Undernutrition in Infants and Young Children in India: A Leadership Agenda for Action

In India, child undernutrition happens very early in life; 30 per cent of Indian infants younger than six months old are underweight and 58 per cent of children in the age group 18–23 months old are stunted; moreover, 56 per cent of severe wasting in India happens before children are two years old. Recognising the centrality of the first two years of life to respond to India's nutrition challenge, the Coalition for Sustainable Nutrition Security in India called on an Expert Task Force on Infant and Young Child Nutrition to identify the ten evidence?based, high impact, cost?effective interventions with the greatest potential to reduce rates of undernutrition in infants and young children (0–23 months old) in India. These ten Essential Interventions are the evidence base for a broad?base Leadership Agenda for Action to Reduce Undernutrition in Infants and Young Children in India

Cities and Children: the challenge of urbanisation in Tanzania

Cities are becoming home to a growing proportion of Africa’s children. In Tanzania, already one in four lives in an urban centre – and\ud many more will in coming years. Within the short span of a generation, more than one-third of Tanzania’s children will be raised in a city\ud or town. Growing up urban can offer these children the chance for a brighter future, or the grim conditions in which so many are now\ud living in the sprawling cities of the continent.\ud \ud Increasingly urban\ud Tanzania is more urbanised than it perceives itself to be. Urban Tanzanians feel emotionally rooted in their villages of origin, rather than\ud in the cities and towns where they live. Despite this perception, conditions that are typical of urban areas are more widespread across\ud Tanzania than official figures disclose. Extensive, heavily populated areas are often counted as ‘rural’ simply because they are not\ud officially classified as ‘urban’. Nestled in one of the world’s fastest urbanising region, Tanzania itself is urbanising fast. Nearly half of its\ud urban population is already, and will continue to be, made up of children younger than 18 years.\ud As urbanisation rapidly transforms Tanzania’s physical, social and economic landscape, attention must be paid to the conditions in\ud which new generations of Tanzanian children will be raised. Far too many are living in overcrowded informal settlements that lack\ud clean water and adequate sanitation. They play in heaps of garbage littered with dangerous and even toxic materials. Their families\ud cannot afford quality food, schools or health care; their health and well-being are constantly at risk from mosquitos and other pests that\ud thrive in unsanitary environments – as well as human predators that prey on those least able to defend themselves, exposing children\ud to violence, abuse and sexual assault that increase their risk of HIV infection. Tanzania’s urban children today are more often exposed\ud to the ugly underbelly of city life than to its potential advantages. Fulfilling the rights and aspirations of these children will be a major\ud challenge; careful and timely preparation is needed to address it adequately.\ud \ud Urban advantage\ud The challenges posed by urban growth continue to receive scant attention from policy makers, due partly to widespread belief in\ud an ‘urban advantage’ – the idea that compared to rural residents, city dwellers are invariably better off. It is true that cities enjoy an\ud edge: high concentration of people, proximity and economies of scale permit cities to become engines of growth. Facilities, services,\ud infrastructure and amenities are more readily available in urban than rural settings. Urban centres offer more avenues for jobs and\ud education, and can provide children with greater opportunities for survival, growth and development. Economic resources and political\ud visibility enhance the scope for investments in critical services and infrastructure that can make service provision less costly and more\ud widely available than in Tanzania’s vast and sparsely populated hinterland. Urban areas are also hubs of technological innovation and\ud social interaction. It is no wonder that children and young people are often attracted to cities, where they can draw from resources that\ud are denied to their rural peers.\ud \ud City promises… and realities\ud But for many urban children, the notion of an unqualified ‘urban advantage’ simply does not hold true. Life in the sprawling, unplanned\ud informal settlements of most Tanzanian cities does not match the promise that urban life is supposed to fulfil. The misconception\ud according to which urban dwellers must invariably be better off than rural people stems partly from the tendency to equate availability\ud of services with access to them. But in most cities adequate facilities and quality services are distributed unequally across the urban\ud space, concentrated in affluent areas that tend to attract the most qualified teachers, health workers and other service providers.\ud Meanwhile, the less well-endowed schools and health facilities are located in the poorer parts of a city – the unplanned settlements\ud where up to 80 per cent of urban residents live, most of whom cannot afford to pay fees and other costs for services. The truth is that\ud the ‘urban advantage’ is not shared by all city dwellers.\ud Only a limited few can afford services and amenities that would be unthinkable in a rural setting; the majority not only experience levels\ud of deprivation not unlike those affecting rural children, but a host of social, physical and environmental ills that are specific to an urban\ud context – contaminated water and polluted air, traffic congestion and noise, cramped living conditions in substandard shelters built\ud along riverbanks, on steep slopes or dumping grounds, untreated waste washing away into waterways, lack of safe places for children\ud to gather and play, among other troubling signs of urban malaise.\ud \ud Narrowing gaps\ud Official statistics that compare overall conditions in rural and urban areas tend to mask the actual living conditions of poor urban\ud dwellers. Even so, they indicate that the vaunted urban edge is eroding with the passage of time. For many dimensions of child wellbeing,\ud Tanzania’s rural areas are catching up with cities, where the provision of social services and infrastructure has not kept pace\ud with the growing demand generated by rapid urban growth. For instance: Availability of basic services, expected to be higher in urban centres than remote rural areas, has been declining. Consequently, thetraditional performance gap across the rural/urban divide has narrowed for many indicators in education, health, nutrition, water and sanitation. In some cases rural areas now outperform urban centres.