Tag Archives: child health

Children in Myanmar wash their hands with soap at a hand-washing station, while other students behind them wait their turn to use latrines.

New data cast light on poor hygiene

Children in Myanmar wash their hands with soap at a hand-washing station, while other students behind them wait their turn to use latrines.

Children in Myanmar wash their hands with soap at a hand-washing station. © UNICEF/NYHQ2012-2056/Dean

This week is World Water Week. Each year, leaders and experts meet in Stockholm to discuss global challenges relating to water. This year the conference celebrates its 25th year, with a specific focus is on water for development. There will also be lots of discussion about the broad spectrum of water issues ranging from water resources and climate change to access to the most basic of drinking water and sanitation facilities. There will be some, but all too little debate about the related topic of hygiene.

Four surprising facts on hygiene

  1. Handwashing with soap is one of the most effective interventions to reduce diarrhoea and pneumonia, two leading causes of child mortality.
  2. Research studies have suggested that very few people – approximately one in five globally – wash their hands after going to the loo. Whilst these data are limited they certainly demonstrate the scale of the challenge.
  3. Last year the Guinness World record for handwashing was won when almost 13 million students washed their hands simultaneously across over 1,300 schools in Madhya Pradesh, India.
  4. Menstrual hygiene remains a taboo in many settings – with poor knowledge and misconceptions as great a challenge as access to adequate facilities at home as well as at school. Learn more about menstrual hygiene and its impacts on women and girls in the Menstrual Hygiene Matters report.

It also happens to be the 25th anniversary of the WHO/UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation, whose report at the end of the Millennium Development Goals showed that 663 million people still lack an improved source of drinking water and 2.4 billion lack an improved sanitation facility.The ability to track progress on drinking water and sanitation during the last twenty-five years has helped to draw attention to people without basic services and to highlight persistent inequalities both between and within countries. Until recently, far less attention had been given to hygiene, which unlike water and sanitation, was not part of the Millennium Development Goals and has not been systematically tracked at the global level.

An adolescent girl takes part in an handwashing demonstration for a group of adolescent girls in Chowrapara, Rangpur, Bangladesh.

An adolescent girl takes part in an handwashing demonstration for a group of adolescent girls in Chowrapara, Rangpur, Bangladesh. © UNICEF/BANA2014-01296/Paul

Of the range of hygiene behaviours considered important for health, handwashing with soap is a top priority in all settings. Handwashing with soap is one of the most effective interventions to reduce diarrhoea and pneumonia, two leading causes of child mortality. But handwashing behaviours are tricky to measure – people know the “right” answer and are very likely to tell you it if you ask them directly. For that reason, the most practical approach leading to reliable measurement of handwashing is observation of the place where hands are washed and noting the presence of water and soap at that location. This lets you know whether households have the necessary tools for handwashing and provides a proxy for their behaviour. Learn more by reading the World Bank’s Water and Sanitation Program working paper: Practical Guidance for Measuring Handwashing Behavior.

The data for over 50 countries show consistently low levels of access to handwashing facilities in many countries, particularly in sub-Saharan Africa but also Southern Asia and Latin America and the Caribbean. For example, in the Democratic Republic of Congo fewer than one in ten people have access to a facility. In countries with higher coverage overall, such as Mongolia – the poorest are greatly disadvantaged: only one in ten have access compared with almost all of those in the wealthiest quintile (96%). Similarly, people living in rural areas are less likely to have access to handwashing facilities – as is the case in Afghanistan where they are only half as likely as people in urban areas. Explore the available handwashing data for yourself using the interactive dashboard on handwashing.

The great news is that hygiene is part of the new Sustainable Development Goals and is specifically mentioned together with sanitation in Target 6.2 which by 2030 seeks to ‘achieve access to adequate and equitable sanitation and hygiene for all, and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations’. UN member states still need to select an indicator for handwashing to track progress and ensure these ambitions are properly reflected.And you can join the Global Public-Private Partnership for handwashing campaign to advocate for a handwashing SDG indicator. Over the next few years, data will then continue to be collected in household surveys such as the Multiple Indicator Cluster Surveys and Demographic and Health Surveys and it will become possible to tell whether and how much the situation has improved. The data will also tell us whether the international community is giving hygiene the attention it most surely deserves.

Explore the interactive dashboard on handwashing:

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Robert Bain is a Statistical Specialist focusing on water, sanitation and hygiene in UNICEF’s Data and Analytics Section in New York.


Syrian women risk their lives to protect children from polio

More than 200 Syrian women risk their lives every day to save the lives of children by teaching fellow mothers about the importance of polio vaccinations in the most hard-to-reach areas, including in Dar’a in the far south of Syria, and Aleppo in the northern part of the war-torn country. UNICEF works with local partners to train these women on holding educational sessions and delivering key messages to parents of the young children.

