An analytical study of child survival using the Sudan, Egypt and Yemen PAP-CHILD surveys.

The thesis is a comparative study of, Egypt, Sudan and Yemen, three countries with similar social and economic profiles, yet with a variable dynamic in achieving reductions in child mortality levels. The study begins with a consideration of the individual country backgrounds and then presents comparative findings on population health and child survival. Empirical results on the correlates of child survival are presented, together with a selective review of the related techniques of analysis. The analyses of survival to age five was based on data from the PAPCHILD surveys carried-out in Egypt (1991), Sudan (1992/93) and Yemen (1991/92). The aim was to investigate the determinants of child survival with the innovation of adjusting for the effect of a family's "child mortality background". Methods of analysis included life-table analysis, logistic (marginal and multilevel) and Cox regression models. The transition to better child survival could further benefit from the spacing of births, the avoidance of higher-order births, and the concentration of childbearing in the central reproductive ages. Unequivocally, deaths of older siblings prior to the birth of every index child were strong predictors of poor survival settings. Deaths of older siblings after the birth of the index child were rare, yet captured "immediate" risk spells. Events of conception, birth and death of a subsequent sibling entailed time-varying excess risks. Evidently, adjusting for measures of familial child losses explains much of the "between-households" variation in mortality risks and spell-out "within-households" inter-dependencies of survival. Households further correlate in risks to child survival when they belonged to the same geographical cluster. The novelty in representing the latter correlation with a "regional" component of unmeasured effects was in aid of pertinent policy recommendations. Further, the study makes recommendations on reducing reporting errors of demographic data collected from mothers. Critical findings and policy implications are: for Egypt, better child survival rates are achievable by narrowing "regional" socio-economic gaps and sustaining lower fertility rates; in Sudan, the slowing pace of declines in child mortality were not best explained by relations with observed correlates, and appears further underpinned by the country's economic crisis; in Yemen, child mortality levels can be reduced by a third if the timing between successive births could be extended to two years, net of key promotive socio-economic interventions

Worldwide implementation of the WHO Child Growth Standards

Abstract Objective To describe the worldwide implementation of the WHO Child Growth Standards (‘WHO standards'). Design A questionnaire on the adoption of the WHO standards was sent to health authorities. The questions concerned anthropometric indicators adopted, newly introduced indicators, age range, use of sex-specific charts, previously used references, classification system, activities undertaken to roll out the standards and reasons for non-adoption. Setting Worldwide. Subjects Two hundred and nineteen countries and territories. Results By April 2011, 125 countries had adopted the WHO standards, another twenty-five were considering their adoption and thirty had not adopted them. Preference for local references was the main reason for non-adoption. Weight-for-age was adopted almost universally, followed by length/height-for-age (104 countries) and weight-for-length/height (eighty-eight countries). Several countries (thirty-six) reported newly introducing BMI-for-age. Most countries opted for sex-specific charts and the Z-score classification. Many redesigned their child health records and updated recommendations on infant feeding, immunization and other health messages. About two-thirds reported incorporating the standards into pre-service training. Other activities ranged from incorporating the standards into computerized information systems, to providing supplies of anthropometric equipment and mobilizing resources for the standards' roll-out. Conclusions Five years after their release, the WHO standards have been widely scrutinized and implemented. Countries have adopted and harmonized best practices in child growth assessment and established the breast-fed infant as the norm against which to assess compliance with children's right to achieve their full genetic growth potentia

Monitoring the implementation of the WHO Global Code of Practice on the International Recruitment of Health Personnel

OBJECTIVE: To present the findings of the first round of monitoring of the global implementation of the WHO Global Code of Practice on the International Recruitment of Health Personnel (“the Code”), a voluntary code adopted in 2010 by all 193 Member States of the World Health Organization (WHO). METHODS: WHO requested that its Member States designate a national authority for facilitating information exchange on health personnel migration and the implementation of the Code. Each designated authority was then sent a cross-sectional survey with 15 questions on a range of topics pertaining to the 10 articles included in the Code. FINDINGS: A national authority was designated by 85 countries. Only 56 countries reported on the status of Code implementation. Of these, 37 had taken steps towards implementing the Code, primarily by engaging relevant stakeholders. In 90% of countries, migrant health professionals reportedly enjoy the same legal rights and responsibilities as domestically trained health personnel. In the context of the Code, cooperation in the area of health workforce development goes beyond migration-related issues. An international comparative information base on health workforce mobility is needed but can only be developed through a collaborative, multi-partnered approach. CONCLUSION: Reporting on the implementation of the Code has been suboptimal in all but one WHO region. Greater collaboration among state and non-state actors is needed to raise awareness of the Code and reinforce its relevance as a potent framework for policy dialogue on ways to address the health workforce crisis

CORE GROUP Coordinator: Luc de Bernis

Country contributions: Many thanks to the heads of the UNFPA and WHO country offices, their staff, and the people that coordinated, completed, and verified responses to the State of the World’s Midwifery country survey. In particular, thanks to the country focal points