\ud As urban performance stagnates and even declines, it is likely that poor, under-serviced communities are being hit hardest. Although\ud aggregate figures for urban and rural areas prevent detailed analysis of intra-urban disparities, evidence from low-income urban\ud communities – on access to basic services and on health and education outcomes – suggests that poor urban children may often\ud be faring worse than rural peers.\ud \ud Hidden poverty\ud Despite these trends, national policy and programme frameworks continue to mostly target rural poverty, perceived as the nation’s core\ud development challenge. Urban poverty, growing alongside urban affluence, remains mainly unnoticed and, therefore, unaddressed.\ud By depicting rural and urban averages that obscure the disparities so prevalent in cities and towns, official statistics largely miss out\ud on the conditions of the urban poor and their children. Moreover, standard measures of poverty typically underestimate its true extent\ud in urban settings, where families have to incur high costs to afford not only food, but also housing, schooling, health, transport and\ud other necessities. In a monetised urban economy, all necessities have to be purchased with cash, a rare commodity when jobs are\ud irregular and poorly paid. Hidden in official estimates and tucked away in peripheral urban fringes, poor children thus run the risk of\ud remaining invisible in development policy and investments. Gathering and analysing sub-municipal data must be a priority for planners,\ud service providers and communities; local-area data can help to reveal the actual conditions in which poor children live, as well as the\ud inequalities that exist side by side within the confines of a city.\ud \ud An urban future\ud Urban growth is projected to continue in coming decades, and could even accelerate. If the current predicament facing Tanzania’s\ud urban centres is not addressed now, conditions will likely deteriorate. As density increases and unplanned settlements become more\ud congested, investments in facilities, services and infrastructure are likely to become costlier, both financially and socially. Unless it is\ud leveraged properly, the potential advantage that cities can offer could turn instead into a disadvantage. Already Dar es Salaam has one\ud of the highest proportions of urban residents living in unplanned settlements in all of sub-Saharan Africa. If present trends continue\ud unabated, Tanzania could then find itself facing a daunting scenario: not only are today’s urban children exposed to one of the most\ud hazardous environments imaginable, but climate change is poised to further increase their vulnerability. Clearly the future need not\ud pose a threat. It is ultimately up to the current generation of Tanzanians to ensure that their children will get the best, while avoiding the\ud worst that cities have to offer.\ud \ud Urban governance\ud Urban centres must seek ways to exploit their edge – or watch it disappear. The difference will lie in how access to resources is\ud managed in Tanzania’s towns and cities. A competent, accountable and equitable system of local governance can make that difference.\ud Good local governance can help overcome the disparities that bar access by the urban poor to resources, services and infrastructure:\ud secure land tenure and decent housing, safe water and sanitation, quality education, adequate health care and nutrition, affordable\ud transport. Good local governance can make the difference between a city friendly to children and one that is indifferent to their needs\ud and rights. Municipal governments have the advantage of being close to their constituents; they could make the most of this situation\ud by forming alliances with civil society groups, the media, private sector, community organisations and others, with the aim of improving\ud the conditions in which poor urban families live. Accountable local authorities, proactive communities and children are key actors in a\ud governance process seeking to create an urban environment fit for children.\ud \ud Citizenship and participation\ud Children and adolescents have a right to express their opinions in both defining their problems and providing solutions. This is a right\ud enshrined in the Convention on the Rights of the Child. Today, Tanzania’s children and adolescents already take part in local governance\ud processes. Some are active in Children’s Municipal Councils, School Barazas and other grassroots institutions. But the majority are\ud rarely consulted – at home, at school or in their communities. Listening to children’s voices can inform local decision-makers about the\ud world in which they live and how they see it, thereby offering a more nuanced understanding of “childhood” and how specific social,\ud cultural and economic realities condition children’s lives. Their scale and proximity makes cities and communities the most relevant\ud place for genuine participation by children.\ud \ud Child-friendly cities\ud It is ultimately in Tanzania’s local communities that children’s rights will be realised and global development goals will be met – in the\ud family, the school, the ward, and the city. Cities offer an ideal platform for convergence of development interventions that normally\ud target children independently, in a fragmented manner. Instead, they need to be delivered holistically, which is easier at the level where\ud children live. Children’s horizon is local. If development goals and children’s rights are not implemented locally, they are likely to remain\ud abstract declarations of intent, without practical translation.\ud Creating an environment friendly to children in every town and city of Tanzania is not only a laudable goal, but a sensible choice for\ud municipal authorities around the country. Local authorities, communities, families and children can and must work together to transform\ud today’s often hostile urban settings into child-friendly cities – as cities friendly to children are ones that are friendly to all.\u