The fight against polio in Syria is one that goes beyond administering vaccinations – it also requires changing misconceptions, especially in the most inaccessible areas.

“Being a parent myself, makes me want to protect all the children of the world,” said Suzan, a mother of three and a volunteer in Dar’a. “I learned about the importance of vaccinations from a health worker, so I vaccinated my children. But what if other mothers did not? Why should the children suffer?” she asked, explaining her drive to help out.

A woman volunteer takes the stand at a mosque in Aleppo to teach gathered women on the importance of Polio vaccinations and their safety. ©UNICEF Syria/2015

A woman volunteer takes the stand at a mosque in Aleppo to teach gathered women on the importance of polio vaccinations and their safety. ©UNICEF Syria/2015

Suzan took advantage of any opportunity to reach out to mothers and give them critical information on protection from polio. While most of her work entailed holding informative sessions in shelters for the internally displaced people, she took innovative steps to spread her knowledge.

“During major water cuts, I’d approach women gathering to fill their cans with water and talk to them about vaccination and hygiene,” she said. “I can tell how responsive they were because they asked questions and interacted with me, especially young mothers.”

Working in hard to reach areas, the mission of these unsung heroes is dotted with challenges. According to the women, a deteriorating security situation, increased restrictions on the movement of women without a male companion and resistance against vaccinations in some parts of the country are among the obstacles they face on a daily basis.

“The violence in the area is making people hesitant to take their children to medical centres to get vaccinated,” said Jinan, a volunteer in Aleppo. Jinan noted another obstacle faced by the volunteers; the misperceptions of parents over the safety of the vaccinations.

“Parents were too scared to get their children vaccinated due to rumours,” she explained. “We clarified over and over again the credibility of the source and the importance of the polio vaccine until we convinced them.”

Despite challenges, these courageous and dedicated women are reaching out to as many mothers as possible – and getting them to vaccinate their children as a result.

A volunteer with UNICEF holds in-house sessions with mothers in Aleppo and distributes informative flyers on protection from polio. ©UNICEF Syria/2015

A volunteer with UNICEF holds in-house sessions with mothers in Aleppo and distributes informative flyers on protection from polio. ©UNICEF Syria/2015

“The most exciting thing is sharing your knowledge, then watching the mothers take actions based on it,” said Mariam, another community influencer in Aleppo. “One woman went and vaccinated her three children immediately after the information session”.

“Since the outbreak of polio in Syria in late 2013 that resulted in 36 recorded cases in the country, 15 massive vaccination campaigns supported by UNICEF have been rolled out combined with raising public awareness at the community level,” explained Hanaa Singer, UNICEF representative in Syria.

The campaigns reached more than 2.9 million children under the age of five across the country. Many were vaccinated several times. “We were able to reach some children living under siege or in areas hard-to-reach. However, we estimate that some 80,000 children continue to miss out on the life-saving vaccination,” warned Singer.

“Mothers listen and relate better to other mothers,” said Dr. Nidal Abou Rshaid, UNICEF immunization officer. “The volunteers’ role is extremely important because they are more capable of delivering the information.”

Yasmine Saker is a Communication and Reporting Consultant working with UNICEF Syria.

One-month-old Monyaguek from South Sudan is held by his mother while receiving a dose of oral polio vaccine.

A great day for Africa: polio nears its end

Today marks one year since we have had a case of the wild poliovirus anywhere in Africa, the last having been reported from Somalia with a date of onset of 11th August 2014.

What an extraordinary achievement and what a powerful symbol of the progress that has been made on the African continent over the past generation.

What got us to this point was not just a vaccine, it was the tireless work of hundreds of thousands of volunteers, traditional and religious leaders at community level, combined with the commitment and determination of national and local governments. On the global level it has involved a remarkable partnership between WHO, Rotary International, the Centres for Disease Control, the Bill and Melinda Gates Foundation and UNICEF, backed by the generous contributions of many public and private donors.

A girl in Somalia holds out her hand to display her ink-marked finger, which demonstrates that she has been vaccinated against polio.

A girl in Somalia displays her ink-marked finger, demonstrating that she has been vaccinated against polio. © UNICEF/NYHQ2013-1318/Ohanesian

Last month we applauded Nigeria for having achieved a year without detection of the wild poliovirus, despite the enormous challenges posed by insecurity in the Northeast of the country. We have also seen polio outbreaks in Cameroon, Equatorial Guinea and the Horn of Africa halted, thanks to the professionalism, ingenuity and courage of UNICEF staff and our partners.

Globally, we are on the verge of totally eradicating a disease for only the second time in history – as we approach the General Assembly’s endorsement of the Sustainable Development Goals, what a wonderful time to be able to encourage the global community to set ambitious goals and to know that such goals can be met – if we believe.

