Tracking Progress in Maternal, Newborn & Child Survival: The

TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL The 2008 Report

TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT Tracking Progress in Maternal, Newborn & Child Survival The 2008 Report

ISBN: 978-92-806-4284-1

Cover photo © UNICEF/HQ07-1153/Shehzad Noorani

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www.countdown2015mnch.orgTRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT ii iii Abbreviations Contributors

AARP Average annual rate of reduction Lead Authors Acknowledgements ARV Anti-retroviral treatment Jennifer Bryce (Johns Hopkins University, USA) and Jennifer Harris CHERG Child Health Epidemiology Reference Group Requejo (PMNCH, Switzerland) The Countdown Group would like to thank the following: DHS Demographic and Health Surveys GAVI Global Alliance for Vaccines Initiative Special Recognition UNICEF/Strategic Information Section for use of global databases, GFATM Global Fund for AIDS, TB and Malaria Tessa Wardlaw, Archana Dwivedi, Holly Newby of UNICEF, for technical preparation of country profiles, and review of report text. Particular Hib Haemophilus influenzae type B support and substantial contribution to all phases of report preparation recognition goes to Xiaodong Cai, Khin Wityee Oo, and Me Me ILO International Labour Organization and production Khine for their input and review of country profiles. Irene Deineko for IMCI Integrated management of childhood illness administrative support and convening of review meetings. ISCO International Standard Classification of Occupations 2008 Countdown Working Group ITNs Insecticide-treated nets Jasmina Acimovic, UNICEF, USA WHO regional offices and headquarters staff who contributed to data LSHTM London School of Hygiene and Tropical Medicine Priscilla Akwara, UNICEF, USA collection: Christopher Drasbek, Susan Farhoud, Olivier Fontaine, JMP WHO/UNICEF Joint Monitoring Programme on Water Supply and Sanitation Henrik Axelson, PMNCH, Switzerland Phanuel Habimana, Ardi Kaptinisingh, Aigul Kuttumaratova, Ramez MDGs Millennium Development Goals Stan Bernstein, UNFPA, USA Mahaini, Sudhansh Malhotra, Shameen Qazi and Mariana Trias. MERG Roll Back Malaria Monitoring and Evaluation Reference Group Zulfiqar Bhutta, Aga Khan University, Pakistan MICS Multiple Indicator Cluster Surveys Robert Black, Johns Hopkins University, USA The Countdown communications team for their inputs in shaping the NMR Neonatal Mortality Rate Ties Boerma, WHO, Switzerland key messages, media strategy and Countdown Executive Summary: OECD Organisation for Economic Co-operation and Development Josephine Borghi, LSHTM, UK Genine Babakian, Flavia Bustreo, Marie Agnes Heine, Olivia Lawe- PMNCH Partnership for Maternal, Newborn and Child Health Jennifer Bryce, Johns Hopkins University, USA Davies, Kate Kerber, Ruth Landy, Jessica Malter, Tunga Namjilsuren, SWAps Sector-Wide Approaches Flavia Bustreo, PMNCH, Switzerland George Ngwa, Jennifer Requejo, Jacqueline Toupin, Michelle Zelsman. U5MR Under-five mortality rate Dennis Caillaux, Global Movement for Children, Switzerland UNGASS United Nations General Assembly Special Session Naomi Cassirer, ILO, Switzerland Christa Fischer-Walker and Jeremy Schiefen of Johns Hopkins UNICEF United Nations Children’s Fund Eleanora Cavagnero, WHO, Switzerland University, USA for preparing maps. WFFC World Fit for Children David Clark, UNICEF, USA WHO World Health Organization Giorgio Cometto, Save the Children, UK The DevInfo initiative for the development of the database and the Bernadette Daelmans, WHO, Switzerland production of the Country Profiles. Nita Dalmiya, UNICEF, USA Maria Dal Poz, WHO, Switzerland UN Country Team in South Africa, particularly the UNICEF Sub-Office in Archana Dwivedi, UNICEF, USA Cape Town for administrative and logistics support. Leslie Elder, Saving Newborn Lives / Save the Children, USA David Evans, WHO, Switzerland The PMNCH Secretariat for convening meetings for Countdown Vincent Fauveau, UNFPA, Switzerland Core Groups and PMNCH colleague Tigest Yilma Desta for providing Helga Fogstad, NORAD, Norway administrative support. Anastasia J. Gage Tulane University, USA Youssouph Gaye, Ministry of Health, Senegal Working Groups Wendy Graham, University of Aberdeen, UK Giulia Greco, LSHTM, UK Coverage Indicators: Fred Arnold, Linda Bartlett, Stan Bernstein, Neeru Gupta, WHO, Switzerland Zilfiqar Bhutta, Robert Black, Ties Boerma, Jennifer Bryce, Flavia Richard Horton, The Lancet, UK Bustreo, Simon Cousens, Trevor Croft, Bernadette Daelmans, Leslie Julia Hussein, University of Aberdeen, UK Elder, Anastasia Gage, Wendy Graham, Kate Kerber, Stein-Erik Kruse, Monir Islam, WHO, Switzerland Joy Lawn, Elizabeth Mason, Jeffrey Mecaskey, Carine Ronsmans, Peter Kareen Jabre, Inter-Parliamentary Union, Switzerland Salama, Harshad Sanghvi, Lale Say, Werner Schultink, Anuraj Shankar, Kate Kerber, Saving Newborn Lives / Save the Children, USA Nancy Terreri, Anne Tinker, Vincent Fauveau, Cesar Victora, Tessa Betty Kirkwood, LSHTM, UK Wardlaw Joy Lawn, Saving Newborn Lives / Save the Children, USA Samantha Lobis, Columbia University, USA Equity: Henrik Axelson, Stan Bernstein, Ties Boerma, Wendy Graham, Viviana Mangiaterra, WHO, Switzerland Kate Kerber, Betty Kirkwood, Jeffrey Mecaskey, Carine Ronsmans, Elizabeth Mason, WHO, Switzerland Cesar Victora Jeffrey Mecaskey, Save the Children, UK Anne Mills, LSHTM, UK Financial Flows: Henrik Axelson, Zulfiqar Bhutta, Josephine Borghi, Holly Newby, UNICEF, USA Flavia Bustreo, Guilia Greco, Anne Mills, Tim Powell-Jackson Maryanne Neill, UNICEF, USA Arletty Pinel, UNFPA, USA Policy Review: Bernadette Daelmans, Vincent Faveau, Andy Haines, Tim Powell-Jackson, LSHTM, UK Monir Islam, Stein-Erik Kruse, Viviana Mangiaterra, Jeffrey Mecaskey, Sonya Rabeneck, PMNCH, Switzerland Ann Starrs, Nancy Terreri, Stewart Tyson, Patrick Unterlerchner Jennifer Harris Requejo, PMNCH, Switzerland Carine Ronsmans, LSHTM, UK Peter Salama, UNICEF, USA David Sanders, University of Western Cape, South Africa Harshad Sanghvi, JHPIEGO, USA Lale Say, WHO, Switzerland Werner Schultink, UNICEF, USA Anuraj Shankar, WHO, Switzerland Meera Shekar, World Bank, USA Robert Scherpbier, WHO, Switzerland

© UNICEF/HQ05-2159/Giacomo Pirozzi Francisco Songane, PMNCH, Switzerland Marcus Stahlhofer, WHO, Switzerland Ann Starrs, Family Care International, USA Sissel Hodne Steen, NORAD, Norway Nancy Terreri, UNICEF, USA Anne Tinker, Save the Children, USA Jim Tulloch, AusAid, Australia Stewart Tyson, DFID, UK Patrick Unterlerchner, PMNCH, Switzerland Costanza Vallenas, WHO, Switzerland Cesar Victora, Universidade Federal de Pelotas, Brazil Tessa Wardlaw, UNICEF, USA

TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT iiiv iii Summary

The last few years have seen enormous and The Countdown pursues these objectives through Interventions and indicators Key findings of the 2008Countdown welcome developments in global public health and conferences, publications and follow-up regional and All interventions tracked through the Countdown The report contains profiles for each of the 68 nutrition. There is growing recognition – increasingly country activities, focusing attention on progress are empirically proven to reduce mortality among Countdown priority countries. Benin is shown as an backed by resources – that achieving the Millennium towards national-level coverage of proven interventions mothers, newborns or children. Coverage with broader example in figure 2. Benin was selected because it is Development Goals (box 1) will demand radical in countries with the highest maternal and child approaches, such as antenatal and postnatal care, the first country profile (in alphabetical order) where changes to the scale and scope of effective strategies. mortality rates. The activities of the Countdown are delivery and reproductive health services also need data were available for all major indicator categories. The Countdown to 2015 responds to these calls for guided by four principles (box 2). to be tracked, as they provide the basic platform for Figure 3 presents median national level coverage for change. delivery of multiple effective interventions to reduce maternal and newborn mortality. Coverage Levels Countdown Principles The Millennium Development Goals The Countdown tracks only interventions and approaches that are feasible for universal implementation in poor countries. In addition, to be tracked, an intervention or approach must be Focus on coverage Hib3 immunization 85 Goal 1: Eradicate extreme poverty and hunger. Focus on effective interventions associated with a valid coverage indicator that is reliable and comparable across countries and time. Neonatal tetanus Goal 2: Achieve universal primary education. Maintain a country orientation protection 81 Goal 3: Promote gender equality and empower Build on existing goals and monitoring efforts The Countdown recognizes the limitations of some women. coverage indicators now used and is doing technical DPT3 immunization 81 Goal 4: Reduce child mortality. work to improve them. Finally, the 68 Countdown Box 2: Countdown principles Goal 5: Improve maternal health. country profiles present other information helpful for Measles immunization 80 interpreting coverage levels, including: Goal 6: Combat HIV/AIDS, malaria and other Vitamin A supple- 78 diseases. Countdown priority countries • Country-specific estimates of maternal and mentation (2 doses) Goal 7: Ensure environmental sustainability. child mortality and child nutritional status, Improved drinking 69 The 68 priority countries for the Countdown to 2015 s water Goal 8: Develop a global partnership for • The status of policies related to maternal, e bear the world’s highest burdens of maternal and child h c Complementary development. newborn and child health, a 62 o feeding (6-9 months) mortality (figure 1). Together these countries account r

• Indicators of health system strength, p for 97 per cent of maternal and child deaths. Included p a Skilled attendant Box 1: The Millennium Development Goals 53 • Measures of equity in coverage, d at delivery

among the priority countries are 34 of the 36 countries n a

in the world with the highest prevalence of child • Estimates of financial flows to maternal, s 4+ antenatal care visits 49 n o i

undernutrition. newborn and child health and nutrition. t

A collaboration among individuals and institutions n Careseeking for e 48 v

established in 2005, the Countdown aims to stimulate r pneumonia e t n

country action by tracking coverage for interventions i Improved sanitation 43 n facilities

needed to attain Millennium Development Goals 4 and w

The 68 Countdown Priority Countries Country Profiles o

d Early initiation of 5 – and, in addition, parts of Millennium Development t 43 n breastfeeding Goals 1, 6 and 7. Through this unified effort national and u o international policy makers, programme implementers, C Malaria treatment 40

development and media partners and researchers are Benin DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 8,760 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 1,488 (2006) undernutrition Unmet need for family planning (%) 27 (2001) Diarrhoea treatment 38 working together to: Births (000) 358 (2006) Causes of neonatal Obstructed labor Other Contraceptive 200 185 Injuries deaths Abortion 17 Pre-pregnancy 0% Malaria Diarrhoea 2% Antenatal visits for woman (4 or more visits, %) 62 (2001) Anaemia 4% prevalence rate Birth registration (%) 70 (2006) 2% 4% 27% Tetanus 4% 4% Antenatal visit 148 Other 5% 88 Pregnancy Under-five mortality rate (per 1000 live births) 148 (2006) 160 HIV/AIDS Intermittent preventive treatment for malaria (%) 3 (2006) (1 or more) 2% Congenital 8% Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 88 (2006) disorders Haemorrhage 78 Birth 120 Measles Asphyxia 19% C-section rate (total, urban, rural; %) at birth 9% 34% Neonatal mortality rate (per 1000 live births) 38 (2000) 5% Neonatal (Minimum target is 5% and maximum target is 15%) 3, 6, 2 (2001) 80 62 25% *Postnatal care Neonatal period Total under-five deaths (000) 53 (2006) Preterm 28% Sepsis/Infections, Exclusive Early initiation of breastfeeding (within 1 hr of birth, %) 49 (2001) including AIDS 70 Infancy Maternal mortality ratio (per 100,000 live births) 840 (2005) 40 breastfeeding • Summarise, synthesise and disseminate the best and MDG Target 16% Diarrhoea Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 20 (2005) Infection 34% Measles 89 0 17% Pneumonia Other causes 2,900 (2005) 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 21% 0 20 40 60 80 100 Antibiotics for Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition 32 INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Antenatal care Skilled attendant at delivery Neonatal tetanus protection Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus pneumonia most recent information on country-level progress skilled health provider during pregnancy NUTRITION 100 100 100 Stunting prevalence (moderate and severe, %) 44 (2006) Complementary feeding rate (6-9 months, %) 50 (2006) 88 80 81 94 Wasting prevalence (moderate and severe, %) 9 (2006) Low birthweight incidence (%) 16 (2001) 80 80 78 80 66 66 60 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent Percent Percent 40 40 40 towards high, sustained and equitable coverage with At least one dose Two doses Exclusive 94 94 100 100 100 98 20 20 20 100 85 96 95 95 92 80 80 80 89 0 0 28 70 1996 2001 2006 1996 2001 2006 1986 1991 1996 2001 2006 56 DHS DHS DHS DHS DHS DHS 60 60 60 Source: WHO/UNICEF 22 breastfeeding 20 Percent 40 Percent 40 38 Percent 40

health interventions to save women and children. 20 20 10 20 WATER AND SANITATION EQUITY 0 0 0 0 0 0 0 2001 2006 1996 2001 2006 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile DHS DHS DHS DHS DHS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 100 Children sleeping CHILD HEALTH 78 80 73 80 80 67 • Take stock of progress in maternal, 63 57 57 59 7 Immunization Malaria prevention Prevention of mother to child 60 60 60 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs

transmission of HIV Percent Percent Percent Percent of children immunised with 3 doses DPT 40 40 32 33 40 under ITNs Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 20 20 12 11 20 100 93 100 100 2 93 0 0 0 80 89 80 80 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest newborn and child survival. Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 60 60 53 1996 2001 DHS DHS Percent 40 Percent 40 Percent 40 Source: Authors’ compilation based on information supplied in text 27 POLICIES SYSTEMS 20 20 20 20 7 Coverage gap (%) 48 41 International Code of Marketing of Breastmilk Financial Flows and Human Resources IPTp for malaria 0 7 0 0 Substitutes Yes Ratio 1990 1995 2000 20052006 2001 2006 2005 2006 Per capita total expenditure on health (US$) 40 (2007) poorest/wealthiest 1.9 1.7 • Call on governments, development partners Source: WHO/UNICEF DHS MICS Other NS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Yes % of total government expenditure (%) 10 (2007) poorest-wealthiest (%) 29 22 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics Partial Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 49 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 0.9 (2004) 100 100 100 Costed implementation plan(s) for maternal, and the broader community to be accountable newborn and child health available Yes Official Development Assistance to child health Figure 1: The 60 priority countries in 2005 (red). The 8 priority (US$) (2005) 80 80 80 per child 7 Midwives be authorised to administer a core set of 60 60 60 54 60 life saving interventions Partial Official Development Assistance to maternal and neonatal health per live birth (US$) 4 (2005) Benin Percent 40 Percent 40 Percent 40 35 Maternity protection in accordance with ILO 0 20 40 60 80 100 32 23 42 Convention 183 No National availability of Emergency Obstetric Care countries added in 2008 (yellow): Bolivia, Eritrea, Guatemala, 20 20 20 services (% of recommended minimum) 66 (2002) Specific notification of maternal deaths Yes if rates of progress are not satisfactory. 0 0 0 1996 2001 2001 2006 1996 2001 Countdown to 2015 DHS DHS DHS DHS DHS DHS Democratic People’s Republic of Korea, Lao People’s 2008 Report Median level of national • Identify knowledge gaps that are hindering progress. Democratic Republic, Lesotho, Morocco, Peru. coverage • Propose new actions to achieve the health-related Figure 2. Country profile example of Benin Source: UNICEF 2007c Millennium Development Goals, in particular Millennium Development Goals 4 and 5. Figure 3. Median coverage levels for selected Countdown interventions and approaches

TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT iv v selected Countdown interventions and approaches Weak health systems and broader contextual Aid needs to increase and become more based on the most recent data available. factors obstruct progress. Health systems in many predictable. Official development assistance to The Countdown Call to Action countries cannot now deliver essential interventions child, newborn and maternal health increased by 28 Seven key conclusions and approaches widely or well enough to reduce percent from 2004 to 2005, including increases of 49 mortality nationwide. Indicators of health financing per cent to child health and 21 per cent to maternal Seven key conclusions emerge from an analysis of the All institutions and individuals involved in the Countdown and health worker density are useful markers of and newborn health. Such aid for maternal, newborn should use the information it provides – in combination with profile data: health system strength. Of the 68 Countdown priority and child health and nutrition has increased in most their diverse skills and resources – to promote the following countries, 54 – or 80 percent – have workforce Countdown priority countries, but has decreased in immediate actions: Countries, while rapidly increasing coverage densities below the critical threshold for improved others. Of the 68 countries, 38 received more per for some interventions, are making little or no prospects for achieving the health-related Millennium capita official development assistance to child health • Sustain and expand successful efforts to achieve high and equitable coverage for priority interventions. Recent progress with others. Most Countdown countries Development Goals. It has been estimated that annual in 2005 than in 2004, while 39 received more to areas of progress – especially immunizations, vitamin have high or increasing coverage for preventive per capita total health expenditures of less than $45 maternal and newborn health per live birth in 2005 A supplementation and insecticide-treated bed nets interventions such as vaccinations, vitamin A are insufficient to ensure access to a very basic set than in 2004. Although maternal, newborn, and child – represent a major success for governments and their development partners. Such efforts should continue. But supplementation and insecticide-treated bed nets to of needed services. Of the 68 priority countries, 21 health programmes within the priority countries have comparable efforts and investments are required for the prevent malaria (figure 3). But very few are making had annual per capita health expenditures below this benefited from these increases in official development case management of childhood illnesses, family planning progress reaching women and children with clinical amount. assistance, such programmes are still grossly services, and antenatal, childbirth, and postnatal care. care services, such as skilled attendants at delivery underfunded and much more needs to be done. • Focus on the priority period within the continuum of care, from pre-pregnancy through 24 months – especially around or treatment for pneumonia, diarrhoea and malaria. Many Countdown priority countries face the time of birth. To reduce mortality during childbirth and Postnatal care is an especially important gap in the additional challenges to progress. For example, Countries need more and better coverage in the immediate days afterwards, programming efforts first week of life when mothers and newborns are at must focus on the effective and integrated delivery of in the 26 countries with no or reversed progress estimates and research on programme interventions and approaches associated with this crucial the highest risk. Prevalence rates for the nutritional towards Millennium Development Goal 4, contextual implementation. Since the firstCountdown report period (e.g., antenatal, delivery, and postnatal care). indicators that require social and behavioural challenges, such as armed conflict, natural disasters, in 2005, an unprecedented amount of household Contraceptive services and efforts to improve infant feeding practices also need to be given high priority. changes in order to improve, such as early initiation high HIV burdens and low adult female literacy rates, surveys have been conducted and include new of breastfeeding, exclusive breastfeeding, and • Within increased efforts to achieve the health-related contribute to stagnating or deteriorating coverage. MICS data from 54 countries and new DHS data Millennium Development Goals, make improving maternal complementary feeding, are also low. for 35 countries. However, many countries are still and child nutrition a priority. Nutrition must be central to determining coverage levels for essential interventions both national and subnational development strategies. The continuum of care for maternal, newborn and using data that is 5, 10 or even 15 years old. In • Strengthen health systems, focusing on measurable results. Health systems need to deliver on demand, creating a child health requires multiple delivery approaches. Challenges to Progress consequence, the knowledge gained through current functional continuum of care over time and across places of Progress towards the Millennium Development Goals and ongoing efforts to promote maternal, newborn service delivery. All new initiatives must focus on outcomes will require a range of interventions to be delivered and child health and nutrition has not been adequately that measurably advance this aim. in different points during the life-cycle. Services that disseminated. Data collection and dissemination • Set geographic and population priorities, and stick to contribute to the achievement of one Millennium processes need improvement to make timely data them. The health-related Millennium Development Goals Over one-third of the priority Countdown countries cannot be met globally without faster progress in sub- Development Goal will not necessarily advance were affected by violent, high-intensity conflict more readily available, which is crucial for planning and Saharan Africa and South Asia. Development efforts and progress towards another. Of particular concern today between 2002 and 2006. implementation purposes. official development assistance must increasingly target is a serious breakdown in the continuum of care countries in these regions with large populations and poor performance. at several points in the pre-pregnancy to two-year • Prioritize a programme for equity. Describing inequities, postnatal period when opportunities to deliver essential Box 3: Many Countdown priority countries face additional challenges to progress though an important first step, is not enough. Programmatic services are being lost. efforts to address inequities must be supported by strong monitoring and evaluation activities. • Do even more to ensure predictable long-term aid flows Undernutrition is an area of little or no progress. for maternal, newborn and child health. Governments More than one-third of deaths in children under age Inequities obstruct progress. Mortality in children and their development partners cannot meet the health- five are attributable to undernutrition – the underlying related Millennium Development Goals unless assistance is under age five is now concentrated in sub-Saharan cause of 3.5 million child deaths annually. Maternal adequate, predictable and targeted to those goals. Africa (almost 50 per cent) and South Asia (30 per undernutrition increases the mother’s risk of death • Monitor. Evaluate. Conduct locally driven implementation cent). Maternal and newborn mortality are similarly research. And act on the results. The ‘community of at delivery, accounting for at least 20 per cent of concentrated in those regions. Meanwhile, within practice’ for maternal, newborn and child health must such deaths. In 33 of the 68 priority countries, lead the change by improving monitoring and evaluation countries, the richest quintile is gaining access to key at least 20 percent of children are moderately or activities, and supporting efforts to rapidly disseminate and interventions more quickly than the poorest. Reducing build-on important findings. severely underweight, and 62 countries have stunting both types of inequity – between regions and within • Lead the change for maternal, newborn and child survival. prevalence rates exceeding 20 per cent. countries – is crucial for achieving the health-related It is time for all to work together as partners to improve the lives of women, newborns and children. Millennium Development Goals.

TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT vi vii Contents

Chapter 1: Tracking intervention coverage for maternal, newborn and child survival 1 Countdown principles 2 Links to other monitoring efforts 4 Overview of this report 4 Notes 5

Chapter 2: Tracking indicators and methods 7 Selecting the Countdown priority countries 7 Priority interventions and coverage indicators 9 Indicators for factors that contribute to coverage 10 Tracking improvements in equity 11 Data sources and methods 11 Coverage 12 Policies, health systems and financial flows 13 Equity 14 Notes 15

Chapter 3: The 2008 Countdown findings - and a call to action 17 The bottom line: mortality 17 Nutritional status 21 Coverage in 2008 22 Recent coverage trends 23 Coverage levels and trends for selected programmatic areas 24 Equity in coverage levels 40 Health policies and health systems 41 Human resources and financing 44 Financial flows to maternal, newborn and child health 44 Conclusions and recommendations 46 The Countdown call to action 48 Notes 49

Chapter 4: The country profiles 51

References 188

Annexes Annex A: Initiatives, resources and databases for monitoring progress towards the health-related Millennium Development Goals, with a special focus on maternal,newborn and child survival Annex B: Indicators and data sources Annex C: Defining current Countdown indicators Annex D: Definitions of policy and health systems indicators Annex E: Countdown to 2015 measuring equity in maternal, newborn and child health through the coverage gap index: technical notesz Annex F: Countdown priority countries considered to be malaria endemic

TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT

The last few years have seen enormous and welcome A common theme in these Lancet1 series was the developments in global public health and nutrition. call for a systematic mechanism to track progress in There is growing recognition, increasingly backed by achieving high, sustainable and equitable coverage resources, that achieving the health-related Millennium with interventions proven to reduce maternal, newborn Development Goals will demand radical changes and child mortality – ‘coverage’ being defined as the to the scale and scope of effective strategies. The proportion of those needing an intervention who Countdown to 2015, a movement of governments, receive it.9 The response to this call is reflected individuals and institutions, is responding to these calls broadly in global efforts to track progress towards the for change. Millennium Development Goals (box 1.1), and is the specific focus of the Countdown to 2015. In 2003 the Bellagio Lancet Child Survival Series helped raise global awareness of more than 10 million deaths Supported through contributions of time and money occurring each year in children under age five, mainly and governed by a Core Group, the Countdown aims from preventable conditions that rarely affect children to stimulate country action by tracking coverage

© UNICEF/HQ06-1391/Giacomo Pirozzi in wealthy countries.1 In 2005 a second Lancet series for interventions needed to attain Millennium focused on the approximately 4 million annual deaths Development Goals 4 and 5, together with parts among newborns.2 Later series focused on maternal of Millennium Development Goals 1, 6 and 7. The survival3 and broader issues of child development Countdown tracks coverage within populations in developing countries,4 sexual and reproductive targeted by specific interventions and usually measures health,5 maternal and child health and nutrition6 and coverage at the population level (rather than in health health systems.7 Finally, a special issue of the Lancet facilities, for example). Through the Countdown, on “Women Deliver” highlighted the importance of national and international policy makers, programme the continuum of care for maternal, newborn and child implementers, development and media partners and health.8 researchers are working together to: • Summarise, synthesise and disseminate the best and most recent information on country-level progress towards high, The Millennium Development Goals sustained and equitable coverage with health interventions to save women and children. • Take stock of progress in maternal, newborn and child survival. Goal 1: Eradicate extreme poverty and hunger. • Call on governments, development partners Goal 2: Achieve universal primary education. and the broader community to be accountable Goal 3: Promote gender equality and empower if rates of progress are not satisfactory. women. Goal 4: Reduce child mortality. • Identify knowledge gaps that are hindering progress. Goal 5: Improve maternal health. • Propose new actions to achieve the health-related Goal 6: Combat HIV/AIDS, malaria and other Millennium Development Goals, in particular diseases. Millennium Development Goals 4 and 5. Goal 7: Ensure environmental sustainability. Goal 8: Develop a global partnership for The Countdown has planned a series of conferences to development. be held every two to three years until 2015. Focusing attention on national coverage levels for high-impact Box 1.1. The Millennium Development Goals interventions in countries with the highest burden of

TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT viii maternal and child mortality rates, the Countdown Millennium Development Goal 5 to achieve universal 2. Build on existing goals and monitoring efforts combines existing data with those collected specifically conferences will catalyse greater action and increase access to reproductive health is an indication of The Countdown aims to sharpen and reinforce efforts for the Countdown. The primary purpose of this report accountability for country and partner commitment its importance to maternal and newborn survival. already under way to support countries in meeting is to bring available data on the priority countries to the Millennium Development Goals – in particular, Contraceptive prevalence and unmet need are tracked their commitments to global goals, and to further the together in one place to facilitate evidence-based 10 to rapid reductions in maternal and child mortality. in the present Countdown cycle, and in the next cycle effective use of information collected through existing review and planning efforts designed to accelerate In addition, Countdown publications report on major of technical work the Core Group will thoroughly monitoring mechanisms. Countdown indicators and country-level actions in maternal, newborn and child determinants of coverage, including policies, health review this area. The 2008 report is complimented by measurement approaches build on efforts started in health. system performance measures and financial flows to a corresponding Lancet special series on the major the 1990s to monitor progress towards the World maternal, newborn and child health. findings of the Countdown. Summit for Children goals, which evolved into 3. Promote effective interventions monitoring strategies for the Millennium Development The Countdown monitors coverage for interventions The first international Countdown conference, focusing Goals.15 and approaches feasible for universal implementation on child survival, was hosted in London in December Countdown Principles in poor countries and with proven effectiveness in 11 2005 by 12 organisations. Coverage reports were Emphasis on measuring progress towards international improving maternal and child survival and nutrition. available for 60 countries, accounting for 94 per cent goals and targets has rapidly increased the availability (The next chapter describes how the Countdown 12 of child deaths worldwide. More information on of intervention coverage data. Today’s maternal and selects these interventions and approaches and the conference can be found online (http://www. The activities of the Countdown are guided by child survival indicators reflect a united effort to define explains the coverage indicators used.) countdown2015mnch.org/). four principles: and measure indicators consistently, permitting the assessment of trends over time. In some cases, 4. Maintain a country orientation Success for the Countdown, however, will be 1. Focus on coverage however – notably the definition and measurement The Countdown aims to help countries and their measured by country-level results. In 2006 Senegal 2. Build on existing goals and monitoring efforts of indicators for oral rehydration therapy to prevent development partners achieve the Millennium was the first country to hold a national Countdown 3. Promote effective interventions diarrhoea dehydration16 – changing public health Development Goals and the World Fit for Children conference, bringing together government leaders, 4. Maintain a country orientation recommendations made changes in definition and goals and targets.17 While the Countdown will not and private and public partners and the research measurement unavoidable. should not supplant governments and their partners in community to review progress in child survival. their roles as policy makers and service providers, its The second international Countdown conference is Box 1.2. The Countdown principles Tracking through the Countdown complements role extends beyond monitoring – making public health scheduled for 17–19 April 2008 in Cape Town, South and promotes country-level monitoring of maternal, science a basis for public health action. By bringing Africa. Covering maternal, newborn and child survival, Countdown principles newborn and child health programmes. Country-level together diverse individuals with complementary it will be held in tandem with an Inter-Parliamentary monitoring focuses on ensuring that policies, plans experience, Countdown participants hope to spark Union meeting, providing government leaders with 1. Focus on coverage and resources are in place and that programmes and and support new insights and concrete directions opportunities for greater involvement in efforts to save Timely data on intervention coverage are essential for strategies are implemented fully and adequately; key for improving the health and survival of women and women’s and children’s lives. good programme management. Governments and outcomes for assessing programme implementation their partners need up-to-date information on whether children. So far the Countdown has not taken strong include access, quality, coverage and equity. Methods follow-up action in countries, but is a central element Participants in the 2005 international Countdown their programmes are reaching targeted groups. and indicators for monitoring purposes must provide of the work scheduled to begin immediately after the conference had already recognized the importance Such coverage information must be supplemented, timely information and must reflect country-level April Conference. of working within a broader continuum of care – one of course, with measures of intervention quality and needs and decisions. The Countdown aims to build on that “promotes care for mothers and children from effectiveness. country-level data, attracting attention and resources pre-pregnancy to delivery, the immediate postnatal for addressing service delivery barriers and to further period, and early childhood, recognising that safe For interventions proven to reduce mortality, coverage speed up progress towards the health-related childbirth is critical to the health of both the woman is a useful indicator of progress. Increases in coverage Millennium Development Goals. and the newborn child.”13 Such a continuum should show that policies and delivery strategies are reaching also link service provision across various settings, from women and children. Failures to increase coverage The Countdown complements country-level monitoring households to community-based care to primary care – assuming that resources have been adequate and efforts by focusing on indicators that are closer to services to hospitals. The Countdown has explicitly that planning has been good – are a cause for urgent impact and that can be measured in ways that permit adopted a continuum of care approach. In this report concern. District, regional and national managers and cross-country comparisons and the estimation of global it tracks coverage across the continuum for the first their partners should address low coverage rates trends. Coverage indicators meet these criteria, as do time. by examining how interventions are delivered and many indicators of the impact of programme activities removing bottlenecks or revising service delivery plans. on the nutrition and health status of women, newborns The Countdown has always made nutrition central to and children. Efforts to identify and define indicators its efforts. Improving coverage for proven maternal This report, which provides the best and most recent of policies, financial flows and human resources that and child nutrition interventions will contribute to information on country-level progress in achieving are sufficiently valid and reliable for global monitoring Millennium Development Goal 1.14 At this time, intervention coverage, is a central part of the began in 2005 and are continuing. however, only child nutritional status and nutrition Countdown effort. It offers a basis for documenting interventions are tracked through the Countdown. accomplishments and revitalising efforts where The coverage information presented by the Countdown © UNICEF/HQ02-0571/Giacomo Pirozzi needed. in this report required no new data collection. But the The Countdown also recognises the importance of information on policies, health systems and financial reproductive health services. The target added to flows – here and in future Countdown reports –

TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT Links to other monitoring efforts present this report recognising its limitations, and action can be improved. Comments, critiques and Notes accept the need to expand the range of interventions suggestions can be proposed through communication As part of a much larger effort to track progress 1 Black, Morris and Bryce 2003; Jones, Steketee, Black and others that can be tracked effectively in each Countdown with any of the many Countdown co-sponsors, or sent 2003; Bryce, Arifeen, Pariyo, and others 2003; Victora, Wagstaff, towards the Millennium Development Goals, the cycle while preserving the quality of the effort, directly to www.countdown2015mnch.org. Armstrong-Schellenberg and others 2003; The Bellagio Study Group Countdown aims to complement the work of others on Child Survival 2003. especially as new evidence about the impact of – not replace it. Annex A lists resources and initiatives 2 interventions becomes available Lawn, Cousens and Zupan 2005; Darmstadt, Bhutto, Cousens related to Millennium Development Goal monitoring and others 2005; Knippenberg, Lawn, Darmstadt and others 2005; Martines, Paul, Bhutta and others 2005. for mothers, newborns and children at the international level. Box 1.3 highlights the Countdown’s added value Overview of this report 3 Ronsmans and Graham 2006; Campbell and Graham 2006. compared with other international monitoring efforts. This report is intended to help policy makers and 4 Grantham-McGregor, Cheung, Cueto and others 2007; Walker, Wachs, Gardner and others 2007; Engle, Black, Behrman and others their partners assess progress and prioritise actions 2007. to reduce maternal, newborn and child mortality. 5 Glasier, Gülmezoglu, Schmid and others 2006; Wellings, Collumbien, How the Countdown Adds Value Almost all the data presented here can be found Slaymaker and others 2006; Cleland, Bernstein, Ezeh and others 2006; elsewhere. The Countdown adds value by collecting Cleland, Bernstein, Ezeh and others 2006; Grimes, Benson, Singh and others 2006; Low, Broutet, Adu-Sarkodie and others 2006. in one place the basic information needed to decide whether maternal and child mortality reductions can 6 Black, Allen, Bhutta and others 2008; Victora, Adair, Fall and others • By maintaining a country focus. Individual country profiles 2008; Bhutta, Ahmed, Black and others 2008; Bryce, Coitinho, offer selected information about demographic and be expected in countries with the highest rates or Darnton-Hill and others 2008; Morris, Cogill and Uauy 2008. epidemiological contexts and key coverage determinants. numbers of such deaths. It adds further value by 7 Haines and Victora 2004; Gwatkin, Bhuiya and Victora 2004; Palmer, • By tracking progress in 68 priority countries. Sharing the creating a context – the Countdown conferences – that Mueller, Gilson and others 2004; Hongoro and McPake 2004; Victora, highest burden of maternal and child mortality, these can make policy makers, development agencies and Hanson, Bryce and others 2004; Lavis, Posada, Haines and others countries represented more than 97 per cent of all such 2004. deaths (deaths in children under 5 in 2006, and maternal donors more likely to notice challenges to progress and 8 Starrs 2007; Kerber, de Graft-Johnson, Bhutta and others 2007; deaths in 2005). to respond to them with sound decisions. Freedman, Graham, Brazier and others 2007. • By maintaining continuity through 2015. The Countdown 9 will continue reporting on progress through 2015, the target Bryce, Arifeen, Pariyo and others 2003, p. 1068. Chapter 2 explains how and why the Countdown date for achieving the Millennium Development Goals. 10 Bryce, Terreri, Victora and others 2006. A supra-institutional effort, the Countdown brings together priority countries were selected, and summarises • 11 representatives from United Nations agencies, civil the selection of Countdown indicators and the data The hosting organisations were the London School of Hygiene & Tropical Medicine, the Bellagio Child Survival Group, UNICEF, World society, governments, and the donor and development sources and methods used to track progress. Health Organization, Lancet, Save the Children, United States Agency communities. for International Development (USAID), USAID’s Basic Support for • By promoting country-level action. The Countdown Institutionalizing Child Survival (BASICS), the UK’s Department for presents information needed to assess progress and to Chapter 3 summarises the findings of the 2008 International Development (DFID), the World Bank, the International speed up country-level actions in pursuit of Millennium Paediatric Association and the Partnership for Maternal, Newborn and Report. Specific note is taken of countries with Child Health. Development Goals 4 and 5, together with parts of demonstrated progress in raising coverage levels, Millennium Development Goals 1, 6 and 7. 12 and areas where intensified effort is needed within Bryce, Terreri, Victora and others 2006. and across the priority countries. This preliminary 13 Tinker, ten Hoope-Bender, Azfar and others 2005, p. 823. Box 1.3. How the Countdown adds value compared with other discussion provides a starting point for more in-depth 14 Millennium Development Goal Monitoring efforts World Bank 2006. review, discussion and action planning that will take 15 The World Summit for Children goals can be found at UNICEF’s place at the Countdown conference scheduled for website (http://www.unicef.org/wsc/). Committed to by heads of state

and government in 2002, they cover vital areas of children’s well- April 2008 in Cape Town, South Africa and subsequent © UNICEF/HQ07-1506/Anita Khemka Country-level program monitoring being and development and serve as stepping stones towards the regional- and country-level Countdown conferences. Millennium Development Goals (UNICEF 2007b). Country-level programme monitoring is the most 16 Victora, Bryce, Fontaine and others 2000. important part of monitoring progress towards the Chapter 4 introduces the individual country profiles. 17 Millennium Development Goals. The Countdown seeks The World Fit for Children goals and targets can be found at UNICEF’s These profiles represent the basic information to be website (http://www.unicef.org/specialsession/wffc/). to enhance such monitoring whenever possible. Yet analysed at Countdown conferences, and evidence for countries bear the main responsibility for interpreting assessing progress since the first Countdown Report in the Countdown results and using them to improve 2005. Each profile presents the most recent available programming. (Quality monitoring and service provision information on selected demographic measures of monitoring are the responsibility of governments and maternal, newborn and child survival and nutritional their partners and are not addressed here.) status, coverage rates for priority interventions, and selected indicators of equity, policy support, human The Countdown as an evolving effort resources and financial flows. .The Countdown is a process, and will continue to expand and improve over time to address additional Because the Countdown is an ongoing process that elements of the continuum of care. For example, represents an informal affiliation of individuals and although family planning is included as an essential agencies committed to accelerating progress toward intervention in the 2008 report, special health risks, the health MDGs, we encourage readers to engage vulnerabilities and barriers to access for adolescents with this material critically and to make suggestions are not addressed explicitly, nor is the full range of about how its utility in promoting and guiding potential interventions to address undernutrition. We

TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT Tracking indicators and methods

This chapter begins with an overview of how the Phase 1: Selecting priority2 countries based on priority Countdown countries were selected. In the deaths among children under age five second section we introduce the interventions and In 2005 the Countdown did not yet address maternal approaches within the continuum of care for maternal, survival. It therefore drew its priority countries from newborn and child health that are tracked through the two lists of all developing countries. The first list Countdown and the coverage indicators associated rank-ordered countries by the total number of child with each. The third section discusses determinants deaths in 2004, the most recent year for which data of coverage at the country level, such as policies, were available.1 All countries with at least 50,000 child health system strength and financial flows, followed deaths were selected from this list for inclusion in the by a description of how equity is tracked through the Countdown. The second list rank-ordered countries by Countdown. In the final section of the chapter we under-five mortality rate. Any country that had a rate describe the data sources and methods used for the of at least 90 under-five deaths per 1,000 live births Countdown tracking effort. – and that had not already been selected from the first list – was selected from the second list for inclusion Selecting the Countdown priority countries in the Countdown. The addition of the second list ensured that countries with small populations but high The Countdown tracks coverage for the 68 countries mortality rates, most of them in sub-Saharan Africa, with the highest burden of maternal and child mortality, were included. shown in figure 2.1. Country selection took place in two phases – the first in 2004, when the Countdown Core Group defined countries with the highest Together, the 60 Countdown priority countries selected numbers or rates of under-five mortality, and the in 2005 represented almost 500 million children under second in 2007, when the list was expanded to include age five – over 75 per cent of all such children then those with the highest numbers of maternal deaths living. They also represented 94 per cent of all deaths or maternal mortality ratios. Each phase is described among children under age five in 2004.2 below. Phase 2: Expanding the priority countries based on maternal deaths The 68 Countdown Priority Countries For this report the Countdown expanded to include maternal deaths. We relied on procedures like those used for the first Countdown report to determine whether additional priority countries should be included. We again developed two lists of all developing countries. The first list rank-ordered countries by the maternal mortality ratio estimates from the year 2005, the most recent year for which this information was available.3 All countries with a maternal mortality ratio greater than 550 were retained at this stage. The second list rank-ordered countries Source: Authors’ compilation based on information supplied in text by the total number of maternal deaths in 2005. Using Figure 2.1. The 60 priority countries in 2005 (red). The 8 priority both lists, we selected for inclusion in the Countdown countries added in 2008 (yellow): Bolivia, Eritrea, Guatemala, – if they had not already been included for having a Democratic People’s Republic of Korea, Lao People’s high burden of under-five mortality – all countries with Democratic Republic, Lesotho, Morocco, Peru. a maternal mortality ratio greater than 550 and all

countries with both a maternal morality ratio greater TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT © UNICEF/HQ06-2693/ SHEHZAD NOORANI TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT than 200 and at least 750 maternal deaths in 2005. intermediate determinants of health outcomes include Priority interventions and coverage indicators The Countdown does not aim to be comprehensive Countries with high under-five mortality overlapped women’s education and nutritional status, household and does not necessarily include all interventions and Chapter 1 described the principles that guide the significantly with those that had high maternal wealth and cultural factors that affect health seeking approaches meeting the criteria described above. Countdown, including its focus on tracking population mortality. This exercise led to the inclusion of just eight behaviours.4 In addition, the root causes of poor health For example, as explained below, interventions have coverage for effective interventions and approaches additional Countdown priority countries: Bolivia, the include disruptions in a country’s social fabric and been excluded if no appropriate coverage indicator is that are feasible for universal implementation in Democratic Republic of Korea, Eritrea, Guatemala, Lao economic infrastructure. This is evident in conflict and available. In addition, the Countdown strives to limit poor countries. In this section we describe how People’s Democratic Republic, Lesotho, Morocco and post-conflict situations5 and in countries characterised the total number of interventions and indicators to the Countdown interventions and approaches were Peru. by severe governance problems. Finally, natural and keep the effort manageable and focused. chosen, how indicators of coverage were selected for environmental disasters also contribute to the death each and how we arrived at the coverage estimates in toll and strain the capacity of already weak public Table 2.1 shows the proportion of Countdown priority this report. The criteria used to assess potential coverage countries in each region and their share of each health systems.6 Many Countdown priority countries indicators were based on the normative principle that region’s population. Priority countries account for a are affected by these and other important contextual a ‘good’ coverage indicator should provide a valid vast majority of people in sub-Saharan Africa and South factors. For example: Inclusion criteria for interventions and measure of whether the target population for a given Asia, and smaller but still substantial proportions of approaches intervention receives it when it is needed and when those in the East Asia and the Pacific, Latin America • In 32 per cent (17 of 53) of priority The Countdown’s most important criterion for including it is clinically effective. In addition, though, indicators and the Caribbean, and Middle East and North Africa countries with data on adult female literacy, an intervention is the availability of internationally used for the Countdown must produce results that are: regions. the rate is 50 per cent or less.7 accepted (peer-reviewed) evidence demonstrating that • In 93 per cent (62 of 67) of priority countries with it can reduce mortality among mothers, newborns or • Nationally representative. children under age five. The first Countdown, in 2005, The 68 priority countries represent 97 per cent of data on stunting prevalence among children under • Reliable and comparable across countries and time was able to draw on the 2003 and 2005 Lancet series maternal and child deaths worldwide and in developing five years of age, the rate is at least 20 per cent.8 • Clear and easily interpreted by policy on child and neonatal survival, respectively, which countries. Therefore, the Countdown’s findings are • In 23 per cent (15 of 64) of priority countries with makers and program managers. indicative of global progress towards the Millennium used systematic literature reviews to identify such data on HIV prevalence among adults age 15–49, interventions.14 • Available regularly in most of the Development Goals – although countries with small the rate is estimated at 5 per cent or greater. 9 Countdown priority countries. populations may be underrepresented, and care • In 98 per cent (49 of 50) of priority countries with As the Countdown expanded to include maternal must be taken when generalizing the results to those None of the 68 priority countries has a health data on the World Bank’s international poverty survival, and in light of new thinking about the settings. information system that can now produce coverage indicators, there are populations living on less continuum of care,15 the Core Group recognized that 10 estimates meeting the standards described above for than $1 USD per day (range 3 to 85 per cent). the focus on single interventions was too narrow. Numerous factors not directly related to health all indicators.11 Fortunately, most of the Countdown • In 2006, 68 per cent of all Countdown priority Coverage with broader approaches such as antenatal service coverage can have an important impact on coverage indicators used in 2005 have since been countries (46 of 68) were low-income countries and postnatal care, delivery care and reproductive health outcomes. Though beyond the scope of the included in the protocols for the major population- – defined as countries with less than $905 of health services – as basic platforms for delivering Countdown, such factors should be kept in mind based surveys used in the 68 priority countries 11 multiple interventions proven to reduce maternal when using the findings. For example, important gross national income per capita per year. – usually either the UNICEF-supported Multiple and newborn mortality – also needed to be tracked. • Between 2002 and 2006, 35 per cent of all Indicator Cluster Surveys16 or the Demographic Beginning with this report, the Countdown will track Countdown priority countries (24 of 68) were and Health Surveys supported by the United States both interventions and approaches, provided that at Countdown Countries Compared by Region affected by violent, high-intensity conflict.12 Agency for International Development.17 Exceptions least one effective intervention is supported by each • Between 2000 and 2007, 88 per cent of all include interventions for which data collection and the approach. Countdown priority countries (60 of 68) were analysis of coverage indicators are not yet routine or Countdown priority countries (n=68) struck by a natural disaster killing at least 100 harmonised, such as unmet need for family planning For this report a Countdown Working Group on Compared with number of people or affecting more than 10,000 people.13 or a postnatal visit for the newborn within two days of countries in region Percentage Indicators and Coverage Data was convened Region of region’s birth. In addition, coverage estimates for vaccinations, Number of Number of population and charged with reviewing new evidence on vitamin A supplementation and the prevention of Countdown countries (2006) interventions included in the 2005 Countdown, as countries in region mother-to-child transmission of HIV/AIDS reflect the Achieving the health-related Millennium Development South Asia 5 8 99 well as determining whether additional interventions synthesis of routine program data and data from Goals in the 68 Countdown priority countries will Eastern and Southern Africa 18 22 99 or delivery platforms should be included in 2008. household surveys. Annex B lists the data sources for require extraordinary investments and efforts on many West and Central Africa 22 24 100 A full report of the Working Group’s deliberations all indicators included in the 2008 Countdown cycle. Middle East and North fronts. Given the magnitude of the challenge, a special 6 20 51 and decisions is at the Countdown website (www. Africa effort is needed to enlist parliamentary champions and countdown2015mnch.org). East Asia and Pacific 8 29 88 harness national commitments at the highest levels The 2008 Countdown coverage indicators Latin America and 6 33 63 of government. Achieving the goals for mothers, The Countdown builds on the work of others. Coverage Caribbean Among proven interventions, the Countdown newborns and children is a shared responsibility of estimates and trends for HIV-related interventions, Central and Eastern Europe includes only those judged feasible for delivery with national governments and their United Nations and and the Commonwealth of 3 21 5 universal coverage in low-income countries. Because immunisation, vitamin A supplementation and water Independent States non-governmental partners at both international and intervention costs and delivery strategies can change, and sanitation reflect the work of various interagency Industrialized countries 0 39 0 national levels, together with academic and research this criterion must be reassessed in each Countdown working groups described more fully below. For other Source: UNICEF 2007c institutions, religious and community groups and cycle. indicators the Countdown reports available estimates Table 2.1. Countdown priority countries compared with the dedicated individuals. but recognizes the need for improvement in data number of countries in each region and as a percentage of each availability and estimation methods. (Annex C defines region’s population, 2006, by region the Countdown 2008 coverage indicators.)

TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT Through its efforts the Countdown has acquired a clear and child health, including reproductive health. Results Data sources and methods view of the limitations of available coverage indicators, Health Policies and Health Systems Indicators on a greater number of countries are expected in the The Countdown aims to bring together data on the data that support them and the process through next Countdown cycle. coverage for interventions and approaches with proven which country-specific estimates are updated. A part of effectiveness in reducing maternal, newborn and child the Countdown work plan is addressing these issues. Countries with adopted national policies indicating: Tracking improvements in equity survival, making this information readily accessible • International Code of Marketing of Breastmilk Substitutes Efforts to monitor coverage for interventions proven and spurring donors and policy makers to action. The Coverage indicators are summarized only for countries adopted. to reduce maternal and child mortality are incomplete Countdown does not normally collect new coverage to which they are relevant. For example, only 45 • International Labour Organization Convention 183 on without measures of equity, defined here as the data. This section describes the sources of Countdown of the 68 countries have endemic malaria, defined Maternity Protection ratified. extent to which mothers and children in different data (listed for each indicator in annex B) and the here as documented risk of Plasmodium falciparum • Notification of maternal deaths. socioeconomic or ethnic groups or children of different quality control mechanisms that are already in place transmission nationwide and throughout the year.18 • Midwives authorized to administer a core set of life-saving sexes are equally likely to receive services. Each to assess and ensure their validity. Any secondary The country profiles estimate coverage for countries interventions. 2005 Countdown country profile included a graph analysis carried out solely for the Countdown’s use is with limited geographic areas of malaria risk, but such • Integrated management of childhood illness guidelines showing the proportion of children under age five in described in detail. The section follows the order in countries are not included in the results summarized adapted to cover newborns 0–1 week of age. two population quintiles – the poorest and the least which indicators are presented on the country profiles in this chapter. All Countdown priority countries • Low osmolarity oral rehydration salts and zinc supplements poor – who were receiving six or more preventive child available in chapter 4. are considered to need antiretroviral treatment for for the management of diarrhoea. survival interventions.22 pregnant women with HIV/AIDS to prevent mother-to- • Community management of pneumonia with antibiotics. child transmission.19 • Costed implementation plan or plans for maternal, Child and maternal mortality newborn and child health available. In the 2008 Countdown cycle we focus on Country-specific estimates of mortality in children socioeconomic inequities across a broader set of under age five were abstracted from tables in The Indicators for factors that contribute to National indicators of health system preparedness to interventions. Because curative services are needed State of the World’s Children 2008.23 The methods coverage improve maternal, newborn and child health only by particular subpopulations in response to and limitations associated with these estimates are The Countdown Core Group identified two particular health events, we developed a new measure available elsewhere.24 Country-specific cause-of- • Per capita total expenditure on health (at international US prerequisites for success in attaining high, sustained dollar rate). reflecting the gap between universal coverage for an death profiles were abstracted from World Health intervention (100 per cent of the population in need) 25 and equitable levels of coverage for interventions and • Government expenditure on health as a percentage of Organization statistical databases, based on work by approaches proven to improve maternal and child total government expenditure. and current coverage for each country. This ‘coverage the Child Health Epidemiology Reference Group.26 survival: a supportive policy environment with adequate • Out-of-pocket expenditure as a percentage of total gap’ measure includes eight interventions grouped into health systems support (including human resources) expenditure on health. four areas: Progress towards Millennium Development Goal 4 and predictable, longer term financial support. For the • Density of physicians, nurses and midwives per 1,000 was assessed by determining whether the average people. 2008 Countdown, technical groups were convened 1. Family planning (need met or modern contraceptive annual rate of reduction in mortality in children under in each area and charged with reviewing the 2005 • Availability of emergency obstetric care services as a percentage of recommended minimum. use). age five from 1990–2006 matched or exceeded the Countdown experience and improving on the tracking rate needed from 2007–2015 if the goal is to be met. procedures. Box 2.1. Health policies and health systems indicators 2. Maternal and newborn care (antenatal care and If a country’s mortality rate in children under age five tracked in the 2008 Countdown skilled birth attendance). is less than 40 per 1,000 live births, or greater than or The Working Group on health policies and health equal to 40 with an average annual reduction rate of systems searched for relevant indicators, prioritising The Countdown has worked to develop methods for 3. Immunisation (measles vaccine, Bacille Calmette- at least 4 per cent for 1990–2006, it is considered on those with international benchmarks for health tracking domestic and external financial investments Guerin vaccine against tuberculosis and third dose track’. If the country’s mortality rate in children under systems strengthening and with data either available in child health. Efforts through the 2005 Countdown of diphtheria and tetanus with pertussis vaccine). age five is greater than or equal to 40 and the average in the public domain or objectively assessable within to track official development assistance indicated that annual reduction rate for 1990–2006 was between 1.0 the timeframe of the 2008 Countdown cycle. Box 2.1 per cent and 3.9 per cent, the country is considered to overall funding for child survival in the priority countries 4. Treatment of child illness (medical care sought shows the list of indicators finally selected through be making ‘insufficient progress’. If the mortality rate was insufficient and not well targeted to countries with for acute respiratory infection and oral rehydration a consultative process involving the Countdown 20 in children under age five is greater than or equal to 40 the greatest needs. The present Countdown cycle’s therapy with continued feeding for diarrhoea). Core Group, health systems experts and experts in official development assistance tracking effort has and the average annual reduction rate for 1990–2006 maternal, newborn and child health. expanded to include support for maternal and newborn was less than 1.0 per cent, the country is considered Larger coverage gaps indicate poorer coverage for activities in the priority countries. The country profiles to be making ‘no progress’. these interventions; smaller coverage gaps indicate Each technical or intersectoral policy identified as include estimates of official development assistance better coverage. Thus, while the coverage gap across critical to maternal, newborn and child health was to child health per child and official development Country-specific maternal mortality ratios per 100,000 wealth quintiles represents coverage inequities coded as being either fully adopted at country level assistance to maternal and neonatal health per live live births reflect 2005 data,27 drawing on estimates within a country, it can also be compared with other (‘Yes’), partially adopted (‘Partial’) or not adopted (‘No’; birth. developed by the Maternal Mortality Working Group. countries’ coverage gaps to suggest intracountry see annex table D1). The inclusion of a policy or plan Because large uncertainty margins surround these coverage inequities. (Annex E offers further details does not necessarily reflect the extent or quality of estimates, progress towards Millennium Development Work on tracking domestic investments in maternal, about the construction of the coverage gap measure implementation, but can often be a prerequisite for Goal 5 – improving maternal health – was assessed newborn and child health has also progressed. The and guidance on its interpretation.) effective programme action. (Annexes B and D present most promising method identified by the Working using four broad categories for maternal mortality: low further information on data sources, definitions and Group was to build on the National Health Accounts (maternal mortality ratio of less than 100), moderate coding criteria for each indicator.) approach21 and develop specific procedures for a sub (maternal mortality ratio of 100–299), high (maternal analysis of resources directed to maternal, newborn mortality ratio of 300–549) and very high (maternal mortality ratio of 550 or greater).28

TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT 10 11 Nutritional status needs urgent attention is the development of standard The Countdown country profiles include nutritional procedures for estimating uncertainty. The 2008 report Quality Review and Improvement Mechanisms status indicators (such as underweight prevalence, presents point estimates and makes no attempt to stunting prevalence, wasting prevalence and incidence estimate precision or provide uncertainty ranges. of low birthweight) as an important reference point for Review Group Coverage or mortality indicators Membership interpreting coverage. Country-specific estimates for Data summary and analysis. The Countdown focuses Interagency Child Mortality Estimation Group None at present International organizations (Develop joint estimates for under-five, infant and (UNICEF, WHO, The World Bank, UN Population 29 nutritional status indicators were adjusted to reflect on accelerating coverage improvements at the country neonatal mortality) Division) new World Health Organization growth standards.30 level. Therefore, in summarizing the results this report Academia and institutions (Harvard and others) uses the country as its unit of analysis, consistent with An exception is estimates of low birthweight, which Malaria Monitoring and Evaluation Reference Use of insecticide-treated nets by children under International organizations are not dependent on the growth standards and have the need for in-depth country-by-country analysis and Group (MERG) five (UNICEF, MACEPA, WHO, USAID, The World action. The most appropriate summary measures for Treatment of fever among children under five Bank, The Global Fund) been adjusted here for high underreporting (especially Intermittent preventative treatment for prgnant Academia and institutions in sub-Saharan Africa).31 this purpose are the median, which gives each of the women (malaria; IPTp) (Macro International, CDC, LSHTM, 68 countries an equal weight, and the range, which others) illustrates the extent of the variation among countries. Joint Monitoring Program (JMP) for Water Use of improved drinking water sources International organizations Coverage Supply and Sanitation and Technical Advisory Use of improved sanitation facilities (UNICEF, WHO, The World Bank, USAID) Group Academia and institutions Data sources and quality. Household surveys are the (LSHTM, Macro International and others) All Countdown Core Group members were invited HIV/AIDS Monitoring and Evaluation HIV+ pregnant women receiving ARVs for PMTCT International organizations primary data source for tracking progress in coverage to participate in a consultative process to agree on Reference Group (MERG) (UNAIDS, UNICEF, WHO, UNFPA and others) for maternal, newborn and child survival. The main Academia and institutions the most important aspects of the country-specific (various) sources of coverage data for the Countdown are findings and their implications for achieving Millennium WHO UNICEF Joint Working Group on Measles vaccination International organizations UNICEF’s global databases and the coverage estimates Development Goals 4 and 5. Meetings were held Immunizations DPT vaccination (UNICEF, WHO) Hib vaccination in its annual The State of the World’s Children reports. in Addis Ababa (2 December 2007), Geneva (10 The two most important sources of household survey Child Health Epidemiology Reference Group None at present International organizations December 2007) and New York (12 January 2008). (CHERG) (Conduct systematic reviews on cause-specific (UNICEF, WHO, UNFPA, CDC, Save the Children data are the Multiple Indicator Cluster Surveys (MICS) mortality, morbidity and risk factors, including US and others) At each meeting participants examined preliminary nutrition) Academia and institutions and the Demographic and Health Surveys (DHS). The results and agreed on the most important findings (Johns Hopkins, LSHTM, others) latest protocols for these two surveys permit collecting and their implications for continued implementation Interagency group for maternal mortality None at present International organizations harmonised information on most of the Countdown estimation and trend analysis (Develop joint maternal mortality estimates and new (UNICEF, WHO, UNFPA, World Bank, UN efforts. These findings were then shared with the methodology for trend analysis; Prepare regional Population Division) coverage indicators. broader Countdown Core Group through a draft workshops to explain methodology and promote Academia and institutions data analysis and use) (Harvard and others) report, resulting in extensive further discussion and The remaining coverage estimates come from agreement on the conclusions presented here. several sources. The latest available coverage data Source: Author’s compilation based on data as described in the report and methods of estimating coverage for antiretroviral In 2005, summaries of performance across the priority Table 2.2. Quality review and improvement mechanisms for country-specific estimates of coverage and mortality treatment to prevent mother-to-child HIV transmission countries for each indicator were categorized in three reflect harmonised estimates developed by the Joint ways – on track’, ‘watch and act’ or ‘high alert’ – based United Nations Programme on HIV/AIDS (UNAIDS), on international targets. For indicators without targets, UNICEF and the World Health Organization. Based on these data points being at least three years apart. We time periods other than 2000–2006, or with data that categorizations across the priority countries were calculated the difference in the coverage estimates differ from the standard definition or refer only to denominators derived from unpublished HIV estimates based on arbitrary thresholds for high, middle and low and divided it by the number of years between the two part of a country, were excluded from the analysis. for 2007 by the Joint United Nations Programme on performance. HIV/AIDS and the World Health Organization, these point estimates. This product was then multiplied by Exceptions to this rule are coverage estimates for harmonised estimates are more recent than those three to produce a three-year estimate, resulting in a vitamin A supplementation, which refer only to In 2008 the challenge was to compare progress over continuous variable across the 68 countries. published in UNICEF’s The State of the World’s 2005 data, and coverage estimates for measles time as well as across countries. Countries were first Children 2008. Data on Caesarean section prevalence immunisation, neonatal tetanus protection, the grouped into the 2005 categories for each indicator. are drawn from the Demographic and Health Surveys. Coverage patterns for the interventions and third dose of diphtheria and tetanus with pertussis But since the number of countries had increased from approaches presented in the country profiles were also vaccine (DPT3) and the third dose of haemophilus 60 in 2005 to 68 in 2008 – resulting in a lack of data for analyzed for the continuum of care. This was done by Many groups share responsibility for the quality one of the two years in some countries – summaries influenzae type B vaccine (Hib3), which refer only to control of the coverage estimates for interventions counting the number of countries that had coverage like those presented in 2005 proved difficult to levels for four of the component indicators of at least 2006 data. and approaches effective in reducing maternal, produce, and an alternative approach to summary newborn, and child mortality. Table 2.2 summarizes 10 per cent, at least 20 per cent, at least 30 per cent analysis was devised. Policies, health systems and financial flows quality review and improvement mechanisms for and so on. the maternal, newborn and child health coverage Information on country-specific policies related to For the 2008 Countdown, then, progress is measured indicators, together with selected mortality measures. The Countdown countries that were included in the maternal, newborn and child health was obtained from by the average annual percentage point change in summary estimates for each coverage indicator met staff of the UNICEF and World Health Organization coverage for each indicator, standardized to a three- the following criteria, consistent with those used in offices in the 68 priority countries in November 2007. A number of methodological challenges in coverage year reference period to conform to the Countdown measurement have been known for some time. The global reporting: These reports were then reviewed and confirmed reporting cycle. Using the databases containing the • Only data from countries with available coverage with technical staff in the relevant programme area Countdown throws these challenges into relief. They trend information presented in the 2008 country estimates for 2000–2006 were used. at UNICEF’s New York headquarters and the World will be prioritized as part of the Countdown technical profiles, we identified the subset of countries that work plan in the next reporting cycle. One area that • Countries with summary measures from years or Health Organization headquarters in Geneva. The had two data points for each indicator since 1998 with information on emergency obstetric care was derived

TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT 12 13 from a joint Averting Maternal Death and Disability– Equity Notes UNICEF database. Averting Maternal Death and The 2008 Countdown country profiles present the 1 UNICEF 2005. Disability and UNICEF headquarters staff reviewed coverage gap by wealth quintiles, drawing on Multiple 2 initial country assessments and consulted country UNICEF 2004. Indicator Cluster Surveys and Demographic and Health staff, United Nations Population Fund colleagues and 3 WHO, UNICEF, UNFPA and World Bank 2007; UNICEF 2007c; Hill, Surveys conducted since 1990. In particular, the other experts to determine the reliability of the data. Thomas, AbouZahr and others 2007. profiles show: 4 Glewwe, 1999; Schell, Reilly, Rosling and others 2007. • The absolute size of the coverage gap (the The Countdown Working Group on Financial Flows 5 Pedersen 2002; Al Gasseer, Dresden, Keeney and others 2004. difference between universal coverage analysed and coded the complete aid activities 6 for these eight interventions and actual Noji 2000. database for 2005, using the methodology for the 7 UNICEF 2006b. 2005 Countdown cycle.32 The analysis included all 22 coverage as measured in each survey). donor countries and the European Union, represented • The ratio between the gap in the poorest and the 8 UNICEF 2007c. in the Development Assistance Committee of least poor (‘best-off’) quintile of the population. 9 UNICEF 2007a; UNAIDS and WHO 2007; UNAIDS 2007. • The absolute difference between the two quintiles. the Organisation for Economic Co-operation and 10 UNICEF 2007c. Development. The World Bank, UNICEF, the Joint 11 World Bank n.d. United Nations Programme on HIV/AIDS, the Global Larger gaps reflect poorer coverage; smaller gaps Alliance for Vaccines Initiative and the Global Fund to reflect better coverage. 12 Personal communication from Edilberto Loaiza, DPP/SIS UNICEF, 25 January 2008, based on a recent analysis by UNICEF of the Uppsala Fight AIDS, Tuberculosis and Malaria were included conflict database, the Conflict Barometer of the Heidelberg Institute as multilateral development organisations and global The coverage data used to construct the coverage for International Conflict Research, and Project Ploughshares 2007.the Project Ploughshares’ Armed Conflicts Report 2007. health initiatives. Consistent with earlier analyses, gap index for each country, as well as its wealth 13 the United Nations Population Fund was treated as quintiles, are based on national Demographic and Emergency Events Database n.d. a delivery channel and does not appear in the donor Health Surveys34 and Multiple Indicator Cluster 14 Jones, Steketee, Black and others 2003; Darmstadt, Bhutto, Cousens list. Because it is a significant supporter of maternal Surveys. Where multiple surveys were available and others 2005. and reproductive health efforts, this approach will be for a Countdown country, all data were used to 15 Tinker, ten Hoope-Bender, Azfar and others 2005; Kerber, de Graft- Johnson, Bhutta and others 2007. reviewed in future work. assess current levels and trends in the coverage gap measure by wealth quintile. Data on coverage for 16 UNICEF n.d. For all but one of the donors the analysis used data key interventions by wealth quintile were available 17 Measure DHS, MACRO International, Inc. n.d. from the Creditor Reporting System database, which from surveys conducted since 1990 for 53 of the 68 18 WHO 2007a. is maintained and administered by the Organisation Countdown priority countries. Forty countries had more 19 33 UNICEF 2007c; UNICEF 2007a; UNAIDS and WHO 2007; UNAIDS for Economic Co-Operation and Development. The than one survey, 22 more than two surveys. 2007. analysis also includes disbursement data provided 20 Powell-Jackson, Borghi, Mueller and others 2006. by the Global Alliance for Vaccines Initiative. The coverage gap was analyzed by wealth quintiles 21 Disbursements by the Global Fund to fight AIDS, using a standard methodology.35 (Further details about World Bank, WHO and USAID 2003. Tuberculosis and Malaria were already included in the the analysis methods are in annex E.) 22 Bryce, Terreri, Victora and others 2006. Creditor Reporting System database; the Working 23 UNICEF 2007c. Group triangulated the information with the data 24 UNICEF, WHO, World Bank and UNPD 2007. that the Global Fund to Fight AIDS, Tuberculosis and Malaria provided on its website. The Creditor Reporting 25 WHO 2007b. System database shows no reported disbursements 26 Bryce, Boschi-Pinto, Shibuya and others 2005.

for Norway, only commitments. 27 UNICEF 2007b, p. 27.

28 Hill, Thomas, AbouZahr and others 2007. Results are reported for two groups: first, children 29 under five years of age; second, mothers and UNICEF 2007c, pp. 118–21. newborns. Both categories include financial flows for 30 WHO 2006a. nutrition, so far as these could be identified – although 31 Blanc and Wardlaw 2005. nutrition is not defined as a separate category. 32 Powell-Jackson, Borshi, Mueller and others 2006.

33 IDS n.d.

34 Gwatkin, Rutstein, Johnson and others 2007.

35 Filmer and Pritchett 2001. © UNICEF/HQ04-1220/Ami Vitale

TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT 14 15 The 2008 Countdown findings – and a call to action

The Countdown’s most important findings appear in Table 3.1 shows progress towards3 Millennium the individual country profiles, which answer basic Development Goal 4 – reducing child mortality – in the questions about maternal, newborn and child survival. 68 Countdown priority countries. Most have under- For example: five mortality rates greater than 40. Such countries are considered ‘on track’ if their under-five mortality • What proportion of women, newborns and children rates from 1990–2006 showed an average annual have benefited from life-saving interventions? reduction rate of at least 4.0 per cent, roughly the improvement needed for all developing countries to • Are there coverage gaps? achieve Millennium Development Goal 4. All countries • Are supportive policies in place? with under-five mortality rates of less than 40 are • Are adequate resources directed to considered ‘on track.’ maternal, newborn and child health? • How equitable is existing coverage? For the 2008 Countdown cycle, 16 of 68 countries

(24 per cent) were judged ‘on track,’ compared with Aggregated statistics often mask the answers to 7 of 60 (12 per cent) in 2005. Seven countries which such questions, making it difficult to see where the had been ‘on track’ in reducing child mortality in 2005 problems are and the steps needed to address them. retained that status in 2008 (Bangladesh, Brazil, Egypt, Indonesia, Mexico, Nepal and the Philippines). Among This chapter summarises information from the 68 the remaining nine ‘on track’ countries in 2008, three country profiles in simple ways that can be useful for had been included in the Countdown in 2005 and made planning country programmes and future analyses, and demonstrable progress in reducing child mortality since the text follows the layout of the country profiles. We then (China, Haiti and Turkmenistan). The six remaining begin with a summary of the epidemiological context ‘on track’ countries participated in the Countdown for in the 68 countries, continue by examining coverage the first time in 2008 (Bolivia, Eritrea, Guatemala, Lao levels and equity in coverage, and end with information People’s Democratic Republic, Morocco and Peru). about health system policies and financial flows. Where the data are sufficient we highlight trends, and Twenty-six of the 68 priority countries (38 per cent) especially progress or its absence, since about 2000. were judged to have made insufficient progress in reducing child mortality in 2008, and 26 (38 per cent) Finally, this chapter presents the core group’s no progress at all.3 In twelve countries the average preliminary conclusions capped by a Countdown call to annual rates of reduction in under-five mortality since action 1990 were negative (Botswana, Cameroon, Central African Republic, Chad, Congo, Equatorial Guinea, The bottom line: mortality Kenya, Lesotho, South Africa, Swaziland, Zambia and Zimbabwe), indicating that child mortality has Coverage indicators for effective interventions increased. and approaches are linked to mortality reduction. The correlation between coverage indicators and mortality in children under age five is very strong.1 The correlation is less strong for maternal mortality2 – suggesting that coverage, though a necessary condition for impact, may not be sufficient when care

is substandard. TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT © UNICEF/HQ06-2765/Bruno Brioni TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT 16 17 Mauritania 133 125 44 0.4 11.5 No progress 820 22 Very high Progress Towards Millennium Development Goals 4 and 5 Mexico 53 35 18 2.6 7.6 On track 60 670 Low Morocco 89 37 30 5.5 2.4 On track 240 150 Moderate Mozambique 235 138 78 3.3 6.3 Insufficient 520 45 High Millennium Development Goal 4 Millennium Development Goal 5 (reduce by two-thirds, between 1990 and 2015, (reduce by three-quarters, between 1990 Myanmar 130 104 43 1.4 9.7 Insufficient 380 110 High a the mortality rate in children under age five) and 2015, the maternal mortality ratio) Nepal 142 59 47 5.5 2.5 On track 830 31 Very high Under-five Average annual rate of mortality rate reduction (%) Lifetime Niger 320 253 107 1.5 9.6 Insufficient 1,800 7 Very high Progress Maternal risk Nigeria 230 191 77 1.2 10.1 Insufficient 1,100 18 Very high Millennium towards the mortality of maternal Development Millennium ratio death Level of Pakistan 130 97 43 1.8 9.0 Insufficient 320 74 High Goal target Observed Required Development (2005, (2005) maternal Papua New Guinea 94 73 31 1.6 9.4 Insufficient 470 55 High Country or territory 1990 2006 2015 1990–2006 2007–2015 Goal target adjusted) 1 in: mortality Peru 78 25 26 7.1 –0.4 On track 240 140 Moderate Afghanistan 260 257 87 0.1 12.1 No progress 1,800 8 Very high Philippines 62 32 21 4.1 4.8 On track 230 140 Moderate Angola 260 260 87 0.0 12.2 No progress 1,400 12 Very high Rwanda 176 160 59 0.6 11.1 No progress 1,300 16 Very high Azerbaijan 105 88 35 1.1 10.2 Insufficient 82 670 Low Senegal 149 116 50 1.6 9.4 Insufficient 980 21 Very high Bangladesh 149 69 50 4.8 3.6 On track 570 51 Very high Sierra Leone 290 270 97 0.4 11.4 No progress 2,100 8 Very high Benin 185 148 62 1.4 9.7 Insufficient 840 20 Very high Somalia 203 145 68 2.1 8.5 Insufficient 1,400 12 Very high Bolivia 125 61 42 4.5 4.2 On track 290 89 Moderate South Africa 60 69 20 –0.9 13.8 No progress 400 110 High Botswana 58 124 19 –4.7 20.7 No progress 380 130 High Sudan 120 89 40 1.9 8.9 Insufficient 450 53 High Brazil 57 20 19 6.5 0.6 On track 110 370 Moderate Swaziland 110 164 37 –2.5 16.6 No progress 390 120 High Burkina Faso 206 204 69 0.1 12.1 No progress 700 22 Very high Tajikistan 115 68 38 3.3 6.4 Insufficient 170 160 Moderate Burundi 190 181 63 0.3 11.7 No progress 1,100 16 Very high Tanzania, United Republic of 161 118 54 1.9 8.7 Insufficient 950 24 Very high Cambodia 116 82 39 2.2 8.3 Insufficient 540 48 High Togo 149 108 50 2.0 8.6 Insufficient 510 38 High Cameroon 139 149 46 –0.4 13.0 No progress 1,000 24 Very high Turkmenistan 99 51 33 4.1 4.8 On track 130 290 Moderate Central African Republic 173 175 58 –0.1 12.3 No progress 980 25 Very high Uganda 160 134 53 1.1 10.2 Insufficient 550 25 Very high Chad 201 209 67 –0.2 12.6 No progress 1,500 11 Very high Yemen 139 100 46 2.1 8.6 Insufficient 430 39 High China 45 24 15 3.9 5.2 On track 45 1300 Low Zambia 180 182 60 –0.1 12.3 No progress 830 27 Very high Congo 103 126 34 –1.3 14.5 No progress 740 22 Very high Zimbabwe 76 105 25 –2.0 15.8 No progress 880 43 Very high Congo, Democratic Republic of the 205 205 68 0.0 12.2 No progress 1,100 13 Very high

