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SITUATION ANALYSIS
CHILD
HEALTH
IN SOMALIA:
SITUATION ANALYSIS
2
CHILD HEALTH IN SOMALIA
December 2011
CHILD
HEALTH
IN SOMALIA:
SITUATION ANALYSIS
4
CHILD HEALTH IN SOMALIA
© World Health Organization, 2012
All rights reserved. The designations employed and the presentation of the material in this publication do not imply
the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status
of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.
Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.
The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or
recommended by the World Health Organization in preference to others of a similar nature that are not mentioned.
Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.
All reasonable precautions have been taken by the World Health Organization to verify the information contained in
this publication.
However, the published material is being distributed without warranty of any kind, either expressed or implied. The
responsibility for the interpretation and use of the material lies with the reader.
In no event shall the World Health Organization be liable for damages arising from its use.
Cover photo: © WHO Somalia
Design and layout: blossoming.it
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SITUATION ANALYSIS
Chapter 1. Introduction and background
1.1 Purpose and scope of the study
1.2 Methodology
1.2.1 Literature review
1.2.2 Interviews
1.2.3 Limitations of the study
1.3 Background: Somalia
1.3.1 Geography and demography
1.3.2 Economic and social development
1.4 Child health-related indicators for Somalia
1.5 Somalia’s ratification of child health rights instruments
Chapter 2. Child mortality and morbidity in Somalia
2.1 Child mortality and morbidity in a developing context
2.2 Childhood mortality in Somalia
2.2.1 Pneumonia
2.2.1.1 Tuberculosis
2.2.2 Diarrhoea
2.2.3 Measles
2.2.4 Malaria
2.3 Common causes of morbidity among Somali children
2.4 Neonatal mortality
Chapter 3. Determinants of child morbidity and mortality in Somalia
3.1 Nutrition
3.2 Water, sanitation and hygiene (WASH)
3.3 Social and economic factors
3.4 Health system
3.5 Education
3.6 Conflict
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Table of Contents
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CHILD HEALTH IN SOMALIA
3.7 Cultural and traditional aspects
3.7.1 Traditional health seeking behaviour
3.7.2 Educated vs. traditional attitudes
3.7.3 Gender issues
3.7.4 Birth spacing
3.7.5 Breastfeeding
3.7.6 Home deliveries
3.7.7 Female genital mutilation
Chapter 4. Structure and performance of the health system related to child health
4.1 Governance
4.2 Service delivery
4.2.1 Structure of health care delivery
4.2.1.1 Referral hospitals
4.2.1.2 District hospitals
4.2.1.3 Maternal and child health (MCH) clinics
4.2.1.4 Outpatient therapeutic programmes (OTPs)
4.2.1.5 Health posts
4.2.2 Delivery of preventive and supportive child health services
4.2.2.1 Antenatal care
4.2.2.2 Deliveries
4.2.2.3 Postnatal care
4.2.2.4 Extended programme of immunization (EPI)
4.2.2.5 Other child health promoting interventions
Vitamin A
Deworming
Growth monitoring and nutritional counselling
4.2.3 Capacity for service delivery
4.2.3.1 Availability
4.2.3.2 Accessibility
4.2.3.3 Quality of care
4.2.3.4 Demand
4.2.3.5 Coverage
4.2.4 Outreach campaigns
4.2.4.1 Polio programme
4.2.4.2 Measles campaigns
4.2.4.3 Child health days (CHD)
4.3 Health-care workforce
4.3.1 Qualified health professionals
4.3.2 Unqualified health workers: traditional birth attendants
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SITUATION ANALYSIS
4.4 Health information systems
4.4.1 Health management information system (HMIS)
4.4.2 Communicable disease surveillance and response (CSR)
4.5 Medical products and vaccines
4.6 Financing and funding
4.6.1 Health expenditures and financial aid
4.6.2 Financial distribution of aid to the health sector
Chapter 5. Conclusions and recommendations
5.1 Neonates and infants
5.2 Nutrition
5.3 Water, sanitation and hygiene
5.4 Infectious diseases
5.5 School-aged children and adolescents
5.6 Support, guidance and management
5.7 Way forward
References
Annex I. Interview guide
Annex II. Articles 6 and 24 of the United Nations Convention on the Rights of the Child
Annex III. Lists of kits for medicines and equipment provided to Somali health care
facilities from UNICEF Somalia (according to EPHS)
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Latest available data on selected child health indicators for Somalia
Health-seeking behaviour for children with pneumonia
Basic WASH-figures for Somali households
Number and types of health facilities in Somalia
Coverage rates for routine immunization with standard EPI vaccines by the age of 1 in Somalia
Interventions and target groups for the child health day campaign
Distribution of physicians, nurses and midwives in Somalia
Map of Somalia
Global causes of mortality for children under the age of five
Under-five mortality rates for Somalia
Underlying causes of mortality for Somali children under the age of five
Morbidity pattern for under-fives attending Somali MCH clinics
Global estimate of the distribution of conditions responsible for neonatal mortality
Schematic structure of the zonal health systems in Somalia
Regional availability of MCH clinics
Regional immunization coverage of DPT3 and measles vaccine (MCV) through routine EPI
during 2009
Approximate distribution of international financial support to different parts and
programmes of the health sector in Somalia in 2009
WHO definitions of anthropometric deviations due to malnutrition
Defining the characteristics of BEmOC and CEmOC facilities at the hospital level
Immunization schedule for Somalia
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Tables and figures
Table 1.