In November I will end a career of nearly forty years in development. On the 15th of August 1977 I set off for Khartoum. In the months and years that followed I travelled extensively throughout Sudan – on the top of trucks, by train, at the wheel of a Land Rover on nearly impossible roads, and by paddle steamer down the Nile. During these journeys I gained an appreciation for the enormous size of the country and for the extraordinary hardship and isolation in which many of its population lived. I left Sudan in 1983, as the civil war was starting and returned in 2007, as Director of the UNICEF programme in the South of what was then still a united country.

In 2008 we had an outbreak of polio that originated in Jonglei State, close to the border with Ethiopia. It is hard to describe the isolation of this place – an area of marshes, vast cotton-soil plains that become impassable after rains, and an area that has long been plagued by insecurity. Despite all of these challenges – and ongoing insecurity and conflict to this day – the polio outbreak was contained and, what is now the independent nation of South Sudan, has not seen a single case of wild poliovirus since.

One-month-old Monyaguek from South Sudan is held by his mother while receiving a dose of oral polio vaccine.

One-month-old Monyaguek from South Sudan is held by his mother while receiving a dose of oral polio vaccine. © UNICEF/NYHQ2011-2460/Sokol

Similar remarkable achievements across Africa have provided the basis for what we celebrate today.

While today’s milestone is extraordinary, it is not an endpoint. For Nigeria, two more years must pass without a case of wild poliovirus before it can finally be certified as polio-free, along with the rest of the African continent. To achieve this goal, Nigeria and the many other African countries that remain at risk for polio must maintain high-quality surveillance, work ever-harder to improve the quality of vaccination campaigns, and act decisively, should further outbreaks occur. They must also re-double their efforts to improve routine immunization.

With Africa now on track, we are left with only two countries where polio transmission has never been interrupted: Pakistan and Afghanistan. Here too, despite enormous challenges, communities, governments and partners are working with courage and determination to end polio once and for all: today’s anniversary in Africa gives us the faith to believe that they too can succeed.

Peter Crowley is the head of UNICEF’s Polio unit.

Ngewa feeds her baby with Plumpy‘Nut.

Treating malnutrition in Kenya: two very different journeys

I feel anxious and a little weary as we leave Maralal, the capital of Samburu county in Kenya, in a three-vehicle convoy, one of which has armed soldiers inside. My weariness is due to hours already spent in the car over the past couple of days. To reach Samburu, 400 kilometres north of Nairobi, has taken eight hours, half of which was on dirt road. The road ahead is worse.

My feeling of anxiety is because I have been told that security on the road is unpredictable. Some pastoralists on this route may be armed with guns to protect themselves from cattle rustling. Traditionally, cattle rustling was heralded as a demonstration of bravery and it was carried out with spears. Today cattle rustlers use guns and people get killed, including children.

The guns used illegally for protection have also occasionally been used to hold up vehicles. Fortunately, the rocky, narrow, dirt tracks that wind their way across the hills and deep escarpments distract me.

Views en route to Barsaloi. ©UNICEF Kenya/2015/Ruth Ayisi

Views en route to Barsaloi. ©UNICEF Kenya/2015/Ruth Ayisi

We eventually reach the health centre in Barsaloi, a rural location. Also arriving at the health centre is Ngewa Lempate, 30, carrying her 15-month-old baby, Loilashu. By contrast Ngewa has made the journey on foot. It took her three hours across rocky hills. And she made the journey on an empty stomach.

She is given a packet of Plumpy’Nut, a peanut paste fortified by micronutrients, for her baby, Loilashu, to suck. He does so hungrily. Plumpy’Nut is supplied by UNICEF to health centres and is an effective treatment for severe acute malnutrition. Ngewa will be able to take stock back to give to Loilashu four times each day for about 16 weeks. She will have to bring him back to the health centre each week to be monitored though. Severe acute malnutrition can be life threatening if left untreated.

Ngewa feeds her baby with Plumpy‘Nut.

Ngewa feeds her baby with Plumpy‘Nut. ©UNICEF Kenya/2015/Ruth Ayisi

Ngewa looks serene despite the trek. She is dressed in an immaculate sky-blue cloth and wears white bead bracelets up her arms and a huge brightly-coloured beaded necklace. There is no trace of weariness from her hike, nor self- pity.

Ngewa, who has never attended school, is mother to five children, all of whom have been treated for severe acute malnutrition at some point. She explains that recurrent droughts have killed their 20 cows. Now they only have five goats and she survives by cutting and selling aloe vera.

Her family only eats once a day – and that is just a bowl of porridge and vegetables. There is no piped water nearby so they collect from a stream; and they have no latrine so they just use the bush. Only when she talks about her late husband does her voice waver and sadness seems to envelop her. “He died,” she says.

Ngewa’s story is not unique. Her poverty is not only typical of many living in the arid county of Samburu, but is also common in other parts of Kenya. Classified as a middle-income country, Kenya’s economic growth over the past 20 years has not trickled down to many sectors of society. Malnutrition is a serious nationwide public health problem, contributing to 45 per cent of all child deaths in Kenya. An estimated one third of Kenyan children under the age of 5 are stunted.