Côte d’Ivoire 153 127 51 1.2 10.1 Insufficient 810 27 Very high a. Due to the large margins of uncertainty around these estimates, country-level trend analysis is problematic. Progress towards this Millennium Development Goal is therefore assessed based on the latest available estimates and is classified according to the following thresholds: Very high: maternal mortality ratio of 550 or more; High: maternal mortality ratio of 300–549; Moderate: maternal mortality ratio of 100–299; Low: Djibouti 175 130 58 1.9 8.9 Insufficient 650 35 Very high maternal mortality ratio below 100. Source: UNICEF 2007a Egypt 91 35 30 6.0 1.6 On track 130 230 Moderate Table 3.1. Progress towards Millennium Development Goals 4 and 5. Equatorial Guinea 170 206 57 –1.2 14.3 No progress 680 28 Very high Eritrea 147 74 49 4.3 4.6 On track 450 44 High Ethiopia 204 123 68 3.2 6.6 Insufficient 720 27 Very high Neonatal deaths – deaths in the first month of life and a transparent methodology for developing Gabon 92 91 31 0.1 12.1 No progress 520 53 High – account for 40 per cent of deaths in children under estimates, where data on neonatal mortality rates are Gambia 153 113 51 1.9 8.8 Insufficient 690 32 Very high age five, or four million worldwide deaths each year.4 not available, are urgently needed for tracking progress Ghana 120 120 40 0.0 12.2 No progress 560 45 Very high As countries reduce deaths of children under age five, towards Millennium Development Goal 4. Guatemala 82 41 27 4.3 4.5 On track 290 71 Moderate the proportion of children dying in the neonatal period Guinea 235 161 78 2.4 8.0 Insufficient 910 19 Very high typically increases. Reaching Millennium Development Reducing stillbirths also requires more attention and Guinea-Bissau 240 200 80 1.1 10.2 Insufficient 1,100 13 Very high Goal 4 will require specific attention to achieving good depends on improved data collection and monitoring. Haiti 152 80 51 4.0 5.1 On track 670 44 Very high coverage for interventions to reduce neonatal mortality. Up to 3.2 million babies are dying each year during the India 115 76 38 2.6 7.6 Insufficient 450 70 High Latin America and South-East Asia have made last 12 weeks of pregnancy.6 Indonesia 91 34 30 6.2 1.3 On track 420 97 High substantial progress in reducing neonatal mortality rates. Africa has made no measurable progress. In Iraq 53 46 18 0.9 10.6 No progress 300 2 High In addition to under-five mortality rates, table 3.1 South Asia progress has been minimal, though a few Kenya 97 121 32 –1.4 14.7 No progress 560 39 Very high presents the best available estimates of maternal countries such as Bangladesh and Nepal have achieved Korea, Democratic People’s Rep 55 55 18 0.0 12.2 No progress 370 140 High mortality ratios for the 68 Countdown priority countries. substantial reductions.5 Lao People’s Democratic Republic 163 75 54 4.9 3.6 On track 660 33 Very high Country-specific maternal mortality ratios are the basis Lesotho 101 132 34 –1.7 15.2 No progress 960 45 Very high for judging progress towards Millennium Development Annual country-level data or estimates for neonatal Liberia 235 235 78 0.0 12.2 No progress 1,200 12 Very high Goal 5 – improving maternal survival. Because large mortality are an important adjunct to tracking Madagascar 168 115 56 2.4 8.0 Insufficient 510 38 High uncertainty margins surround these estimates, for Millennium Development Goal 4. Although Malawi 221 120 74 3.8 5.4 Insufficient 1,100 18 Very high progress towards Millennium Development Goal 5 Demographic and Health Surveys produce neonatal was assessed using four broad categories for maternal Mali 250 217 83 0.9 10.6 No progress 970 15 Very high mortality rates, Multiple Indicator Cluster Surveys mortality: low (maternal mortality ratio of less than currently do not. Careful assessment of data reliability

TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT 18 19 100), moderate (maternal mortality ratio of 100–299), Nutritional status using the new World Health Organization Child Growth high (maternal mortality ratio of 300–549) and very high Standards.12 In 33 of the 68 priority countries, at Undernutrition is the underlying cause of over one- (maternal mortality ratio of 550 or greater). Of the 68 least 20 per cent of children are either moderately or third of deaths among children under age five. And it priority countries, 56 (82 per cent) have either high or severely underweight. Among the 67 countries with is the underlying cause of one-fifth of maternal deaths very high maternal mortality ratios. Only three have stunting prevalence data, 62 have stunting prevalence in childbirth.7 The aim of Millennium Development low maternal mortality ratios (Azerbaijan, China and of at least 20 per cent and 12 have stunting prevalence Goal 1 – eradicating extreme poverty and hunger Mexico). of more than 50 per cent. A recent analysis showed – is inextricably linked to achieving Millennium that stunting rates could be reduced by at least 36 Development Goals 4 and 5.8 One target for per cent in countries with rates of 20 per cent or In table 3.1, the column for lifetime risk of maternal Millennium Development Goal 1, “to halve, between more by achieving high coverage for interventions death reflects the combined input of risks associated 1990 and 2015, the proportion of people who suffer that are already available and affordable in developing with each birth (the maternal mortality ratio) and from hunger,”9 is now monitored through an indicator countries.13 Results from the 2008 Countdown show the total exposure to risk represented by the total of underweight prevalence among children under that progress in coverage for such interventions number of births (the total fertility rate). Lifetime risk age five. Underweight can reflect either wasting (low remains unacceptably low. of maternal death varies widely across the priority weight-for-height, indicating acute weight loss), or countries, from 1 in 7 (Niger) to 1 in 1,300 (China). much more commonly, stunting (low height-for-age, indicating chronic restriction of a child’s potential Nutritional Status As explained in chapter 2, reproductive health will growth).10 Table 3.3 shows the Countdown priority receive special attention in the next cycle of the countries that are ‘on track’ for the underweight Countdown. target of Millennium Development Goal 1, based on Number of Number of Countdown priority countries with their average annual rate of reduction in underweight countries prevalence among under-fives Comparisons of country-specific progress towards prevalence. < 5% 5–19% 20–30% 31–50% >50% Underweight Millennium Development Goal 4 and Millennium © UNICEF/HQ05-1870/Donna DeCesare moderate or 68 1 34 16 17 0 Development Goal 5 show that the great majority severe Stunting of the priority countries (50 of 68) are judged to be Progress Towards Underweight Targets moderate or 67 5 11 39 12 0 doing poorly in both areas, with either ‘no progress’ severe Wasting or ‘insufficient progress’ towards Millennium moderate or 66 11 51 4 0 0 Development Goal 4 and either ‘high’ or ‘very high’ No progress (n=15) On track (n=16) severe Burkina Faso Afghanistan Source: UNICEF 2007c, adapted based on new World Health Organization growth standards maternal mortality ratios. Burundi Bangladesh Cameroon Bolivia Table 3.4. Nutritional status indicators in the Countdown priority Central African Rep. Botswana countries (n=68) The remaining 18 countries, however, are making good Djibouti Brazil progress towards Millennium Development Goal 4, Lesotho Cambodia Madagascar China Millennium Development Goal 5 or both (table 3.2). Niger Congo Babies who are born at term (after 37 weeks of Sierra Leone Ghana gestation) but with low birthweight (less than 2,500 Somalia Guatemala A closer look at the country profiles for the 10 South Africa Guinea-Bissau grams) are likely to have experienced intrauterine countries making good progress towards both Sudan Indonesia growth restriction, which is rarely a direct cause Millennium Development Goal 4 and Millennium Togo Malawi of neonatal death but is an indirect contributor to Development Goal 5 is encouraging, since several Yemen Mauritania neonatal mortality.14 Monitoring low birthweight is Zimbabwe Mexico are among the priority countries with the largest Peru difficult in developing countries, where fewer than 6

populations. Source: UNICEF 2007b in 10 newborns are weighed at birth. A procedure to Table 3.3. Countdown countries making ‘no progress’ or ‘on adjust for the missing data, and for the bias introduced track’ towards achieving the underweight target of Millennium when mothers report birthweight inaccurately, was Development Goal 1 (2008) developed in 200415 and has since been applied to estimates of low birthweight prevalence.16 Estimates 17 Many countries with a high burden of maternal and are available for 65 of the 68 priority countries. Summary of Progress child undernutrition also show high maternal mortality The median low birthweight prevalence in these 65 rates and high mortality rates in children under age countries is 13, with a range from 2 per cent (China) to five. Of the 36 countries that account for 90 per cent 32 per cent (Yemen). Good progress towards Millennium Good progress towards Millennium Good progress towards Millennium 11 Development Goal 4 and Millennium Development Goal 4 but not Development Goal 5 but not of the world’s estimated 178 million stunted children, Development Goal 5 Millennium Development Goal 5 Millennium Development Goal 34 are among the 68 Countdown priority countries (the Maternal and child nutrition need to be improved more Number of countries 10 6 2 Bolivia, Brazil, China, Egypt, Guatemala, Bangladesh, Eritrea, Haiti, Indonesia, Azerbaijan, Tajikistan exceptions are Viet Nam and Turkey). vigorously and rapidly in most of the 68 Countdown Countries Mexico, Morocco, Peru, the Philippines, Lao People’s Democratic Republic, priority countries. Nutrition during the period from Turkmenistan Nepal pre-pregnancy through 24 months is associated Source: Abstracted from UNICEF 2007b The Countdown country profiles include data on with adult health and productivity.18 And weighing Table 3.2. Summary of progress towards Millennium Development Goals 4 and 5 underweight, wasting, stunting and low birthweight as contextual information important to interpreting newborns, though not a lifesaving measure, should coverage levels for interventions to reduce maternal, be a part of packaged maternal, newborn and child newborn and child mortality. Underweight, wasting health interventions because it yields critical monitoring and stunting estimates (table 3.4) have been adjusted information.

TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT 20 21 Coverage in 2008 mortality estimates in table 3.1 may refer to periods Table 3.5 highlights three points with important deaths each year that could be prevented if all before increases in intervention coverage reflected in programming implications: interventions were universally available. Unprecedented amounts of household survey activity the 2008 Countdown coverage estimates could have in 2005–2006 have yielded new coverage estimates affected mortality. Second, coverage data for some for most of the 68 Countdown priority countries. Figure • Overall coverage levels remain too low. Figure • Median coverage estimates vary widely across countries are from around 2000. Even 2006 coverage 3.1 shows the year in which the most recent Multiple 3.2 shows the distribution of median coverage different interventions. Such variations can survey results might not fully reflect recent global Indicator Cluster Survey19 or Demographic and Health across 18 interventions and approaches tracked reflect the different characteristics of interventions, scaled-up efforts to meet the health-related Millennium Survey20 was conducted for each country. through the Countdown. Of these 18, only the 4 such as how each is delivered, how long it has Development Goals. The next round of Countdown been available, if it is accessible and affordable in reporting is expected to register such recently vaccination interventions are reaching 80 per cent The years for the specific estimates presented in the intensified efforts. of the children who could benefit from them. The developing countries, and the training required to country profiles deserve special attention. First, the empty space in the chart represents millions of deliver it adequately and with effective management Table 3.5 shows the latest available medians and and monitoring. Other reasons for coverage variations include differences between services that Most Recent MICS or DHS Coverage Data ranges across the priority countries for the subset of coverage indicators for which: Coverage Levels can be scheduled in advance (for example, through • Data from at least 19 countries are available. campaigns that reach children of a particular age An exception is antiretroviral prophylaxis to prevent during recommended immunisation periods) and mother-to-child transmission of HIV, which is reported services that must be more regularly available (such separately to maintain consistency with other global Hib3 immunization 85 as delivery, postnatal care, family planning services reports. Postnatal care coverage, for which few or nutritional counselling). The characteristics of Neonatal tetanus countries have data, is also presented separately. protection 81 interventions, and their relationship to achieving high and sustained coverage, are priority areas for the DPT3 immunization 81 Countdown’s continuing technical work. Measles immunization 80

Source: Compiled by UNICEF based on MICS and DHS surveys conducted through to 2006 • Coverage levels for all interventions show large Vitamin A supple- Figure 3.1. Most recent MICS or DHS coverage data available in mentation (2 doses) 78 intercountry differences. The ‘Range’ columns in the 68 Countdown priority countries table 3.5 show wide variations in coverage for each Improved drinking 69 s water intervention across the 68 priority countries. Though e h

c Complementary a full explanation of these gaps is beyond the scope a 62 o feeding (6-9 months) r of this report, it should be a priority research topic p

Medians and Ranges of Coverage Indicators p

a Skilled attendant 53 for Countdown conference participants. d at delivery n a

s 4+ antenatal care visits 49 n Recent coverage trends o

Range i t

Coverage indicator Number of Median Low High n Careseeking for e 48 This section presents results on progress by the countries v

r pneumonia e

t priority countries in increasing coverage for the n

Nutrition i Improved sanitation 43 Exclusive breastfeeding (less than six months) 63 28 1 88 n facilities interventions and approaches proven effective in Breastfeeding and complementary feeding (6–9 months) 63 62 10 91 w o reducing mortality among mothers and children.

d Early initiation of Vitamin A supplementation: two doses 55 78 0 99 t 43 Vitamin A supplementation: at least one dose 55 90 9 100 n breastfeeding As was explained in chapter 2, trend assessment u Child health o is limited to those countries with coverage data for Measles immunisation 68 80 23 99 C Malaria treatment 40 Third dose of diphtheria and tetanus with pertussis vaccine (DPT3) immunisation 68 81 20 99 at least two points in time: one around 2000 and Third dose of haemophilus influenzae type B vaccine (Hib3) immunisation 20 85 10 99 one around 2005. An exception is neonatal tetanus Oral rehydration therapy or increased fluids, with continued feeding 57 38 7 76 Diarrhoea treatment 38 Children sleeping under insecticide-treated netsa 35 7 0 49 protection, for which annual coverage estimates are Antimalarial treatment for fevera 34 40 0 63 Antibiotics for available; here data from 2003 and 2006 are used. (The Careseeking for pneumonia 60 48 12 93 pneumonia 32 Antibiotic use for pneumonia 19 32 3 82 four missing countries have no data for any year since Maternal and newborn health Exclusive 28 1980. No matter what years were used, they could not Contraceptive prevalence rate 64 29 3 87 breastfeeding Unmet need for family planning 40 23 9 41 have been included in the trend analysis for neonatal Children sleeping Antenatal care coverage: four or more visits 39 49 12 87 7 tetanus protection coverage.) Antenatal care coverage: at least one visit 65 82 16 99 under ITNs Neonatal tetanus protection 64 81 31 94 Intermittent preventive treatment for pregnant women (IPTp) for malariaa 22 7 0 61 IPTp for malaria 7 Skilled attendant at delivery 66 53 6 100 The inter-survey periods vary considerably; most, Early initiation of breastfeeding (within one hour of birth) 47 43 23 78 however, span five years. Progress is measured Water and sanitation 0 20 40 60 80 100 Use of improved drinking water sources (total) 68 69 22 100 by calculating the average annual percentage-point Urban 68 87 32 100 Median level of national change between the data point collected within two Rural 68 56 11 100 coverage years of 2000 and the most recent data point, then Use of improved sanitation facilities ( total) 68 43 9 86 Source: UNICEF 2007c Urban 68 59 24 95 standardising to a three-year period for consistency Rural 68 32 3 82 a. Intervention applies only to the 45 malaria endemic priority countries. Figure 3.2. Median national coverage levels for selected with the Countdown reporting cycle. Source: Author’s analysis based on data from UNICEF global databases with contributions from WHO databases abd United Nations Population Fund databases Countdown indicators and approaches across the 68 priority Table 3.5. Coverage estimates for selected Countdown interventions and approaches, 68 priority countries, latest available data countries, most recent estimate (2000–2006)

TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT 22 23 Table 3.6 summarises the trend data reported in the 2008 Countdown country profiles for select coverage Changes in Exclusive Breastfeeding indicators. The greatest reported increase is in the proportion of children sleeping under insecticide- treated nets (median: 7; range: 2 to 18), followed by neonatal tetanus protection (median: 5, range –11 Change over to 31). Delivery care, contraceptive prevalence and 2008 Country 3 years diarrhoea treatment have median three-year increases Median: 29 Cambodia 29 of 2 percentage points. Careseeking for pneumonia Range: 1 - 88 Madagascar 20 has increased by a median of 1 percentage point Benin 19 Lesotho 16 over three years. The table shows that interventions Bolivia 15 showing steadier progress are generally preventive Ghana 9 Haiti 8 and deliverable on a planned schedule – unlike other Change over Country 3 years Guinea 8 interventions that must be available on demand in Gambia Turkmenistan -1 7 Tajikistan response to health events. Uganda -2 7 Peru -2 Change Iraq 6 countries with 2 coverage over 3 estimates (n=35) Cote d'Ivoire -3 Country years Niger 6 Malawi 6 Changes in Coverage Ethiopia -3 Burkina Faso 0 Bangladesh -4 Kenya 0 Tanzania 6 Zimbabwe -5 Nigeria 0 India 5

Countdown Chad -6 Somalia 0 Togo 5 Rwanda Average three-year change in percentage points Nepal -9 4 Number of Range Burundi -10 Cameroon 3 Coverage indicator countries Median Low High Guinea Bissau -10 Central African Rep. 3 Egypt -11 Sierra Leone 2 Nutrition Exclusive breastfeeding (0–5 months) 36 3 –11 29 Maternal and newborn health -40 -20 0 20 40 Antenatal care coverage (at least one visit to skilled provider) 42 4 –21 19 Births attended by skilled health personnel 45 2 –5 12 Percentage point change over 3-year period Neonatal tetanus protection 64 5 –11 31

Contraceptive prevalence rate 39 2 –7 10 Source: Authors’ compilation based on data from UNICEF global database (household survey data 2000–2006) Child health Careseeking for pneumonia 33 1 –10 18 Figure 3.3. Estimated percentage point change in exclusive breastfeeding over a three-year period, by country, 2000-2006 Oral rehydration therapy (oral rehydration salts or recommended home fluids) or 31 2 –17 23 increased fluids, with continued feeding Children sleeping under insecticide-treated nets 19 7 2 18

Source: Author’s analysis based on data from UNICEF global database Figure 3.3 shows the estimated percentage point Table 3.6. Summary of estimated coverage changes for selected interventions for the most recent three-year period since 2000 (for change in exclusive breastfeeding in countries with Countdown priority countries with at least two measurements since about 2000) adequate data to support trend analysis (n=36). Five countries have reported increases in the prevalence of exclusive breastfeeding of at least 10 percentage Coverage levels and trends for selected Nutrition points over a three-year period since about 2000. But programmatic areas Infant and young child feeding. The recent Lancet drops in coverage of similar magnitude occurred in This section summarises the most recent coverage series on maternal and child undernutrition reinforces three countries. Readers can refer to the individual levels, and trends in coverage levels since 2000, as this area’s importance and offers guidance about country profiles to better understand these changes. presented in the 2008 Countdown country profiles. effective country interventions and strategies.21 Its Current coverage levels and three-year progress recommendations are consistent with the Global estimates for specific subsets of interventions are Strategy for Infant and Young Child Feeding.22 Most described. In addition, an analysis of four component of the interventions identified as effective23 are being indicators associated with continuum of care for tracked through the Countdown. maternal, newborn and child survival. (Descriptive statistics for each coverage indicator were shown in The Lancet series emphasised the importance of table 3.5; trends were summarised in table 3.6. Later exclusive breastfeeding in the first six months of life24 analyses will bring together the coverage results and highlighted individual and group counselling as and measures of policy, health system strength and effective ways to increase exclusive breastfeeding equity.) rates in countries with high stunting rates.25 In 2008, in the 66 priority countries with available data, the median The Countdown is an evolving effort. Further input on prevalence of exclusive breastfeeding for infants methodological and programmatic issues is expected less than six months old was 28 per cent (table 3.5), from discussions planned for the 2008 Countdown with a range from 1 per cent (Djibouti) to 88 per cent conference. Readers are cautioned that this section (Rwanda). presents simple summary measures and that more meaningful programmatic information can be found in the profiles of coverage for the individual countries.

TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT 24 25 Breastfeeding plus complementary foods between However, 11 countries with available trend data six and nine months is a Countdown coverage Changes in Vitamin A Coverage still report two-dose vitamin A coverage rates of indicator reflecting the importance of ensuring that less than 80 per cent, and in two of these countries children receive adequate quantities and quality of coverage has remained at 0 per cent (Djibouti, complementary foods after six months and up to Change Papua New Guinea). The lack of sufficient progress (percentage 24 months of age. This is an essential intervention Country 2003 (%) 2005 (%) points) in achieving high two-dose coverage rates in some to prevent stunting.26 An evidence base pointing to priority countries is a reminder that increased efforts Rwanda 8 99 91 specific effective interventions is described in detail Sudan 0 90 90 to institutionalise support for semi-annual delivery elsewhere.27 Zimbabwe 0 81 81 strategies, such as child health days, are needed to Cameroon 21 95 74 Nigeria 0 73 73 ensure that more at-risk children are fully protected Two methodological problems continue to constrain Malawi 14 86 72 from vitamin A deficiency. Also needed are outreach Kenya 0 69 69 coverage monitoring for complementary feeding: the Eritrea 0 50 50 strategies that target areas of poor coverage within lack of a consensus about a valid and measurable Haiti 0 42 42 countries. Swaziland 0 40 40 indicator of complementary feeding behaviour and Ethiopia 22 59 37 the use of a behavioural outcome (feeding behaviour) Niger 68 94 26 Child health Togo 72 92 20 as a proxy for the intervention or interventions that India 45 64 19 Immunisation. Measles immunisation is an indicator could affect that outcome. The Steering Team of Cambodia 47 65 18 Burundi 0 17 17 for Millennium Development Goal 4. Nearly all deaths the Interagency Working Group on Infant and Young Ghana 78 95 17 attributable to measles in 2006 occurred in the 68

Child Feeding is addressing the first issue, having © UNICEF/HQ04-0174/Roger LeMoyne HAITI Mozambique 0 16 16 31 Yemen 0 15 15 Countdown priority countries. recently completed a five-year programme of research Congo, The Democratic Republic of 72 87 15 to develop new and more valid indicators.28 There Burkina Faso 80 95 15 Indonesia 62 76 14 In 2006, for the first time, global routine coverage has also been some progress in defining effective Madagascar 84 95 11 rates for measles vaccination reached 80 per cent (up interventions and approaches.29 This Countdown cycle Sierra Leone 84 95 11 Congo 0 9 9 from 72 per cent in 1990).32 Across the Countdown relies on the existing indicator, which is not adequate Philippines 76 85 9 priority countries, estimates based on 2006 data show to support the estimation of trends. Myanmar 87 95 8 Afghanistan 85 91 6 median measles coverage at 80 per cent, with a range Mali 61 66 5 Tanzania, United republic of 91 95 4 from 23 per cent (Chad) to 99 per cent (Brazil, Peru, As shown in table 3.5, among the 63 countries with Guinea 93 95 2 Turkmenistan). coverage data available for this report, the median Bolivia 38 39 1 prevalence of complementary feeding from six to nine Djibouti 0 0 0 Papua New Guinea 0 0 0 Similarly, the estimated median coverage rate for three months was 62 per cent, with a range from 10 to 91 Korea, Democratic People’s Republic of 95 95 0 doses of diphtheria and tetanus with pertussis vaccine per cent. Ten countries reported rates of 80 per cent Pakistan 95 95 0 Nepal 96 96 0 (DPT3) is 81 per cent for the 68 priority countries, or more (Tanzania 91, Malawi 89, Burundi 88, Haiti Lao People’s Democratic Republic 64 62 –2 with a range from 20 per cent (Chad) to 99 per cent and Zambia 87, Kenya 84, Cambodia 82, Peru 81, Angola 68 65 –3 Benin 95 92 –3 (Brazil, Malawi, Rwanda, South Africa). A recent Mozambique and Uganda 80). Three countries reported Bangladesh 87 82 –5 analysis estimated that in 2007 there were 26 million prevalence rates of less than 20 per cent (Somalia 15, Zambia 73 66 –7 Gambia 52 16 –36 children not immunised with DPT3 and that 20 million Tajikistan 15, Lao People’s Democratic Republic 10). Lesotho 75 2 –73 of those children lived in just 10 countries – all of them Source: UNICEF Vitamin A global database 2008 Countdown priority countries.33 Vitamin A supplementation. Of the 68 Countdown Table 3.7. Trends in two-dose vitamin A coverage in Countdown priority countries, 66 are also priority countries priority countries, 2003–2005 Haemophilus Influenzae Type B (Hib) vaccine is for vitamin A supplementation, underscoring the a fairly new intervention, recently recommended importance of national-level programmes to ensure for delivery with DPT3 in all low-income country high two-dose coverage in almost all the Countdown Table 3.7 shows the remarkable progress many priority 34 30 immunisation schedules. In 2005 the Countdown countries. Table 3.7 shows fairly high coverage rates © UNICEF/HQ04-1202/Ami Vitale countries have made in achieving gains in vitamin A reported on the number of priority countries that had for 2005, when 55 of 68 priority countries (81 per cent) coverage. From 2003–2005 the number of countries included haemophilus influenzae type B vaccine in reported estimates. The median for two-dose coverage with 80 per cent two-dose coverage nearly doubled their child immunisation schedules as an indicator of of children 6–59 months of age is 78 per cent, with a (from 12 to 22), 13 countries increased two-dose country responsiveness to new interventions. This range from 0 per cent (Djibouti, Papua New Guinea) to coverage by more than 20 percentage points, and 8 report presents coverage rates for the third dose of 99 per cent (Rwanda). And the median coverage for at others sustained a rate of greater than 80 per cent haemophilus influenzae type B vaccine (Hib3) for the least one dose is 90 per cent, with a range from 9 per (Cameroon, Malawi, Niger, Nigeria, Rwanda, Sudan, first time. Among the 68 Countdown countries, 20 cent (Lesotho) to 100 per cent (Rwanda). Togo, Zimbabwe). Much of this progress is attributable had data on Hib3 coverage for 2006. The median was to including vitamin A and other low-cost, high-impact 85 per cent, with a range from 10 per cent (Morocco) preventive child survival interventions (measles to 99 per cent (Brazil, Malawi, Rwanda, South Africa). immunisation, insecticide-treated bed nets) as part of These results demonstrate that rapid increases in integrated child health events. immunisation coverage are possible where a strong delivery platform already exists.

TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT 26 27 Insecticide-treated bed nets. Another fairly new sleeping under insecticide-treated nets in those 45 For each of the 19 priority countries with available Coverage rates remain low in some Countdown priority intervention, insecticide-treated bed nets have received countries. The median coverage is 7 per cent, with a trend data, figure 3.5 presents two successive recent countries, particularly in sub-Saharan Africa where the much attention and resources at both national and range from 0 per cent (Guinea, Madagascar, Sudan) to estimates for insecticide-treated net coverage. While greatest country HIV prevalence rates occur. All 15 international levels, with international funding for 49 per cent (The Gambia). showing dramatic increases for most countries, the Countdown countries with adult HIV prevalence of at malaria control increasing dramatically over the past results also show that additional rapid improvement is least 5 per cent are in sub-Saharan Africa, yet in 11 of decade.35 needed to achieve global targets. Some programme those countries coverage rates for antiretrovirals to Changes in ITN Coverage efforts may not yet be captured in these estimates. prevent mother-to-child HIV transmission remain less Of the 68 Countdown priority countries, 45 have For example, both Ethiopia and Kenya are reported to than 40 per cent (table 3.8). endemic malaria – defined here as nationwide risk of have distributed millions of nets since coverage data Plasmodium falciparum throughout the year.36 Figure were last collected in 2005 (for Ethiopia) and 2003 (for 49 Gambia (2000, 2006) 37 3.4 shows median coverage and ranges for children 15 Kenya). Future surveys are expected to document Prevention of Mother-to-Child HIV Transmission 39 coverage rates that reflect these accelerated efforts. Guinea-Bis s au (2000, 2006) 7 38 Togo (2000, 2006) ITN Coverage 2 Antiretroviral prophylaxis to prevent mother-to- Country 2004 2005 2006 Botswana 87 (81-94) 64 (60-69) >95 --- 23 child HIV transmission. Over 90 per cent of infant Malawi (2000, 2006) Around 2005 Cameroon 11 (10–13) 10 (9–12) 22 (18–30) 3 and child HIV infections are passed on by mothers Central African Around 2000 2 (2–3) 7 (7–8) 18 (16–20) 23 38 Republic Zambia (1999, 2006) during pregnancy, labour, delivery or breastfeeding. 1 Congo 7 (6–8) 23 (20–28) 7 (6–9) 22 Effective, feasible and well-known interventions to Gabon — — 4 (3–5) 4 (3–5) Ghana (2003, 2006) 4 reduce such transmission could save thousands Kenya 25 (22–29) 24 (21–28) 48 (42–59) Lesotho 7 (6–7) 15 (14–16) 17 (15–18) 20 Benin (2001, 2006) annually. Many low- and middle-income countries are Malawi 4 (4–5) 8 (7–9) 14 (12–16) 10 countries had no 7 data for this indicator scaling up national programmes to approach the global Mozambique 3 (3–4) 9 (8–11) 13 (11–15) Tanzania, United Rep. of 16 South Africa 15 (13–17) 34 (29–40) 50 (43–60) (1999, 2004-5) 2 target – set by the United Nations General Assembly Swaziland 5 (4–5) 36 (33–40) 62 (57–69) Tanzania, United Central African Republic 15 Special Session on HIV/AIDS in 2001 – of reaching at 2 (1.7–2) 6 (6–7) 15 (14–16) (2000, 2006) 2 Rep. of least 80 per cent of pregnant women with services to Uganda 9 (8–11) 15 (13–17) 25 (22–28) 13 Cameroon (2000, 2006) Zambia 18 (16–20) 19 (17–22) 35 (31–39) Guinea, Madagascar and Sudan had 1 prevent mother-to-child HIV transmission by 2010. Zimbabwe 8 (7–8) 13 (12–14) 17 (16–19) “0%” coverage (see country profiles) 13 Rwanda (2000, 2005) 5 Note: Numbers in parentheses, representing the range in coverage estimates, are based on In a number of Countdown priority countries increased plausibility (uncertainty) bounds in the denominator (low and high estimated numbers of HIV-infected 10 pregnant women). Uganda (2000, 2001, 2006) — is not available. 0 amounts of effort, resources and political commitment Source: For the latest available coverage data and methods of estimating coverage, UNICEF and 10 have significantly boosted coverage for antiretrovirals WHO, Report Card on the Prevention of Mother-to-Child Transmission of HIV and Paediatric Care Burkina Fas o (2003, 2006) (2007); for denominators, unpublished 2007 HIV estimates by the Joint United Nations Programme on 2 to prevent mother-to-child HIV transmission. The HIV/AIDS and the World Health Organization 8 Roll Back Malaria Burundi (2000, 2005) target for 2010 Countdown country profiles present trend data on HIV- 1 Table 3.8. Percentage of HIV-infected pregnant women 7 infected pregnant women receiving this intervention Median 7 Niger (2000, 2006) receiving antiretrovirals to prevent mother-to-child HIV 1 for 2004–2006.39 Coverage increased in each of the transmission in Countdown priority countries with estimated Range 0 - 49 7 adult (age 15–49) HIV prevalence of at least 5 per cent, S enegal (2000, 2005) 51 countries that reported data during that period. 2 2004–2006 priority countries (n=45) 6 Progress is especially evident in Eastern and Southern Cote d'Ivoire (2000,2006) 1 African Countdown countries, where the majority of 5 Roll Back Malaria S ierra Leone (2000,2005) target for 2005 new child HIV infections occur (for example, coverage Preventing mother-to-child HIV transmission requires 2 (Abuja) in South Africa tripled from 15 per cent in 2004 to 50 giving pregnant women access to testing, safe delivery

Countdown 5 Kenya (2000, 2003) 3 per cent in 2006). practices, antiretroviral therapy where needed and 0 20 40 60 80 100 guidance for selecting safe and optimal infant-feeding Despite the increasing trends in coverage for options. Complementary efforts to prevent HIV Per cent coverage transmission include providing family planning services Source: UNICEF and Roll Back Malaria, 2007 antiretrovirals to prevent mother-to-child transmission, progress towards meeting the United Nations General to all women – with and without HIV infection – to Figure 3.5. Children sleeping under ITN’s in Countdown priority increase the proportion of births that are intended. countries with two coverage surveys since about 2000 Assembly Special Session goal remains insufficient in most Countdown countries. Using an average annual 8 per cent target increase in antiretroviral coverage Treatment of child pneumonia, diarrhoea and for each year since 2001, countries are defined as malaria. Pneumonia remains the biggest killer of ‘on track’ if at least 48 per cent of all HIV-positive children40 and, together with diarrhoea and malaria, pregnant women received the intervention in 2006. Of constitutes the cause of over 50 per cent of child the 51 Countdown countries that reported data, only deaths in most sub-Saharan African countries.41 0 20 40 60 80 100 8 achieved that coverage rate and are considered ‘on Prompt and effective treatment of these three Per cent coverage track’ to meet the global goal of 80 percent coverage infectious diseases is essential for newborn and child

Source: Author’s analysis based on data from UNICEF global database (household survey data from for prevention of mother-to-child transmission survival. 2000–2006) (Botswana, Brazil, Swaziland, Rwanda, Burkina Faso, Figure 3.4. Insecticide-treated net coverage for children in the Benin, South Africa, Kenya). 45 countries with endemic malaria, most recent estimate, 2008. (Endemic countries defined here as countries with nationwide risk of p. falciparum throughout the year.)

TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT 28 29 Coverage of antibiotic use for pneumonia in children Figure 3.6 shows coverage for antimalarial treatment under age five in the priority countries is low. Of all among children under age five. The results are similar Changes in Treatment of Diarrhoea children under age five with suspected pneumonia, to those for diarrhoea and pneumonia treatment, with a median of 32 per cent receive antibiotics. Country a median of 40 percent across the 34 countries with coverage rates range from 3 per cent (Haiti) to 82 per available data. cent (Iraq).

Coverage is only slightly better for diarrhoea treatment. 2008 Change Of children under age five with diarrhoea, the median Median: 38 over 3 Range: 7 - 76 Country years proportion receiving oral rehydration therapy (or Philippines 23 increased fluids) with continued feeding is 38 per cent, Kenya 18 with a range of 7 per cent (Botswana, Somalia) to 76 Lesotho 18 Change Myanmar 17 per cent (the Philippines). over 3 Peru 8 Country years Tanzania 7 Egypt -1 Bangladesh 7 Togo -2 Côte d'Ivoire 6 Tajikistan -4 Senegal 5 Antimalarial Treatment Coverage Bolivia -5 Iraq 5 Burundi 5 Cameroon -5 Change Indonesia -5 over 3 Guinea 5 Rwanda 5 Sierra Leone -5 Country years India 4 Malawi -13 Madagascar 0 Turkmenistan 2 Ethiopia -14 Central African Republic 0 Ghana 2 Chad -17 Gambia 0 Haiti 2

11 countries had no data for this indicator

-20 -15 -10 -5 0 5 10 15 20 25

Percentage point change over three-year period Source: Author’s analysis based on data from UNICEF global database (household survey data from 1998–2006) Figure 3.7. Estimated percentage point change in treatment of diarrhoea among children less than five years of age over a three-year period, by country (1998-2006). Cambodia had “0%” coverage (see country profile) Trend data are available only for diarrhoea treatment (figure 3.7) and careseeking for pneumonia (figure 3.8). Both show limited progress – if any – over the most recent three-year period for which data are available. Median 40

Range 0 - 63 Pneumonia, diarrhoea and malaria, together with undernutrition, caused 54 per cent of the 10.6 million

priority countries (n=45) annual deaths from 2000–2003, or a total of more than 17 million deaths in newborns and children under age five.42 In the 68 Countdown priority countries, which © UNICEF/HQ04-1292/Giacomo Pirozzi account for 97 per cent of all child deaths, coverage Countdown rates for pneumonia, diarrhoea and malaria treatment are poor and generally not improving.

The priority countries can reach more newborns and children with timely identification and treatment by adopting and implementing related policies monitored by the Countdown. The extension of integrated 0 20 40 60 80 100 management of childhood illness to cover newborns, the introduction of new low osmolarity oral rehydration Per cent coverage salts and zinc supplements for diarrhoea and policies Source: Author’s analysis based on data from UNICEF global database (household survey data from 2000–2006) facilitating the treatment of uncomplicated pneumonia Figure 3.6. Antimalarial treatment coverage in the 45 countries in the community, for example, are all measures that with endemic malaria, most recent estimate, 2008. (Endemic the priority countries can introduce to reach more countries defined here as nationwide risk of p. falciparum throughout the year.) newborns and children with needed care.

TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT 30 31 Maternal & newborn tetanus. Mothers and Changes in Pneumonia Treatment Family Planning Unmet Need newborns are considered protected from tetanus if the pregnant woman receives two doses of tetanus toxoid vaccine during an appropriate period before the birth. Those vaccines are often provided at antenatal care visits. But many countries have improved their rates 2008 by introducing special maternal and neonatal tetanus Median: 48 Change campaigns. Some countries have also introduced over 3 Range: 12 - 93 Country years programmes to cover school-age girls and adolescents. Myanmar 18 Turkmenistan 16 Ghana 12 Change over 3 Senegal 12 28 countries with data Country years Malawi 12 missing or collected Cote d'Ivoire -1 Nepal 10 before 2000 Burundi -1 Tajikistan 8 Sierra Leone -1 Peru 8 Bolivia -2 Lesotho 7 Antenatal Care Coverage Egypt -2 Burkina Faso 7 Togo -3 Change Cambodia 7 Gambia -3 over 3 Cameroon 5 Country years Tanzania -4 Rwanda 5 Central African Haiti 3 Guinea Bissau -4 Republic Bangladesh -5 Iraq 3 Kenya -5 Ethiopia 2 Chad -7 Guinea 1 Philippines -10 India 1 Madagascar 1 Median 23 29 countries with data Range 9 - 41 missing or collected 15 10 5 0 5 10 15 20 before 2000

Percentage point change over three-year period priority countries (n=68)

Source: Author’s analysis based on data from UNICEF global database (household survey data from 1998–2006) Figure 3.8. Estimated percentage point change over three years in the proportion of children less than five years of age with suspected

pneumonia taken to an appropriate health provider, by country (1998-2006) Countdown

Maternal and newborn health need rate that exceeds contraceptive prevalence. Overall, the proportion of stated desires to space the Contraceptive prevalence and unmet need for Median 49 next birth by at least two years or avoid pregnancy family planning. Every woman has the right to Range 12 - 87 plan her pregnancies and have access to effective that are being met by family planning services requires

family planning methods to space or limit births and significant improvement through various supply and priority countries (n=68) to prevent unintended pregnancies benefits both demand efforts. The Lancet sexual and reproductive health series has addressed this topic.43 maternal and newborn health. Target coverage rates 0 20 40 60 80 100

for this indicator are less than 100 per cent because Countdown Per cent unmet need at any given time a certain proportion of women Antenatal care can provide a platform for delivering will want to conceive. The median prevalence of several effective maternal and newborn interventions, Source: Author’s analysis based on data from United Nations Population Fund global database, 2008 contraceptive use among currently married women or including (among others) tetanus toxoid immunisation, Figure 3.9. Median prevalence of unmet need for family planning in the Countdown countries, 2008 those in union of reproductive age (15–49) is 29 per intermittent preventive treatment for malaria and cent in the 64 priority countries with available data, preventing mother-to-child transmission for HIV. with a range from 3 per cent per cent (Chad) to 87 per The Countdown indicator for antenatal care is the cent (China). Unlike the contraceptive prevalence rate, percentage of women attending at least four antenatal the survey protocol asks about the type of provider unmet need for family planning is based on a target care sessions during pregnancy, as recommended for the one-visit indicator but not for the four- coverage rate of 100 per cent; the indicator measures by the World Health Organization and UNICEF.44 For visit indicator. Future analyses will explore the the gap between the proportion of women who desire continuity with past monitoring efforts, the country relationship between the two measures. contraception and those who receive it. The median profiles also include the percentage of women Figure 3.10 summarises the median prevalence of at rate of unmet need is 23, with a range from 41 percent attending at least one antenatal care session under a least four antenatal care visits in the 39 Countdown 0 20 40 60 80 100 (Uganda) to 9 percent (Indonesia, Peru). But as figure skilled health provider. priority countries for which data were available. In Per cent 3.9 shows, data on unmet need are available for only those countries a median of 49 per cent of mothers Source: Author’s analysis based on data from UNICEF and WHO global databases (household survey 40 of the 68 Countdown priority countries. Indicators for one and for four visits have recently attended four or more antenatal care sessions, with a data from 2000–2006) been added to the list of indicators for Millennium range from 12 per cent (Ethiopia) to 87 per cent (Peru). Figure 3.10. Median coverage for antenatal care ( four or more Of the countries with estimates for both contraceptive Development Goal 5 (Millennium Development visits) prevalence and unmet need, nearly half have an unmet Goal 5B, Target 5.5).45 Readers should note that

TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT 32 33 In the 64 Countdown priority countries with data for The results suggest that while the majority of 2006, the median coverage estimates for neonatal Malaria Treatment these priority countries are improving delivery care tetanus protection is 81 per cent, with a range from coverage, some need further improvement and others 31 per cent (Haiti) to 94 per cent (Benin, The Gambia). require efforts to sustain high coverage rates. The Table 3.6 reports a median three-year increase of 5 effectiveness of this approach depends on the specific percentage points in the 64 countries – an impressive interventions provided and on the quality of delivery, trend, given that coverage is already so high. making national and subnational monitoring necessary.

Intermittent preventive treatment for pregnant Caesarean section coverage differs in important ways women (IPTp) for malaria involves the provision of 23 countries had no from the other coverage indicators tracked through the data for this indicator two or more doses of an antimalarial drug to women Countdown. First, the target coverage rate is not 100 during pregnancy, protecting both mothers and their per cent. Instead, the suggested acceptable rate of children. Figure 3.11 shows coverage for 22 of the 45 caesarean section – based on the estimated frequency priority countries with endemic malaria (annex F);46 the of life-threatening obstetric complications – is between remaining 23 had no coverage data. 5 and 15 percent of births.50 By general agreement, rates of less than 5 per cent indicate that a substantial Niger and R wanda “0%” coverage proportion of women lack access to caesarean sections

In most countries with intermittent preventive priority countries (n=45) (see country profile) treatment for pregnant women, the countries have and could die as a result. But rates greater than 15 adopted it only recently. Rapid gains are expected in per cent could indicate that the procedure is being the next round of national surveys. Priority countries Median 7 over-utilised and performed for other than life-saving that adopted this intervention earlier had achieved fairly Countdown Range 0 - 61 reasons, increasing morbidity and possibly mortality high coverage levels by 2006, such as 61 per cent from unneeded risks associated with surgery.51 (Zambia) or 45 per cent (Malawi).

Intermittent preventive treatment for pregnant women is not recommended for malaria endemic countries where large proportions of the population live in low- 0 20 40 60 80 100 intensity malaria transmission areas. For this reason Per cent coverage

Botswana, Burundi, Eritrea and Ethiopia have not made Source: Author’s analysis based on data from UNICEF global database (household survey data from it a part of their national malaria control strategies. 2000–2006) Changes in Births Attended by Skilled Health Personnel They are not included in the coverage estimates for Figure 3.11. Coverage for intermittent preventive malaria 47 treatment in pregnancy 45 countries with endemic malaria, this indicator. most recent estimates, 2008. (Endemic countries defined here as nationwide risk of p. falciparum throughout the year.)

The presence of a skilled attendant at delivery is associated in observational studies with better delivery Change 48 over 3 outcomes, including reduced maternal deaths. This Country years association is plausible, since an attendant who Azerbaijan 12 Peru 11 is authorised to perform life-saving functions and Burkina Faso 10 supported by a performing health system can provide Niger 9 Itaq, Egypt 8 life-saving interventions in a timely manner. Across Tajikistan, Benin, Cambodia 7 Change the 66 priority countries with available coverage data over 3 Togo for this Countdown cycle the median was 53 per cent, Country years Somalia, Pakistan 6 Nigeria -5 Burundi, Nepal, Central African 5 with a range from 6 per cent (Ethiopia) to 100 per cent Senegal -4 Republic, Tanzania, South Africa Lesotho -3 Rawanda, Bangladesh, 4 (Azerbaijan, Turkmenistan). That rate may be compared Change Madagascar Côte d'Ivoire -3 over 3 Indonesia, Zimbabwe 3 with a recently published estimate of 61 per cent Bolivia -2 Country years India, Guinea Bissau, Ghana, 49 Kenya -2 Ethiopia 0 coverage for all developing countries. Afghanistan, Uganda, 2 Chad -1 Korea, DPR 0 Philippines, Guinea, Cameroon Malawi -1 Haiti, Turkmenistan, Gambia,

© UNICEF/HQ06-1391/Giacomo Pirozzi Of the 68 Countdown priority countries, 45 have data Sierra Leone, China 1 for the presence of a skilled attendant at delivery from -6 -4 -2 0 2 4 8 6 10 12 two coverage surveys conducted at least three years apart between 1998 and 2007. Figure 3.12 shows the Three-year percentage point change in coverage average three-year percentage point change for each. Source: Analysis by authors based on UNICEF global database (household survey data from 1998–2006) Figure 3.12. Estimated percentage point change in the percentage of live births attended by skilled health personnel, by country (1998- 2006)

TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT 34 35 Second, caution is required when interpreting these Effective postnatal care, like antenatal care, requires results at the national level because of the substantial Early Initiation of Breastfeeding Births by Caesarean Section several contact visits. Visits after the first should occur heterogeneity between urban and rural areas, different at around day 3, at 6 to 7 days and six weeks after the wealth strata and public and private sectors. If rates birth. for a minority of the country’s population exceed 15 Country Urban (%) Rural (%) Total (%) Azerbaijan 4 1 3 per cent, then a national rate considerably greater than Bangladesh 11 2 4 Comparable data for postnatal care are lacking. 5 per cent could mask widespread unmet need in a Benin 6 2 3 Bolivia 21 6 15 Demographic and Health Surveys provide data on majority of the population. Even if country coverage Burkina Faso 3 0 1 postnatal visits for 12 countries, but the question refers rates are within the acceptable range, unmet need Cambodia 6 1 2 only to the mother, and it is not clear whether care might vary both within and across countries. Cameroon 4 1 2 21 countries with no data Chad 1 0 0 for the baby (such as breastfeeding counselling) is Cote d’Ivoire 8 6 6 included. Coverage for the 12 countries with such data Table 3.9 shows the percentage of live births delivered Egypt 29 15 20 is very low, with a median of 24 per cent and a range Eritrea 7 1 3 by caesarean section for the 39 priority Countdown Ethiopia 9 0 1 that begins at 2 per cent. Two countries have better countries with estimates from 2000 to 2006, stratified Gabon 6 4 6 coverage – 64 per cent (Cambodia) and 56 per cent Ghana 8 2 4 by urban or rural residence. Rural rates range from 0 Guatemala 19 8 11 (Egypt). per cent (Burkina Faso, Chad, Ethiopia, Mali, Niger) to Guinea 5 1 2 15 per cent (Egypt), with a median of 2 per cent. Urban Haiti 6 1 3 India 17 6 9 Five countries have adapted the standard Demographic rates range from 1 to 29 per cent, with a median of Indonesia 7 2 4 and Health Survey questionnaire to ask mothers 7 per cent. In rural areas all but 8 of the 39 countries Kenya 9 3 4 about whether a postnatal visit for the newborn Lesotho 8 5 5 have caesarean section rates of less than 5 percent. Madagascar 2 1 1 occurred within two days after the birth. For those In urban areas 5 countries have rates greater than the M edian 43 Malawi 4 3 3 five countries, table 3.10 shows the coverage rates recommended threshold of 15 per cent (Bolivia, Egypt, Mali 3 0 1 R ange 23 - 78 Mauritania 6 1 3 for postnatal newborn care. Since this question is Guatemala, India, Peru) and 10 have rates less than 5 Morocco 9 2 5 addressed only to mothers who delivered at home, per cent. Mozambique 5 1 2 the denominator differs from that for the maternal

priority countries (n=68) Nepal 8 2 3 Niger 5 0 1 postnatal care question; data from the two questions These data indicate that, in the 68 priority countries, Nigeria 4 1 2 cannot be compared. Peru 23 6 16 rates of life-saving caesarean section use are low and Philippines 10 5 7 require urgent attention. Despite evidence of overuse Countdown Rwanda 8 2 3 Postnatal care is a neglected area in many Countdown in some urban settings, large urban-rural differentials Senegal 7 1 3 Tanzania 8 2 3 priority countries. Without clear policies –especially for suggest inadequate access in most countries. The data Turkmenistan 4 2 3 early contact, specified programmatic delivery (who, for caesarean section rates should spur programme Uganda 9 2 3 what, where) and consistent data tracking – the lack planners at the subnational, national and international Zambia 4 1 2 Zimbabwe 9 3 5 of postnatal care represents a significant gap in the levels to take urgent action to achieve appropriate continuum of care. Important opportunities for the coverage for this life-saving procedure. The limited Source: Author’s analysis based on data from UNICEF and WHO global database (household survey data from 2000–2006) delivery of needed care to mothers and babies are availability of emergency obstetric care facilities, missed, and linkages between care at birth and child documented later in this report, is further evidence Table 3.9. Percentage of live births delivered by caesarean section in Countdown priority countries with coverage health and ongoing reproductive health services remain of the need for greater investments in health care estimates since 2000, by maternal residence (urban or rural) poor.56 systems so that pregnant women have access to essential care. referral or treatment when required – and for providing benefits both counselling on family planning services.53 Early initiation of breastfeeding Postnatal Visits mothers and newborns. Immediate breastfeeding, 0 20 40 60 80 100 facilitated by placing the newborn skin-to-skin on Per cent reporting early initiation of breastfeeding Compelling evidence shows that the earlier the first the mother’s breast, helps prevent hypothermia, Source: Author’s analysis based on data from UNICEF global database (household survey data from postnatal visit, the more effectively it will prevent 2000–2006) Country Total (%) promotes bonding, and reduces the mother’s risk neonatal mortality and improve healthy behaviours. Bangladesh 22 Figure 3.13. Median prevalence of early initiation of Egypt 9 of haemorrhage. The mother’s milk during the first breastfeeding in the Countdown priority countries, 2008 Home visits by trained community health workers Haiti 4 post-partum days, colostrum, also provides protective in the first two days of life can significantly reduce Ethiopia 2 Nepal 2 antibodies and essential nutrients. Figure 3.13 shows Postnatal care is a Countdown indicator because of neonatal mortality.54 Other studies show that, the prevalence of for the 68 priority countries, which the importance of the postnatal period for maternal controlling for other factors, a visit on the first day of Source: Analysis provided by Saving Newborn Lives (household survey data from 2000–2006) was included as a Countdown intervention for the and newborn survival and health. Three-quarters of life is associated with fewer neonatal deaths compared Table 3.10. Percentage of newborns delivered at home whose mothers report receiving a postnatal visit for the newborn 55 first time in 2008. Among the 47 priority countries newborn deaths occur in the first week of life – up with a visit on the third day. All mothers and babies within two days of delivery with available data, the median prevalence is 43 per to half (2 million) on the first day.52 The same period should receive a first postnatal contact within 24 hours cent with a range of 23 (Guinea-Bissau, Senegal) to 78 poses high risks for maternal death. On the other of birth or within 24 hours of discharge after a facility (Eritrea), suggesting that the uptake and reinforcement hand, it is a crucial time for establishing home care birth. For these reasons the Countdown indicator has of this behaviour will require special programmatic practices – especially breastfeeding, warmth for been revised to focus on early postnatal care within attention within the continuum of care. the baby, recognition of illness or danger signs and two days of birth (rather than three days as in the 2005 report).

TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT 36 37 Data availability and quality for postnatal care would Few countries have even moderately good coverage improve if the standard Demographic and Health Continuum of Care Coverage across this grouping of four interventions. Starting with Water and Sanitation Survey questionnaire were to ask about postnatal the leftmost bar in figure 14, 52 of the 62 countries care for the mother and the baby, detail more visits with the required data (84 per cent) have at least 10 per than just the first and make the questionnaire ask 60 cent coverage across the four interventions. Moving Use of improved drinking water Use of improved sanitation facilities sources (n=36) (n=14) about postnatal care at home after facility births (so towards the right, only 40 countries (65 percent) have Afghanistan Afghanistan that denominators become comparable). Advancing * Intervention or approach at least 20 per cent coverage, and only 26 countries (42 India China Antenatal care (at least 1 visit) Angola Djibouti these aims now will create better data for the next percent) have at least 30 per cent coverage. Just two Indonesia Egypt 52 Skilled attendent at delivery Countdown report. In at least 12 countries, large-scale Exclusive breastfeeding countries have at least 60 per cent coverage across Azerbaijan Guatemala Kenya Malawi implementation research is evaluating an expansion of (<6 months) the four interventions and approaches (Benin, Peru); Bolivia Mexico 50 locally adapted approaches for visits to mothers and Measles Immunization only one has reached 70 per cent coverage or above Korea, DPR Morocco babies, including postnatal care. (Benin). Botswana Myanmar Malawi Nepal Brazil Pakistan Focusing on the continuum of care means focusing Mali Peru Coverage across the continuum of care Burkina Faso Philippines Achieving the health-related Millennium Development 40 on the need to strengthen health systems. Health Mauritania Senegal 40 systems need to be shored up so that they can Burundi Goals must start with an effective response to Mexico support a continuum of high quality services, one that the needs of women, newborns and children. The =62) Cambodia n continuum of care for maternal, newborn and child ( spans the family and community and that includes Morocco s Cameroon e

i both local providers and providers who can deliver

health includes integrated health service delivery r Myanmar t

n emergency obstetrical care (contacted through Central African Republic throughout the lifecycle, including adolescence, u o Nepal c operative referral mechanisms). Renewed efforts must pregnancy, childbirth, the postnatal period and 30 Chad y t

i focus on clarifying the root causes of health system childhood. This care is provided by families and r Pakistan o

i 26

r underperformance and on effective approaches for China

communities and through outpatient, outreach and p 58 Peru

n strengthening health systems. clinical services. To save the most lives, linkages Côte d’Ivoire w

o Rwanda

among the time periods and places for caregiving are d t Egypt 57 n

u Water and sanitation crucial. Senegal o 20 C The seventh Millennium Development Goal includes Eritrea f

o South Africa

The graph in each 2008 Countdown country profile r 15 a target of halving, from 1990–2015, the proportion Ghana e

(upper right corner) highlights coverage for six b of people without sustainable access to safe drinking Uganda

m Guatemala interventions and approaches within the continuum u water. Improving water and sanitation are important

N Zimbabwe of care: contraceptive use, antenatal care, a skilled to preventing infectious diseases and thereby to Source: UNICEF 2007b attendant at delivery, a postnatal care visit for the 10 achieving the health-related Millennium Development newborn, exclusive breastfeeding up to six months 7 Goals. Table 3.11. Countries ‘on track’ to achieve the Millennium Development Goal targets for water and sanitation and measles vaccination. Of these six interventions, four have target coverage levels of 100 per cent and 2 Table 3.11 shows the Countdown priority countries coverage data since 2000 for a majority of the 68 1 that were ‘on track’ to achieve the targets for water Countdown countries and could therefore be included 0 (n=36) and sanitation (n=14), based on data from 1990 in a summary coverage measure for the continuum. 59 10% 20% 30% 40% 50% 60% 70% and 2004. Countries not listed had shown either (Another measure reflecting coverage across multiple insufficient or no progress. interventions is presented and discussed later in the Minimum coverage achieved report, in the section on equity.) for 4 interventions/approaches* within the continuum of care

Source: Adapted from UNICEF 2007c Figure 3.14 shows the number of the 62 priority Figure 3.14. Number of countdown priority countries achieving countries with coverage data since 2000 that have coverage for interventions/aproaches within the continuum achieved specific coverage rates for all four of these of care (n=62 countries with coverage data for all four interventions: at least one antenatal care visit, a skilled interventions/aproaches) attendant at delivery, exclusive breastfeeding up to six months and measles vaccination.

TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT 38 39 Equity in coverage levels inequities, efforts can decrease the coverage gap for all Coverage Gaps by Wealth Quintile but the least poor. Adoption Status of Key Health Policies The 2008 Countdown country profiles present findings about equity in coverage using a new measure, the The pattern is different in countries with the lowest ‘coverage gap’, which includes eight interventions coverage gap, indicating relatively high coverage grouped into four areas across the continuum of care: > 60% levels across the eight interventions (the lower light International Code of Marketing of Breastmilk • Family planning (need satisfied or contraceptive use). 50-60% orange line in figure 3.15). Though in these findings the 90 • Maternal and newborn care (antenatal effect is relatively small, there is a linear improvement 40-50% care and skilled birth attendance). ILO Convention 183 on from the second poorest quintile to the least poor Maternity Protection • Immunisation (measles vaccine, Bacille 80 30-40% quintile, with a noticeable change in the slope of the Calmette-Guerin vaccine against tuberculosis < 30% line representing the poorest quintile. Referred to as Notification of [BCG] and third dose of diphtheria and 70 ‘bottom’ inequity, this can often be addressed through maternal deaths tetanus with pertussis vaccine [DPT3]. effective targeting of services to the poor. Midwives authorised to • Treatment of child illness (medical care sought 60 administer core set of interventions for acute respiratory infection and oral rehydration The country profiles provide a wide array of examples therapy with continued feeding for diarrhoea). ) 50 of these patterns, with notable exceptions. Some % IMCI guidelines adopted ( countries (such as Turkmenistan and Azerbaijan) show to cover newborns p a only small differences by wealth quintile. Others have Annex E gives further details on the data sources G 40 and methods of analysis. (Some inconsistencies in dramatic ‘top inequity’ (for example, Burkina Faso) or Low osmolarity ORS and zinc supplement Yes definitions between the component indicators of the 30 ‘bottom inequity’ (such as Brazil). Partial coverage gap measure and Countdown indicators Community management No should not affect the validity of results as a measure of Countries with multiple surveys provide examples of of pneumonia with 20 antibiotics No data coverage equity.) changes over time. The analyses show that the overall annual rate of coverage gap change is just less than Costed implementation 10 plan(s) Comparing the absolute size of coverage gaps across 1 percentage point on average and rarely exceeds the Countdown priority countries suggests intercountry 2 percentage points. Patterns of inequity by wealth 0 0 10 20 30 40 50 inequities. The coverage gaps for 54 countries ranged quintile normally change only gradually – but there from less than 20 per cent, indicating about 80 per cent P oorest 20% M iddle 20% B est-off 20% are several examples of rapid change. For example, Source: Compiled by WHO and UNICEF coverage for the eight interventions (Turkmenistan, in Cambodia a substantial reduction of the coverage Figure 3.16. Adoption status of key maternal, newborn and child Source: Analysis provided by WHO, 2008 Peru), to over 70 per cent, indicating about 30 per cent gap from 2000–2005 changed the pattern from ‘top health policies in the 68 Countdown priority countries coverage for the eight interventions (Chad, Ethiopia). Figure 3.15. Coverage gaps by wealth quintile (countries inequity’ to a linear pattern. In Egypt and Peru progress grouped by overall coverage gap size) was marked by reduced ‘bottom inequity.’ Yet in several countries, such as India, a marked overall In the 40 Countdown countries with at least two reduction in the coverage gap did not change the surveys since 1990, coverage gaps decreased by To examine trends, associations between patterns of inequity pattern and was not associated with greater about 1 percentage point per year, indicating improved inequity and coverage gap size were first examined; progress for the poorest quintile. In most sub-Saharan coverage across the eight interventions or approaches. intracountry trends were then assessed. The surveys African countries, likewise, coverage gaps decreased, Coverage gap decreases, measured in percentage were classified into five groups based on coverage gap but ‘top inequity’ remained. points, were faster for countries with gaps over 40 per size. Figure 3.15 summarises the size of the coverage cent than for countries with smaller gaps – suggesting gap in each of the five groups across the five wealth that improvements in coverage can occur more rapidly categories. Although the coverage gap is consistently Health policies and health systems where initial coverage levels are low. higher among the poorer and lower among the less Figure 3.16 shows the frequency distribution of poor, there are important differences in the patterns of responses from 68 countries on adopting specific The ‘coverage gap’ provides information on equity inequity (the shape of the curve) that have implications health policies affecting the continuum of care for in coverage within countries, as reflected in the for how programmes should be designed and targeted maternal, newborn and child health. The remainder of country profiles. The profiles show large intracountry to reduce inequities. this section summarises findings for each individual differences between the poorest quintile of the policy. population and the least poor quintile. In India (2006), In countries where the coverage gap is the highest Philippines (2003) and Peru (2000), for example, the – indicating low coverage (the upper red line in figure The International Code of Marketing of coverage gap was at least three times as large in the 3.15) – there is an almost linear relationship between Breastmilk Substitutes poorest as in the least poor quintile. Measured by increasing wealth and decreases in the coverage gap In 1981, as a minimum requirement to protect and absolute differences in coverage, the largest inequity except among the least poor, for whom coverage is promote breastfeeding, the World Health Organization for maternal, newborn and child health interventions much greater and the coverage gap much smaller. This member states almost unanimously adopted the and approaches is in Nigeria (2003), where the pattern has been termed ‘top inequity’, its unusual International Code of Marketing of Breastmilk difference between universal and current coverage for feature being the striking comparative superiority in Substitutes. As urged in the Global Strategy for Infant the eight interventions is 45 percentage points greater coverage for the least poor. To address such coverage and Young Child Feeding, governments should act for the poorest than for the least poor quintile.

TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT 40 41 and non-discrimination and rights to breastfeeding the seven signal functions (administer perenteral Notification of maternal death Progress on Three Key Policies breaks for nursing mothers. The Social Security antibiotics, perenteral oxytocics and perenteral Maternal death is a rare event. It is also a very (Minimum Standards) Convention, 1952 (No. 102), anticonvulsants, manually remove the placenta, sensitive indicator of the health system functionality. A is also relevant to maternal health, setting minimum remove retained products of conception, assist with national policy requiring specific notification of maternal requirements for the provision of health care during vaginal delivery and resuscitate newborns) and, if International Code of deaths can be a powerful instrument to examine the Marketing of Breastmilk pregnancy and confinement, cash maternity benefits needed, a comprehensive emergency obstetric care quality and responsiveness of health services and to 2005 Yes replacing lost income and minimum standards for facility that can also perform caesarean section and help identify critical barriers in the continuum of care. Partial access to preventive and curative health services in blood transfusion. International Code of No In this cycle of the Countdown, 23 countries reported Marketing of Breastmilk No data general. Conventions are binding in ratifying countries. having a policy requiring notification of maternal death, 2007 No. of To date, none of the 68 priority countries has ratified The availability of emergency obstetric care services 14 countries reported having a policy but no systematic countries Convention No. 183, while 21 have ratified one of provides one measurement of a health system’s implementation, and 18 countries reported having Low osmolarity ORS not included the earlier maternity protection conventions. Of the and zinc supplement for capacity to prevent both maternal and newborn no such policy. No information was available for 13 management of diarrhoea countries that have ratified none of the maternity deaths. For every 500,000 people it is recommended countries. protection conventions, five have ratified Convention to provide at least five basic emergency obstetric Low osmolarity ORS No. 102. care facilities, of which at least one should also offer and zinc supplement for Integrated management of childhood illness 65 management of diarrhoea comprehensive emergency obstetric care. The adapted to cover newborns 0–1 week old Forty-seven countries had not ratified any convention geographic distribution of such facilities should ensure Community management on maternity protection. Intensified advocacy is needed access for all women, not only those living in a few A cost-effective way to diagnose and treat children of pneumonia with with common illnesses, the integrated management antibiotics 2005 in this area. Measures stipulated under the Convention regions or urban centers. are critical for ensuring direct protection, maternity of childhood illness approach (IMCI) has been adopted Community management by over 100 countries. The first generic version of leave, cash and medical benefits, employment security The emergency obstetric care availability data in this of pneumonia with its guidelines was developed for children up to five antibiotics 2007 and non-discrimination for women and newborns. report come from government surveys conducted years of age; it did not address newborns in the first with support from agencies and organisations such 0 10 20 30 40 45 week of life. Based on new evidence, revised generic as UNICEF, the United Nations Population Fund, the Midwives authorised to administer a core set of guidelines have been promoted since 2006 to cover Source: Compiled by WHO and UNICEF, 2008 World Health Organization and the Averting Maternal life-saving interventions infants 0–2 months old.66 Figure 3.17. Progress in implementing three policies Midwives are the primary skilled care providers at Death and Disability Program at Columbia University. (International Code of Marketing of Breastmilk Substitutes, low The data are reported as percentages of needed osmolarity oral rehydration salts and zinc supplementation and birth in many countries. Often, though, they are not facilities based on country populations. Data on In this Countdown cycle, 39 of the 68 priority countries community treatment of pneumonia with antibiotics) in the 68 authorised to perform life-saving skills that can affect reported having national guidelines covering infants in Countdown priority countries (2005–2007) geographic distribution, though available for several the survival of the mother or her newborn. As early as the first week of life, in line with the generic guidelines. 1997 global guidelines called for authorising midwives, countries, are not reported. on the Code and on later World Health Assembly Three countries reported having partial adaptations for among others, to perform a set of signal functions.63 resolutions.60 young infants; 21 reported having no such adaptations. Essential care for women and newborns requires Twenty-seven countries had comparable data that the that midwives be authorised to administer perenteral Countdown could use. Of those 27, 11 had at least half By the end of 2007, 25 of the 68 Countdown priority antibiotics, perenteral oxytocics and perenteral of the recommended minimum number of functioning Low osmolarity oral rehydration salts and zinc countries had reported adopting legislation covering all anticonvulsants, to manually remove the placenta, to emergency obstetric care facilities. The remaining supplementation provisions of the International Code while 28 reported remove retained products of conception, to assist with 16 countries with comparable and usable data had Strong evidence demonstrating the effectiveness having legislation or voluntary agreements covering vaginal delivery and to resuscitate newborns. between 14 per cent and 48 per cent of the minimum. of both a new, low osmolarity formulation of oral some Code provisions. Another 13 countries had taken Even without knowing the geographical distribution rehydration solution (oral rehydration salts) and no action to adopt the Code and no information was Of the 68 Countdown priority countries, 27 reported of facilities within countries, one can see that a much zinc supplementation in reducing the duration and available for 2 countries. These data reflect marked having a policy authorising midwives to perform these greater investment is needed for emergency obstetric incidence and severity of diarrhoeal episodes resulted improvement since 2005, when the Countdown seven functions, 25 countries reported having a policy care services to reach all the women who need them. in an international call for action to countries to adopt reported that 15 of 60 countries had fully adopted the allowing midwives to perform part of them and 5 (Eighteen countries either had conducted smaller the new guidelines and intensify efforts to increase Code and 39 had adopted parts of it (figure 3.17).61 67 reported having no policy. For 11 countries no data assessments, had not yet analysed their data or had coverage for oral rehydration therapy. By the end of were available. conducted different types of facility surveys that were 2007, 34 Countdown priority countries had adopted The ILO Convention 183 on Maternity Protection not comparable. For 23 other countries no data were the new guidelines and 17 had adopted one of the available.) two improved interventions (either low osmolarity International labour standards on maternity protection Emergency obstetric care service availability are important to protect the maternal health of women oral rehydration salts or zinc supplementation but not Three-quarters of maternal deaths are caused by direct at work and to protect the employment of women All countries should be encouraged to conduct both), while 10 had not changed their policy to reflect obstetric complications including haemorrhage, sepsis, during maternity.62 Over the history of the International a national assessment and to routinely collect the new technical advances. That was a marked eclampsia and prolonged or obstructed labour.64 The Labour Organization, member states have adopted information on the signal functions and the availability, improvement from 2005, when just 6 of 50 priority occurrence of these life-threatening complications three Conventions on maternity protection (No. 3, functioning and quality of care at emergency obstetric countries had adopted the new policy and 36 reported is unpredictable and often unpreventable. But nearly 1919; No. 103, 1952; No. 183, 2000), progressively care facilities. It is expected that this set of indicators no policy (figure 3.17). all deaths from these causes can be averted through expanding the scope and entitlements of maternity will be integrated into national health information timely and appropriate intervention with quality protection at work. Convention No. 183 provides for systems so that the availability and quality of these Although it might be too early to find nationwide emergency obstetric care, including caesarean section. health protection at work, 14 weeks of maternity services can be monitored more regularly. increases in coverage for low osmolarity oral It is critical that all pregnant women have access leave, cash and medical benefits, employment security rehydration salts in countries that have updated their both to a basic emergency obstetric care facility for

TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT 42 43 policy, future progress should be tracked to assess health services, at least 2.5 health workers are needed whether and how policy changes can affect coverage per 1,000 people. Results from global databases that Official Development Assistance to Child and Maternal Health for an intervention. include both facility- and community-based health workers show that in 54 out of the 68 Countdown priority countries (80 per cent), the numbers of such Official development assistance to child health per Official development assistance to maternal and Community treatment of pneumonia with child (2005 dollars) newborn health per live birth (2005 dollars) antibiotics workers are too few to improve country prospects for Recipient country 2004 2005 2004 2005 achieving the health-related Millennium Development Afghanistan 5.51 8.6 4.30 8.43 Pneumonia remains the leading killer of children under Angola 7.12 11.34 10.28 16.11 Goals. five years of age.68 As table 3.5 shows, coverage Azerbaijan 1.24 3.87 4.61 2.18 Bangladesh 0.84 1.58 8.42 9.56 levels for careseeking and the treatment of pneumonia Benin 9.93 7.36 13.32 3.76 with an effective antibiotic are alarmingly low in most There is no demonstrated association between health Bolivia 9.67 6.43 22.74 11.04 worker density and coverage for interventions. But Botswana 1.50 0.05 2.43 0.45 of the 68 Countdown priority countries. Community Brazil 0.12 0.1 1.51 0.16 health workers can manage uncomplicated pneumonia these data show that many countries are facing a Burkina Faso 6.06 8.17 7.23 6.72 effectively and bring treatment closer to the home. health worker crisis that could obstruct coverage Burundi 6.19 8.57 5.32 5.73 increases. Cambodia 2.93 6.38 5.46 19.05 In 2004, the World Health Organization and UNICEF Cameroon 4.20 6.87 3.41 4.45 called on countries to adopt and promote policies that Central African Republic 8.57 6.72 9.14 5.49 Chad 4.34 4.22 3.11 5.41 would support community health workers in identifying Per capita total expenditure on health China 0.39 0.32 0.66 0.4 and treating pneumonia, while improving service at It has been estimated that less than $45 per capita Congo 12.13 2.42 4.28 2.73 first-level heath facilities.69 total expenditure on health is insufficient to ensure Congo, Democratic Republic of the 6.56 3.21 3.82 2.97 Cote D’Ivoire 3.98 2.9 1.53 1.63 access to a very basic set of needed services. Among Djibouti 7.42 24.89 18.03 22.27 In 2005, of 60 Countdown priority countries, 16 the 68 Countdown priority countries, 21 had a total per Egypt 0.72 1.26 0.35 3.3 had policies authorising community health workers capita expenditure smaller than $45. Equatorial Guinea 10.75 14.28 11.87 12.73 Eritrea 4.47 3.77 4.77 2.36 to identify and manage pneumonia; 2 had no Ethiopia 2.70 3.56 4.81 9.96 policies, but were implementing the approach in General expenditure on health as a percentage Gabon 11.04 17.09 15.57 20.65 selected geographic areas; 41 explicitly prohibited Gambia 7.50 17.79 5.80 11.05 of total expenditure Ghana 12.74 11.24 14.63 12.01 community-based pneumonia management (one This indicator reflects government commitment to Guatemala 2.04 3.41 10.53 14.49 country lacked data). For the 2008 Countdown, 18 Guinea 3.65 6.17 2.75 11.34 health. While there is no threshold, African heads of of 68 priority countries reported having community Guinea-Bissau 5.73 6.27 18.49 11.87 state have made a commitment to allocate at least 15 Haiti 8.57 4.18 7.86 15.53 case management policies; 11 reported having no India 0.90 1.1 1.78 3.24 per cent of the overall budget to health. An ideal target, policies, but some implementation of the approach Indonesia 1.15 1.11 4.25 2.8 it has only been achieved by 7 of the 68 Countdown Iraq 4.08 20.47 3.70 26.87 in selected areas; 31 reported having no policies or priority countries. Kenya 7.71 8.98 6.04 14.7 explicit prohibitions (figure 3.17). Country respondents Korea, Democratic Republic of 1.57 1.75 0.73 0.62 to the Countdown survey offered reasons for the lack Laos 3.93 8.41 8.66 17.88 Lesotho 9.50 4.77 13.32 5.01 of progress, focusing on the complexities of decisions Out-of-pocket expenditure as a percentage of Liberia 12.91 7.81 14.32 7.54 about which cadres of health providers would be total expenditure Madagascar 4.90 5.91 8.46 6.95 permitted to administer antibiotics. Very high out-of-pocket payments prevent many people Malawi 13.0 11.18 13.67 13.57 Mali 6.69 6.51 6.23 13 from seeking care. And they impoverish households. Mauritania 3.38 3.2 9.74 7.59 Where such payments comprise less than 15 per cent Mexico 0.17 0.12 0.81 0.51 Costed implementation plan Morocco 1.01 1.5 4.31 5.61 of total health spending, very few households tend For the 2008 Countdown, 31 countries reported having Mozambique 14.20 9.4 26.57 20.15 to be harmed by catastrophic payments. Of the 68 Myanmar 0.28 3.01 0.79 1.82 developed costed implementation plans for maternal, Countdown priority countries, only 6 have a rate of out- Nepal 5.25 3 11.96 3.39 newborn and child health; 18 countries reported Niger 4.15 5.32 2.77 5.32 of-pocket payments of less than 15 percent. having partial plans that were either not costed or did Nigeria 1.91 2.23 1.12 2.99 Pakistan 3.58 1.88 1.93 4.4 not cover the entire continuum of care; 14 countries Papua New Guinea 9.21 3.26 30.37 6.42 indicated having no such plans. Information was Financial flows to maternal, newborn and Peru 3.17 4.9 5.50 12.46 Philippines 0.97 0.4 1.51 1.58 not available for 5 countries. Interpretations of this child health Rwanda 13.91 13.47 14.47 12.68 indicator varied between countries, since in some an The Countdown Financial Flows Working Group Senegal 9.56 9.83 11.44 16.73 investment case has been made for achieving the Sierra Leone 5.79 5.48 5.30 5.64 developed two new indicators for use in monitoring Somalia 4.87 4.39 4.86 4.19 Millennium Development Goals while in others it has progress across the 68 priority countries: official South Africa 1.82 3.6 4.09 6.21 not. For countries in which it has not, the indicator Sudan 4.86 9.05 7.35 15.21 development assistance to child health per child Swaziland 3.24 15.09 1.56 1.41 was rated as full when medium-term plans and related and official development assistance to maternal and Tajikistan 6.55 4.83 5.09 5.19 programme costs were available. neonatal health per live birth. Both indicators are Tanzania 8.79 15.62 11.87 14.8 Togo 5.07 5.72 6.89 4.63 included in the 2008 country profiles, with estimates Turkmenistan 1.82 2.12 4.25 1.01 Human resources and financing for 2005. Uganda 11.09 9.89 6.59 8.4 Yemen 4.45 6.01 11.81 17.49 Density of health workers per 1,000 people Zambia 21.24 26.55 22.43 44.77 Zimbabwe 3.61 7.11 8.88 18.32 The World Health Organization estimates that to Source: Compiled by WHO, 2008 ensure adequate coverage for basic maternal and child Table 3.12. Official development assistance to child health per child and official development assistance to maternal and newborn health per live birth for the 68 Countdown priority countries (2004–2005)

TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT 44 45 The two new indicators are presented next to more visiting randomly selected villages and knocking on The continuum of care for maternal, newborn and Aid needs to increase and become more established general health expenditure indicators. doors to ask family members to participate in building child health requires multiple delivery approaches. predictable. Overseas development assistance to Unlike the coverage indicators, there is little agreement an information base sufficient to guide policy. The Progress towards the Millennium Development Goals child, newborn and maternal health increased by 28 on what makes a funding target desirable or adequate. answers have been recorded, checked, summarised, will require a range of interventions to be delivered percent from 2004 to 2005, including increases of 49 The evidence points broadly towards a substantial shared and interpreted in districts and capital cities in different points in the life-cycle. Services that per cent to child health and 21 per cent to maternal funding gap in maternal, newborn and child health in throughout the world. If there is a better way to do contribute to the achievement of one Millennium and newborn health. Such aid for maternal, newborn developing countries, which must be filled partly by things, let’s do it together – not just as a ‘community Development Goal will not necessarily advance and child health and nutrition has increased in most increased funding from donors.70 of practice,’ aiming at improving the health of women progress towards another. Of particular concern today Countdown priority countries, but has decreased in and children, but also as scientists wanting a fuller is a serious breakdown in the continuum of care some. Of the 68 countries, 38 received more per capita While acknowledging the unpredictability of understanding and as policy makers and programme at several points in the pre-pregnancy to two-year official development assistance to child health, and 39 international aid, the authors of this report make a managers hoping to learn more about how to make postnatal period when opportunities to deliver essential received more to maternal and newborn health per live tentative assessment of progress to increase official programmes and services more effective. services are being lost. birth, in 2005 than in 2004. development assistance to maternal, newborn and child health by making a comparison across years. The Countdown is an informal ‘community of practice’ Undernutrition is an area of little or no progress. Countries need more and better coverage Table 3.12 presents estimates of the two official that brings together information and interprets it More than one-third of deaths in children under age estimates and research on local implementation. development assistance indicators by country for for several purposes: for science, for policy and five are attributable to undernutrition – the underlying Since the first Countdown report in 2005, an 2004–2005, expressed in constant 2005 dollars. The governance, for better development assistance and cause of 3.5 million child deaths annually. And unprecedented amount of household surveys have volume of official development assistance to child, for easier access and ownership by women and maternal undernutrition increases the mother’s risk of been conducted and include new MICS data from newborn and maternal health increased by 28 per cent children. Any conclusions drawn from the information death at delivery, accounting for at least 20 per cent 54 countries and new DHS data for 35 countries. worldwide in 2005, representing increases of 49 per in these pages is in a sense premature, since a full of such deaths.72 In 33 of the 68 priority countries, However, many countries are still determining cent in official development assistance to child health understanding requires more input from those working at least 20 percent of children are moderately or coverage levels for essential interventions using data and 21 per cent in official development assistance to to achieve high, sustained and equitable coverage in severely underweight, and 62 countries have stunting that is 5, 10 or even 15 years old. In consequence, maternal and newborn health. Of the 68 Countdown individual countries, districts and communities. But the prevalence rates exceeding 20 per cent. the knowledge gained through current and ongoing countries, 38 experienced increases in official community of practice also includes those responsible efforts to promote maternal, newborn and child health development assistance to child health per capita for the international Countdown movement. In that Weak health systems and broader contextual and nutrition has not been adequately disseminated. in 2005; 39 countries also saw official development spirit we present a summary of what we see as factors obstruct progress. Health systems in many The Countdown is drawing attention to the fact that assistance to maternal and newborn health per live the most important conclusions of this Countdown countries cannot now deliver essential interventions data collection and dissemination need improvement birth rise from 2004–2005. The Countdown Financial cycle and what those conclusions might mean for and approaches widely or well enough to reduce to make timely data more readily available, which is Flows Working Group is doing further statistical the immediate next steps towards the health-related mortality nationwide. Indicators of health financing crucial for planning and implementation. analysis of aid flow determinants. Millennium Development Goals. and health worker density are useful markers of health system strength. Of the 68 Countdown priority Conclusions and recommendations Country representatives who participate in the April, countries, 54 – or 80 percent – have workforce 2008 Countdown conference in Cape Town, South densities below the critical threshold for improved This second Countdown report, issued three Africa will issue a statement. We see that statement prospects for achieving the health-related Millennium years after the first report of findings at the 2005 as a companion to this section and an essential Development Goals. It has been estimated that annual conference,71 documents what can be done and what complement to the remainder of the chapter. per capita total health expenditures of less than $45 needs to be done. Coverage for selected interventions are insufficient to ensure access to a very basic set – such as vitamin A supplementation and the use of needed services. Of the 68 priority countries, of insecticide-treated bed nets to prevent malaria Preliminary conclusions proposed by the 21 had less than $45. In addition, 11 out of the 14 – has increased rapidly in many countries, but not in Countdown Core Group countries with reversed progress towards Millennium all. And coverage levels for other interventions have Development Goal 4, contextual challenges – such stagnated or even deteriorated. Examining country-by- Countries, while rapidly increasing coverage as armed conflict, high HIV burdens and low female country progress can yield important knowledge about for some interventions, are making little or no literacy rates – contribute to stagnating or deteriorating hindrances to progress, spurring further action. progress with others. Coverage trends are most coverage. promising for many preventive interventions, such as The power of the Countdown depends on the quality vitamin A supplementation, immunisation (including Inequities obstruct progress. Mortality in children of the coverage data in the priority countries. Let us measles, neonatal tetanus protection, Hib3 and DPT3) under age five is now concentrated in sub-Saharan be the first to say that many improvements can and and insecticide-treated bed nets to prevent malaria. But Africa (almost 50 per cent) and South Asia (30 per should be made in defining indicators, measuring them progress is lagging for most curative interventions and cent).73 Maternal and newborn mortality are similarly and interpreting the results. We, better than most, interventions requiring 24-hour service availability, such concentrated in those regions. Meanwhile, the inequity recognise that there is an urgent technical agenda as antenatal, postnatal and delivery care or treatment analyses show that within countries the richest to be pursued in strengthening the measurement of for pneumonia, diarrhoea and malaria. Postnatal care quintile is gaining access to key interventions more coverage. But do the methodological weaknesses is an especially important gap in the first week of life quickly than the poorest.74 Reducing both types of invalidate the massive amounts of information when mothers and newborns are at the highest risk. inequity – between regions and within countries – is a presented in the country profiles? We believe not. Progress on nutrition indicators requiring behavioural crucial part of achieving the health-related Millennium Millions of person-hours have been invested in defining and social change – such as exclusive breastfeeding Development Goals. measurement strategies, developing protocols, and complementary feeding practices – is mixed and often insufficient.

TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT 46 47 The Countdown call to action Notes 44 WHO and UNICEF 2003. 45 Set geographic and population priorities, and 1 United Nations 2008a. All people involved in the Countdown, who together • Boerma, Bryce, Kinfu and others (forthcoming). stick to them. The health-related Millennium 46 WHO 2007a. constitute a ‘community of practice’ for achieving 2 Graham, Bell and Bullough 2001, pp.97–129; WHO, UNICEF, UNFPA Development Goals cannot be met globally without and AMDD 2006. the health-related Millennium Development Goals, 47 UNICEF and Roll Back Malaria 2007. are encouraged to use the Countdown results and faster progress in sub-Saharan Africa and South 3 UNICEF 2007b. 48 Graham, Bell and Bullough 2001, pp.97-129; WHO, UNICEF, UNFPA Asia. Development efforts and official development and AMDD 2006. products to improve their effectiveness in reducing 4 Lawn, Cousens and Zupan 2005.

mortality and improving nutrition among women, assistance must increasingly target countries in 49 5 UNICEF 2007b. newborns and children – each in their own way, these regions with large populations and poor Ibid. 50 UNICEF, WHO and UNFPA 1997. applying their diverse skills and resources. performance. 6 Stanton, Lawn, Rahman and others 2006. 51 Villar, Carroli and Zavaleta 2007. 7 Black, Allen, Bhutta and others 2008. 52 Lawn, Cousens and Zupan 2005. Participants in this round of data review for the • Programme for equity. Describing inequities, 8 World Bank 2006. Countdown effort identified the following immediate 53 Darmstadt, Bhutta, Cousens 2005. though an important first step, is not enough. 9 United Nations n.d. actions to be promoted and discussed at the second Programmatic efforts to address inequities must 54 Bacqui, Ahmed, Arifeen and others n.d. 10 Black, Allen, Bhutta and others 2008. international Countdown conference, Cape Town, be supported by strong monitoring and evaluation 55 Bacqui, Ahmed, Arifeen and others 2007. South Africa, 17–19 April 2008. 11 Ibid. activities. 56 Lawn, and Kerber 2006. 12 WHO 2006a. 57 Tinker, ten Hoope-Bender, Azfar and others 2005; Kerber, de Graft- • Sustain and expand successful efforts to 13 Bhutta, Ahmed, Black and others 2008. • Do even more to ensure predictable long- Johnson, Bhutta and others 2007. achieve high and equitable coverage for priority , newborn and child 14 term aid flows for maternal Black, Allen, Bhutta and others 2008. 58 interventions. Recent areas of progress – especially Travis, Bennett, Haines and others 2004. health. Governments and their development 15 Blanc and Wardlaw 2005. 59 immunisations, vitamin A supplementation and partners cannot meet the health-related Millennium UNICEF 2007b. 16 UNICEF and WHO 2004. insecticide-treated bed nets – represent a major Development Goals unless assistance is adequate, 60 WHO and UNICEF 2003. 17 UNICEF 2007c. success for governments and their development predictable and targeted to those goals. 61 Bryce, Terreri, Victora 2006. partners. Such efforts should continue. But 18 Victora, Adair, Fall and others 2008. 62 ILO 2007. comparable efforts and investments are required 19 • Monitor. Evaluate. Conduct locally driven UNICEF n.d. 63 for childbirth care and the case management of UNICEF, WHO and UNFPA 1997. implementation research. And act on the results. 20 Measure DHS, MACRO International, Inc. n.d. childhood illness. 64 Khan, Wojdyla, Say and others 2006; Ronsmans and Graham 2006. The ‘community of practice’ for maternal, newborn 21 Bryce, Coitinho, Darnton-Hill and others 2008. 65 and child health must lead the change by improving UNICEF, WHO and UNFPA 1997. 22 WHO and UNICEF 2003. • Focus on the priority period within the monitoring, evaluation and dissemination. 66 The Young Infants Clinical Signs Study Group 2008. 23 Bhutta, Ahmed, Black and others 2008. continuum of care, from pre-pregnancy through 67 WHO and UNICEF 2004. 24 months – especially around the time of birth. To 24 Black, Allen, Bhutta and others 2008. • Lead the change for maternal, newborn 68 Wardlaw, Salama, Johansson and others 2006. reduce mortality during childbirth and in newborns, 25 and child survival. It is time for all to work Bhutta, Ahmed, Black and others 2008. 69 programming efforts must focus on the effective WHO and UNICEF 2006. together as partners to improve the lives 26 Black, Allen, Bhutta and others 2008. 70 Johns, Sigurbjörnsdóttir, Fogstad and others 2007; Stenberg, Johns, and integrated delivery of interventions and of women, newborns and children. 27 Bhutta, Ahmed, Black and others 2008; Bryce, Coitinho, Darnton-Hill Scherpbier and others 2007; Greco, Powell-Jackson, Borghi and approaches associated with this crucial period. and others 2008. others (forthcoming). Examples include contraceptive services, antenatal, 71 28 Arimond, Daelmans and Dewey 2008. Bryce, Terreri, Victora and others 2006.

delivery, and postnatal care and infant feeding 72 29 UNICEF 2007c. Black, Allen, Bhutta and others 2008. practices. 73 30 UNICEF 2007d. UNICEF 2007b.

74 • Within increased efforts to achieve the health- 31 Dabbagh, Gacic-Dobo, Wolfson and others 2007. Victora, Wagstaff, Armstrong-Schellenberg and others 2003. related Millennium Development Goals, make 32 UNICEF 2007b.

improving maternal and child nutrition a priority. 33 Ibid. Nutrition must be central to both national and 34 WHO 2006b. subnational development strategies. 35 Waddington, Martin, Walford and others 2005.

36 • Strengthen health systems, focusing on WHO 2007a. measurable results. Health systems need to deliver 37 UNICEF and Roll Back Malaria 2007. on demand, creating a functional continuum of care 38 UNICEF 2007b

over time and in different places. All new initiatives 39 Ibid. must focus on outcomes that measurably advance 40 UNICEF 2006a; Wardlaw, Salama, Johansson and others 2006. this aim. 41 Bryce, Boschi-Pinto, Shibuya and others 2005; WHO 2007b.

42 Bryce, Boschi-Pinto, Shibuya and others 2005.

43 Cleland, Bernstein, Ezeh and others 2006.

TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT 48 49 The country profiles

Chapter 4 introduces the individual country profiles. Guatemala 4 These profiles represent the basic information to be Guinea analysed at Countdown conferences, and evidence for Guinea-Bissau assessing progress since the firstCountdown Report in Haiti 2005. Each profile presents the most recent available India information on selected demographic measures of Indonesia maternal, newborn and child survival and nutritional Iraq status, coverage rates for priority interventions, and Kenya selected indicators of equity, policy support, human Korea, Democratic People’s Republic of resources and financial flows. Lao People’s Democratic Republic Lesotho The information summarised in these pages is Liberia intended to help policy makers and their partners Madagascar assess progress and prioritise actions in the effort Malawi to reduce maternal, newborn and child mortality. Mali Mauritania Afghanistan Mexico Angola Morocco Azerbaijan Mozambique Bangladesh Myanmar Benin Nepal Bolivia Niger Botswana Nigeria Brazil Pakistan Burkina Faso Papua New Guinea Burundi Peru Cambodia Philippines Cameroon Rwanda Central African Republic Senegal Chad Sierra Leone China Somalia Congo South Africa Congo, Democratic Republic of the Sudan Côte d’Ivoire Swaziland Djibouti Tajikistan Egypt Tanzania, United Republic of Equatorial Guinea Togo Eritrea Turkmenistan Ethiopia Uganda Gabon Yemen Gambia, The Zambia

Ghana Zimbabwe © UNICEF/HQ06-0152/Michael Kamber TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT 50 51 Afghanistan DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 26,088 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Asia, 1997-2002 Total under-five population (000) 4,823 (2006) undernutrition Unmet need for family planning (%) --- Births (000) 1,272 (2006) 260 Malaria Injuries Causes of neonatal Abortion Measles 1% 1% 6% Contraceptive 250 deaths prevalence rate 10 Pre-pregnancy (2006) 257 6% Antenatal visits for woman (4 or more visits, %) --- Obstructed labor Birth registration (%) 6 Diarrhoea HIV/AIDS Diarrhoea 5% Other 6% 9% Antenatal visit 19% 0% 16 Pregnancy Under-five mortality rate (per 1000 live births) 257 (2006) 200 Congenital 7% Intermittent preventive treatment for malaria (%) --- (1 or more) Hypertensive Tetanus 10% Haemorrhage Skilled attendant Infant mortality rate (per 1000 live births) 165 (2006) disorders 14 Birth 150 (total, urban, rural; %) 31% at birth Preterm 17% C-section rate 9% Neonatal mortality rate (per 1000 live births) 60 (2000) Other Neonatal (Minimum target is 5% and maximum target is 15%) ---, ---, --- *Postnatal care 100 22% 26% Neonatal period Total under-five deaths (000) 327 (2006) 87 Asphyxia 20% Sepsis/Infections, Early initiation of breastfeeding (within 1 hr of birth, %) --- including AIDS Exclusive Infancy Maternal mortality ratio (per 100,000 live births) 1,800 (2005) 50 MDG Target 12% breastfeeding Postnatal visit for baby (within 2 days for home births, %) --- Other causes Lifetime risk of maternal death (1 in N) 8 (2005) Infection 36% Anaemia Measles 68 0 Pneumonia 21% 26,000 (2005) 25% 13% Total maternal deaths 1990 1995 2000 2005 2010 2015 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 59 (2004) Complementary feeding rate (6-9 months, %) 29 (2003) 100 100 100 88 Wasting prevalence (moderate and severe, %) 8 (2004) Low birthweight incidence (%) --- 80 80 80 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent 40 37 Percent 40 Percent 40 At least one dose Two doses 96 95 16 100 100 20 20 12 14 20 84 84 86 78 95 80 80 70 85 91 0 0 2000 2003 2000 2003 1980 1985 1990 1995 2000 2006 76 MICS MICS MICS MICS 60 60 67 Source: WHO/UNICEF No data 58 Percent 40 37 35 Percent 40

20 20 WATER AND SANITATION EQUITY 0 0 0 2000 2004 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile MICS Other NS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 CHILD HEALTH 80 80 63 60 60 Immunization Malaria prevention Prevention of mother to child 49 No data Percent of children immunised against measles Percent children < 5 years sleeping under ITNs

transmission of HIV Percent 39 Percent Percent of children immunised with 3 doses DPT 40 40 34 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 31 29 20 20 10 7 100 3 4 2 3 0 0 1990 2004 1990 2004 80 77 68 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 No data No data Percent 40 POLICIES SYSTEMS 20 Coverage gap (%) No data International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 Substitutes Partial Ratio 1990 1995 2000 2005 2006 Per capita total expenditure on health (US$) 19 (2007) poorest/wealthiest Source: WHO/UNICEF New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Partial % of total government expenditure (%) 2 (2007) poorest-wealthiest (%) Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics Yes Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 81 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age No antibiotics Density of health workers (per 1000 population) 0.4 (2001) 100 100 Costed implementation plan(s) for maternal, newborn and child health available Yes Official Development Assistance to child health 80 80 per child (US$) 9 (2005) Midwives be authorised to administer a core set of 60 60 life saving interventions Yes Official Development Assistance to maternal and 48 No data neonatal health per live birth (US$) 8 (2005) Afghanistan Percent 40 Percent 40 Maternity protection in accordance with ILO 28 Convention 183 No National availability of Emergency Obstetric Care 20 20 services (% of recommended minimum) --- Specific notification of maternal deaths No 0 0 2003 2003 Countdown to 2015 MICS MICS 2008 Report Angola DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 16,557 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 3,082 (2006) undernutrition Unmet need for family planning (%) --- (000) 792 (2006) 260 260 Causes of neonatal Births Injuries Pneumonia Obstructed labor Contraceptive 250 deaths Abortion 6 Pre-pregnancy 1% 25% Diarrhoea 5% Antenatal visits for woman (4 or more visits, %) --- Anaemia 4% 4% prevalence rate Birth registration (%) 29 (2006) HIV/AIDS Congenital 5% 4% Antenatal visit (per 1000 live births) 260 (2006) 200 2% Tetanus 6% (1 or more) 66 Pregnancy Under-five mortality rate Other 7% Intermittent preventive treatment for malaria (%) --- Measles Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 154 (2006) disorders Haemorrhage 45 Birth 150 5% Asphyxia 24% C-section rate (total, urban, rural; %) at birth 9% 34% Neonatal mortality rate (per 1000 live births) 54 (2000) Neonatal (Minimum target is 5% and maximum target is 15%) ---, ---, --- 100 Malaria 22% *Postnatal care Neonatal period Total under-five deaths (000) 206 (2006) Sepsis/Infections, 8% Preterm 25% (within 1 hr of birth, %) Exclusive 87 Early initiation of breastfeeding --- including AIDS 11 Infancy Maternal mortality ratio (per 100,000 live births) 1,400 (2005) 50 breastfeeding MDG Target Other 16% Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 12 (2005) 17% Infection 29% Measles 48 0 Diarrhoea Other causes 11,000 (2005) 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 19% 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 51 (2001) Complementary feeding rate (6-9 months, %) 77 (2001) 100 100 100 Wasting prevalence (moderate and severe, %) 8 (2001) Low birthweight incidence (%) 12 (2000) 80 80 80 80 66 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 60 45 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent Percent Percent 40 40 40 At least one dose Two doses 23 100 100 100 88 20 20 20 94 100 75 77 79 80 80 80 68 0 0 64 65 2001 1996 2001 1983 1988 1993 1998 2003 2006 MICS MICS MICS 60 60 60 68 Source: WHO/UNICEF Percent 40 37 Percent 40 Percent 40 28

20 20 11 20 0 WATER AND SANITATION EQUITY 0 0 0 0 0 0 1996 2001 2001 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile MICS MICS MICS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 100 CHILD HEALTH 80 75 80 80 61 56 Immunization Malaria prevention Prevention of mother to child 60 53 60 60 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs

Percent 40 Percent Percent Percent of children immunised with 3 doses DPT transmission of HIV 40 40 36 40 31 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 29 23 20 20 18 16 20 100 25 0 0 0 80 20 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 15 14 2001 48 No data MICS Percent 40 44 Percent 10 POLICIES SYSTEMS 20 5 3 Coverage gap (%) 55 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 Substitutes No Ratio 1990 1995 2000 2005 2006 2005 2006 Per capita total expenditure on health (US$) 38 (2007) poorest/wealthiest 1.6 Source: WHO/UNICEF Other NS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea No % of total government expenditure (%) 4 (2007) poorest-wealthiest (%) 25 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics No Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 21 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age No antibiotics Density of health workers (per 1000 population) 1.4 (2004) 100 100 Costed implementation plan(s) for maternal, newborn and child health available Partial Official Development Assistance to child health 80 80 per child (US$) 11 (2005) Midwives be authorised to administer a core set of 58 60 60 life saving interventions Yes Official Development Assistance to maternal and neonatal health per live birth (US$) 16 (2005) Angola

Percent No data Percent 40 32 40 Maternity protection in accordance with ILO Convention 183 No National availability of Emergency Obstetric Care 20 20 services (% of recommended minimum) --- Specific notification of maternal deaths Yes 0 0 2001 2001 Countdown to 2015 MICS MICS 2008 Report Azerbaijan DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 8,406 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Asia, 1997-2002 Total under-five population (000) 547 (2006) undernutrition Unmet need for family planning (%) 12 (2001) 105 Injuries Malaria Causes of neonatal Abortion Births (000) 129 (2006) Measles Contraceptive 1% 1% 0% deaths 6% 55 100 (1996-2001) Obstructed labor prevalence rate Pre-pregnancy Birth registration (%) 97 (2006) Diarrhoea Diarrhoea 2% Antenatal visits for woman (4 or more visits, %) 30 HIV/AIDS Other 6% 9% Antenatal visit 15% 70 Pregnancy Under-five mortality rate (per 1000 live births) 88 (2006) 80 88 0% Congenital 11% Intermittent preventive treatment for malaria (%) --- (1 or more) Hypertensive Haemorrhage Skilled attendant Infant mortality rate (per 1000 live births) 73 (2006) disorders 100 Birth 60 Infection 20% (total, urban, ; %) 31% at birth C-section rate rural 9% Neonatal mortality rate (per 1000 live births) 36 (2000) Neonatal (Minimum target is 5% and maximum target is 15%) 3, 4, (2001) 1 *Postnatal care Neonatal period 44% Asphyxia 22% Total under-five deaths (000) 11 (2006) 40 Sepsis/Infections, 35 Early initiation of breastfeeding (within 1 hr of birth,%) --- including AIDS Exclusive breastfeeding 7 Infancy Maternal mortality ratio (per 100,000 live births) 82 (2005) 20 MDG Target Pneumonia 12% 18% Preterm 35% Postnatal visit for baby (within 2 days for home births ,%) --- Other causes Lifetime risk of maternal death (1 in N) 670 (2005) Anaemia Measles 96 0 Other 21% 110 (2005) 20% 13% Total maternal deaths 1990 1995 2000 2005 2010 2015 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy 100 100 100 100 Stunting prevalence (moderate and severe, %) 18 (2001) Complementary feeding rate (6-9 months, %) 39 (2000) 100 100 84 88 Wasting prevalence (moderate and severe, %) 3 (2001) Low birthweight incidence (%) 12 (2001) 80 80 66 70 60 60 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation No data Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent Percent 40 40 At least one dose Two doses 100 100 100 20 20

80 80 80 0 0 2000 2001 1998 2000 2001 2002 2003 2004 60 60 60 MICS Other NS Other NS MICS Other NS Other NS Other NS Other NS Percent Percent Percent 40 40 40 29 14 20 14 20 20 29 WATER AND SANITATION EQUITY 6 8 7 0 0 0 0 0 0 0 0 0 2000 2001 2006 2000 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile MICS Other NS DHS MICS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 95 100 100 CHILD HEALTH 82 80 80 73 80 68 77 59 Immunization Malaria prevention Prevention of mother to child 60 51 60 54 60 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs*

transmission of HIV Percent Percent Percent Percent of children immunised with 3 doses DPT 40 40 36 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 20 20 20 96 100 100 0 0 0 95 80 80 1990 2004 2004 Poorest 2nd 3rd 4th Wealthiest Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 60 2000 No data MICS Percent 40 Percent 40 POLICIES SYSTEMS 20 20 Coverage gap (%) 51 1 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 Substitutes Partial Ratio 1990 1995 2000 2005 2006 2000 Per capita total expenditure on health (US$) 138 (2007) poorest/wealthiest 1.2 Source: WHO/UNICEF MICS New ORS formula and zinc for management of *Very limited risk of malaria transmission General government expenditure on health as Difference diarrhoea No % of total government expenditure (%) 3 (2007) poorest-wealthiest (%) 9 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials* Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics Partial Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 70 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age No antibiotics Density of health workers (per 1000 population) 11.8 (2003) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available No Official Development Assistance to child health 80 80 80 per child (US$) 4 (2005) Midwives be authorised to administer a core set of 60 60 60 life saving interventions Partial Official Development Assistance to maternal and neonatal health per live birth (US$) 2 (2005) 40 Azerbaijan Percent 40 Percent 40 Percent 40 36 Maternity protection in accordance with ILO Convention 183 Partial National availability of Emergency Obstetric Care 20 20 20 services (% of recommended minimum) --- 1 Specific notification of maternal deaths Yes 0 0 0 2000 2000 2000 Countdown to 2015 MICS MICS MICS *Very limited risk of malaria transmission 2008 Report Bangladesh DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 155,991 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Asia, 1997-2002 Total under-five population (000) 18,951 (2006) undernutrition Unmet need for family planning (%) 11 (2004) Measles Malaria Causes of neonatal Abortion Births (000) 4,013 (2006) Injuries Contraceptive 149 2% 1% deaths 6% 58 150 3% (4 or more visits, %) (2004) Obstructed labor prevalence rate Pre-pregnancy Birth registration (%) 10 (2006) HIV/AIDS Antenatal visits for woman 16 Other 9% Antenatal visit 0% 48 Pregnancy Under-five mortality rate (per 1000 live births) 69 (2006) 120 11% Intermittent preventive treatment for malaria (%) --- (1 or more) Hypertensive Haemorrhage Skilled attendant Infant mortality rate (per 1000 live births) 52 (2006) disorders 20 Birth 90 (total, urban, ; %) 31% at birth 69 C-section rate rural 9% Neonatal mortality rate (per 1000 live births) 36 (2000) Neonatal (Minimum target is 5% and maximum target is 15%) 4, 11, 2 (2004) 50 45% No data *Postnatal care 20 Neonatal period Total under-five deaths (000) 277 (2006) 60 Sepsis/Infections, Early initiation of breastfeeding (within 1 hr of birth, %) 36 (2006) including AIDS Exclusive Pneumonia breastfeeding 37 Infancy Maternal mortality ratio (per 100,000 live births) 570 (2005) 30 MDG Target 18% 12% Postnatal visit for baby (within 2 days for home births, %) 22 (2007) Other causes Lifetime risk of maternal death (1 in N) 51 (2005) Anaemia Measles 81 0 Diarrhoea 21% 21,000 (2005) 20% 13% Total maternal deaths 1990 1995 2000 2005 2010 2015 0 20 40 60 80 100 Source: UNICEF, 2006 Source: WHO, 2006 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 51 (2004) Complementary feeding rate (6-9 months, %) 52 (2006) 100 100 100 92 Wasting prevalence (moderate and severe, %) 15 (2004) Low birthweight incidence (%) 22 (2006) 80 80 80

60 60 60 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 49 48 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent Percent 40 40 Percent 40 33 40 40 At least one dose Two doses 26 26 20 100 100 100 90 87 20 20 12 12 14 13 20 99 85 84 83 83 10 8 80 80 80 90 87 0 0 85 83 82 79 1993-941996-971999-00 2001 2003 2004 2006 1993-941996-971999-00 2001 2003 2004 2006 1980 1985 1990 1995 2000 2006 DHS DHS DHS Other NS MICS DHS MICS DHS DHS DHS Other NS MICS DHS MICS 60 60 60 Source: WHO/UNICEF 43 46 45 46 Percent Percent 40 39 40 36 37 Percent 40

20 20 20 0 WATER AND SANITATION EQUITY 0 0 0 2004 2005 1993-94 1996-97 1999-00 2004 2006 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile DHS Other NS DHS DHS DHS DHS MICS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 100 CHILD HEALTH 83 82 80 74 80 80 69 72 72 55 Immunization Malaria prevention Prevention of mother to child 60 60 51 60 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs

transmission of HIV Percent Percent 39 Percent Percent of children immunised with 3 doses DPT 40 40 35 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 20 20 20 12 20 100 88 0 0 0 80 81 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 No data No data 1997 2000 2004 2007 DHS DHS DHS MICS Percent 40 POLICIES SYSTEMS 20 Coverage gap (%) 50 48 41 38 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 Substitutes Partial Ratio 1990 1995 2000 2005 2006 Per capita total expenditure on health (US$) 64 (2007) poorest/wealthiest 1.7 1.9 2.0 Source: WHO/UNICEF New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Partial % of total government expenditure (%) 6 (2007) poorest-wealthiest (%) 24 27 27 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics Partial Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 63 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 0.6 (2004) 100 100 Costed implementation plan(s) for maternal, newborn and child health available Partial Official Development Assistance to child health 80 80 per child (US$) 2 (2005) Midwives be authorised to administer a core set of 60 53 60 life saving interventions Yes Official Development Assistance to maternal and 49 neonatal health per live birth (US$) 10 (2005) No data Bangladesh Percent Percent Maternity protection in accordance with ILO 40 35 40 33 28 27 30 Convention 183 No National availability of Emergency Obstetric Care 20 22 20 20 services (% of recommended minimum) 54 (2007) Specific notification of maternal deaths Partial 0 0 1999-2000 2004 2006 1993-94 1996-97 1999-00 2004 2006 Countdown to 2015 DHS DHS MICS DHS DHS DHS DHS MICS 2008 Report Benin DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 8,760 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 1,488 (2006) undernutrition Unmet need for family planning (%) 27 (2001) Causes of neonatal Births (000) 358 (2006) Other Obstructed labor Contraceptive 200 185 Injuries deaths Abortion 17 Pre-pregnancy 0% Malaria Diarrhoea 2% Antenatal visits for woman (4 or more visits, %) 62 (2001) Anaemia 4% prevalence rate Birth registration (%) 70 (2006) 2% 4% 27% Tetanus 4% 4% Antenatal visit 148 Other 5% 88 Pregnancy Under-five mortality rate (per 1000 live births) 148 (2006) 160 HIV/AIDS Intermittent preventive treatment for malaria (%) 3 (2006) (1 or more) 2% Congenital 8% Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 88 (2006) disorders Haemorrhage 78 Birth 120 Measles Asphyxia 19% C-section rate (total, urban, rural; %) at birth 9% 34% Neonatal mortality rate (per 1000 live births) 38 (2000) 5% Neonatal (Minimum target is 5% and maximum target is 15%) 3, 6, 2 (2001) 80 62 25% *Postnatal care Neonatal period Total under-five deaths (000) 53 (2006) Preterm 28% Sepsis/Infections, Exclusive Early initiation of breastfeeding (within 1 hr of birth, %) 49 (2001) including AIDS 70 Infancy Maternal mortality ratio (per 100,000 live births) 840 (2005) breastfeeding 40 MDG Target 16% Diarrhoea Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 20 (2005) Infection 34% Measles 89 0 17% Pneumonia Other causes 2,900 (2005) 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 21% 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy 100 100 100 Stunting prevalence (moderate and severe, %) 44 (2006) Complementary feeding rate (6-9 months, %) 50 (2006) 88 80 81 94 Wasting prevalence (moderate and severe, %) 9 (2006) Low birthweight incidence (%) 16 (2001) 80 80 78 80 66 66 60 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent Percent Percent 40 40 40 At least one dose Two doses 94 94 100 100 100 98 20 20 20 100 85 96 95 95 89 92 80 80 70 80 0 0 1996 2001 2006 1996 2001 2006 1986 1991 1996 2001 2006 56 DHS DHS DHS DHS DHS DHS 60 60 60 Source: WHO/UNICEF Percent 40 Percent 40 38 Percent 40 22 20 20 20 10 20 WATER AND SANITATION EQUITY 0 0 0 0 0 0 0 2001 2006 1996 2001 2006 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile DHS DHS DHS DHS DHS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 100 CHILD HEALTH 78 80 73 80 80 67 63 59 Immunization Malaria prevention Prevention of mother to child 60 57 57 60 60 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs

transmission of HIV Percent Percent Percent Percent of children immunised with 3 doses DPT 40 40 32 33 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 20 20 12 11 20 100 93 100 100 2 93 0 0 0 80 89 80 80 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 60 60 53 1996 2001 DHS DHS Percent 40 Percent 40 Percent 40 27 POLICIES SYSTEMS 20 20 20 20 7 Coverage gap (%) 48 41 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 0 Substitutes Yes Ratio 1990 1995 2000 2005 2006 2001 2006 2005 2006 Per capita total expenditure on health (US$) 40 (2007) poorest/wealthiest 1.9 1.7 Source: WHO/UNICEF DHS MICS Other NS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Yes % of total government expenditure (%) 10 (2007) poorest-wealthiest (%) 29 22 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics Partial Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 49 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 0.9 (2004) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available Yes Official Development Assistance to child health 80 80 80 per child (US$) 7 (2005) Midwives be authorised to administer a core set of 60 60 60 54 60 life saving interventions Partial Official Development Assistance to maternal and (US$) (2005) 42 neonatal health per live birth 4 Benin Percent Percent Percent 35 Maternity protection in accordance with ILO 40 40 40 32 23 Convention 183 No National availability of Emergency Obstetric Care 20 20 20 services (% of recommended minimum) 66 (2002) Specific notification of maternal deaths Yes 0 0 0 1996 2001 2001 2006 1996 2001 Countdown to 2015 DHS DHS DHS DHS DHS DHS 2008 Report Bolivia DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 9,354 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Latin America, 1997-2002 Total under-five population (000) 1,243 (2006) undernutrition Unmet need for family planning (%) 23 (2003) Sepsis/Infections, Anaemia Births (000) 264 (2006) Injuries Malaria Measles Causes of neonatal 0% including AIDS 0% Contraceptive 150 5% 1% deaths prevalence rate 58 Pre-pregnancy Birth registration (%) 82 (2006) HIV/AIDS Diarrhoea 2% Antenatal visits for woman (4 or more visits, %) 58 (2003) 8% 125 Diarrhoea 14% 0% Tetanus 2% Antenatal visit Under-five mortality rate (per 1000 live births) 61 (2006) 120 Other 8% Hypertensive (1 or more) 79 Pregnancy Congenital 9% Intermittent preventive treatment for malaria (%) --- Abortion disorders Pneumonia 12% Skilled attendant Infant mortality rate (per 1000 live births) 50 (2006) 26% 67 Birth 90 17% Infection 23% C-section rate (total, urban, rural; %) at birth Neonatal mortality rate (per 1000 live births) 27 (2000) 61 Neonatal (Minimum target is 5% and maximum target is 15%) 15,21,6 (2003) 60 38% *Postnatal care Neonatal period Total under-five deaths (000) 16 (2006) 42 Obstructed labor Asphyxia 26% (within 1 hr of birth, %) (2003) Exclusive Early initiation of breastfeeding 61 13% 54 Infancy Maternal mortality ratio (per 100,000 live births) 290 (2005) breastfeeding 30 MDG Target Haemorrhage Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 89 (2005) 21% Measles 81 0 Other Preterm 31% Other causes 760 (2005) 25% 21% Total maternal deaths 1990 1995 2000 2005 2010 2015 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 33 (2003) Complementary feeding rate (6-9 months, %) 74 (2003) 100 100 100 83 79 Wasting prevalence (moderate and severe, %) 2 (2003) Low birthweight incidence (%) 7 (2003) 80 80 80 71 69 69 65 67 59 60 60 60 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 46 53 47 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses 43 Percent Percent Percent 40 40 40 At least one dose Two doses 100 100 100 20 20 20 85 80 80 80 73 0 0 1989 1994 1998 2000 2003 1989 1994 1998 2000 2002 2003 1987 1992 1997 2002 2006 60 60 54 60 DHS DHS DHS MICS DHS DHS DHS DHS MICS Other NS DHS 50 68 50 Source: WHO/UNICEF 43 38 42 39 Percent Percent 39 Percent 40 40 40 31 42 38 39 35 33 20 20 20 31 WATER AND SANITATION EQUITY 6 6 0 0 0 1998 2003 1994 1998 2000 2003 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile DHS DHS MICS DHS DHS DHS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 95 100 91 100 100 CHILD HEALTH 85 80 80 80 72 68 60 Immunization Malaria prevention Prevention of mother to child 60 60 60 49 49 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs* 46 Percent of children immunised with 3 doses DPT transmission of HIV Percent Percent Percent Percent HIV+ pregnant women receiving ARVs for PMTCT 40 40 33 40 Percent of children immunised with 3 doses Hib 22 20 20 14 20 100 81 0 0 0 80 81 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest 81 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 1994 1998 2000 2003 No data No data DHS DHS MICS DHS Percent 40 POLICIES SYSTEMS 20 Coverage gap (%) 48 44 33 33 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 Substitutes Partial Ratio 1990 1995 2000 2005 2006 Per capita total expenditure on health (US$) 186 (2007) poorest/wealthiest --- 2.5 2.4 2.8 Source: WHO/UNICEF New ORS formula and zinc for management of *Sub-national risk of malaria transmission General government expenditure on health as Difference diarrhoea --- % of total government expenditure (%) 13 (2007) poorest-wealthiest (%) --- 38 30 30 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials* Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics Yes Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 32 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 3.3 (2001) 100 100 Costed implementation plan(s) for maternal, newborn and child health available Partial Official Development Assistance to child health 80 80 per child (US$) 6 (2005) Midwives be authorised to administer a core set of 59 54 life saving interventions --- Official Development Assistance to maternal and 60 60 54 52 neonatal health per live birth (US$) 11 (2005) 40 43 Bolivia Percent No data Percent 40 34 40 Maternity protection in accordance with ILO 30 Convention 183 Partial National availability of Emergency Obstetric Care 20 20 services (% of recommended minimum) 48 (2003) Specific notification of maternal deaths --- 0 0 1994 1998 2000 2003 1994 1998 2000 2003 Countdown to 2015 DHS DHS MICS DHS DHS DHS MICS DHS *Sub-national risk of malaria transmission 2008 Report Botswana DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 1,858 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 216 (2006) undernutrition Unmet need for family planning (%) --- Causes of neonatal Births (000) 47 (2006) Obstructed labor Contraceptive 150 HIV/AIDS deaths Abortion 48 Pre-pregnancy (2006) 54% Tetanus 3% Antenatal visits for woman (4 or more visits, %) --- Anaemia 4% 4% prevalence rate Birth registration (%) 58 124 Diarrhoea 3% 4% Antenatal visit (per 1000 live births) (2006) 120 Other 6% (1 or more) 97 Pregnancy Under-five mortality rate 124 Congenital 7% Intermittent preventive treatment for malaria (%) --- Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 90 (2006) disorders Haemorrhage 94 Birth 90 Asphyxia 21% C-section rate (total, urban, rural; %) at birth Malaria 9% 34% Neonatal mortality rate (per 1000 live births) 40 (2000) 58 Neonatal (Minimum target is 5% and maximum target is 15%) ---, ---, --- 60 0% 40% *Postnatal care Neonatal period Total under-five deaths (000) 6 (2006) Measles Sepsis/Infections, 19 Infection 24% Early initiation of breastfeeding (within 1 hr of birth, %) --- including AIDS Exclusive 0% breastfeeding 34 Infancy Maternal mortality ratio (per 100,000 live births) 380 (2005) 30 16% MDG Target Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 130 (2005) Other Measles 90 0 0% Preterm 36% Other causes Diarrhoea 30% Total maternal deaths 170 (2005) 1990 1995 2000 2005 2010 2015 Injuries 0 20 40 60 80 100 1% Pneumonia 3% Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 1% for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy 97 Stunting prevalence (moderate and severe, %) 29 (2000) Complementary feeding rate (6-9 months, %) 57 (2000) 100 92 100 94 100 87 84 Wasting prevalence (moderate and severe, %) 6 (2000) Low birthweight incidence (%) 10 (2000) 80 80 78 80 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent Percent Percent 40 40 40 At least one dose Two doses 100 100 100 20 20 20 85 85 80 80 80 0 0 62 1998 2000 1988 1996 2000 1981 1986 1991 1996 2001 2006 Other NS MICS DHS Other NS MICS 60 60 60 Source: WHO/UNICEF Percent 40 Percent 40 34 Percent 40