Female genital mutilation/cutting in Mali and Mauritania: understanding trends and evaluating policies

Despite international commitments to end female genital mutilation/cutting (FGM/C), very little is known about the effectiveness of national policies in contributing to the abandonment of this harmful practice. To help address this gap in knowledge, we apply a quasi-experimental research design to study two west African countries, Mali and Mauritania. These countries have marked similarities with respect to practices of FGM/C, but differing legal contexts. A law banning FGM/C was introduced in Mauritania in 2005; in Mali, there is no legal ban on FGM/C. We use nationally representative survey data to reconstruct trends in FGM/C prevalence in both countries, from 1997 to 2011, and then use a difference-in-difference method to evaluate the impact of the 2005 law in Mauritania. FGM/C prevalence in Mauritania began to decline slowly for girls born in the early 2000s, with the decline accelerating for girls born after 2005. However, a similar trend is observable in Mali, where no equivalent law has been passed. Additional statistical analysis confirms that the 2005 law did not have a significant impact on reducing FGM/C prevalence in Mauritania. These findings suggest that legal change alone is insufficient for behavioral change with regard to FGM/C. This study demonstrates how it is possible to evaluate national policies using readily available survey data in resource-poor settings

Successful Community Nutrition Programming:lessons from Kenya,Tanzania,and Uganda

Learning from success is the most effective and efficient way of learning.This report brings together the main findings of a series of assessments of successful community nutrition programming carried out in Kenya, Tanzania, and Uganda between 1999 and 2000. The overall aim of the assessments was to identify key lessons, or the main driving forces behind the successful processes and outcomes in these programs. Such elements of success fundamentally have to do with both what was done and how it was done. Experience with community-based nutrition programming, as documented in various syntheses and reviews during the 1990s, does show that malnutrition can be effectively addressed on a large scale, at reasonable cost, through appropriate programs and strategies, and backed up by sustained political support. In most cases, successful attempts to overcome malnutrition originate with participatory, community-based nutrition programs undertaken in parallel with supportive sectoral actions directed toward nutritionally at-risk groups. Such actions are often enabled and supported by policies aimed at improving access by the poor to adequate social services, improving women’s status and education, and\ud fostering equitable economic growth. Successful community-based programs are not islands of excellence existing in an imperfect world. Rather, part of their success has to do with contextual factors that provide an enabling or supportive environment. Some of these contextual factors are particularly influenced by policy, some less so. Contextual factors may include, for example, high literacy rates, women’s empowerment, community organizational capacity and structures, appropriate legislation. Nutrition program managers cannot normally influence contextual factors, at least in the short term.\ud In addition to favorable contextual factors, certain program factors contribute to successful programs, such as the design, implementation, and/or management of the program or project, which can, of course, be influenced by program managers. Both contextual and program factors, and the way they interact, need to be identified in order to understand the dynamics behind success. In 1998, under the Greater Horn of Africa Initiative (GHAI) supported by the United States Agency for International Development (USAID), nutrition coalitions were formed in Kenya, Tanzania, and Uganda. These nutrition coalitions, comprising individuals representing government, non-governmental organizations (NGOs), donors, academic institutions, and the private sector, seek to advance the nutrition agenda both in policy and programming through coordination and advocacy efforts. One of the first tasks of the nutrition coalitions, under the leadership of the Program for Applied Technologies in Health (PATH) in Kenya, the Tanzania Food and Nutrition Centre (TFNC) in Tanzania, and the African Medical Research Foundation (AMREF) in Uganda, was to prepare an inventory of community nutrition programs in their respective countries and identify of better practices in community nutrition programming. Country teams, supported by USAID/REDSO/ESA and LINKAGES/AED, then selected three successful programs in their respective countries based on preestablished "process" and "outcome" criteria. UNICEF has a long history of promoting and supporting community-based programs in Eastern and Southern Africa and has supported many reviews and evaluations. As part of its continued effort to strengthen community-based programs by learning from new success stories, UNICEF also identified for review a relatively large scale successful program in Tanzania\u