Hopefully other women like Ngewa will reap the benefit of a €19 million, four-year maternal and child nutrition programme funded by the European Union. It is part of a larger resilience-building programme covering the Horn of Africa. The goal of the programme, which is supported by UNICEF, is to reduce the impact of recurrent food shortages in Kenya’s semi-arid and arid lands, like Samburu, by strengthening health systems, advocating for stakeholders to invest more in the nutrition of women and children and building up the resilience of communities to withstand drought and other shocks.

After Loilashu has finished his packet of Plumpy ‘Nut, Ngewa starts her journey home. We do too. Our return trip is tricky as this time we have some steep climbs and threatening dark clouds hover above. To the pastoralists the rains will be welcome as it has not rained for four months in this area. I hope we get home before the clouds burst.

To my alarm, at one point the vehicle leading the convoy starts rolling back just as we almost reach a peak and are navigating a cliffhanger bend. The UNICEF driver skilfully reverses around the bend down the hill until the driver in front manages to gain control of his vehicle. Baboons jump out, agilely climbing up the rocks.

When we are on level ground, I think of Ngewa again, trekking on an empty stomach with her baby in the rain – her efforts have probably saved Loilashu’s life.

A mother from Luhansk in Ukraine, breastfeeds her child.

Combatting breastfeeding myths in Ukraine

A mother from Luhansk in Ukraine, breastfeeds her child.

A mother from Luhansk in Ukraine, breastfeeds her child. © UNICEF Ukraine/2015

Over the past month I’ve been working with UNICEF Ukraine to support nutrition interventions during the emergency response. Advocating for early initiation of breastfeeding, six months exclusive breastfeeding and complementary breastfeeding for up to two years is a regular part of my job. It is driven by my medical background but also my experiences as a father of two children who enjoyed the benefits of breastfeeding.

Beyond providing technical assistance to partners in the Ministry of Health, technical institutions and local authorities, I work with partners to advocate and support breastfeeding because it gives the healthiest start in life for each child.

Time after time, I cite the facts and quote global studies to mothers and those who can play a crucial role in supporting them – their extended families:

  • Breastfeeding plays a critical role in reducing preventable infant deaths.
  • Breastfeeding protects against infectious diseases.
  • Breastmilk provides essential nutrients.
  • Breastfeeding promotes brain and cognitive development, contributing to higher IQs.
  • Exclusive and extended breastfeeding has been linked to longer school attendance and higher incomes as adults.

According to country survey data from 2012, only 66 per cent of Ukrainian mothers start breastfeeding newborns within one hour of birth, even though early initiation of breastfeeding is a very important step to ensure healthy start in life. And only 20 per cent of children under six months were exclusively breastfed.

Aiming to support nutrition interventions in Eastern Ukraine, UNICEF is working with partners from the US Centers of Disease Control (CDC) and Save the Children to support ongoing data collection about infant and young child feeding.

It is very important to use different opportunities to disseminate the message to Health professionals, media, outreach activities, volunteers, families, religious leaders that breastfeeding is the best for children and there is no need for any additional food or water up to six months.

From my work I have seen that mothers around the world have managed to breastfeed their children in very difficult situations – during conflicts and displacement, lacking water and sanitation. In fact, exclusive breastfeeding can be a lifesaving practice during crises and emergencies, protecting babies against diseases and malnutrition. It can mean the difference between life and death.

Here in Ukraine, the conflict has had an impact on breastfeeding. Based on an assessment conducted earlier this year in three regions, exclusive breastfeeding among internally displaced children under six months is only 26 per cent. Providing water, breastmilk substitutes and early complementary foods for children under six months are common practice. Some health workers provide incorrect advice to parents about the early introduction of water, complementary food, and even breastmilk substitutes.

Several humanitarian organizations are supporting displaced people and providing family food baskets. Some also distribute food packets for children. Nevertheless, the practice of distributing infant formula to large numbers of families with young children should be discontinued immediately and urgently, as per global guidelines.

Tragically, almost half of the internally displaced mothers stopped breastfeeding their infants under six months because they perceive a drop in breastmilk due to the stress of their vulnerable situation. While the weight of their situation understandably causes tremendous worry for new mothers, stress does not have a substantial, long-term impact on breastmilk production. In fact, only the “let down” – for which mothers need to be relaxed – is affected. With caring, emotional and practical support, mothers can continue to breastfeed.

Considering this, we need to join efforts and resources to provide evidence-based information about breastfeeding to policy makers, decision makers, health workers and parents to permanently dispel myths about breastfeeding.

This situation can be improved by supporting mothers, providing counselling and education in health centres and in their communities. Research has shown that continuous support of mothers by fathers and other family members is very important to achieve exclusive breastfeeding for the first 6 months.