15 20 11 20 20 0 WATER AND SANITATION EQUITY 0 0 0 0 0 0 0 0 0 0 0 0 1996 2000 2000 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile MICS Other NS Other NS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 95 100 93 90 100 CHILD HEALTH 88 100 100 80 80 61 Immunization Malaria prevention Prevention of mother to child 60 60 57 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs 42 No data

Percent Percent 38 Percent of children immunised with 3 doses DPT transmission of HIV Percent HIV+ pregnant women receiving ARVs for PMTCT 40 40 Percent of children immunised with 3 doses Hib 25 21 20 20 100 100 97 >95 90 87 0 0 80 80 1990 2004 1990 2004 64 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 60 114 No data Percent 40 Percent 40 87 POLICIES SYSTEMS 20 20 Coverage gap (%) No data International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 Substitutes Yes Ratio 1990 1995 2000 2005 2006 2004 2005 2006 Per capita total expenditure on health (US$) 504 (2007) poorest/wealthiest Source: WHO/UNICEF Other NS Other NS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Partial % of total government expenditure (%) 11 (2007) poorest-wealthiest (%) Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics --- Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 10 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age --- antibiotics Density of health workers (per 1000 population) 3.1 (2004) 100 100 Costed implementation plan(s) for maternal, newborn and child health available --- Official Development Assistance to child health 80 80 per child (US$) 0 (2005) Midwives be authorised to administer a core set of 60 60 life saving interventions --- Official Development Assistance to maternal and neonatal health per live birth (US$) 0 (2005) Botswana

Percent No data Percent 40 40 Maternity protection in accordance with ILO Convention 183 No National availability of Emergency Obstetric Care 20 20 14 services (% of recommended minimum) --- 7 Specific notification of maternal deaths --- 0 0 2000 2000 Countdown to 2015 MICS MICS 2008 Report Brazil DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 189,323 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Latin America, 1997-2002 Total under-five population (000) 18,092 (2006) undernutrition Unmet need for family planning (%) 7 (1996) Sepsis/Infections, Births (000) 3,720 (2006) Injuries Malaria Causes of neonatal Anaemia Diarrhoea 3% HIV/AIDS including AIDS Contraceptive 100 1% 0% deaths 0% prevalence rate 77 Pre-pregnancy Birth registration (%) 89 (2006) 12% Antenatal visits for woman (4 or more visits, %) 76 (1996) 8% Measles Other 6% Antenatal visit (per 1000 live births) 20 (2006) 0% Asphyxia 10% Abortion (1 or more) 97 Pregnancy Under-five mortality rate 80 Pneumonia Intermittent preventive treatment for malaria (%) --- Hypertensive 13% Congenital 13% 12% disorders Skilled attendant Infant mortality rate (per 1000 live births) 19 (2006) 88 Birth 60 C-section rate (total, urban, rural; %) 26% at birth Neonatal mortality rate (per 1000 live births) 15 (2000) Neonatal Infection 28% (Minimum target is 5% and maximum target is 15%) 36, 42, 20 (1996) 57 38% Obstructive labor *Postnatal care Neonatal period Total under-five deaths (000) 74 (2006) 40 13% (1996) Exclusive 19 Early initiation of breastfeeding (within 1 hr of birth, %) 33 Infancy Maternal mortality ratio (per 100,000 live births) 110 (2005) 20 breastfeeding 20 MDG Target Other Preterm 43% Postnatal visit for baby (within 2 days for home births, %) --- Haemorrhage Lifetime risk of maternal death (1 in N) 370 (2005) 33% Other causes Measles 99 0 21% 21% 4,100 (2005) Total maternal deaths 1990 1995 2000 2005 2010 2015 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy 97 97 Stunting prevalence (moderate and severe, %) 14 (1996) Complementary feeding rate (6-9 months, %) 30 (1996) 100 100 100 86 88 92 Wasting prevalence (moderate and severe, %) 3 (1996) Low birthweight incidence (%) 8 (2004) 80 74 80 70 80 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent Percent Percent 40 40 40

100 20 20 20

80 0 0 1986 1996 2003 2004 1991 1996 1987 1992 1997 2002 2006 DHS DHS Other NS Other NS DHS DHS 60 Source: WHO/UNICEF No data No data Percent 40

20 WATER AND SANITATION EQUITY 5 4 0 1996 2002-2003 Water Sanitation Coverage gap by wealth quintile DHS Other NS Percent population using improved drinking water sources Percent population using improved sanitation facilities

*Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 96 100 93 90 100 100 CHILD HEALTH 83 82 83 80 80 71 75 80 57 Immunization Malaria prevention Prevention of mother to child 60 55 60 60 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs*

transmission of HIV Percent Percent Percent Percent of children immunised with 3 doses DPT 40 40 37 37 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT

99 20 20 20 100 99 100 99 0 0 0 80 80 80 75 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest 71 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 60 75 1996 No data 71 DHS Percent 40 Percent 40 POLICIES SYSTEMS 20 20 3 Coverage gap (%) 24 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 Substitutes Yes Ratio 1990 1995 2000 20052006 2004 2005 2006 Per capita total expenditure on health (US$) 1520 (2007) poorest/wealthiest 2.4 Source: WHO/UNICEF Other NS Other NS Other NS New ORS formula and zinc for management of *Sub-national risk of malaria transmission General government expenditure on health as Difference diarrhoea No % of total government expenditure (%) 14 (2007) poorest-wealthiest (%) 20 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials* Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics No Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 29 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 5.0 (2000) 100 100 Costed implementation plan(s) for maternal, newborn and child health available No Official Development Assistance to child health 80 80 per child (US$) 0 (2005) Midwives be authorised to administer a core set of 60 60 life saving interventions Partial Official Development Assistance to maternal and No data 46 neonatal health per live birth (US$) 0 (2005) Brazil Percent 40 Percent 40 Maternity protection in accordance with ILO 28 Convention 183 Partial National availability of Emergency Obstetric Care 20 20 13 15 services (% of recommended minimum) --- Specific notification of maternal deaths Yes 0 0 1996 1991 1996 Countdown to 2015 DHS DHS DHS *Sub-national risk of malaria transmission 2008 Report Burkina Faso DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 14,359 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 2,605 (2006) undernutrition Unmet need for family planning (%) 29 (2003) Births (000) 641 (2006) Causes of neonatal Obstructed labor Abortion Contraceptive 250 Diarrhoea deaths 4% prevalence rate 17 Pre-pregnancy (%) 64 (2006) Diarrhoea 2% Antenatal visits for woman (4 or more visits, %) 18 (2003) Anaemia 4% Birth registration 206 204 19% Tetanus 5% Congenital 5% 4% Antenatal visit Under-five mortality rate (per 1000 live births) 204 (2006) 200 Malaria (1 or more) 85 Pregnancy 20% Other 6% Intermittent preventive treatment for malaria (%) 1 (2006) Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 122 (2006) disorders Haemorrhage 54 Birth 150 Asphyxia 20% C-section rate (total, urban, rural; %) at birth 9% 34% Neonatal mortality rate (per 1000 live births) 36 (2000) Neonatal (Minimum target is 5% and maximum target is 15%) 1, 3, 0 (2003) 69 18% *Postnatal care Neonatal period Total under-five deaths (000) 131 (2006) 100 Preterm 23% Sepsis/Infections, Early initiation of breastfeeding (within 1 hr of birth, %) 33 (2003) including AIDS Exclusive breastfeeding 7 Infancy Maternal mortality ratio (per 100,000 live births) 700 (2005) 50 MDG Target Pneumonia 16% 23% Other Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 22 (2005) Measles 88 10% Infection 39% Other causes 0 Injuries Total maternal deaths 4,300 (2005) 1990 1995 2000 2005 2010 2015 2% HIV/AIDS 30% Measles 4% 0 20 40 60 80 100 Source: UNICEF, 2006 Source: WHO, 2006 3% Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 41 (2006) Complementary feeding rate (6-9 months, %) 50 (2006) 100 85 100 100 80 Wasting prevalence (moderate and severe, %) 25 (2006) Low birthweight incidence (%) 16 (2006) 80 73 80 80 59 61 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 54 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses 42 Percent Percent Percent 38 40 40 31 40 At least one dose Two doses 100 100 100 97 95 95 95 20 20 20 99 93 97 95 95 80 80 80 91 0 0 80 1992-1993 1998-1999 2003 2006 1992-1993 1998-1999 2003 2006 1983 1988 1993 1998 2003 2006 DHS DHS DHS MICS DHS DHS DHS MICS 60 60 60 Source: WHO/UNICEF 61 Percent Percent 35 Percent 40 32 40 40 19 20 20 20 WATER AND SANITATION EQUITY 6 3 7 0 20 0 0 0 2003 2006 1992-1993 1998-1999 2003 2006 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile DHS MICS DHS DHS DHS MICS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 94 100 100 CHILD HEALTH 80 80 80 61 61 Immunization Malaria prevention Prevention of mother to child 60 54 60 60 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs 42 transmission of HIV Percent 38 Percent Percent Percent of children immunised with 3 doses DPT 40 34 40 32 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 20 20 13 20 7 6 100 95 100 100 3 88 0 0 0 80 76 80 80 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 60 60 53 1999 2003 DHS DHS Percent 40 Percent 40 Percent 40 29 POLICIES SYSTEMS 20 20 20 10 12 Coverage gap (%) 61 52 2 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 0 Substitutes Yes Ratio 1990 1995 2000 2005 2006 2003 2006 2004 2005 2006 Per capita total expenditure on health (US$) 77 (2007) poorest/wealthiest 1.8 2.3 Source: WHO/UNICEF DHS MICS Other NS Other NS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Yes % of total government expenditure (%) 15 (2007) poorest-wealthiest (%) 31 37 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics No Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 44 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 0.5 (2004) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available Yes Official Development Assistance to child health 80 80 80 per child (US$) 8 (2005) Midwives be authorised to administer a core set of 60 60 60 life saving interventions Yes Official Development Assistance to maternal and 47 50 48 42 neonatal health per live birth (US$) 7 (2005) Burkina Faso

Percent Percent Percent 39 40 40 32 40 36 Maternity protection in accordance with ILO National availability of Emergency Obstetric Care 22 Convention 183 Partial 19 19 services (% of recommended minimum) --- 20 20 20 12 15 Specific notification of maternal deaths Yes 0 0 0 1992-1993 2003 2006 1992-1993 2003 2006 1992-1993 1998-1999 2003 2006 Countdown to 2015 DHS DHS MICS DHS DHS MICS DHS DHS DHS MICS 2008 Report Burundi DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 8,173 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 1,461 (2006) undernutrition Unmet need for family planning (%) --- Births (000) 381 (2006) Malaria Measles Causes of neonatal Obstructed labor Abortion Contraceptive 200 181 8% HIV/AIDS 3% deaths 4% prevalence rate 9 Pre-pregnancy Birth registration (%) 60 (2006) 8% Diarrhoea 3% Antenatal visits for woman (4 or more visits, %) --- Anaemia 4% 190 Injuries Congenital 5% 4% Antenatal visit Tetanus 5% 92 Pregnancy Under-five mortality rate (per 1000 live births) 181 (2006) 160 Other 2% (%) (1 or more) 15% Other 7% Intermittent preventive treatment for malaria --- Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 109 (2006) disorders Haemorrhage 34 Birth 120 Preterm 23% C-section rate (total, urban, rural; %) at birth 9% 34% Neonatal mortality rate (per 1000 live births) 41 (2000) Neonatal (Minimum target is 5% and maximum target is 15%) ---, ---, --- 80 63 23% *Postnatal care Neonatal period Total under-five deaths (000) 69 (2006) Asphyxia 25% Sepsis/Infections, Early initiation of breastfeeding (within 1 hr of birth, %) --- including AIDS Exclusive breastfeeding 45 Infancy Maternal mortality ratio (per 100,000 live births) 1,100 (2005) 40 MDG Target Diarrhoea 16% 18% Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 16 (2005) Infection 31% Measles 75 0 Pneumonia Other causes 3,900 (2005) 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 23% 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 58 (2005) Complementary feeding rate (6-9 months, %) 88 (2005) 100 92 100 100 84 Wasting prevalence (moderate and severe, %) 9 (2005) Low birthweight incidence (%) 11 (2005) 80 79 78 80 80 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent Percent Percent 40 40 25 34 40 At least one dose Two doses 19 100 100 100 20 20 20 96 95 95 94 80 80 80 92 89 69 0 0 62 1987 2000 2005 1987 2000 2005 1983 1988 1993 1998 2003 2006 DHS MICS MICS DHS MICS MICS 60 60 60 Source: WHO/UNICEF 45 Percent Percent 40 39 35 40 Percent 40

20 20 20 WATER AND SANITATION EQUITY 0 0 0 0 0 0 17 0 0 0 2000 2005 2000 2005 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile MICS Other NS MICS Other NS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 97 92 100 100 CHILD HEALTH 80 77 79 80 80 67 69 Immunization Malaria prevention Prevention of mother to child 60 60 60 47 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs 44 42 44 35 36 transmission of HIV Percent Percent Percent Percent of children immunised with 3 doses DPT 40 40 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 20 20 20 100 100 25 0 0 0 75 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest 80 74 80 20 74 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 60 15 14 2000 MICS Percent 40 Percent 40 Percent 10 6 POLICIES SYSTEMS 20 20 5 4 8 Coverage gap (%) 51 1 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 0 Substitutes No Ratio 1990 1995 2000 2005 2006 2000 2005 2004 2005 2006 Per capita total expenditure on health (US$) 16 (2007) poorest/wealthiest 1.3 Source: WHO/UNICEF MICS MICS Other NS Other NS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Partial % of total government expenditure (%) 2 (2007) poorest-wealthiest (%) 15 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics No Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 74 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Partial antibiotics Density of health workers (per 1000 population) 0.2 (2004) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available Partial Official Development Assistance to child health 80 80 80 per child (US$) 9 (2005) Midwives be authorised to administer a core set of 60 60 60 life saving interventions No Official Development Assistance to maternal and neonatal health per live birth (US$) 6 (2005) 40 Burundi Percent Percent Percent 38 40 40 31 40 Maternity protection in accordance with ILO 30 National availability of Emergency Obstetric Care 23 26 Convention 183 No 20 16 20 20 services (% of recommended minimum) --- 1 Specific notification of maternal deaths Partial 0 0 0 2000 2005 2000 2005 1987 2000 2005 Countdown to 2015 MICS MICS MICS MICS DHS MICS MICS 2008 Report Cambodia DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 14,197 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Asia, 1997-2002 Total under-five population (000) 1,690 (2006) undernutrition Unmet need for family planning (%) 33 (2000) (000) 377 (2006) Measles HIV/AIDS Causes of neonatal Abortion Births 6% Contraceptive 150 Diarrhoea 2% 2% Injuries deaths Obstructed labor prevalence rate 40 Pre-pregnancy Birth registration (%) 66 (2006) 2% Antenatal visits for woman (4 or more visits, %) 27 (2005) 17% 9% Antenatal visit 116 Malaria 69 Pregnancy Under-five mortality rate (per 1000 live births) 82 (2006) 120 (%) (1 or more) Pneumonia 1% Intermittent preventive treatment for malaria --- Hypertensive Haemorrhage Skilled attendant Infant mortality rate (per 1000 live births) 65 (2006) 82 21% disorders 44 Birth 90 C-section rate (total, urban, rural; %) 31% at birth 9% Neonatal mortality rate (per 1000 live births) 40 (2000) Neonatal (Minimum target is 5% and maximum target is 15%) 2, 6, 1 (2005) *Postnatal care 60 30% No data 64 Neonatal period Total under-five deaths (000) 31 (2006) 39 Sepsis/Infections, Exclusive Early initiation of breastfeeding (within 1 hr of birth, %) 35 (2005) including AIDS 60 Infancy Maternal mortality ratio (per 100,000 live births) 540 (2005) breastfeeding 30 MDG Target 12% Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 48 (2005) Other causes Measles 78 0 Anaemia 21% 13% Total maternal deaths 2,300 (2005) 1990 1995 2000 2005 2010 2015 Other 26% 0 20 40 60 80 100 Source: UNICEF, 2006 Source: WHO, 2006 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 44 (2005) Complementary feeding rate (6-9 months, %) 82 (2005) 100 100 100 82 Wasting prevalence (moderate and severe, %) 8 (2005) Low birthweight incidence (%) 11 (2000) 80 80 80 69 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 60 44 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent Percent Percent 38 34 40 34 40 32 40 At least one dose Two doses 100 100 100 20 20 20 79 79 80 80 80 72 0 0 63 60 57 1998 2000 2005 1998 2000 2005 1983 1988 1993 1998 2003 2006 60 60 60 72 Other NS DHS DHS Other NS DHS DHS 47 65 Source: WHO/UNICEF 43 40 Percent Percent Percent 55 57 34 40 40 40 28 47 34 20 20 12 20 30 WATER AND SANITATION EQUITY

0 0 0 1996 2000 2005 2000 2005 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile DHS DHS DHS Other NS DHS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 100 CHILD HEALTH 80 80 80 64 Immunization Malaria prevention Prevention of mother to child 60 60 53 60 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs 41 transmission of HIV Percent Percent Percent Percent of children immunised with 3 doses DPT 40 35 40 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 20 20 17 20 8 100 100 30 80 0 0 0 80 80 2004 2004 Poorest 2nd 3rd 4th Wealthiest 24 21 78 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 60 18 2000 2005 14 DHS DHS Percent 40 Percent 40 Percent 12 9 POLICIES SYSTEMS 20 20 6 Coverage gap (%) 54 37 4 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 0 Substitutes Partial Ratio 1990 1995 2000 2005 2006 2005 2004 2005 2006 Per capita total expenditure on health (US$) 140 (2007) poorest/wealthiest 2.0 1.8 Source: WHO/UNICEF DHS Other NS Other NS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Yes % of total government expenditure (%) 11 (2007) poorest-wealthiest (%) 31 22 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics Partial Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 63 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 1.0 (2000) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available Partial Official Development Assistance to child health 80 80 80 per child (US$) 10 (2005) Midwives be authorised to administer a core set of 59 60 60 60 life saving interventions No Official Development Assistance to maternal and 48 neonatal health per live birth (US$) 50 (2005) Cambodia Percent Percent 40 40 Percent 40 37 Maternity protection in accordance with ILO Convention 183 No National availability of Emergency Obstetric Care 20 20 20 services (% of recommended minimum) --- Specific notification of maternal deaths Partial 0.2 0 0 0 2000 2005 2000 2005 Countdown to 2015 DHS DHS DHS DHS 2008 Report Cameroon DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 18,175 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 2,851 (2006) undernutrition Unmet need for family planning (%) 20 (2004) Measles Causes of neonatal Births (000) 649 (2006) HIV/AIDS Injuries Obstructed labor Contraceptive 150 7% 4% 2% deaths Abortion 29 Pre-pregnancy Diarrhoea Diarrhoea 2% Antenatal visits for woman (4 or more visits, %) 60 (2004) Anaemia 4% prevalence rate Birth registration (%) 70 (2006) 17% Other 4% 139 Tetanus 3% 4% Antenatal visit (per 1000 live births) 149 (2006) 120 149 0% Other 7% (1 or more) 82 Pregnancy Under-five mortality rate Congenital 8% Intermittent preventive treatment for malaria (%) 6 (2006) Pneumonia Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 87 (2006) 22% disorders Haemorrhage 63 Birth 90 Asphyxia 25% C-section rate (total, urban, rural; %) at birth 9% 34% Neonatal mortality rate (per 1000 live births) 40 (2000) Neonatal (Minimum target is 5% and maximum target is 15%) 2, 4, 1 (2004) 60 25% *Postnatal care Neonatal period Total under-five deaths (000) 97 (2006) Sepsis/Infections, 46 Infection 25% Early initiation of breastfeeding (within 1 hr of birth, %) 32 (2004) including AIDS Exclusive breastfeeding 21 Infancy Maternal mortality ratio (per 100,000 live births) 1,000 (2005) 30 MDG Target 16% Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 24 (2005) Measles 73 0 Preterm 30% Other causes 5,700 (2005) Malaria 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 0 20 40 60 80 100 23% Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 36 (2006) Complementary feeding rate (6-9 months, %) 64 (2006) 100 100 100 80 79 83 82 Wasting prevalence (moderate and severe, %) 7 (2006) Low birthweight incidence (%) 11 (2006) 80 79 75 80 80 64 58 60 62 63 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent Percent 40 Percent 40 40 At least one dose Two doses 100 100 100 95 86 86 20 20 20 100 100 100 81 95 80 80 80 0 0 1991 1998 2000 2004 2006 1991 1998 2000 2004 2006 1984 1989 1994 1999 2004 2006 DHS DHS MICS DHS MICS DHS DHS MICS DHS MICS 60 60 60 Source: WHO/UNICEF Percent 40 Percent 40 Percent 40 24 21 21 15 16 12 20 20 7 20 WATER AND SANITATION EQUITY 0 0 0 0 0 0 0 0 2004 2006 1991 1998 2004 2006 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile DHS DHS DHS MICS DHS MICS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 100 86 CHILD HEALTH 77 80 80 80 66 59 58 Immunization Malaria prevention Prevention of mother to child 60 50 60 51 60 48 43 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs 44 40 Percent of children immunised with 3 doses DPT transmission of HIV Percent Percent Percent 40 31 40 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 20 20 20 100 100 30 81 0 0 0 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest 80 80 24 22 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 73 60 18 1991 1998 2000 2004 2006 DHS DHS MICS DHS MICS Percent 40 Percent 40 Percent 12 11 10 POLICIES SYSTEMS 20 20 13 6 Coverage gap (%) 48 52 53 40 44 1 1 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 0 Substitutes Yes Ratio 1990 1995 2000 20052006 2000 2004 2006 2004 2005 2006 Per capita total expenditure on health (US$) 83 (2007) poorest/wealthiest 1.9 1.9 1.8 2.2 2.2 Source: WHO/UNICEF MICS DHS MICS Other NS Other NS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Yes % of total government expenditure (%) 11 (2007) poorest-wealthiest (%) 32 31 29 32 33 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics No Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 68 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 1.8 (2004) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available Yes Official Development Assistance to child health 80 80 80 per child (US$) 7 (2005) 66 Midwives be authorised to administer a core set of 58 life saving interventions Yes Official Development Assistance to maternal and 60 60 53 60 43 44 neonatal health per live birth (US$) 4 (2005) Cameroon

Percent Percent Percent 40 40 31 32 40 40 34 35 38 Maternity protection in accordance with ILO 22 25 Convention 183 Partial National availability of Emergency Obstetric Care 20 20 20 13 services (% of recommended minimum) 29 (2000) Specific notification of maternal deaths No 0 0 0 1998 2000 2004 2006 2000 2004 2006 1991 1998 2000 2004 2006 Countdown to 2015 DHS MICS DHS MICS MICS DHS MICS DHS DHS MICS DHS MICS 2008 Report Central African Republic DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 4,265 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 668 (2006) undernutrition Unmet need for family planning (%) 16 (1994-1995) Births (000) 157 (2006) Measles Injuries Causes of neonatal Obstructed labor HIV/AIDS Abortion Contraceptive 200 7% 2% deaths 4% prevalence rate 19 Pre-pregnancy Birth registration (%) 49 (2006) 173 175 12% Other Diarrhoea 4% Antenatal visits for woman (4 or more visits, %) 40 (1994-1995) Anaemia 4% 0% Other 6% 4% Antenatal visit (per 1000 live births) 175 (2006) 160 Congenital 6% (1 or more) 69 Pregnancy Under-five mortality rate Diarrhoea Tetanus 10% Intermittent preventive treatment for malaria (%) 9 (2006) 15% Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 115 (2006) disorders Haemorrhage 53 Birth 120 Asphyxia 22% C-section rate (total, urban, rural; %) at birth 9% 34% Neonatal mortality rate (per 1000 live births) 48 (2000) Neonatal (Minimum target is 5% and maximum target is 15%) 2, 2, 2 (1994-1995) 27% *Postnatal care Neonatal period 80 Sepsis/Infections, Total under-five deaths (000) 27 (2006) 58 Preterm 23% Early initiation of breastfeeding (within 1 hr of birth, %) 39 (2006) including AIDS Exclusive Malaria breastfeeding 23 Infancy Maternal mortality ratio (per 100,000 live births) 980 (2005) 40 MDG Target 19% 16% Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 25 (2005) Measles 35 0 Infection 29% Other causes 1,500 (2005) Pneumonia 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 0 20 40 60 80 100 19% Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 43 (2006) Complementary feeding rate (6-9 months, %) 55 (2006) 100 100 100 Wasting prevalence (moderate and severe, %) 12 (2006) Low birthweight incidence (%) 13 (2006) 80 69 80 80 67 62 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 53 60 52 46 44 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent Percent 40 Percent 40 40 At least one dose Two doses 100 100 100 90 20 20 20 100 84 100 79 80 80 80 90 0 0 1994-1995 2000 2006 1994-1995 2000 2006 1980 1985 1990 1995 2000 2006 DHS MICS MICS DHS MICS MICS 60 60 60 Source: WHO/UNICEF 66 Percent 40 Percent 40 Percent 40 22 24 23 20 20 17 20 WATER AND SANITATION EQUITY 3 2 3 0 0 0 0 0 0 0 0 2000 2006 1994-1995 2000 2006 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile DHS MICS MICS MICS MICS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 93 100 100 CHILD HEALTH 80 74 75 80 80 61 Immunization Malaria prevention Prevention of mother to child 60 52 60 60 Percent of children immunised against measles 47 Percent children < 5 years sleeping under ITNs 39 transmission of HIV Percent Percent Percent Percent of children immunised with 3 doses DPT 40 40 34 40 Percent HIV+ pregnant women receiving ARVs for PMTCT 27 Percent of children immunised with 3 doses Hib 23 17 20 20 12 20 100 100 20 18 0 0 0 80 80 16 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 18 60 60 12 1995 2000 2006 40 DHS MICS MICS Percent 40 Percent 40 Percent 8 7 POLICIES SYSTEMS 35 7 20 20 15 4 2 Coverage gap (%) 56 58 53 2 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 0 Substitutes No Ratio 1990 1995 2000 20052006 2000 2006 2004 2005 2006 Per capita total expenditure on health (US$) 54 (2007) poorest/wealthiest 1.9 1.9 1.9 Source: WHO/UNICEF MICS MICS Other NS Other NS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea --- % of total government expenditure (%) 11 (2007) poorest-wealthiest (%) 34 33 30 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics No Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 60 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 0.5 (2004) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available Yes Official Development Assistance to child health 80 80 80 per child (US$) 7 (2005) 69 Midwives be authorised to administer a core set of 60 60 57 60 life saving interventions Yes Official Development Assistance to maternal and 47 47 neonatal health per live birth (US$) 5 (2005) 41 39 Central African Republic Percent Percent Percent Maternity protection in accordance with ILO 40 29 40 40 32 32 Convention 183 Partial National availability of Emergency Obstetric Care 20 20 20 services (% of recommended minimum) --- Specific notification of maternal deaths No 0 0 0 1994-1995 2000 2006 2000 2006 1994-1995 2000 2006 Countdown to 2015 DHS MICS MICS MICS MICS DHS MICS MICS 2008 Report Chad DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 10,468 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 1,943 (2006) undernutrition 209 HIV/AIDS Injuries Unmet need for family planning (%) 23 (2004) Births (000) 482 (2006) 201 Measles Causes of neonatal Obstructed labor 4% 2% Abortion Contraceptive 200 7% deaths 4% prevalence rate 3 Pre-pregnancy Birth registration (%) 9 (2006) Other Diarrhoea 3% Antenatal visits for woman (4 or more visits, %) 18 (2004) Anaemia 4% Diarrhoea 0% Congenital 5% 4% Antenatal visit Other 8% 39 Pregnancy Under-five mortality rate (per 1000 live births) 209 (2006) 160 18% Intermittent preventive treatment for malaria (%) --- (1 or more) Tetanus 10% Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 124 (2006) disorders Haemorrhage 14 Birth 120 C-section rate (total, urban, rural; %) at birth Preterm 18% 9% 34% Neonatal mortality rate (per 1000 live births) 45 (2000) Neonatal 67 (Minimum target is 5% and maximum target is 15%) 0, 1, 0 (2004) 80 24% *Postnatal care 2 Neonatal period Total under-five deaths (000) 101 (2006) Asphyxia 27% Sepsis/Infections, Malaria Early initiation of breastfeeding (within 1 hr of birth, %) 34 (2004) including AIDS Exclusive MDG Target breastfeeding 2 Infancy Maternal mortality ratio (per 100,000 live births) 1,500 (2005) 40 22% 16% Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 11 (2005) Measles 23 Infection 28% Other causes 0 Pneumonia 6,900 (2005) 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 23% 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 45 (2004) Complementary feeding rate (6-9 months, %) 77 (2004) 100 100 100 Wasting prevalence (moderate and severe, %) 16 (2004) Low birthweight incidence (%) 22 (2004) 80 80 80 60 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses 42 39 Percent Percent Percent 40 40 40 At least one dose Two doses 23 99 95 15 16 14 100 100 100 92 91 20 20 20 85 84 92 93 80 80 80 88 93 0 0 79 1996-1997 2000 2004 1996-1997 2000 2004 1987 1992 1997 2002 2006 DHS MICS DHS DHS MICS DHS 60 60 60 Source: WHO/UNICEF Percent 34 Percent Percent 40 29 40 40 0 20 20 10 20 WATER AND SANITATION EQUITY 2 2 0 0 0 0 0 2000 2004 1996-1997 2000 2004 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile DHS MICS DHS MICS DHS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 100 CHILD HEALTH 80 80 80

Immunization Malaria prevention Prevention of mother to child 60 60 60 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs 41 43 41 42 transmission of HIV Percent Percent Percent Percent of children immunised with 3 doses DPT 40 40 40 Percent HIV+ pregnant women receiving ARVs for PMTCT 28 Percent of children immunised with 3 doses Hib 24 19 20 13 20 20 7 9 100 100 5 2 4 0 0 0 80 80 4 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 60 3 1997 2000 2004 DHS MICS DHS

Percent Percent Percent 2 40 40 2 23 POLICIES SYSTEMS 1 20 20 1 20 Coverage gap (%) 75 69 79 1 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 0 Substitutes No Ratio 1990 1995 2000 2005 2006 2000 2005 2006 Per capita total expenditure on health (US$) 42 (2007) poorest/wealthiest 1.5 1.4 1.6 Source: WHO/UNICEF MICS Other NS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Yes % of total government expenditure (%) 10 (2007) poorest-wealthiest (%) 30 23 37 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics No Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 60 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age No antibiotics Density of health workers (per 1000 population) 0.5 (2004) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available Yes Official Development Assistance to child health 80 80 80 per child (US$) 4 (2005) Midwives be authorised to administer a core set of life saving interventions Official Development Assistance to maternal and 60 50 60 60 Partial neonatal health per live birth (US$) 5 (2005) Chad

Percent Percent Percent Maternity protection in accordance with ILO 40 27 40 32 40 23 Convention 183 National availability of Emergency Obstetric Care 22 No 19 services (% of recommended minimum) 40 (2002) 20 20 20 12 Specific notification of maternal deaths No 0 0 0 1996-1997 2000 2004 2000 1996-1997 2000 2004 Countdown to 2015 DHS MICS DHS MICS DHS MICS DHS 2008 Report China DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 1,320,864 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Asia, 1997-2002 Total under-five population (000) 84,390 (2006) undernutrition Unmet need for family planning (%) --- Malaria Measles Causes of neonatal Abortion Births (000) 17,309 (2006) Contraceptive 0% 0% deaths Obstructed labor 6% 87 50 45 Injuries HIV/AIDS (4 or more visits, %) prevalence rate Pre-pregnancy Birth registration (%) --- 8% Antenatal visits for woman --- 9% 0% Antenatal visit 90 Pregnancy Under-five mortality rate (per 1000 live births) 24 (2006) 40 Diarrhoea (%) (1 or more) Intermittent preventive treatment for malaria --- Hypertensive 12% Haemorrhage (per 1000 live births) 20 (2006) disorders Skilled attendant Infant mortality rate at birth 98 Birth 30 24 C-section rate (total, urban, rural; %) 9% 31% Neonatal mortality rate (per 1000 live births) 21 (2000) Neonatal (Minimum target is 5% and maximum target is 15%) ---, ---, --- *Postnatal care 20 15 49% No data Neonatal period Total under-five deaths (000) 415 (2006) Sepsis/Infections, Early initiation of breastfeeding (within 1 hr of birth, %) --- including AIDS Exclusive Infancy MDG Target breastfeeding 51 Maternal mortality ratio (per 100,000 live births) 45 (2005) 10 Pneumonia 12% 13% Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 1,300 (2005) Other Other causes Measles 93 0 Anaemia 21% 7,800 (2005) 16% 13% Total maternal deaths 1990 1995 2000 2005 2010 2015 0 20 40 60 80 100 Source: UNICEF, 2006 Source: WHO, 2006 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy 100 100 94 94 97 97 97 97 96 97 98 Stunting prevalence (moderate and severe, %) 15 (2005) Complementary feeding rate (6-9 months, %) 32 (2003) 90 90 89 90 90 89 Wasting prevalence (moderate and severe, %) --- Low birthweight incidence (%) 2 (2005) 80 80 67

Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 50 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent 40 Percent 40 No data

100 100 20 20

80 80 0 0 2001 2002 2003 2004 2005 1988 1990 1995 1997 1998 1999 2000 2001 2002 2003 2004 2005 60 60 51 Other NS Other NS Other NS Other NS Other NS Source: Other NS No data Percent 40 Percent 40

20 20 WATER AND SANITATION EQUITY 7 6 0 0 2002 2005 2003 Water Sanitation Coverage gap by wealth quintile Other NS Other NS Other NS Percent population using improved drinking water sources Percent population using improved sanitation facilities

*Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 93 100 CHILD HEALTH 99 80 77 80 70 69 67 64 59 Immunization Malaria prevention Prevention of mother to child 60 60 No data Percent of children immunised against measles Percent children < 5 years sleeping under ITNs* 44

transmission of HIV Percent Percent Percent of children immunised with 3 doses DPT 40 40 Percent HIV+ pregnant women receiving ARVs for PMTCT 28 Percent of children immunised with 3 doses Hib 23 20 20 7 100 93 20 93 0 0 80 16 1990 2004 1990 2004 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 12 No data 9 Percent 40 Percent 8 POLICIES SYSTEMS 20 4 2 2 Coverage gap (%) No data International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 Substitutes Partial Ratio 1990 1995 2000 2005 2006 2004 2005 2006 Per capita total expenditure on health (US$) 277 (2007) poorest/wealthiest Source: WHO/UNICEF Other NS Other NS Other NS New ORS formula and zinc for management of *Sub-national risk of malaria transmission General government expenditure on health as Difference diarrhoea Partial % of total government expenditure (%) 10 (2007) poorest-wealthiest (%) Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials* Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics Partial Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 54 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 2.1 (2001) Costed implementation plan(s) for maternal, newborn and child health available Partial Official Development Assistance to child health per child (US$) 0 (2005) Midwives be authorised to administer a core set of life saving interventions Partial Official Development Assistance to maternal and No data No data No data neonatal health per live birth (US$) 0 (2005) China Maternity protection in accordance with ILO Convention 183 No National availability of Emergency Obstetric Care services (% of recommended minimum) --- Specific notification of maternal deaths Yes