Table 2.
Table 3.
Table 4.
Table 5.
Table 6.
Table 7.
Figure 1.
Figure 2.
Figure 3.
Figure 4.
Figure 5.
Figure 6.
Figure 7.
Figure 8.
Figure 9.
Figure 10.
Box 1.
Box 2.
Box 3.
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SITUATION ANALYSIS
ACF
ACT
AFP
AMISOM
AMREF
ARI
ART
AWD
BCG
BEmOC
CEmOC
CGS
CHD
CISS
COSV
CHW
CISP
COSV
CSR
CSZ
DALY
DOTS
DPT
ECHO
EPI
EPHS
FSNAU
GAVI
GDP
GFATM
GNP
GPEI
GTZ
Action Contre la Faim
Artemisinin-based combination therapy
Acute flaccid paralysis
African Union Mission in Somalia
African Medical Research Foundation
Acute respiratory infection
Anti-retroviral therapy
Acute watery diarrhoea
Bacillus-calmette-guerin (TB-vaccination)
Basic emergency obstetric care
Comprehensive emergency obstetric care
Child growth standards
Child health days
Coordination of International Support to Somalia
Comitato di Coordinamento delle Organizzazioni per il Servizio Volontario (Coordinating
Committee of the Organizations for Voluntary Service)
Community health workers
Comitato Internazionale per lo Sviluppo dei Popoli (International Committee for the
Development of Peoples)
Coordinating Committee of the Organizations for Voluntary Service
Communicable disease surveillance and response
Central South Zone
Disability-adjusted life-year
Directly observed treatment short courses
Diphtheria-pertussis-tetanus
Humanitarian Aid Department of the European Commission
Extended programme of immunization
Essential package of health services
Food Security Nutrition Analysis Unit
Global Alliance for Vaccines and Immunization
Gross domestic product
Global Fund to Fight AIDS, Tuberculosis and Malaria
Gross national product
Global Poliomyelitis Eradication Initiative
Deutsche Gesellschaft für Technische Zusammenarbeit (German Agency for Technical Cooperation)
Acronyms
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CHILD HEALTH IN SOMALIA
HDI
Hib
HMIS
HP
ICRC
IDP
IFRC
IMC
IMCI
IU
KAPS
MCH
MDG
MICS
MoH
MSF
MUAC
OCHA
OPD
OPV
ORS
ORT
OTP
RDT
RUTF
SFP
SHSC
SRCS
TB
TFC
TFG
TFR
UNDP
UNFPA
UNICEF
UNOPS
VCT
WASH
WFP
WHO
Human Development Index
Haemophilus influenzae type B
Health Management Information System
Health post
International Community of the Red Cross
Internally displaced person
International Federation of Red Cross and Red Crescent Societies
International Medical Corps
Integrated management of childhood illness
International unit
Knowledge attitude practices survey
Maternal and child health
Millennium Development Goal
Multiple indicator cluster survey
Ministry of Health
Médecins Sans Frontières
Measurement of the upper arm circumference
United Nations Office for the Coordination of Humanitarian Affairs
Outpatient department
Oral polio vaccine
Oral rehydration salt
Oral rehydration therapy
Outpatient therapeutic programme
Rapid diagnostic test
Ready-to-use therapeutic food
Supplementary feeding point
Somali Health Sector Committee
Somali Red Crescent Society
Tuberculosis
Therapeutic feeding centre
Transitional Federal Government
Total fertility rate
United Nations Development Programme
United Nations Population Fund
United Nations Children’s Fund
United Nations Office for Project Services
Voluntary counselling and testing
Water, sanitation and hygiene
World Food Programme
World Health Organization
[...]... child health issues Develop a full Somali child health strategy Situation analysis 17 Child Health in Somalia Chapter 1 Introduction and background © Soyda 18 Situation analysis 1.1 Purpose and scope of the study The present report contains an analysis of the child health situation in Somalia, with its principal focus on children in the under-five age group It is mainly based on a review of existing... community health workers Ensure continued outreach campaigns of essential health packages (child health days); immunization, including TT 2 (to pregnant women), vitamin A, deworming, water purifying tablets, and possibly ORS Support MCH clinics to increase routine