I encourage all to support breastfeeding and make sure that Ukraine’s children, and all children in displaced situations, get the best start in life.

Agron Gashi, MD, MP, is a Health and Nutrition Officer working at UNICEF Kosovo

A mother and child from China bond during breastfeeding.

Breastfeeding and work: snapshots from companies around the world

A mother and child from China bond during breastfeeding.

A mother and child from China bond during breastfeeding. © UNICEF/UNI166592/Liu

Breastfeeding provides all children, boys and girls from rich and poor countries, with the healthiest start.  From the first hour of a baby’s life through age two or longer, breastfeeding protects against illness and death. Among its myriad benefits, breastfeeding prevents malnutrition, decreases the risk of childhood diseases, supports healthy brain development and is associated with better school performance, longer school attendance and higher earnings as an adult.  Furthermore, it protects maternal health and is environmentally friendly.  World Breastfeeding Week is celebrated annually around the world to promote the universal value of breastfeeding.

This year’s World Breastfeeding Week theme is Breastfeeding and Work: Let’s Make it Work! to highlight the importance of supporting working mothers to breastfeed. Women with children are the fastest-growing segment of the workforce. Balancing work and family is an important priority for them. When women return to work, time and space to breastfeed or express breastmilk during work hours helps them continue to give their best efforts to their employers and the best food to their baby.

Ensuring adequate maternity protection and time and space for breastfeeding makes economic sense. Working mothers who breastfeed tend to take less time off from work because their children are less likely to be sick. Women who have adequate maternity benefits value their employers, leading to increased productivity, job satisfaction, and loyalty.

Employers increasingly see the financial value of investing in breastfeeding. In Malaysia, for example, the country would gain 2.9 per cent GDP annually if 70 per cent of working-age women participated in the labor force. By endorsing a family and child-friendly workplace, employers not only contribute to the health and wellbeing of mothers and children, but contribute to achieving socio-economic development.

Many companies are taking bold steps and seeing the rewards. In 2007, Google revised its policy on maternity and family care by offering 5 months of fully paid maternity leave to all female employees and offering all employees with a new child $500 for anything from hiring a lactation expert to buying diapers. Following these changes, Google saw a 50 per cent drop in the number of women quitting, bringing company’s female attrition to the same rate as males. Sansiri PLC, one of the largest real estate companies in Thailand, has a private well-equipped breastfeeding room with hygienic breastmilk storage facilities. The company has made it easy for employees to bring their young children to work by establishing, in partnership with UNICEF, an onsite playroom.  In Kenya, the Better Business Practices for Children is a joint initiative between the government, Kenya Private Sector Alliance (KEPSA) and UNICEF. It supports breastfeeding through workplace sensitization, protected time and designated private areas for mothers to express breastmilk or breastfeed their babies.  Safaricom, one of the country’s leading mobile phone service providers and a member of KEPSA, provides comprehensive maternity insurance cover, flexible working hours and state-of-the-art workplace breastfeeding facilities.

Global support for breastfeeding is rising but more needs to be done. The large majority of the 830 million women workers in the world do not have adequate maternity protection, particularly in low- and middle-income countries. Women working in the informal, seasonal or part-time economy are particularly vulnerable and often face even greater barriers to continue breastfeeding and are virtually excluded from protection. It is time to galvanize support from government, private and public sector employers, and communities to support working women to breastfeed.

Werner Schultink is Chief of Nutrition based at UNICEF HQ in New York.

Children draw and colour in the playground at Battambang Provincial Hospital. © UNICEF Cambodia/2015/Martina Tomassini

Want to innovate paediatric care in Cambodia? Set up a playground in a hospital

Children draw and colour in the playground at Battambang Provincial Hospital. © UNICEF Cambodia/2015/Martina Tomassini

Children draw and colour in the playground at Battambang Provincial Hospital. © UNICEF Cambodia/2015/Martina Tomassini

A first-time initiative in Cambodia – “Playgrounds in Hospitals” is helping health care providers, parents and sick children have a better experience during treatment. I spoke with Sedtha Chin, HIV/AIDS Specialist at UNICEF Cambodia, who led this innovative project, to learn more.

Q: In a nutshell, what is the “Playgrounds in Hospitals” project?
Sedtha: The project is about introducing playgrounds into the paediatric ward of Cambodian hospitals to benefit hospitalized children; children with HIV going in for their monthly treatment; hospital staff; and parents. Playgrounds are equipped with toys and books for children and adults to read. The idea is to create an environment where children enjoy themselves and learn while waiting to be treated; healthcare providers are under less pressure because children are not crying to go home; and it’s easier for parents to keep their children waiting.