Countdown to 2015

*Sub-national risk of malaria transmission 2008 Report Congo DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 3,689 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 587 (2006) undernutrition Unmet need for family planning (%) 16 (2005) Measles Causes of neonatal Births (000) 132 (2006) Obstructed labor Contraceptive HIV/AIDS 7% Injuries deaths Abortion 44 Pre-pregnancy 150 Tetanus 2% Antenatal visits for woman (4 or more visits, %) 75 (2005) Anaemia 4% prevalence rate Birth registration (%) 81 (2006) 126 9% 3% 4% Other Diarrhoea 2% 4% Antenatal visit Diarrhoea Other 7% 86 Pregnancy Under-five mortality rate (per 1000 live births) 126 (2006) 120 0% Congenital 8% Intermittent preventive treatment for malaria (%) --- (1 or more) 11% Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 79 (2006) 103 Infection 23% disorders Haemorrhage 83 Birth 90 C-section rate (total, urban, rural; %) at birth 9% 34% Neonatal mortality rate (per 1000 live births) 32 (2000) Neonatal (Minimum target is 5% and maximum target is 15%) 3, 4, 2 (2005) *Postnatal care 24 60 31% Neonatal period Total under-five deaths (000) 17 (2006) Asphyxia 26% Sepsis/Infections, 34 Early initiation of breastfeeding (within 1 hr of birth, %) 39 (2005) including AIDS Exclusive breastfeeding 19 Infancy Maternal mortality ratio (per 100,000 live births) 740 (2005) 30 Pneumonia 16% MDG Target Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 22 (2005) 14% Measles 66 0 Malaria Preterm 31% Other causes 1,300 (2005) 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 26% 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 31 (2005) Complementary feeding rate (6-9 months, %) 78 (2005) 100 100 100 86 83 88 Wasting prevalence (moderate and severe, %) 8 (2005) Low birthweight incidence (%) 13 (2005) 80 80 80 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent Percent 40 Percent 40 40 At least one dose Two doses 100 100 100 94 20 20 20 86 89 90 100 100 80 80 80 74 0 0 2005 2005 1986 1991 1996 2001 2006 DHS DHS 60 60 60 Source: WHO/UNICEF Percent Percent 40 40 Percent 40 21 19 20 12 20 20 WATER AND SANITATION EQUITY 0 0 0 0 0 0 9 0 0 0 1987 2005 2005 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile Other NS DHS DHS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 100 CHILD HEALTH 84 80 80 80

Immunization Malaria prevention Prevention of mother to child 60 58 60 60 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs Percent of children immunised with 3 doses DPT transmission of HIV Percent Percent Percent Percent HIV+ pregnant women receiving ARVs for PMTCT 40 40 40 Percent of children immunised with 3 doses Hib 27 25 28 27 20 20 20 100 100 30 0 0 0 79 80 80 24 23 2004 2004 Poorest 2nd 3rd 4th Wealthiest Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 60 18 66 2005 DHS Percent 40 Percent 40 Percent 12 7 7 POLICIES SYSTEMS 20 20 6 Coverage gap (%) 33 6 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 0 Substitutes No Ratio 1990 1995 2000 2005 2006 2005 2004 2005 2006 Per capita total expenditure on health (US$) 30 (2007) poorest/wealthiest 2.2 Source: WHO/UNICEF DHS Other NS Other NS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Yes % of total government expenditure (%) 21 (2007) poorest-wealthiest (%) 24 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics No Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 51 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 1.2 (2004) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available Yes Official Development Assistance to child health 80 80 80 per child (US$) 2 (2005) Midwives be authorised to administer a core set of 60 60 60 life saving interventions Yes Official Development Assistance to maternal and 48 48 neonatal health per live birth (US$) 3 (2005) Congo

Percent 39 Percent Percent 40 40 40 Maternity protection in accordance with ILO Convention 183 No National availability of Emergency Obstetric Care 20 20 20 services (% of recommended minimum) --- Specific notification of maternal deaths No 0 0 0 2005 2005 2005 Countdown to 2015 DHS DHS DHS 2008 Report Congo DR DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 60,644 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 11,843 (2006) undernutrition Unmet need for family planning (%) --- Births (000) 3,026 (2006) Measles Causes of neonatal Obstructed labor Other 5% HIV/AIDS Abortion Contraceptive 200 deaths 4% prevalence rate 31 Pre-pregnancy Birth registration (%) 34 (2006) 205 205 6% 4% Diarrhoea 3% Antenatal visits for woman (4 or more visits, %) --- Anaemia 4% Malaria Injuries Tetanus 5% 4% Antenatal visit Under-five mortality rate (per 1000 live births) 205 (2006) 160 Other 7% (1 or more) 68 Pregnancy 17% 2% Congenital 7% Intermittent preventive treatment for malaria (%) --- Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 129 (2006) disorders Haemorrhage 61 Birth 120 Asphyxia 23% C-section rate (total, urban, rural; %) at birth 9% 34% Neonatal mortality rate (per 1000 live births) 47 (2000) Neonatal (Minimum target is 5% and maximum target is 15%) ---, ---, --- 68 26% *Postnatal care Neonatal period Total under-five deaths (000) 620 (2006) 80 Sepsis/Infections, Infection 27% Exclusive Early initiation of breastfeeding (within 1 hr of birth, %) --- including AIDS 24 Infancy (per 100,000 live births) 1,100 (2005) MDG Target Diarrhoea breastfeeding Maternal mortality ratio 40 18% 16% Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 13 (2005) Measles 73 0 Pneumonia Preterm 28% Other causes 32,000 (2005) 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 23% 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 44 (2001) Complementary feeding rate (6-9 months, %) 79 (2001) 100 100 100 Wasting prevalence (moderate and severe, %) 21 (2001) Low birthweight incidence (%) 12 (2000) 80 80 80 77 68 61 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent Percent 40 Percent 40 40 At least one dose Two doses 100 100 100 93 92 20 20 20 81 78 98 80 80 80 80 62 87 0 0 2001 2001 1984 1989 1994 1999 2004 2006 72 MICS MICS 60 60 60 70 Source: WHO/UNICEF Percent Percent Percent 40 31 34 40 40 24 24 20 20 20 11 WATER AND SANITATION EQUITY 0 0 0 0 0 0 1995 2001 1995 2001 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile MICS MICS MICS MICS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 90 100 100 CHILD HEALTH 82 80 80 80

Immunization Malaria prevention Prevention of mother to child 60 60 53 60 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs 43 46 42 transmission of HIV Percent Percent Percent Percent of children immunised with 3 doses DPT 40 40 40 Percent HIV+ pregnant women receiving ARVs for PMTCT 29 30 Percent of children immunised with 3 doses Hib 25 25 20 20 16 20 100 100 10 1 0 0 0 77 80 80 8 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 73 60 6 2001 MICS

Percent Percent Percent 4 40 40 4 POLICIES SYSTEMS 2 20 20 2 1 Coverage gap (%) 60 1 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 0 Substitutes Yes Ratio 1990 1995 2000 2005 2006 2001 2004 2005 2006 Per capita total expenditure on health (US$) 15 (2007) poorest/wealthiest 1.6 Source: WHO/UNICEF MICS Other NS Other NS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Yes % of total government expenditure (%) 7 (2007) poorest-wealthiest (%) 25 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics Yes Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 72 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 0.6 (2004) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available Yes Official Development Assistance to child health 80 80 80 per child (US$) 3 (2005) Midwives be authorised to administer a core set of life saving interventions Yes Official Development Assistance to maternal and 60 60 52 60 neonatal health per live birth (US$) 3 (2005) Congo DR Percent 40 Percent 40 Percent 40 36 Maternity protection in accordance with ILO Convention 183 Partial National availability of Emergency Obstetric Care 20 17 20 20 services (% of recommended minimum) --- Specific notification of maternal deaths Yes 0 0 0 2001 2001 2001 Countdown to 2015 MICS MICS MICS 2008 Report Côte d’Ivoire DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 18,914 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 2,849 (2006) undernutrition Unmet need for family planning (%) 28(1998-99) (2006) Measles Causes of neonatal Births (000) 684 153 HIV/AIDS Injuries Obstructed labor Contraceptive 150 3% 2% deaths Abortion 13 Pre-pregnancy 6% Other Congenital 5% Antenatal visits for woman (4 or more visits, %) 45 (2005) Anaemia 4% prevalence rate Birth registration (%) 55 (2006) 127 0% 4% 4% Antenatal visit Other 6% 85 Pregnancy Under-five mortality rate (per 1000 live births) 127 (2006) 120 Diarrhoea Diarrhoea 6% Intermittent preventive treatment for malaria (%) 8 (2006) (1 or more) 15% Tetanus 12% Hypertensive Infant mortality rate (per 1000 live births) 90 (2006) Haemorrhage Skilled attendant 90 disorders at birth 57 Birth C-section rate (total, urban, rural; %) 34% (2000) Neonatal Asphyxia 19% 9% Neonatal mortality rate (per 1000 live births) 65 51 (Minimum target is 5% and maximum target is 15%) 6, 8, 6 (2005) 60 35% *Postnatal care Neonatal period Total under-five deaths (000) 87 (2006) Sepsis/Infections, MDG Target Pneumonia Infection 23% Early initiation of breastfeeding (within 1 hr of birth, %) 25 (2006) including AIDS Exclusive breastfeeding 4 Infancy Maternal mortality ratio (per 100,000 live births) 810 (2005) 30 20% 16% Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 27 (2005) Measles 73 Preterm 29% Other causes 0 Malaria 5,400 (2005) 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 21% 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 40 (2006) Complementary feeding rate (6-9 months, %) 54 (2006) 100 100 100 88 87 83 84 85 Wasting prevalence (moderate and severe, %) 8 (2006) Low birthweight incidence (%) 17 (2006) 80 80 80 68 63 57 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 55 60 52 45 47 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent Percent Percent 40 40 40 At least one dose Two doses 95 100 100 100 97 97 20 20 20 89 80 80 80 0 0 60 1994 1998-1999 2000 2005 2006 1994 1998-1999 2000 2003-2004 2005 2006 1989 1994 1999 2004 2006 DHS DHS MICS Other NS MICS DHS DHS MICS Other NS Other NS MICS 60 60 60 Source: WHO/UNICEF Percent 40 Percent 40 Percent 40

18 16 16 20 20 10 20 0 WATER AND SANITATION EQUITY 3 4 5 4 0 0 0 0 0 0 0 0 1998-1999 2006 1994 1998-1999 2000 2003-2004 2006 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile DHS DHS MICS Other NS MICS DHS MICS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 97 100 100 CHILD HEALTH 84 80 73 74 80 80 67 69 Immunization Malaria prevention Prevention of mother to child 60 60 60 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs 46 Percent of children immunised with 3 doses DPT transmission of HIV Percent Percent 37 37 Percent Percent HIV+ pregnant women receiving ARVs for PMTCT 40 40 29 40 Percent of children immunised with 3 doses Hib 21 20 20 10 20 100 100 15 0 0 0 77 80 80 12 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest 73 9 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 60 9 8 1994 1999 2000 2006 DHS DHS MICS MICS Percent 40 Percent 40 Percent 6 POLICIES SYSTEMS 20 20 3 6 Coverage gap (%) 55 49 49 40 1 4 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 0 Substitutes Partial Ratio 1990 1995 2000 2005 2006 2000 2003-2004 2006 2005 2006 Per capita total expenditure on health (US$) 64 (2007) poorest/wealthiest 2.0 2.6 Source: WHO/UNICEF MICS Other NS MICS Other NS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Partial % of total government expenditure (%) 5 (2007) poorest-wealthiest (%) 35 34 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics No Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 68 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age No antibiotics Density of health workers (per 1000 population) 0.7 (2004) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available Partial Official Development Assistance to child health 80 80 80 per child (US$) 3 (2005) Midwives be authorised to administer a core set of 58 60 60 60 life saving interventions Partial Official Development Assistance to maternal and 45 neonatal health per live birth (US$) 2 (2005) 39 Côte d’Ivoire Percent Percent Percent 38 40 34 40 36 40 35 35 Maternity protection in accordance with ILO 26 31 Convention 183 Partial National availability of Emergency Obstetric Care 19 20 20 20 services (% of recommended minimum) --- Specific notification of maternal deaths Partial 0 0 0 1994 1998-1999 2000 2006 2000 2006 1994 1998-1999 2000 2006 Countdown to 2015 DHS DHS MICS MICS MICS MICS DHS DHS MICS MICS 2008 Report Djibouti DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 819 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 107 (2006) undernutrition Unmet need for family planning (%) --- Births (000) 24 (2006) Measles HIV/AIDS Causes of neonatal Obstructed labor Injuries deaths Abortion Contraceptive 200 4% 3% 2% 4% prevalence rate 9 Pre-pregnancy Birth registration (%) 89 (2006) 175 Diarrhoea 3% Antenatal visits for woman (4 or more visits, %) --- Anaemia 4% Diarrhoea Malaria Other 6% 4% Antenatal visit Under-five mortality rate (per 1000 live births) 130 (2006) 160 1% Tetanus 6% (1 or more) 67 Pregnancy 130 17% Congenital 15% Intermittent preventive treatment for malaria (%) --- Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 86 (2006) disorders Haemorrhage 61 Birth 120 Asphyxia 20% C-section rate (total, urban, rural; %) at birth 9% 34% Neonatal mortality rate (per 1000 live births) 38 (2000) Neonatal (Minimum target is 5% and maximum target is 15%) ---,---,--- 80 27% *Postnatal care Neonatal period Total under-five deaths (000) 3 (2006) 58 Sepsis/Infections, Pneumonia Preterm 24% Early initiation of breastfeeding (within 1 hr of birth, %) 55 (2006) including AIDS Exclusive breastfeeding 1 Infancy Maternal mortality ratio (per 100,000 live births) 650 (2005) 40 MDG Target 20% 16% Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 35 (2005) Measles 67 Infection 27% Other causes 0 Other 180 (2005) 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 26% 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 34 (2006) Complementary feeding rate (6-9 months, %) 23 (2006) 100 100 100 Wasting prevalence (moderate and severe, %) 26 (2006) Low birthweight incidence (%) 10 (2006) 77 80 67 80 80 61 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent Percent Percent 40 40 40 At least one dose Two doses 100 100 100 91 91 20 20 20 80 80 80 75 0 0 2003 2003 1984 1989 1994 1999 2004 2006 Other NS Other NS 60 60 60 52 Source: WHO/UNICEF Percent 40 Percent 40 Percent 40 24 20 20 16 16 20 20 WATER AND SANITATION EQUITY 1 0 0 0 0 0 0 0 0 0 0 1990 1996 2002 2006 2006 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile MICS Other NS Other NS Other NS MICS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 88 88 82 CHILD HEALTH 76 76 79 80 72 73 80 59 59 Immunization Malaria prevention Prevention of mother to child 60 60 50 50 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs No data transmission of HIV Percent Percent Percent of children immunised with 3 doses DPT 40 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 20 20 100 100 10 0 0 80 72 80 8 1990 2004 1990 2004 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 6 6 60 67 60 6 Percent 40 Percent 40 Percent 4 POLICIES SYSTEMS 2 20 20 2 Coverage gap (%) 1 International Code of Marketing of Breastmilk Financial Flows and Human Resources No data 0 0 0 Substitutes Partial Ratio 1990 1995 2000 2005 2006 2006 2004 2005 2006 Per capita total expenditure on health (US$) 87 (2007) poorest/wealthiest Source: WHO/UNICEF MICS Other NS Other NS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea --- % of total government expenditure (%) 12 (2007) poorest-wealthiest (%) Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics No Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 30 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age No antibiotics Density of health workers (per 1000 population) 0.6 (2004) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available Yes Official Development Assistance to child health 80 80 80 per child (US$) 25 (2005) 62 Midwives be authorised to administer a core set of 60 60 60 life saving interventions Partial Official Development Assistance to maternal and 43 neonatal health per live birth (US$) 22 (2005) Djibouti Percent 40 33 Percent 40 Percent 40 Maternity protection in accordance with ILO Convention 183 No National availability of Emergency Obstetric Care 20 20 20 services (% of recommended minimum) 50 (2004) 10 Specific notification of maternal deaths Yes 0 0 0 2006 2006 2006 Countdown to 2015 MICS MICS MICS 2008 Report Egypt DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 74,166 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 8,634 (2006) undernutrition Unmet need for family planning (%) 10 (2005) Births (000) 1,828 (2006) Malaria Measles Causes of neonatal Obstructed labor Injuries Abortion Contraceptive 100 2% 0% 0% deaths 4% prevalence rate 59 Pre-pregnancy Birth registration (%) --- 91 Diarrhoea 1% Antenatal visits for woman (4 or more visits, %) 59 (2005) Anaemia 4% Diarrhoea HIV/AIDS Tetanus 2% 4% Antenatal visit Under-five mortality rate (per 1000 live births) 35 (2006) 80 13% 0% Other 6% (1 or more) 70 Pregnancy Congenital 14% Intermittent preventive treatment for malaria (%) --- Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 29 (2006) Pneumonia disorders Haemorrhage 74 Birth 60 Asphyxia 22% C-section rate (total, urban, rural; %) at birth 15% 9% 34% Neonatal mortality rate (per 1000 live births) 21 (2000) Neonatal (Minimum target is 5% and maximum target is 15%) 20,29, (2005) 15 *Postnatal care 56 Neonatal period 40 35 30 44% Total under-five deaths (000) 64 (2006) Infection 26% Sepsis/Infections, Early initiation of breastfeeding (within 1 hr of birth,%) 43 (2005) including AIDS Exclusive breastfeeding 38 Infancy Maternal mortality ratio (per 100,000 live births) 130 (2005) 20 MDG Target 16% Postnatal visit for baby (within 2 days for home births, %) 9 (2005) Lifetime risk of maternal death (1 in N) 230 (2005) Measles 98 Other Preterm 30% Other causes 0 26% 2,400 (2005) 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy 100 100 100 Stunting prevalence (moderate and severe, %) 24 (2005) Complementary feeding rate (6-9 months, %) 67 (2005) 86 Wasting prevalence (moderate and severe, %) 5 (2005) Low birthweight incidence (%) 14 (2005) 80 80 74 80 69 70 69 61 60 53 52 53 52 53 60 56 55 60 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 47 46 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses 39 41 Percent Percent Percent 40 40 35 37 40

100 100 20 20 20

80 80 0 0 56 57 1988 1991 1992 1995 1997 1998 2000 2003 2005 1988 1991 1992 1995 1997 1998 2000 2003 2005 1981 1986 1991 1996 2001 2006 60 60 DHS Other NS DHS DHS DHS DHS DHS DHS DHS DHS Other NS DHS DHS DHS DHS DHS DHS DHS 46 Source: WHO/UNICEF 38 No data Percent Percent 40 40 30

20 11 20 WATER AND SANITATION EQUITY 9 5 0 0 1995 2003 2005 1992 1995 2000 2003 2005 Water Sanitation Coverage gap by wealth quintile DHS DHS DHS DHS DHS DHS DHS DHS Percent population using improved drinking water sources Percent population using improved sanitation facilities

*Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 97 99 98 100 92 97 94 100 100 CHILD HEALTH 86 80 80 70 70 80 58 Immunization Malaria prevention Prevention of mother to child 60 60 54 60 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs* 42

transmission of HIV Percent Percent Percent Percent of children immunised with 3 doses DPT 40 40 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 20 20 20 98 100 98 0 0 0 80 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 1995 2000 2005 No data No data DHS DHS DHS Percent 40 POLICIES SYSTEMS 20 Coverage gap (%) 38 29 24 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 Substitutes Partial Ratio 1990 1995 2000 2005 2006 Per capita total expenditure on health (US$) 258 (2007) poorest/wealthiest 2.4 2.2 1.9 Source: WHO/UNICEF New ORS formula and zinc for management of *Very limited risk of malaria transmission General government expenditure on health as Difference diarrhoea Yes % of total government expenditure (%) 8 (2007) poorest-wealthiest (%) 31 21 15 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials* Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics No Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 58 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 2.5 (2004) 100 100 Costed implementation plan(s) for maternal, newborn and child health available Yes Official Development Assistance to child health 75 per child (US$) 1 (2005) 80 80 70 66 Midwives be authorised to administer a core set of 59 62 63 60 60 life saving interventions Partial Official Development Assistance to maternal and neonatal health per live birth (US$) 3 (2005) Egypt

Percent No data Percent Maternity protection in accordance with ILO 40 27 40 29 26 Convention 183 No National availability of Emergency Obstetric Care 19 25 20 20 services (% of recommended minimum) --- Specific notification of maternal deaths Yes 0 0 1995 2000 2003 2005 1992 1995 2000 2003 2005 Countdown to 2015 DHS DHS DHS DHS DHS DHS DHS DHS DHS *Very limited risk of malaria transmission 2008 Report Equatorial Guinea DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 496 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 81 (2006) undernutrition Unmet need for family planning (%) --- HIV/AIDS Causes of neonatal Births (000) 19 (2006) Obstructed labor Contraceptive 200 Measles 7% Injuries deaths Abortion Pre-pregnancy (2006) 170 Diarrhoea 4% Antenatal visits for woman (4 or more visits, %) --- Anaemia 4% 4% prevalence rate Birth registration (%) 32 206 7% 3% Congenital 4% Other 4% Antenatal visit (2006) Diarrhoea Tetanus 5% 86 Pregnancy Under-five mortality rate (per 1000 live births) 206 160 14% 0% Other 7% Intermittent preventive treatment for malaria (%) --- (1 or more) Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 124 (2006) disorders Haemorrhage 65 Birth 120 Infection 23% C-section rate (total, urban, rural; %) at birth 9% 34% Neonatal mortality rate (per 1000 live births) 40 (2000) Neonatal (Minimum target is 5% and maximum target is 15%) ---, ---, --- 28% *Postnatal care Neonatal period Total under-five deaths (000) 4 (2006) 80 Asphyxia 25% Sepsis/Infections, Exclusive 57 Early initiation of breastfeeding (within 1 hr of birth, %) --- including AIDS 24 Infancy Pneumonia breastfeeding Maternal mortality ratio (per 100,000 live births) 680 (2005) 40 MDG Target 16% 17% Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 28 (2005) Measles 51 0 Malaria Preterm 33% Other causes 150 (2005) 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 24% 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 43 (2000) Complementary feeding rate (6-9 months, %) --- 100 100 100 86 Wasting prevalence (moderate and severe, %) 9 (2000) Low birthweight incidence (%) 13 (2000) 80 80 80 65 59 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent Percent 40 37 Percent 40 40 At least one dose Two doses 100 100 100 20 20 20 5 80 80 80 0 0 1994 2000 1994 2000 1985 1990 1995 2000 2006 Other NS MICS Other NS MICS 60 60 60 Source: WHO/UNICEF Percent Percent 40 40 Percent 40 24 20 16 20 20 WATER AND SANITATION EQUITY 0 0 0 0 0 0 0 0 0 0 2000 2000 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile MICS MICS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 CHILD HEALTH 80 80 60 Immunization Malaria prevention Prevention of mother to child 60 60 53 45 46 No data Percent of children immunised against measles Percent children < 5 years sleeping under ITNs 42 43 transmission of HIV Percent Percent Percent of children immunised with 3 doses DPT 40 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 20 20 100 100 25 0 0 80 80 20 2004 2004 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 14 60 51 60 15

Percent 40 Percent 40 Percent 10 POLICIES SYSTEMS 33 20 20 5 Coverage gap (%) No data 1 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 0 Substitutes Partial Ratio 1990 1995 2000 2005 2006 2000 2006 Per capita total expenditure on health (US$) 223 (2007) poorest/wealthiest Source: WHO/UNICEF MICS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Yes % of total government expenditure (%) 7 (2007) poorest-wealthiest (%) Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics Yes Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 17 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age No antibiotics Density of health workers (per 1000 population) 0.8 (2004) 100 100 Costed implementation plan(s) for maternal, newborn and child health available Partial Official Development Assistance to child health 80 80 per child (US$) 14 (2005) Midwives be authorised to administer a core set of life saving interventions Partial Official Development Assistance to maternal and 60 60 49 No data neonatal health per live birth (US$) 13 (2005) Equatorial Guinea Percent 40 36 Percent 40 Maternity protection in accordance with ILO Convention 183 Partial National availability of Emergency Obstetric Care 20 20 services (% of recommended minimum) --- Specific notification of maternal deaths Partial 0 0 2000 2000 Countdown to 2015 MICS MICS 2008 Report Eritrea DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 4,692 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 808 (2006) undernutrition Unmet need for family planning (%) 27 (2002) (2006) HIV/AIDS Causes of neonatal Births (000) 186 147 Obstructed labor Contraceptive 6% Injuries deaths Abortion 8 Pre-pregnancy 150 Other Diarrhoea 1% Antenatal visits for woman (4 or more visits, %) 41 (2002) Anaemia 4% prevalence rate Birth registration (%) --- 13% 3% Measles 4% Tetanus 3% 4% Antenatal visit 3% Congenital 5% 70 Pregnancy Under-five mortality rate (per 1000 live births) 74 (2006) 120 Other 7% Intermittent preventive treatment for malaria (%) --- (1 or more) Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 48 (2006) Asphyxia 26% disorders Haemorrhage 28 Birth 90 Malaria C-section rate (total, urban, rural; %) at birth 74 9% 34% Neonatal mortality rate (per 1000 live births) 25 (2000) 14% Neonatal 49 (Minimum target is 5% and maximum target is 15%) 3, 7, 1 (2002) *Postnatal care 60 27% Neonatal period Total under-five deaths (000) 14 (2006) Preterm 27% Sepsis/Infections, Early initiation of breastfeeding (within 1 hr of birth, %) 78 (2002) including AIDS Exclusive breastfeeding 52 Infancy Maternal mortality ratio (per 100,000 live births) 450 (2005) 30 MDG Target Diarrhoea 16% 16% Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 44 (2005) Infection 30% Measles 95 0 Pneumonia Other causes 760 (2005) 19% 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 44 (2002) Complementary feeding rate (6-9 months, %) 43 (2002) 100 100 100 79 Wasting prevalence (moderate and severe, %) 15 (2002) Low birthweight incidence (%) 14 (2002) 80 70 80 80 60 60 60 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 49 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent Percent 40 Percent 40 40 28 At least one dose Two doses 21 100 100 100 20 20 20 94 74 80 80 80 0 0 61 1993 1998 2003 2006 59 57 1995 2002 1995 2002 51 52 50 DHS DHS DHS DHS 60 60 52 60 Source: WHO/UNICEF Percent Percent 37 38 Percent 50 40 33 40 40 42 35 20 20 20 WATER AND SANITATION EQUITY 0 0 0 0 0 0 0 1993 1995 2002 1995 2002 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile Other NS DHS DHS DHS DHS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 100 CHILD HEALTH 80 74 80 80 62 60 Immunization Malaria prevention Prevention of mother to child 60 57 60 60 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs 43 44 Percent of children immunised with 3 doses DPT transmission of HIV Percent 39 Percent Percent 40 40 32 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 20 20 20 9 97 7 3 100 100 10 0 95 0 0 0 80 80 8 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 60 6 1995 2002 DHS DHS

Percent Percent Percent 4 40 40 4 3 3 POLICIES SYSTEMS 20 20 2 Coverage gap (%) 66 53 4 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 0 Substitutes Yes Ratio 1993 1998 2003 2006 2002 2004 2005 2006 Per capita total expenditure on health (US$) 27 (2007) poorest/wealthiest 2.2 2.1 Source: WHO/UNICEF DHS Other NS Other NS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Partial % of total government expenditure (%) 4 (2007) poorest-wealthiest (%) 42 33 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics Partial Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 61 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 0.6 (2004) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available Partial Official Development Assistance to child health 80 80 80 per child (US$) 4 (2005) Midwives be authorised to administer a core set of 60 54 60 60 life saving interventions Partial Official Development Assistance to maternal and 44 neonatal health per live birth (US$) 2 (2005) Eritrea Percent 40 Percent 40 Percent 40 Maternity protection in accordance with ILO Convention 183 No National availability of Emergency Obstetric Care 20 15 20 20 services (% of recommended minimum) --- 4 Specific notification of maternal deaths No 0 0 0 1995 2002 2002 2002 Countdown to 2015 DHS DHS DHS DHS 2008 Report Ethiopia DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 81,021 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 13,439 (2006) undernutrition Unmet need for family planning (%) 34 (2005) Births (000) 3,159 (2006) 204 Measles Causes of neonatal Obstructed labor Abortion Contraceptive 200 Malaria 4% HIV/AIDS deaths 4% prevalence rate 15 Pre-pregnancy Birth registration (%) 7 (2006) 6% 4% Congenital 4% Antenatal visits for woman (4 or more visits, %) 12 (2005) Anaemia 4% Injuries Diarrhoea 4% 4% Antenatal visit Under-five mortality rate (per 1000 live births) 123 (2006) 160 Other 2% Other 7% (1 or more) 28 Pregnancy 14% Tetanus 9% Intermittent preventive treatment for malaria (%) --- 123 Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 77 (2006) disorders Haemorrhage 6 Birth 120 Preterm 16% C-section rate (total, urban, rural; %) at birth 9% 34% Neonatal mortality rate (per 1000 live births) 51 (2000) Neonatal (Minimum target is 5% and maximum target is 15%) 1, 9, 0 (2005) 68 30% *Postnatal care 5 Neonatal period 80 Asphyxia 24% Total under-five deaths (000) 389 (2006) Diarrhoea Sepsis/Infections, Early initiation of breastfeeding (within 1 hr of birth, %) 69 (2005) including AIDS Exclusive 17% breastfeeding 49 Infancy Maternal mortality ratio (per 100,000 live births) 720 (2005) 40 MDG Target 16% Postnatal visit for baby (within 2 days for home births, %) 2 (2005) Lifetime risk of maternal death (1 in N) 27 (2005) Infection 36% Measles 63 0 Pneumonia Other causes 22,000 (2005) 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 22% 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 51 (2005) Complementary feeding rate (6-9 months, %) 54 (2005) 100 100 100 80 Wasting prevalence (moderate and severe, %) 12 (2005) Low birthweight incidence (%) 20 (2005) 80 80 80 Underweight Prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent Percent 40 Percent 40 40 28 At least one dose Two doses 27 100 100 100 20 20 20 88 6 6 86 80 80 80 65 65 0 0 59 2000 2005 2000 2005 1981 1986 1991 1996 2001 2006 60 60 54 60 52 DHS DHS DHS DHS 49 59 Source: WHO/UNICEF 42 Percent Percent 40 35 40 Percent 40 16 16 20 20 20 WATER AND SANITATION EQUITY 22 0 0 0 0 0 0 0 2000 2005 2000 2005 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile DHS DHS DHS DHS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 100 CHILD HEALTH 81 81 80 80 80

Immunization Malaria prevention Prevention of mother to child 60 60 60 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs 44

Percent Percent Percent 4 4 40 40 4 POLICIES SYSTEMS 2 20 20 2 Coverage gap (%) 78 74 2 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 0 Substitutes Partial Ratio 1990 1995 2000 2005 2006 2005 2004 2005 2006 Per capita total expenditure on health (US$) 21 (2007) poorest/wealthiest 1.5 1.6 Source: WHO/UNICEF DHS Other NS Other NS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Yes % of total government expenditure (%) 9 (2007) poorest-wealthiest (%) 26 31 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics No Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 38 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 0.3 (2003) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available Yes Official Development Assistance to child health 80 80 80 per child (US$) 4 (2005) Midwives be authorised to administer a core set of 60 60 60 life saving interventions Yes Official Development Assistance to maternal and neonatal health per live birth (US$) 10 (2005) Ethiopia Percent 40 38 Percent 40 Percent 40 Maternity protection in accordance with ILO Convention 183 No National availability of Emergency Obstetric Care 20 15 20 20 16 19 services (% of recommended minimum) --- 3 3 Specific notification of maternal deaths No 0 0 0 2000 2005 2000 2005 2000 2005 Countdown to 2015 DHS DHS DHS DHS DHS DHS 2008 Report Gabon DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 1,311 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 158 (2006) undernutrition Unmet need for family planning (%) 28 (2000) Births (000) 34 (2006) Measles Injuries Causes of neonatal Obstructed labor Other Contraceptive 100 Diarrhoea 4% 3% deaths Abortion 33 Pre-pregnancy 92 91 0% Diarrhoea 2% Antenatal visits for woman (4 or more visits, %) 63 (2000) Anaemia 4% prevalence rate Birth registration (%) 89 (2006) 9% 4% Tetanus 3% 4% Antenatal visit Other 6% 94 Pregnancy Under-five mortality rate (per 1000 live births) 91 (2006) 80 Intermittent preventive treatment for malaria (%) --- (1 or more) HIV/AIDS Congenital 9% Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 60 (2006) 10% Asphyxia 21% disorders Haemorrhage 86 Birth 60 C-section rate (total, urban, rural; %) at birth 9% 34% Neonatal mortality rate (per 1000 live births) 31 (2000) Neonatal (Minimum target is 5% and maximum target is 15%) 6,6, (2000) 31 4 *Postnatal care Neonatal period 40 35% Infection 22% Total under-five deaths (000) 3 (2006) Sepsis/Infections, Early initiation of breastfeeding (within 1 hr of birth, %) 71 (2000) including AIDS Exclusive breastfeeding 6 Infancy Maternal mortality ratio (per 100,000 live births) 520 (2005) 20 MDG Target Pneumonia 16% 11% Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 53 (2005) Preterm 37% Measles 55 Other causes 0 Malaria 220 (2005) 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 28% 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy 94 Stunting prevalence (moderate and severe, %) 26 (2000) Complementary feeding rate (6-9 months, %) 62 (2000) 100 100 100 86 Wasting prevalence (moderate and severe, %) 4 (2000) Low birthweight incidence (%) 14 (2000) 80 80 80 63 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent Percent Percent 40 40 40 At least one dose Two doses 100 100 100 100 89 87 20 20 20 80 80 80 0 0 2000 2000 1985 1990 1995 2000 2006 DHS DHS 60 60 60 Source: WHO/UNICEF Percent 40 Percent 40 Percent 40 30 20 9 20 6 20 WATER AND SANITATION EQUITY 0 0 0 0 0 0 0 0 0 0 2000 2000 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile DHS DHS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 95 95 100 100 CHILD HEALTH 88 80 80 80

Immunization Malaria prevention Prevention of mother to child 60 60 60 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs 47 Percent of children immunised with 3 doses DPT transmission of HIV Percent Percent 37 36 Percent 40 40 30 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 20 20 20 100 10 0 0 0 80 8 1990 2004 2004 Poorest 2nd 3rd 4th Wealthiest Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 55 6 2000 No data DHS

Percent Percent 4 4 40 4 38 POLICIES SYSTEMS 20 2 Coverage gap (%) 39 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 Substitutes Yes Ratio 1990 1995 2000 2005 2006 2005 2006 Per capita total expenditure on health (US$) 264 (2007) poorest/wealthiest 1.5 Source: WHO/UNICEF Other NS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Yes % of total government expenditure (%) 14 (2007) poorest-wealthiest (%) 19 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics No Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 31 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 5.3 (2004) 100 100 Costed implementation plan(s) for maternal, newborn and child health available Yes Official Development Assistance to child health 80 80 per child (US$) 17 (2005) Midwives be authorised to administer a core set of 60 60 life saving interventions Yes Official Development Assistance to maternal and 48 44 neonatal health per live birth (US$) 21 (2005) Gabon Percent 40 No data Percent 40 Maternity protection in accordance with ILO Convention 183 Partial National availability of Emergency Obstetric Care 20 20 services (% of recommended minimum) 123 (2001) Specific notification of maternal deaths No 0 0 2000 2000 Countdown to 2015 DHS DHS 2008 Report The Gambia DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 1,663 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 261 (2006) undernutrition Unmet need for family planning (%) --- Births (000) 60 (2006) 153 Measles Causes of neonatal Obstructed labor Injuries 3% HIV/AIDS Contraceptive 150 3% deaths Abortion 18 Pre-pregnancy 1% Diarrhoea 3% Antenatal visits for woman (4 or more visits, %) --- Anaemia 4% prevalence rate Birth registration (%) 55 (2006) Diarrhoea 4% Other Tetanus 4% 4% Antenatal visit (per 1000 live births) 113 (2006) 120 12% 0% Congenital 5% (1 or more) 98 Pregnancy Under-five mortality rate Other 6% Intermittent preventive treatment for malaria (%) 33 (2006) 113 Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 84 (2006) Asphyxia 20% disorders Haemorrhage 57 Birth 90 C-section rate (total, urban, rural; %) at birth 9% 34% Neonatal mortality rate (per 1000 live births) 46 (2000) Neonatal (Minimum target is 5% and maximum target is 15%) ---,---, 51 --- *Postnatal care Neonatal period 60 37% Preterm 27% Total under-five deaths (000) 7 (2006) Sepsis/Infections, (2006) Exclusive Early initiation of breastfeeding (within 1 hr of birth, %) 48 including AIDS 41 Infancy (2005) MDG Target Pneumonia breastfeeding Maternal mortality ratio (per 100,000 live births) 690 30 16% 16% Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 32 (2005) Infection 35% Measles 95 0 Malaria Other causes 360 (2005) 29% 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy 98 94 Stunting prevalence (moderate and severe, %) 28 (2006) Complementary feeding rate (6-9 months, %) 44 (2006) 100 91 100 100 Wasting prevalence (moderate and severe, %) 7 (2006) Low birthweight incidence (%) 20 (2006) 80 80 80 57 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 55 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses 44 Percent Percent Percent 40 40 40 At least one dose Two doses 95 100 100 100 20 20 20 87 91 91 91 80 80 80 0 0 2000 2006 1990 2000 2006 1981 1986 1991 1996 2001 2006 52 MICS MICS Other NS MICS MICS 60 60 60 Source: WHO/UNICEF 41 Percent Percent Percent 27 40 40 40 26 15 16 20 20 20 WATER AND SANITATION EQUITY 0 0 0 0 0 16 0 0 0 2000 2006 2000 2006 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile MICS MICS MICS MICS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 95 95 100 100 CHILD HEALTH 77 82 80 80 72 80