immunization, from fixed sites as well as in outreach-mode, for future phasing out of child health days-campaigns Addressing school-aged children... partners in the Somali Health Sector Committee for contributing to interesting and informative meetings within the Health Cluster, and I convey my special thanks to Dr Kamran Mashhadi, Health Sector Coordinator (until March 2010), for supporting me so well and providing valuable reports and other materials Finally, I want to express my sincere gratitude to the following persons for participating in interviews... household level Addressing infectious diseases: • • Introduce new vaccines to the national immunization scheme; 1) exchange DPT for Pentavalent (adding Hib- and hepatitis B-vaccine), 2) pneumococcal vaccine, and 3) oral rotavirus-vaccine Distribute zinc-containing sachets of oral rehydration solution (ORS) through MCH-clinics and community health workers 15 Child Health in Somalia • • • Introduce structured... mortality Information of this kind has been collected in some individual hospitals and larger clinics, but these are managed by several different health- care providers, and have not been collectively compiled into clinical data usable by the health authorities or agencies involved in the joint international support effort for the health sector Stand-alone information on diseases responsible for childhood... fifth of the child mortality in Somalia In line with international estimates, we may assume that a substantial part of these unspecified causes should fall into the neonatal category if the data were of better quality and if the reporting health sector had more insight into child deliveries and children’s first period of life About 90 per cent of child deliveries in Somalia are performed in households... Coordination of Humanitarian Affairs (OCHA) and the United Nations Office for Project Services (UNOPS) These interviews were less structured, since the agencies play more of a supportive role and do not provide regular health services on the ground 1.2.3 Limitations of the study There are many challenges involved in assessing the child health situation in Somalia First, the health situation of children... (5–14 years) – includes extensive household work and working for family business 49 % [b] Prevalence of female genital mutilation 98 % [b] Sources: [a] = UNICEF, The State of the World’s Children 2009; [b] = MICS Somalia 2006 27 Child Health in Somalia Chapter 2 Child mortality and morbidity in Somalia © WHO/Lucie Ngugi 28 Situation analysis 2.1 Child mortality and morbidity in a developing context The... prime instance for consultation whereas the private clinics are mainly frequented by relatively better off Somalis in urban areas The country’s MCH clinics constitute the back-bone of maternal and child health care, particularly in terms of preventive and health promoting services, but some of them also offers in- facility deliveries Here, staffing is under dimensioned, especially in terms of trained... complications and neonatal infections The high neonatal mortality is at least partly maintained by the fact that ninety per cent of deliveries take place at home, without professionally skilled attendance or mandatory follow-up at a health care unit Infections are the main cause of death during remaining infancy and childhood Pneumonia and diarrhea are the main killers, each contributing to 20-25 per cent . 1
SITUATION ANALYSIS
CHILD
HEALTH
IN SOMALIA:
SITUATION ANALYSIS
2
CHILD HEALTH IN SOMALIA
December 2011
CHILD
HEALTH
IN SOMALIA:
SITUATION ANALYSIS. full Somali child health strategy.
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SITUATION ANALYSIS
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CHILD HEALTH IN SOMALIA
Chapter 1.
Introduction and background
© Soyda
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SITUATION ANALYSIS
1.1
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