Playground facilitator Sngiem Sokha tells a story with kamishibai, a Japanese story-box theatre, in the playground at Battambang Provincial Hospital, Cambodia. © UNICEF Cambodia/2015/Martina Tomassini

Playground facilitator Sngiem Sokha tells a story with kamishibai, a Japanese story-box theatre, in the playground at Battambang Provincial Hospital, Cambodia. © UNICEF Cambodia/2015/Martina Tomassini

Q: How did it all start?
Sedtha: In 2007 I worked mostly in hospitals across Cambodia, in their Pediatric Health Care Units. When I travelled the provinces [i.e. rural areas] I thought, “Why don’t we have something like a friendly place for children to enjoy, so that they are less stressed about being in a hospital?”

Often I would see them crying on their beds, looking depressed, just insisting on going home. No child wants to stay at the hospital, right? Then, one day I visited a pre-school and I saw they had a playground. So I thought, “I must try to do something similar in hospitals.”

A few weeks later, when I left the office, I saw a ‘mobile library’ car painted with children’s images and the SIPAR logo [a French-Cambodian NGO that promotes reading among children and youth]. The following day I got in touch with the organization’s director: I told him about my plan to set up a small library in a hospital. He told me that they have lots of experience setting up mobile libraries with schools [i.e. vans with books and a schedule to visit communities] but they had never set up a traditional library in a hospital. We were both eager to give it a go so we made a plan.

I went to talk to the director of the National Paediatric Hospital in Phnom Penh, the capital. He was very excited and said, “What a good idea! Why don’t we try it?” He was familiar with the concept of playgrounds in hospitals because he saw during his travels abroad. So we went for it: UNICEF provided the toys and furniture and SIPAR provided the books and trained two playground facilitators who would engage with children in activities such as storytelling and drawing.

The first evaluation based on interviews with parents, health care providers and parents gave us very positive results. The playground was benefiting hospitalized children, particularly in the Severe Malnutrition ward where it was set up, and children with HIV who were not hospitalized but went to the hospital periodically for their medicine. Both doctors and parents had a more pleasant treatment experience. So we decided to scale up to nine hospitals in the provinces, and three years later we’ve added another six hospitals. As of today, there are 17 playgrounds in paediatric wards in Cambodia – and we keep receiving requests for more.

Two boys reading one of the many books in the playground at Pailin Provincial Hospital, Pailin province, Cambodia. © UNICEF Cambodia/2015/Martina Tomassini

Two boys read one of the many books in the playground at Pailin Provincial Hospital, Cambodia. © UNICEF Cambodia/2015/Martina Tomassini

Q: Did something happen that you didn’t expect when you implemented this project?
Sedtha: I have seen that in some places, like in Prey Veng and Oudar Meanchey provinces, the hospital where we set up the playground is located near to the local primary school. The community knows that the playground has lots of books and toys to play with. So after school some children go to the playground to read and play. This is something I did not expect when we set this up! I am happy to see that this project is not just benefiting children inside and outside the hospitals, but also the whole community.

Q: What are the plans for the future?
Sedtha: Given the positive feedback, we are planning to continue expanding to bring playgrounds to more paediatric wards in Cambodia.

Q: What is the current situation in Cambodia when it comes to children and HIV/AIDS?
Sedtha: Cambodia has been at the forefront of the fight against HIV/AIDS. It is one of the few countries in the world to have successfully reversed its generalized HIV epidemic. The number of children on ART (antiretroviral therapy) has increased steadily, reaching over 80% of children affected by HIV/AIDS in 2014. Today HIV finger-prick testing is accessible at almost all health centers across the country.

Cambodia has done well in terms of providing treatment to children in need ART, however keeping children in ART remains a challenge, especially for children who live in remote areas. We work in close collaboration with the national government and other development partners to support the national HIV/AIDS response and will continue to play an important role to improve services and revise processes so to ensure children and women receive comprehensive services as required.

Martina Tomassini is a Communication Officer at UNICEF Cambodia.

© UNICEF Cuba/2013/García

Cuba: a milestone towards an AIDS-free generation

© UNICEF Cuba/2013/García

© UNICEF Cuba/2013/García

While a report issued on 25 June by the UNAIDS and Lancet Commission urgently calls for greater investments in HIV prevention to reduce new HIV infections and transmission, Cuba’s sustained efforts to prevent mother-to-child transmission has brought the world positive news – the country has become the first to complete the formal validation process for the elimination of vertical transmission of HIV and congenital syphilis, a process led by PAHO/WHO and UNICEF.

