIo-:J _ ._..... '9U._.. ...,-"......... ""_ " WIll. 'H5 110"'1.<'V<,..../' ,

~ ~" ' , -"---... _ 01 ... "" ." -..v..._._-_..--.......,._.....-,-, ,...

6 CMIlIO(>,oo, _ ,___.. """' ..-- .. ..."-"""_I_~I ' ''''•••,- ",_._ ,,_,",,,,",- _ , ,~ ...~-~.....__ .. ,....__ ...' 3 ...... 'IISS--",-,-.... "",,,,-".--'''''''' ''"'~. ,n<

• _ " f """,. '__

........ .....,. --'''''''''''I , ' OJ<'0 -..., ...... $ '00 _ .. _ <no

--~~.... <aI ..,.."" , ......,,. ...- .._ '1 ' ... I"'Vl.' ..,

" -, ,-,- -----",,"".. , ", _1_, ...., 0.000" _ ' N:!..- __."_.._'- .. _""'"___ ..........- wtICI. l ..._,

,' "- __ -'"__ "" _/tI'IIOI____" W><O.'n5

lIoOVII,'j,,_......,.." -...-.-...0_ _.... G«>.oo _ , C , _ .. _

_'.M .. .....,.

" 00n0I0 • , , __ ., SlA>- 'm.. Do ' 0. '---_._~ .._,-, ...,..-- ............. __ 01 __= ...2' _,.5_'._"'_.-"--_'"''''"'-'''' . crt ,........- .. lroo'''' ....~---"'''''''- ...'3_' 0I~

"_H~._"~

-""~-" ....eam- .. v.v. ... c.n...."".... _ _ .. __ lOI •

,)_'m

Reaching all children_20 00:lll

'_ "_,"OAS .. _ ....cu _".,,,,,,,-._,lI051"I'£J','>IOG!'.n,--._--1_ ·_... ..---_ ..~----~~ .-.... ..........~_ ...••_''Ill'3 __, _,_.- ... ..~--_ .. _---_.........,.".__..e--_...'O,_" J'

. ..... _ .--.0""""---"""~-_...-c _,"".

5 H e-._ .. -.e-- ......... __ " __ II 1I._ ' 'IlI'._"'''''''''', ''-",-"""_ ,, . lHClF_ ...

'" ,_ .... _''''" .... ". "<0. ".. _ ", .....CU IlO__ 'N2 1S203)

, .- _ "\;SUH ...,.... .....

........ , ....... l,HCFF tIloPoI- 00_.wI ~ N '-=00__, ...._'...01---.._ .. _ ChIll u.._,...- "--"."'- '" '_",,~O.o.-,w

, "~_......__. \H

eEl- ....., ,m ltllCt>l"'~IC'I",.' 0 ..e.-.-, .....

cu ' 1M ~/QI I . "~ICl'W'

"

,, ---,...._.-....._'-.~"'.... .., 1)000 . "', GooOo'''"'' .._"u

,~ ...... ,"" _.., 1""",,,-,""[.., _._-COO<» _ _ ..<0. "....__.., ~ ~1 ~.-13 "_ _ .. '4' _

.... - -.., """"" l.HQ.f._ '_llollV/I"5")

" """' ......~ ..-"""'.., ....0..._"'._•w' s ..... H e-, _ ., SoOFaeonv- .. _ . ___.._..... ....,. ,".-. H r-. ..- .,-.~ .. _.----,_'" ""'_ ..., 'llfl

,/ -"""" -".....-,-'" _ v ~ ~ ''''-Y_~

"" '"' ',,'I' _ " __"- ""- 1:11". 'M3

, , _ !h' .. ""' • .., ".,. _ ,__".. --lor_II

•• "" • •" UI'OClJo_'Of/>? .,-_ .... _-_ " J. ..

?2 _" ..

The benefitS tor women__ 3' 10 <III

I". _ .. _ .., "'""'"" '-.0....> ...... _ .._ " """ CMHo~

",1_.. ,., 1M33l_"11.. _ .. _

'-"_ " .' G__.__.._-..... __ -..~.

... n .... 2. ,oa>• ' ....__11 _ CMHo..

"""""' '' " , . '043,_p n

__....... "'0"'" CIW_ ... ...., .., '0111

IC _. _ _ .........._......_-- ""'~_ ,n" '!l8!., ....... P-. .._ _ , • •• ".'011...... "" " / 06, ,,,, 500__o.-._ ...... _~_... . _. I> "..., _ , -...:l,

•••

• ,..__.. _INSCO.--.,.. c:'- ,..__ ..---- _q_" .. I, ' I'" 500 _._--____J. ..