United Nations Children’s Fund

The material in this publication has been commissioned by the United Nations Children’s Fund (UNICEF). The contents do not necessarily reflect the policies or the views of UNICEF. The designations employed and the presentation of the material in this publication do not imply on the part of UNICEF the expression of any opinion whatsoever concerning the legal status of any country or territory, or of its authorities or the delimitation of its frontiers. The text has not been edited to official publication standards and UNICEF accepts no responsibility for errors. Any part of this publication may be freely reproduced with the appropriate acknowledgement. For more information, please contac

Pathways to change: improving the quality of education in Timor-Leste

After more than 400 years of Portuguese colonization and a 24-year period of Indonesian occupation, Timor-Leste became a fully independent state on May 20, 2012. Independence followed a period of extreme violence caused by the Indonesians, who destroyed homes, livelihoods and infrastructure and devastated schools before leaving the country. Since 2012, the country has resorted to international aid to reconstruct the country and rebuild its education system. Following the restructuring of the basic education, the country has recently implemented a new general secondary education curriculum, through international cooperation with Portuguese institutions. This article presents the new curriculum developed and puts forward some of the challenges regarding its implementation. Based on interviews conducted with several policy makers, findings suggest challenges related with the use of Portuguese language, the scientific and pedagogical training of teachers and the pedagogical and administrative management capacity in most secondary school

Maternity waiting homes in Southern Lao PDR : the unique \u27silk home\u27

The concept of maternity waiting homes (MWH) has a long history spanning over 100 years. The research reported here was conducted in the Thateng District of Sekong Province in southern Lao People&rsquo;s Democratic Republic (PDR) to establish whether the MWH concept would be affordable, accessible, and most importantly acceptable, as a strategy to improve maternal outcomes in the remote communities of Thateng with a high proportion of the population from ethnic minority groups. The research suggested that there were major barriers to minority ethnic groups using existing maternal health services (reflected in very low usage of trained birth attendants and hospitals and clinics) in Thateng. Unless MWH are adapted to overcome these potential barriers, such initiatives will suffer the same fate as existing maternal facilities. Consequently, the Lao iteration of the concept, as operationalized in the Silk Homes project in southern Lao PDR is unique in combining maternal and infant health services with opportunities for micro credit and income generating activities and allowing non-harmful traditional practices to co-exist alongside modern medical protocols. These innovative approaches to the MWH concept address the major economic, social and cultural barriers to usage of safe birthing options in remote communities of southern Lao PDR.<br /

Child-Abuse-Related-Deaths, Child Mortality (0-4) & Income Inequality in America and Other Developed Nations 1989-91 v 2012-14: Speaking Truth to Power.

The major concern for social work, namely child abuse‐related deaths (CARD), involves parental neglect. Societal neglect, when measured by child mortality rates (CMR), is considered by bodies such as UNICEF to be indicative of how a nation meets the needs of its children. This population‐based study analyses CARD and CMR for children aged from newborn to four years old between 1989–91 and 2013–15 to identify any relative child neglect in the USA and 20 other developed nations (ODN). World Health Organization data were used for CARD, CMR and undetermined deaths (UnD), a possible source of unreported CARD, juxtaposed against World Bank income inequality data. The USA had the highest number of CARD, the highest CMR and the worst income inequality. Five countries reduced their CARD significantly more than the USA, and 14 countries reduced their CMR more than the USA. Income inequality and CMR were correlated. Had the USA matched the CMR of Japan, where income inequality was narrowest, there would have been on average 16 745 fewer child deaths annually. CARD and UnD correlated, suggesting that UnD may contain unreported CARD. US CMR data indicate that services in the USA are less effective than those in ODN, possibly due to income inequality. These results will be unwelcome but child protection services must dare to speak truth to power. ‘This population‐based study analyses CARD and CMR for children aged from newborn to four years old between 1989–91 and 2013–15 to identify any relative child neglect in the USA and 20 other developed nations’ Key Practitioner Messages The richest country in the world, the USA, has the highest rates of child abuse and total child mortality in the Western world. The USA has the highest income inequality in the West, highlighting the statistical link between child mortality and poverty. Children's services should lead the call for the necessary changes and ‘speak truth to power’