This milestone is a great opportunity to pause and reflect on the whole process, to look back at everything that has been done to achieve this result, and to look forward at everything that remains to be done to achieve an AIDS-free generation.
So how has the situation evolved since 1986, the year in which the first HIV cases were diagnosed in Cuba? In the late 1980s, it was very unusual for HIV-positive women aware of their status to start a pregnancy. The mother-to-child transmission rate was above 40 per cent. Only one HIV test was carried out, during the first trimester of pregnancy. Preventive measures for HIV-positive mothers only included a C-section and the suspension of breastfeeding.
As knowledge improved, so did control and prevention measures. Nowadays, all Cuban pregnant women are tested for HIV three times, once per trimester of pregnancy. HIV-positive pregnant women have access to antiretroviral treatment, and their children receive prophylaxis and are tested for HIV during their first year of life. Thanks to these efforts in preventing, controlling and monitoring HIV, in recent years, pregnancies of HIV-positive women have increased, and the mother-to-child transmission rate of HIV has decreased to 1.85%, below the 2% target.
Yet, a milestone is not the end of the process. We still have a long way to go to achieve an AIDS-free world. In Cuba, as in many countries in the world, our big challenge is to improve people’s knowledge about HIV transmission.
Our work in Cuba focuses on supporting the country’s HIV prevention efforts and raising awareness about HIV among adolescents and young people, as evidence shows a low risk perception and risky sexual behaviours: around one-third of young people start their sexual life without protection, and about half of them consider that they do not have any chance of being infected with HIV[1]. Only 60.9 per cent of women and 58.6 per cent of men aged between 15 and 24 correctly identify two ways to prevent sexual transmission of HIV[2]. It is also necessary to keep fighting discrimination against people living with HIV and AIDS.
As a milestone has been reached, let’s take some time to praise the incredible advances that have taken place in the fight against HIV and AIDS since the 1980s. And then, let’s keep moving forward and working to eliminate the remaining obstacles on the path towards an AIDS-free generation.

Anna Lucia D’Emilio is UNICEF Representative in Cuba.

[1] National Office for Statistics and Information, Cuba.
[2] Multiple Indicator Cluster Survey, Cuba, 2014.


PAYNESVILLE, LIBERIA - Children under the age of 5 years old receive Measles and Polio vaccines along with Worm medicine at Duport Road Health Center on Friday, May 8 following the Measles & Polio Vaccines and Deworming Campaign event. The campaign, led by the Ministry of Health and Social Welfare, and supported by UNICEF, the Center for Disease Control and the World Health Organization, will take place countrywide from May 8-14 and reach more than 600,000 children. 

Alpha Sidabey, 3, receives the measles vaccine while at the Duport Road Health Center on Friday, May 8, the first day of the Measles and Polio Vaccines and Deworming Campaign.

The success of social mobilization and community engagement in Liberia

Supported by his mother, Alpha (3) looks on bravely as he receives the measles vaccination.

Supported by his mother, Alpha (3) looks on bravely as he receives the measles vaccination. (c)UNICEF Liberia/S.Grile

Social mobilization and community engagement are two phrases I hear quite frequently these days, in the office and the media, with both activities widely credited as helping turn the tide in stopping the spread of Ebola. UNICEF-supported social mobilization teams have for months been at the forefront of efforts to halt the transmission of Ebola in Liberia. Now, with the country having reached zero cases, their role has changed to that of raising awareness in the communities about the importance of accessing routine health services.

The rules of the game have certainly changed since Liberia reached zero cases of Ebola on May 9. The day before the announcement, the country launched a week-long integrated immunization campaign in response to a measles outbreak – a positive first sign of the restoration of routine services.

The campaign aimed to reach over 600,000 children who had previously been unable to access immunization services during the Ebola outbreak. Preliminary reports indicate that over 90% of children under 5 years of age received vaccines during the campaign and that community engagement was key to the success of the immunization drive.

I am not surprised by these results. When I travelled to Gbarnga in Bong County a few weeks ago, I joined a social mobilization team and witnessed, first hand, the impact they had on encouraging behaviour change and in helping to educate communities.

Talking to communities about the importance of vaccinating children and the prevention of childhood diseases that too frequently lead to the deaths of thousands of Liberian children every year is just one way I saw how community mobilizers are re-engaging with communities.

“Liberians know about vaccinations for diseases like measles and polio. Before they didn’t need convincing, but now it is different. Speaking to both children and their parents yields the best results”, explains Dutch Hamilton, UNICEF’s Community Mobilisation Coordinator in Gbarnga, Bong County (who we met in a previous blog).

It is shocking to think that in Liberia, one in four deaths of children under five are due to measles and pneumonia, both vaccine preventable diseases. During the height of the Ebola crisis, immunization rates dropped to a startlingly low 16%. For this reason, the high coverage achieved in the latest campaign is both encouraging and welcoming.

Three-year-old Stephanie receives the polio vaccine.

Three-year-old Stephanie receives the polio vaccine. (c) UNICEF Liberia/S.Grile

Dutch tells me how difficult it has been working in the current environment and highlights that fear and misinformation have been holding parents back from accessing essential health services.

“A large part of the job is now about rebuilding confidence between the communities and the health workers, as well as with the health system in general,” says Dutch.

UNICEF recruited more than 4,000 social mobilization personnel who were deployed across Liberia to raise awareness during the integrated immunization campaign. Other equally important elements to the campaign were message development and the use of multimedia to encourage behaviour change.

