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Improving Survival Rates of Children Under the Age of Five

A rural health nurse performs a check-up on a baby in Dogetoba, Ethiopia.
A rural health nurse performs a check-up on a baby in Dogetoba, Ethiopia.

To help the survival of children under the age of five, Plan applies the Community Integrated Management of Childhood Illness (C-IMCI) strategy developed by the CORE Group, the World Health Organization and UNICEF in 90% of the communities where we work.

Globally, over the last two decades, the number of children surviving beyond their fifth birthday has steadily improved. From 1990 to 2007, the mortality rate for children under the age of five declined from 93 deaths per 1,000 live births to 67.

However, despite efforts, 9.2 million children still died in 2007 before their fifth birthday — most from a disease or combination of diseases that could have easily been prevented or treated. The five major causes of child mortality are due to diarrhea, pneumonia, malaria, measles, and malnutrition.


How Plan is Making Strides in Improving Child Health


Malaria Prevention and Control
Plan’s efforts have gone into strengthening and supporting partners on the control of malaria among under-five children and pregnant women. One key strategy is to support the Ministry of Health (MOH) in the countries where we work in acquiring long lasting insecticide treated nets and distributing them to dispensary health committees to be sold to pregnant women and under-five children years at a subsidized rate.

  • In Benin, from 2007 to 2009, Plan and the Ministry of Health implemented a community-based malaria prevention project in 20 villages with funding by USAID through the University Research Corporation. Local community volunteers, mothers of children under-five, village leaders, traditional healers, and health workers effectively mobilized the villages to learn and take action against malaria. By the end of 2008, Plan had expanded the project to include an additional 50 villages, with all 70 villages having significantly reduced malaria rates:
    • The percentage of children under five with fever correctly treated with artemisinin combination therapy increased from 25.1% to 65%;
    • The percentage of mothers who seek appropriate care for their child increased from 19% to 59%;
    • The percentage of mothers correctly utilizing insecticide-treated nets increased from 35% to 95%; and
    • The percentage of children under-five sleeping under insecticide-treated nets increased from 35% to 98%.

Child Nutrition

Plan programs support child feeding centers for mothers of malnourished children, facilitate community and home gardens, and assist government health services in the distribution of vitamin A and zinc supplements. Training is provided to communities on the importance of exclusive breastfeeding for six months; how to use locally available foods to prepare various weaning and complementary foods for children; and the micronutrients necessary to meet children’s nutritional needs.

Plan’s country programs also conduct activities for educating fathers on the nutritional needs of children. This is imperative as most of Plan’s programs are in traditional societies where male support for utilization of funds, traveling to seek services and changing household practices is critical to sustained improvement in child survival.

  • In Niger, Plan supported seven villages in the construction of community gardens. These are intended for women to grow vegetables and other crops to provide nutritious meals for under-five children. Participants are provided with simple tools and seeds, and have been trained on gardening techniques, healthy eating and cooking practices. As a result of this initiative, under-five children have benefited from improved diets.
  • In Senegal, about 87,000 children aged 0-23 months and their mothers were enlisted for nutritional education, growth monitoring and promotion. As a result, 63% of children enrolled were regularly weighed; 78% of them gained adequate weight; and 2,000 strengthened food pouches were distributed in the extremely poor zones of poverty of Dakar.

Diarrhea Case Management

Plan programs address diarrhea case management through oral rehydration therapy, provision of zinc supplements, and improved sanitation investments. Plan directly educates community members, especially health workers, mothers and care-givers on diarrhea prevention and management techniques for under-five children.

  • In Nepal, Plan-supported community health workers provide zinc and oral rehydration salts for children with diarrhea.

Pneumonia Case Management

Plan’s interventions in pneumonia case management are designed to enhance the recognition of danger signs by children’s caretakers and the prompt referral of suspected cases to a qualified provider.

  • As part of the child survival program in Kenya (2004-2009), Plan assists health facilities in acquiring drugs and buffer stocks for the treatment of pneumonia. Community members were trained in identifying the danger signs of pneumonia, improving care and treatment for pneumonia. As a result, the percentage of children aged 0-23 months with coughs or difficulty breathing who received care from a health facility increased from 87% to 97% in 2008. Additionally, mothers who were aware of the danger signs of pneumonia increased from 38% to 61.2%.

Child Immunizations

Plan works with local health facilities and community organizations to conduct immunization outreach campaigns.

  • In Kenya, community volunteers intensified community mobilization of mothers and caregivers to seek immunizations for their children, and the opening of three health dispensary facilities increased access to immunization services. These efforts have contributed to improvements in the full immunization and measles coverage for children aged 12-23 months. Plan has also aided dispensary health committees and community health workers to conduct training for health workers on the Kenya government’s immunization program, which includes maintaining cold chains, identifying missed opportunities, reducing vaccine wastage, conducting disease surveillance and tracing the children who have not completed their immunization schedules.