Prospective pilots of routine data captures by paediatricians in clinics and validation of the disability complexity scale

AIMS To pilot prospective data collection by paediatricians at the point of care across England using a defined terminology set; demonstrate feasibility of data collection and utility of data outputs; and confirm that counting the number of needs per child is valid for quantifying complexity. METHOD Paediatricians in 16 hospital and community settings collected and anonymized data. Participants completed a survey regarding the process. Data were analysed using R version 3.1.2

Indicators for Women's Health in Developing Countries: What They Reveal and Conceal

Summary The health of women has recently resurfaced in the health policy debate and has tended to become viewed as important primarily because of its contribution to infant health. Maternal deaths are characterised by a range of fairly typical causes, all of which can normally be prevented with good obstetric medical services and antenatal care. The most widely used indicator, the maternal mortality rare, is closely associated with a range of socioeconomic determinants; most notably poverty and access to obstetric services, which suggests that medicine alone cannot solve the whole problem. Factors such as urbanization, female secondary education, contraceptive prevalence and fertility all appear to be important intermediate determinants, which highlight the fact that the problem is really rooted in a much wider one of the status and role of women in development. The indicator of the maternal mortality rate itself actually underestimates the true impact of fertility on women's health. The indicator of lifetime risk (of dying in childbirth) is much more relevant and it provides an even starker picture of differentials in health risks, and the role fertility plays in these risks. It puts fertility back into women's health and the object of measurement is women's lives rather than the disembodied event of birth. Resumé Indicateurs de la santé des femmes dans les pays en voie de développement: ce qu'ils révèlent et ce qu'ils cachent Le sujet de la santé des femmes remonte à la surface dans le débat concernant les politiques de santé; ce sujet a été censé important, du moins récemment, en raison principalement de sa contribution à la santé infantile. Les décès maternels sont caractérisés par une gamme de causes relativement typiques et qu'il est normalement possible d'éviter moyennant une bonne obstétrique médicale et des soins adéquats en période prénatale. L'indicateur le plus fréquemment employé, le taux de mortalité maternel, est étroitement lié à une gamme de déterminants socio?économiques, notamment la pauvreté et l'accès aux services obstétriques, qui suggèrent que l'accès à la médecine seule ne peut entièrement résoudre le problème. Les facteurs tels que l'urbanisation, l'enseignement secondaire des femmes, la disponibilité de la contraception et la fécondité sembleraient tous être des indicateurs d'ordre intermédiaire, et ceci aurait tendance à souligner le fait que le problème véritable est effectivement encastré dans un problème encore plus grave, à savoir celui du rôle et de la situation des femmes dans le développement. L'indicateur de mortalité maternelle sous?estime en fait l'impact véritable de la fertilité sur la santé des femmes. L'indicateur de risque à longueur de vie (de mourir durant un accouchement) est beaucoup plus approprié et offre une image encore plus déprimante des différentiels dans les risques à la santé, et du rôle que la fertilité joue dans ces risques. Cet indicateur remet en cause la fertilité au sein de la santé des femmes et en fait une mesure de la vie des femmes, à la place du simple événement qu'est tel ou tel accouchement. Resumen Indicadores de salud femenina en los países en desarrollo: lo que revelan y lo que ocultan El tema de la salud de la mujer ha resurgido recientemente en el debate sobre directivas de salud, y la tendencia ha sido considerarlo importante primordialmente por su contribución a la salud infantil. Las muertes maternales tienen una serie de causas bastante típicas, todas las cuales pueden normalmente ser evitadas con buenos servicios obstétricos y cuidados prenatales. El indicator más usado, la tasa de mortalidad maternal, está asociado a los determinantes socioeconómicos, notablemente la pobreza y la falta de acceso a los servicios ginecológicos, lo que sugiere que la medicina no puede resolver todo el problema por sí sola. Factores como la urbanización, la educación secundaria femenina, la prevalencia anticonceptiva y la fertilidad parecen ser importantes determinantes intermedios, y eso destaca el hecho de que el problema está realmente enraizado en otro mucho mas amplio: la condición y el papel de la mujer en el desarrollo. El indicador de la tasa de mortalidad maternal en realidad subestima el verdadero impacto de la fertilidad en la salud femenina. El indicador de riesgo vital: muerte de parto es mucho más significativo y da una imagen aún más severa de los diferenciales en riesgos de salud y el papel jugado por la fertilidad en esos riesgos. Pone a la fertilidad dentro de la salud femenina nuevamente, y lo que se mide es la vida de la mujer en vez del evento aislado del parto