“Reinforcing these messages is an ongoing task and communities are receptive. Ensuring families understand the importance of protecting their children from preventable diseases through immunization remains a challenge,” says Dutch.

Admittedly, it worries me that after Liberia’s success in stopping the transmission of Ebola within its borders, the world’s spotlight will shift away from the country’s growing health needs. In reality, the international community’s support is crucial to the restoration of services and the strengthening of Liberia’s already crippled health system.

Dutch and his team, and the 4,400 other social mobilization workers recruited by UNICEF across the country are now gearing up for the next vaccination campaign for polio and Vitamin A, which will take place between 26-29 June. The rainy season has already begun and the teams’ efforts will be needed more than ever to meet UNICEF’s goal to reach every child. I am hopeful that the success of the last campaign can be repeated again and only time will tell if these positive results can be sustained in the future.

Alvina Lim is a Communication Officer working at UNICEF Liberia.



A woman and her baby await vaccination and growth monitoring in Nigeria, 2013.

Why equity in immunization matters

On a recent trip to Madagascar, I met with families in the South West region – one of the poorest in the country – who earn about US$5 a month. I visited the village of Beronono that is 30 km from the nearest health center. Maria, a mother from Beronono, told me that she spent half of her monthly income to cover the cost of travel to the center. She arranged for several children from her community to travel to the health center together on a traditional cow-drawn cart to have them immunized and get their weight and nutritional status checked.

Sadly, when they arrived, the center had run out of vaccines, leaving the children unprotected and shattering the community’s trust in the health system.

In a low-income country like Madagascar, children from richer, urban families are 1.5 more likely to be immunized than those living in poor rural areas. A child with an educated mother is 1.7 times more likely to be vaccinated than a child whose mother has no formal education*. In the poorest and most disadvantaged regions, children are 3.5 times less likely to be vaccinated than their peers in richer regions.

Thousands of Malagasy children wait most of the day to receive their measles shot and bed net during Mother and Child Health Week 2014.

Thousands of Malagasy children wait most of the day to receive their measles shot and bed net during Mother and Child Health Week 2014. © UNICEF/PFPG2014-1185/Hallahan

Extreme poverty is widespread in Madagascar. The poorest populations are most likely to lack access to vaccination, making immunization an important marker of inequities. Insufficient resources for distributing vaccines and maintaining the all-important vaccine cold chain, along with too few health workers, are keeping vaccination services inaccessible to the poor.

While more children than ever before are being protected with vaccination, over 21 million infants** – one in five babies around the world – in low- and middle-income countries did not receive this vital service in 2013. Most are from the poorest and most marginalized communities and these persistent inequities in access to vital health services put them at risk of death or disability. Because of weak health systems and insufficient funding they miss out on the basic vaccines they need to stay healthy and have a fair chance in life.

Since 2008, global immunization levels for essential childhood vaccines have remained constant around the 80% mark. While efforts to sustain coverage are certainly praiseworthy, the most vulnerable and underprivileged children – those who need immunization the most – are consistently missed. More resources and efforts are needed to include the poorest, most marginalized communities in immunization and other child health programs.

As long as the poorest children aren’t reached with vaccines many will die of preventable causes, when immunization could offer an affordable and simple way to protect them. Over 1.5 million children die annually from diseases that can be prevented by vaccines.

A woman and her baby await vaccination and growth monitoring in Nigeria, 2013.

A woman and her baby wait for vaccination and growth monitoring in Nigeria, 2013. © UNICEF/NYHQ2013-0464/Esiebo

Meanwhile, in some middle- and high-income countries where access is not an issue, parents actively choose not to vaccinate their children because of unfounded fears and a failure to appreciate the vital importance of immunization for their children’s very survival.

For this year’s edition of World Immunization Week, UNICEF and its partners are making a direct appeal to the global health community to close the immunization gap and to focus on vaccinating the most marginalized children. But as long as immunization is not prioritized, and funding for programmes stagnates, the most disadvantaged children will continue to miss out on vaccines, which could mean the difference between their life and death. Failure to scale up access to existing vaccines could result in more than 6 million child deaths and over US$150 billion in treatment costs and productivity losses between 2011 and 2020.

For Madagascar, closing the immunization gap means making funding regularly available to reach every community. It also means prioritizing the most remote rural communities by bringing vaccination services closer to home and making sure that health workers are available and equipped to protect children.

UNICEF is working with the Government of Madagascar to prioritize these regions and communities. This way, Maria won’t need to spend half her monthly income traveling to the health center. Instead, she’ll have her children vaccinated in her own community and have more money to spend on nutritious food and better education.

Maya Vandenent is Senior Immunization Specialist at UNICEF.


*Achieving equity in immunization: a case study of a UNICEF-led equity-based case study in Madagascar, UNICEF March 2015

** http://data.unicef.org/child-health/immunization