'"--,.,,a_,,- ~_,-J.~-..---_..._ '_-'_~I-- ,._._,,21_,_,,_e:- __.._--___ 00Ia00 '----'1 " , '" _

..... .1. ...

1' _ ,--,. ,'J_L __I'1__--,--,-,.. ,. ,'...'_.._...._'_'N'S-_'110 ..." ... _---'"""' -.~" 4 _ ""'0, ...

.' .. 3. '..., .... ~ .._...._--__ J , ... 2'_'~'H', . A_.. .... ......-_ .._ .1 ._ . " llOO" Y... Z. '_500__,_,." 0i0I_-_ .._.....___ ... uc:a.. ... ......_-- _.-

,~ - '---_ ...._._--_._._.....,_..---_ ... ."' ''1 ... 3----"fA e.-. ,.. ......~ -_ ..-----,...-_--.---",," ,----..-,----. .. ..._---,-IIJe e-. __• •_.._- --_ .. 2. ' 'H'

lG r.._ _.--"-'''_'__~,"'33,... 3 ,_

1' A-" __O ,-_.---_.._--_._-... ,.. _'...._ ....D_., ,_.._----'-_ ..' 00. ,_n _ .. ..__ ' . 0>0_ .. ....... , .. , 500__O"- l _._-,.-.. ,..... _..._--- ..-_......,_......- ,-2' rPoo_. f<O ,,->'$ .. A_.--_..._..._...~-_ ... , ~... , ,-

MQo<aICoo'II . _ ,..." • •"_ .... 0000NI, " "" ' .

-'"" "'--'.----_ ......_ ---_ -...- .....c:uNHJ__"-"'WI 4 _,_

10 ...._ . : .'''''''._____0- IMU"

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THE STATE OF THE WORLD'S CHILDREN 1986

Demand for vllCcine5 lLal trebled in the tautWO)utl as many nations aa:dml!C tbcirvaccination PI'OlIramrntS luwarcb the UnitedNations loa! of univasal child immunizationby the year 1990 ,

In 1985, vaccines are eiUmaled to haveprevented the de:llhs of alll105( • millionchildren in the developinJ world.MUllwhilc, IM.pread of on.! rehydratiolll.henpy (ORT ) bas prevented an cs,ilNledSOO,OOO cbiJdll:o from dyiol of dillThoealdehydration in the lasl I~ln months.

laununizalion and ORT ate tbm:foll:beaionmg 10 bd the wlY mwan;l$ thercvolutioa in child .UfVival and lkYdopmemwllkb has mil the main theme of thisreport for the lUI three: )Iran.

Pan I of the 1986 rt"pOrtloob It merecent surge forward in immuniutiollanddescribes how 11K SU1Ilqy of 'malmobiliDtion'ilI being used (0 pili tbis andother low-c<.lSl child proleWOO tec:bniques atIhe di ,po$IJ of. million. of paren!$. Thereport also includes $llIlllIW'its, from (wentynations, of the attcmpl ln inform andsuppan paR'lllS in usina today', knowl~

OXFORD UNIVERSITY PRESS

(0 drastically improve their children'schan«t: of $UrvivailUld nonnal healthy.rowm.

Pan II of the report brings tOllCUler, inIttUSible nOla; and qUCMts form, Idistillation of filtU and mmplt$, =01raean:h lindillgs and current ezpcn npinion,on the maior lOW-Inn opponunities nowavailable ror pt(lltctlng ell1ld.f'tll'a iJl/tIllIddevd opment- including ICCtions on: growthmonitoring; on.! rehydration therapy; breast f..eding rwd 'llUl1ing; immunizaoor:l;ralpiratory infectionJ; iron, iodine: rwdvilUlin A; rnaWUo; female education; foodsupplements; and family .~. This' Ufelines'section is rolled from aninternational colltttion or seven! hundredpublicatiolll and is intended IS; short cut tothe key evi<knce ..,d cond usioJU in each ofthese fields.

Finally, the report includes ;compn::hcmivt: statistical :lttl.ion with alln;tion figUral on nutrition, hc;Jth, education,popubtion and economic JlI'tlllresl. I.Ilkeeping with the ftll(lfl'1 central message,the Illtistical tables list the nations of theworld in order of theiT child lurvival ra t<$.

ISBN o-l9-a285*"1

unicef: the state of the world's children 1986

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