Immunization Malaria prevention Prevention of mother to child 60 60 53 60 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs 46

transmission of HIV Percent Percent Percent Percent of children immunised with 3 doses DPT 40 40 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 20 20 20 95 100 95 100 50 0 0 0 95 80 80 40 1990 2004 2004 Poorest 2nd 3rd 4th Wealthiest Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 60 49 30 2000 2006 21 MICS MICS Percent 40 Percent 40 Percent 20 POLICIES SYSTEMS 20 20 15 10 Coverage gap (%) 38 36 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 0 Substitutes Yes Ratio 1990 1995 2000 2005 2006 2000 2006 2006 Per capita total expenditure on health (US$) 88 (2007) poorest/wealthiest 1.4 1.3 Source: WHO/UNICEF MICS MICS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea --- % of total government expenditure (%) 6 (2007) poorest-wealthiest (%) 12 9 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics Yes Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 50 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 1.4 (2003) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available Yes Official Development Assistance to child health 80 80 80 75 per child (US$) 18 (2005) 69 Midwives be authorised to administer a core set of 63 61 60 60 55 60 life saving interventions Yes Official Development Assistance to maternal and neonatal health per live birth (US$) 11 (2005) The Gambia Percent 40 38 38 Percent 40 Percent 40 32 Maternity protection in accordance with ILO Convention 183 No National availability of Emergency Obstetric Care 20 20 20 services (% of recommended minimum) 86 (2002) Specific notification of maternal deaths No 0 0 0 2000 2006 2000 2006 2000 2006 Countdown to 2015 MICS MICS MICS MICS MICS MICS 2008 Report Ghana DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 23,008 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 3,195 (2006) undernutrition Unmet need for family planning (%) 34 (2003) Births (000) 700 (2006) Malaria Causes of neonatal Obstructed labor Other Abortion Contraceptive 150 0% 33% deaths 4% prevalence rate 17 Pre-pregnancy Birth registration (%) 51 (2006) Diarrhoea 3% Antenatal visits for woman (4 or more visits, %) 69 (2003) Anaemia 4% 120 120 Measles Tetanus 4% 4% Antenatal visit 92 Pregnancy Under-five mortality rate (per 1000 live births) 120 (2006) 120 3% Congenital 6% Intermittent preventive treatment for malaria (%) 27 (2006) (1 or more) Other 6% Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 76 (2006) Asphyxia 23% disorders Haemorrhage 50 Birth 90 C-section rate (total, urban, rural; %) at birth 9% 34% Neonatal mortality rate (per 1000 live births) 27 (2000) Injuries Neonatal 3% (Minimum target is 5% and maximum target is 15%) 4, 8, 2 (2003) *Postnatal care 60 29% Preterm 26% Neonatal period Total under-five deaths (000) 84 (2006) 40 Sepsis/Infections, HIV/AIDS Early initiation of breastfeeding (within 1 hr of birth, %) 46 (2003) including AIDS Exclusive breastfeeding 54 Infancy Maternal mortality ratio (per 100,000 live births) 560 (2005) 30 MDG Target 6% 16% Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 45 (2005) Diarrhoea Infection 32% Measles 85 0 12% Pneumonia Other causes 3,800 (2005) 15% 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy 100 100 100 Stunting prevalence (moderate and severe, %) 28 (2006) Complementary feeding rate (6-9 months, %) 58 (2006) 88 92 92 87 82 86 Wasting prevalence (moderate and severe, %) 6 (2006) Low birthweight incidence (%) 9 (2006) 80 80 80

60 60 60 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 47 50 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses 40 44 44 Percent Percent Percent 40 40 40 At least one dose Two doses 100 99 95 95 100 100 100 91 89 20 20 20 100 99 78 95 80 80 80 89 0 0 1988 1993 1998 2003 2006 1988 1993 1998 2003 2006 54 78 1980 1985 1990 1995 2000 2006 53 DHS DHS DHS DHS MICS DHS DHS DHS DHS MICS 60 60 60 Source: WHO/UNICEF Percent Percent Percent 40 40 31 40 50 19 20 13 20 20 WATER AND SANITATION EQUITY 7 0 0 0 0 2003 2006 1993 1998 2003 2006 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile DHS MICS DHS DHS DHS MICS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 100 CHILD HEALTH 86 88 80 75 80 80 64 Immunization Malaria prevention Prevention of mother to child 60 55 60 60 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs 47 Percent of children immunised with 3 doses DPT transmission of HIV Percent 37 Percent Percent Percent HIV+ pregnant women receiving ARVs for PMTCT 40 40 40 Percent of children immunised with 3 doses Hib 23 27 15 18 20 20 10 11 20 100 100 10 85 0 0 0 8 80 84 80 8 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest 7 84 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 60 6 1993 1998 2003 2006 DHS DHS DHS MICS Percent 40 Percent 40 Percent 4 22 POLICIES SYSTEMS 20 20 2 4 1 Coverage gap (%) 51 48 41 43 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 0 Substitutes Yes Ratio 1990 1995 2000 2005 2006 2003 2006 2004 2005 2006 Per capita total expenditure on health (US$) 95 (2007) poorest/wealthiest 1.9 1.8 2.4 1.5 Source: WHO/UNICEF DHS MICS Other NS Other NS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Partial % of total government expenditure (%) 8 (2007) poorest-wealthiest (%) 29 26 31 17 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics No Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 45 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 0.6 (2004) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available Partial Official Development Assistance to child health 80 80 80 per child (US$) 11 (2005) 61 63 61 Midwives be authorised to administer a core set of 59 60 60 60 life saving interventions Yes Official Development Assistance to maternal and neonatal health per live birth (US$) 12 (2005) 40 43 44 Ghana Percent Percent Percent Maternity protection in accordance with ILO 40 29 40 40 33 24 24 26 Convention 183 Partial National availability of Emergency Obstetric Care 20 20 20 16 services (% of recommended minimum) 51 (2004-2005) Specific notification of maternal deaths Yes 0 0 0 1998 2003 2006 1998 2003 2006 1993 1998 2003 2006 Countdown to 2015 DHS DHS MICS DHS DHS MICS DHS DHS DHS MICS 2008 Report Guatemala DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 13,029 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Latin America, 1997-2002 Total under-five population (000) 2,066 (2006) undernutrition Unmet need for family planning (%) 23 (1999) Sepsis/Infections, (2006) HIV/AIDS Injuries Causes of neonatal Anaemia Births (000) 445 Malaria including AIDS Contraceptive 3% 2% deaths 0% 40 100 Diarrhoea 0% (4 or more visits, %) 8% prevalence rate Pre-pregnancy Birth registration (%) --- 13% Diarrhoea 1% Antenatal visits for woman --- 82 Tetanus 2% Antenatal visit Measles 84 Pregnancy Under-five mortality rate (per 1000 live births) 41 (2006) 80 Congenital 8% Intermittent preventive treatment for malaria (%) --- Abortion Hypertensive (1 or more) Pneumonia 0% Other 8% 12% disorders Skilled attendant Infant mortality rate (per 1000 live births) 31 (2006) 15% 26% 41 Birth 60 Preterm 26% C-section rate (total, urban, rural; %) at birth Neonatal Neonatal mortality rate (per 1000 live births) 19 (2000) 41 (Minimum target is 5% and maximum target is 15%) 11,19,8 (2002) Obstructed labor 40 37% *Postnatal care Neonatal period Total under-five deaths (000) 18 (2006) 27 13% Asphyxia 27% Exclusive Early initiation of breastfeeding (within 1 hr of birth, %) 49 (1998) 51 Infancy Maternal mortality ratio (per 100,000 live births) 290 (2005) breastfeeding 20 MDG Target Postnatal visit for baby (within 2 days for home births, %) --- Haemorrhage (1 in N) 71 (2005) Measles 95 Lifetime risk of maternal death Other Infection 28% Other causes 21% 0 30% 1,300 (2005) 21% Total maternal deaths 1990 1995 2000 2005 2010 2015 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 54 (2002) Complementary feeding rate (6-9 months, %) 67 (2002) 100 100 100 84 79 Wasting prevalence (moderate and severe, %) 2 (2002) Low birthweight incidence (%) 12 (2002) 80 80 80 60 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 53 60 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses 41 41 Percent Percent Percent 40 35 40 35 35 40 29 At least one dose Two doses 100 100 100 20 20 20

80 80 80 0 0 1987 1995 1998-1999 2002 1984 1987 1995 1998-1999 2002 1980 1985 1990 1995 2000 2006 51 DHS DHS DHS Other NS Other NS Other NS DHS DHS Other NS 60 60 60 Source: WHO/UNICEF 46 44 Percent 40 Percent 40 Percent 40 33 20 18 18 36 20 20 20 WATER AND SANITATION EQUITY 0 0 0 0 0 18 0 0 0 1998-1999 2002 1995 2002 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile DHS Other NS DHS Other NS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total 99 Rural Urban Total 100 92 95 100 100 89 88 90 86 79 82 CHILD HEALTH 75 73 80 72 80 80 64 58 Immunization Malaria prevention Prevention of mother to child 60 55 60 60 47 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs* 47

transmission of HIV Percent 37 Percent Percent Percent of children immunised with 3 doses DPT 40 40 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 20 20 20 100 95 100 15 80 0 0 0 80 80 12 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest 80 9 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 60 9 1995 1999 6 DHS DHS Percent 40 Percent 40 Percent 6 POLICIES SYSTEMS 20 20 3 Coverage gap (%) 48 44 1 0.6 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 0 Substitutes Yes Ratio 1990 1995 2000 2006 1998-1999 2004 2005 2006 Per capita total expenditure on health (US$) 256 (2007) poorest/wealthiest 2.8 2.6 Source: WHO/UNICEF DHS Other NS Other NS Other NS New ORS formula and zinc for management of *Very limited risk of malaria transmission General government expenditure on health as Difference diarrhoea --- % of total government expenditure (%) 19 (2007) poorest-wealthiest (%) 40 37 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials* Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics --- Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 53 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age --- antibiotics Density of health workers (per 1000 population) 4.9 (1999) 100 100 Costed implementation plan(s) for maternal, newborn and child health available --- Official Development Assistance to child health 80 80 per child (US$) 3 (2005) 64 Midwives be authorised to administer a core set of 60 60 life saving interventions --- Official Development Assistance to maternal and (2005) 41 neonatal health per live birth (US$) 14 Guatemala Percent 40 No data Percent 40 37 Maternity protection in accordance with ILO National availability of Emergency Obstetric Care 20 22 Convention 183 Partial 20 20 services (% of recommended minimum) --- Specific notification of maternal deaths --- 0 0 1995 1998-1999 1995 1998-1999 2002 Countdown to 2015 DHS DHS DHS DHS Other NS *Very limited risk of malaria transmission 2008 Report Guinea DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 9,181 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 1,544 (2006) undernutrition Unmet need for family planning (%) 21 (2005) (2006) HIV/AIDS Causes of neonatal Births (000) 374 Measles Obstructed labor Contraceptive 250 235 2% Injuries deaths Abortion 9 Pre-pregnancy 6% Diarrhoea 2% Antenatal visits for woman (4 or more visits, %) 49 (2005) Anaemia 4% 4% prevalence rate Birth registration (%) 43 (2006) Diarrhoea 1% Other Tetanus 4% 4% Antenatal visit 17% 82 Pregnancy Under-five mortality rate (per 1000 live births) 161 (2006) 200 0% Congenital 5% Intermittent preventive treatment for malaria (%) 3 (2005) (1 or more) 161 Other 7% Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 98 (2006) Asphyxia 23% disorders Haemorrhage 38 Birth 150 C-section rate (total, urban, rural; %) at birth 9% 34% Neonatal mortality rate (per 1000 live births) 48 (2000) Neonatal (Minimum target is 5% and maximum target is 15%) 2, 5, (2005) 1 *Postnatal care Neonatal period 100 78 29% Total under-five deaths (000) 60 (2006) Infection 29% Sepsis/Infections, Early initiation of breastfeeding (within 1 hr of birth, %) 40 (2005) including AIDS Exclusive breastfeeding 27 Infancy Maternal mortality ratio (per 100,000 live births) 910 (2005) 50 MDG Target Pneumonia 16% 21% Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 19 (2005) Preterm 29% Measles 67 0 Malaria Other causes 3,500 (2005) 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 25% 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 39 (2005) Complementary feeding rate (6-9 months, %) 41 (2005) 100 100 100 91 84 82 Wasting prevalence (moderate and severe, %) 11 (2005) Low birthweight incidence (%) 12 (2005) 80 71 80 80 58 56 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses 38 Percent Percent Percent 35 40 40 31 40 At least one dose Two doses 100 100 100 93 95 98 95 95 20 20 20 100 99 93 95 95 80 80 80 0 0 1992 1999 2003 2005 1992 1999 2003 2005 1986 1991 1996 2001 2006 DHS DHS MICS DHS DHS DHS MICS DHS 60 60 60 Source: WHO/UNICEF Percent 40 Percent 40 Percent 40 27 21 23 47 20 20 11 20 WATER AND SANITATION EQUITY 0 0 0 0 0 0 1999 2005 1999 2005 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile DHS DHS DHS DHS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 100 CHILD HEALTH 78 80 74 80 80

Immunization Malaria prevention Prevention of mother to child 60 50 60 60 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs 44

transmission of HIV Percent Percent Percent Percent of children immunised with 3 doses DPT 40 34 35 40 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 27 31 18 20 20 10 14 11 20 100 100 15 0 0 0 80 71 80 12 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 60 9 1999 2005 67 8 DHS DHS Percent 40 Percent 40 Percent 6 POLICIES SYSTEMS 20 20 3 3 1 Coverage gap (%) 59 54 0.3 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 0 Substitutes Partial Ratio 1990 1995 2000 2005 2006 2005 2004 2005 2006 Per capita total expenditure on health (US$) 96 (2007) poorest/wealthiest 1.9 1.8 Source: WHO/UNICEF DHS Other NS Other NS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Yes % of total government expenditure (%) 5 (2007) poorest-wealthiest (%) 32 28 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics No Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 86 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age No antibiotics Density of health workers (per 1000 population) 0.8 (2004) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available No Official Development Assistance to child health 80 80 80 per child (US$) 6 (2005) Midwives be authorised to administer a core set of 60 60 60 life saving interventions Partial Official Development Assistance to maternal and 44 44 42 neonatal health per live birth (US$) 11 (2005) Guinea

Percent 38 Percent Percent 39 40 40 40 33 Maternity protection in accordance with ILO 29 Convention 183 Partial National availability of Emergency Obstetric Care 20 20 20 services (% of recommended minimum) 25 (2002) Specific notification of maternal deaths Partial 0 0 0 1999 2003 2005 2005 1999 2003 2005 Countdown to 2015 DHS MICS DHS DHS DHS MICS DHS 2008 Report Guinea-Bissau DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 1,646 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 322 (2006) undernutrition Unmet need for family planning (%) --- Births (000) 82 (2006) Other Measles HIV/AIDS Causes of neonatal Obstructed labor 240 3% Abortion Contraceptive 250 6% 3% deaths 4% prevalence rate 10 Pre-pregnancy Birth registration (%) 39 (2006) Injuries Diarrhoea 3% Antenatal visits for woman (4 or more visits, %) --- Anaemia 4% 200 1% Other 6% 4% Antenatal visit Diarrhoea 78 Pregnancy Under-five mortality rate (per 1000 live births) 200 (2006) 200 Congenital 6% Intermittent preventive treatment for malaria (%) 7 (2006) (1 or more) 19% Tetanus 9% Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 119 (2006) disorders Haemorrhage 39 Birth 150 Asphyxia 20% C-section rate (total, urban, rural; %) at birth 9% 34% Neonatal mortality rate (per 1000 live births) 48 (2000) Neonatal (Minimum target is 5% and maximum target is 15%) ---, ---, --- 100 80 24% *Postnatal care Neonatal period Total under-five deaths (000) 16 (2006) Malaria Preterm 24% Sepsis/Infections, Early initiation of breastfeeding (within 1 hr of birth, %) 23 (2006) including AIDS Exclusive 21% breastfeeding 16 Infancy Maternal mortality ratio (per 100,000 live births) 1,100 (2005) 50 MDG Target 16% Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 13 (2005) Measles 60 Infection 33% Other causes 0 Pneumonia 890 (2005) 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 23% 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 47 (2006) Complementary feeding rate (6-9 months, %) 35 (2006) 100 100 100 78 Wasting prevalence (moderate and severe, %) 8 (2006) Low birthweight incidence (%) 24 (2006) 80 80 80 62 69 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses 39 Percent Percent Percent 40 40 35 40 At least one dose Two doses 25 100 100 100 91 20 20 20 100 77 80 80 80 80 0 0 64 2000 2006 1990-1995 2000 2006 1984 1989 1994 1999 2004 2006 MICS MICS Other NS MICS MICS 60 60 60 Source: WHO/UNICEF Percent Percent 37 Percent 40 40 40 22 20 15 20 16 20 34 0 WATER AND SANITATION EQUITY 0 0 0 0 0 0 0 0 2000 2006 2000 2006 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile MICS MICS MICS MICS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 100 CHILD HEALTH 79 80 80 80 59 60 60 57 60 Immunization Malaria prevention Prevention of mother to child 49 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs

transmission of HIV Percent Percent Percent Percent of children immunised with 3 doses DPT 40 40 35 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 23 20 20 20 100 100 25 0 0 0 77 80 80 20 2004 2004 Poorest 2nd 3rd 4th Wealthiest Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 60 15 13 2000 2006 60 39 MICS MICS Percent 40 Percent 40 Percent 10 POLICIES SYSTEMS 39 20 20 5 7 Coverage gap (%) 56 49 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 0 Substitutes Partial Ratio 1990 1995 2000 2005 2006 2000 2006 2006 Per capita total expenditure on health (US$) 28 (2007) poorest/wealthiest 1.5 1.7 Source: WHO/UNICEF MICS MICS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea No % of total government expenditure (%) 4 (2007) poorest-wealthiest (%) 21 25 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics No Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 65 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age No antibiotics Density of health workers (per 1000 population) 0.8 (2007) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available Yes Official Development Assistance to child health 80 80 80 per child (US$) 6 (2005) 64 Midwives be authorised to administer a core set of 58 60 60 60 57 life saving interventions No Official Development Assistance to maternal and 46 42 neonatal health per live birth (US$) 12 (2005) Guinea-Bissau Percent 40 Percent 40 Percent 40 Maternity protection in accordance with ILO 25 Convention 183 National availability of Emergency Obstetric Care 23 22 No 20 20 20 services (% of recommended minimum) 127 (2002) Specific notification of maternal deaths Yes 0 0 0 2000 2006 2000 2006 2000 2006 Countdown to 2015 MICS MICS MICS MICS MICS MICS 2008 Report Haiti DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 9,446 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Latin America, 1997-2002 Total under-five population (000) 1,244 (2006) undernutrition Unmet need for family planning (%) 40 (2000) Sepsis/Infections, Births (000) 269 (2006) 152 Causes of neonatal including AIDS Anaemia Injuries Other Contraceptive 150 deaths 8% 0% prevalence rate 32 Pre-pregnancy Birth registration (%) 81 (2006) Measles 0% 27% Diarrhoea 2% Antenatal visits for woman (4 or more visits, %) 54 (2005-2006) 1% Tetanus 5% Antenatal visit Congenital 6% Abortion 85 Pregnancy Under-five mortality rate (per 1000 live births) 80 (2006) 120 Malaria Other 8% Intermittent preventive treatment for malaria (%) --- Hypertensive (1 or more) 12% disorders 1% Skilled attendant Infant mortality rate (per 1000 live births) 60 (2006) 80 26% 26 Birth 90 HIV/AIDS Infection 26% C-section rate (total, urban, rural; %) at birth Neonatal mortality rate (per 1000 live births) 34 (2000) 8% Neonatal (Minimum target is 5% and maximum target is 15%) 3, 6, 1 (2005-2006) 51 26% Obstructed labor *Postnatal care 30 Neonatal period Total under-five deaths (000) 22 (2006) 60 13% Preterm 26% Exclusive Early initiation of breastfeeding (within 1 hr of birth, %) 44 (2005-2006) 41 Infancy Maternal mortality ratio (per 100,000 live births) 670 (2005) 30 MDG Target Diarrhoea breastfeeding 17% Postnatal visit for baby (within 2 days for home births, %) 4 (2005-2006) Haemorrhage Lifetime risk of maternal death (1 in N) 44 (2005) Asphyxia 27% Measles 58 0 Pneumonia Other causes 21% 1,700 (2005) 20% 21% Total maternal deaths 1990 1995 2000 2005 2010 2015 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 30 (2005-2006) Complementary feeding rate (6-9 months, %) 87 (2005-2006) 100 100 100 85 79 Wasting prevalence (moderate and severe, %) 10 (2005-2006) Low birthweight incidence (%) 25 (2005-2006) 80 80 80 71 68 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent Percent 40 40 Percent 40 At least one dose Two doses 23 24 26 21 31 100 100 100 20 20 20

80 80 80 0 0 1984-1989 1994-1995 2000 2005-2006 1989 1994-1995 2000 2005-2006 1980 1985 1990 1995 2000 2006 Other NS DHS DHS DHS Other NS DHS DHS DHS 60 60 60 Source: WHO/UNICEF 42 41 Percent Percent Percent 32 42 40 40 40 25 24 24 19 20 14 20 20 WATER AND SANITATION EQUITY 0 0 0 0 0 0 0 0 0 1994-1995 2000 2005-2006 2000 2005-2006 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile DHS DHS DHS DHS DHS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 100 CHILD HEALTH 80 80 80

60 56 57 Immunization Malaria prevention Prevention of mother to child 60 52 54 60 60 47 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs* 42 Percent of children immunised with 3 doses DPT transmission of HIV Percent Percent Percent Percent HIV+ pregnant women receiving ARVs for PMTCT 40 40 30 40 Percent of children immunised with 3 doses Hib 23 25 24 20 20 14 20 100 30 0 0 0 80 24 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest 20 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 58 60 18 17 1995 2000 2005 53 No data 13 DHS DHS DHS Percent 40 Percent 12 POLICIES SYSTEMS 20 6 Coverage gap (%) 57 54 54 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 Substitutes Partial Ratio 1990 1995 2000 2005 2006 2004 2005 2006 Per capita total expenditure on health (US$) 82 (2007) poorest/wealthiest 1.8 1.7 1.7 Source: WHO/UNICEF Other NS Other NS Other NS New ORS formula and zinc for management of *Sub-national risk of malaria transmission General government expenditure on health as Difference diarrhoea No % of total government expenditure (%) 24 (2007) poorest-wealthiest (%) 30 24 29 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials* Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics No Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 43 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age No antibiotics Density of health workers (per 1000 population) 0.4 (1998) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available No Official Development Assistance to child health 80 80 80 per child (US$) 4 (2005) Midwives be authorised to administer a core set of 60 60 60 life saving interventions No Official Development Assistance to maternal and neonatal health per live birth (US$) 16 (2005) 41 43 Haiti Percent 40 Percent 40 Percent 40 Maternity protection in accordance with ILO 26 31 Convention 183 No National availability of Emergency Obstetric Care 17 (% of recommended minimum) 20 20 12 20 services --- 5 3 Specific notification of maternal deaths No 0 0 0 2000 2005-2006 2000 2005-2006 1994-1995 2000 2005-2006 Countdown to 2015 DHS DHS DHS DHS DHS DHS DHS *Sub-national risk of malaria transmission 2008 Report India DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 1,151,751 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Asia, 1997-2002 Total under-five population (000) 126,843 (2006) undernutrition Unmet need for family planning (%) 13 (2005-2006) Causes of neonatal Abortion Births (000) 27,195 (2006) Injuries Malaria Contraceptive Measles 2% 1% deaths Obstructed labor 6% 56 150 4% HIV/AIDS Antenatal visits for woman (4 or more visits, %) 51 (2005-2006) prevalence rate Pre-pregnancy Birth registration (%) 41 (2006) 1% 9% Other Antenatal visit 115 74 Pregnancy Under-five mortality rate (per 1000 live births) 76 (2006) 120 9% (%) --- (1 or more) Intermittent preventive treatment for malaria Hypertensive Haemorrhage Infant mortality rate (per 1000 live births) 57 (2006) Pneumonia disorders Skilled attendant 76 at birth 47 Birth 90 19% C-section rate (total, urban, rural; %) 9% 31% Neonatal mortality rate (per 1000 live births) 43 (2000) Neonatal (Minimum target is 5% and maximum target is 15%) 9,17,6 (2005-2006) *Postnatal care 37 60 45% No data Neonatal period Total under-five deaths (000) 2,067 (2006) 38 Sepsis/Infections, Early initiation of breastfeeding (within 1 hr of birth, %) 25 (2005-2006) including AIDS Exclusive breastfeeding 46 Infancy Maternal mortality ratio (per 100,000 live births) 450 (2005) 30 MDG Target 12% Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 70 (2005) Other causes Measles 59 0 Diarrhoea Anaemia 21% 117,000 (2005) 20% 13% Total maternal deaths 1990 1995 2000 2005 2010 2015 0 20 40 60 80 100 Source: UNICEF, 2006 Source: WHO, 2006 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 48 (2005-2006) Complementary feeding rate (6-9 months, %) 56 (2005-2006) 100 100 100 86 Wasting prevalence (moderate and severe, %) 20 (2005-2006) Low birthweight incidence (%) 30 (1998-1999) 80 74 80 80 60 62 60 49 60 60 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 47 Percent children < 3 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses 42 43 Percent Percent Percent 40 40 34 40 At least one dose Two doses 100 100 100 20 20 20 55 80 80 80 0 0 64 1992-1993 1998-1999 2000 2005-2006 1992-1993 1998-1999 2000 2005-2006 1980 1985 1990 1995 2000 2006 60 60 60 51 NFHS NFHS MICS NFHS NFHS NFHS MICS NFHS 44 46 46 45 64 Source: WHO/UNICEF 44 41 Percent Percent 37 Percent 51 40 40 40 27 45 22 25 20 20 20 15 WATER AND SANITATION EQUITY 27 0 0 0 0 0 0 1998-1999 2005-2006 1992-1993 1998-1999 2000 2005-2006 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile NFHS NFHS MICS NFHS NFHS NFHS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 95 100 89 100 100 CHILD HEALTH 83 86 80 70 80 80 64 59 60 60 60 Immunization Malaria prevention Prevention of mother to child 45 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs*

transmission of HIV Percent Percent Percent Percent of children immunised with 3 doses DPT 40 40 33 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 22 14 20 20 20 100 20 3 0 0 0 80 16 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest 59 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 12 60 10 1993 1999 2006 55 No data DHS DHS DHS Percent 40 Percent 8 5 POLICIES SYSTEMS 20 4 3 Coverage gap (%) 49 42 36 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 Substitutes Yes Ratio 1990 1995 2000 2005 2006 2004 2005 2006 Per capita total expenditure on health (US$) 91 (2007) poorest/wealthiest 2.7 2.9 3.0 Source: WHO/UNICEF Other NS Other NS Other NS New ORS formula and zinc for management of *Sub-national risk of malaria transmission General government expenditure on health as Difference diarrhoea Yes % of total government expenditure (%) 3 (2007) poorest-wealthiest (%) 40 39 34 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials* Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics Yes Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 78 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 1.9 (2004) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available Yes Official Development Assistance to child health 80 80 80 per child (US$) 1 (2005) 69 67 69 Midwives be authorised to administer a core set of 60 60 60 life saving interventions Partial Official Development Assistance to maternal and neonatal health per live birth (US$) 3 (2005) India Percent 40 32 Percent 40 Percent 40 33 Maternity protection in accordance with ILO 22 Convention 183 No National availability of Emergency Obstetric Care services (% of recommended minimum) --- 20 20 12 20 Specific notification of maternal deaths Yes 0 0 0 1998-1999 2005-2006 2000 1992-1993 1998-1999 2005-2006 Countdown to 2015 NFHS NFHS MICS NFHS NFHS NFHS *Sub-national risk of malaria transmission 2008 Report Indonesia DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 228,864 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Asia, 1997-2002 Total under-five population (000) 21,720 (2006) undernutrition Unmet need for family planning (%) 9 (2002-2003) Abortion Births (000) 4,427 (2006) Measles Injuries Malaria Causes of neonatal 3% Obstructed labor 6% Contraceptive 100 91 5% 1% deaths prevalence rate 57 Pre-pregnancy Birth registration (%) 55 (2006) Antenatal visits for woman (4 or more visits, %) 81 (2002-2003) 9% Pneumonia HIV/AIDS Antenatal visit 14% 0% 92 Pregnancy Under-five mortality rate (per 1000 live births) 34 (2006) 80 (%) (1 or more) Intermittent preventive treatment for malaria --- Hypertensive Haemorrhage (per 1000 live births) 26 (2006) disorders Skilled attendant Infant mortality rate 31% at birth 72 Birth 60 C-section rate (total, urban, rural; %) 9% Neonatal mortality rate (per 1000 live births) 18 (2000) (Minimum target is 5% and maximum target is 15%) 4,7, (2002-2003) Neonatal 2 *Postnatal care Neonatal period 34 30 38% No data Total under-five deaths (000) 151 (2006) 40 Sepsis/Infections, Exclusive Early initiation of breastfeeding (within 1 hr of birth, %) 39 (2002-2003) including AIDS 40 Infancy (2005) breastfeeding Maternal mortality ratio (per 100,000 live births) 420 20 MDG Target Diarrhoea 12% 18% Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 97 (2005) Anaemia Other causes Measles 72 Other 0 13% 21% 19,000 (2005) 22% Total maternal deaths 1990 1995 2000 2005 2010 2015 0 20 40 60 80 100 Source: UNICEF, 2006 Source: WHO, 2006 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy 100 100 100 Stunting prevalence (moderate and severe, %) --- Complementary feeding rate (6-9 months, %) 75 (2002-2003) 89 92 82 83 Wasting prevalence (moderate and severe, %) --- Low birthweight incidence (%) 9 (2002-2003) 80 76 80 80 68 72 67 64 66 56 56 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 50 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses 41 43 Percent Percent Percent 36 37 40 40 32 40 At least one dose Two doses 100 100 100 20 20 20 82 76 80 80 80 71 73 0 0 64 61 62 1987 1999 1991 1994 1995 1997 1998 1999 2000 2001 2002 02-03 2004 1991 1994 1997 2002-2003 Other NS Other NS DHS DHS Other NS DHS Other NS Other NS Other NS Other NS Other NS DHS DHS 1980 1985 1990 1995 2000 2006 73 76 60 60 60 68 DHS DHS DHS DHS 63 62 Source: WHO/UNICEF 45 42 57 Percent Percent 40 Percent 40 40 37 40 27 23 20 20 20 WATER AND SANITATION EQUITY 0 0 0 0 1995 2003 1991 1994 1997 2002-2003 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile Other NS Other NS DHS DHS DHS DHS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 92 100 100 CHILD HEALTH 87 80 77 80 80 72 69 73 63 65 Immunization Malaria prevention Prevention of mother to child 60 60 55 60 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs* 46

transmission of HIV Percent Percent 40 Percent Percent of children immunised with 3 doses DPT 40 40 37 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 20 20 20 100 100 10 0 0 0 80 72 80 8 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 70 60 6 1997 2003 DHS DHS Percent Percent 40 40 Percent 4 POLICIES SYSTEMS 2 20 20 2 0.8 Coverage gap (%) 30 27 0.1 0.2 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 0 Substitutes Partial Ratio 1990 1995 2000 2005 2006 2000 2004 2005 2006 Per capita total expenditure on health (US$) 118 (2007) poorest/wealthiest 2.7 2.4 Source: WHO/UNICEF MICS Other NS Other NS Other NS New ORS formula and zinc for management of *Sub-national risk of malaria transmission General government expenditure on health as Difference diarrhoea Yes % of total government expenditure (%) 5 (2007) poorest-wealthiest (%) 27 22 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials* Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics No Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 49 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 1.0 (2003) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available No Official Development Assistance to child health 80 80 80 per child (US$) 1 (2005) 64 69 Midwives be authorised to administer a core set of 61 63 61 60 56 60 60 life saving interventions Partial Official Development Assistance to maternal and neonatal health per live birth (US$) 3 (2005) Indonesia Percent 40 37 37 Percent 40 Percent 40 Maternity protection in accordance with ILO Convention 183 No National availability of Emergency Obstetric Care 20 20 20 services (% of recommended minimum) --- 4 1 Specific notification of maternal deaths No 0 0 0 1994 1997 2000 2002-2003 2000 2002-2003 1991 1994 1997 2002-2003 Countdown to 2015 DHS DHS MICS DHS MICS DHS DHS DHS DHS DHS *Sub-national risk of malaria transmission 2008 Report Iraq DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 28,506 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Asia, 1997-2002 Total under-five population (000) 4,223 (2006) undernutrition Unmet need for family planning (%) --- Abortion Births (000) 937 (2006) Malaria Measles Causes of neonatal Injuries 1% 1% Obstructed labor 6% Contraceptive 60 deaths prevalence rate 50 Pre-pregnancy Birth registration (%) 95 (2006) 53 6% HIV/AIDS Diarrhoea 5% Antenatal visits for woman (4 or more visits, %) --- 9% 0% Other 5% Antenatal visit 46 Other 84 Pregnancy Under-five mortality rate (per 1000 live births) 46 (2006) 48 Tetanus 7% Intermittent preventive treatment for malaria (%) --- (1 or more) 11% Congenital 9% Hypertensive Haemorrhage (per 1000 live births) 37 (2006) disorders Skilled attendant Infant mortality rate 31% at birth 89 Birth 36 Asphyxia 17% C-section rate (total, urban, rural; %) 9% Neonatal mortality rate (per 1000 live births) 63 (2000) (Minimum target is 5% and maximum target is 15%) ---, ---, Diarrhoea Neonatal --- *Postnatal care Neonatal period 18 51% Total under-five deaths (000) 43 (2006) 24 13% Preterm 26% Sepsis/Infections, Exclusive Early initiation of breastfeeding (within 1 hr of birth, %) 31 (2006) including AIDS 25 Infancy (2005) breastfeeding Maternal mortality ratio (per 100,000 live births) 300 12 MDG Target 12% Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 72 (2005) Pneumonia Infection 30% Anaemia Other causes Measles 60 0 18% 13% 21% 2,900 (2005) Total maternal deaths 1990 1995 2000 2005 2010 2015 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 26 (2006) Complementary feeding rate (6-9 months, %) 51 (2006) 100 100 100 84 89 89 Wasting prevalence (moderate and severe, %) 6 (2006) Low birthweight incidence (%) 15 (2006) 78 77 80 80 72 80 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 54 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent Percent 40 Percent 40 40

100 100 20 20 20

80 80 0 0 1996 2000 2006 1989 2000 2006 1980 1985 1990 1995 2000 2006 Other NS MICS MICS Other NS MICS MICS 60 60 Source: WHO/UNICEF No data Percent 40 Percent 40 25 20 13 20 12 WATER AND SANITATION EQUITY 6 0 0 2000 2006 2000 2006 Water Sanitation Coverage gap by wealth quintile MICS MICS MICS MICS Percent population using improved drinking water sources Percent population using improved sanitation facilities

*Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 97 97 95 95 CHILD HEALTH 83 81 81 79 80 80

Immunization Malaria prevention Prevention of mother to child 60 60 50 50 48 48 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs* No data

transmission of HIV Percent Percent Percent of children immunised with 3 doses DPT 40 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 20 20 100 100 0 0 80 80 1990 2004 1990 2004 60 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 60 60 No data Percent 40 Percent 40 POLICIES SYSTEMS 20 20 Coverage gap (%) No data 0.1 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 Substitutes No Ratio 1990 1995 2000 2005 2006 2000 Per capita total expenditure on health (US$) 135 (2007) poorest/wealthiest Source: WHO/UNICEF MICS New ORS formula and zinc for management of *Very limited risk of malaria transmission General government expenditure on health as Difference diarrhoea No % of total government expenditure (%) 3 (2007) poorest-wealthiest (%) Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials* Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics No Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 22 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 2.0 (2004) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available Yes 82 82 Official Development Assistance to child health 80 80 80 76 per child (US$) 20 (2005) 64 Midwives be authorised to administer a core set of 60 54 60 60 life saving interventions No Official Development Assistance to maternal and neonatal health per live birth (US$) 27 (2005) Iraq Percent 40 Percent 40 Percent 40 Maternity protection in accordance with ILO Convention 183 No National availability of Emergency Obstetric Care 20 20 20 services (% of recommended minimum) --- Specific notification of maternal deaths Yes 1 0 0 0 2000 2006 2000 2000 2006 Countdown to 2015 MICS MICS MICS MICS MICS *Very limited risk of malaria transmission 2008 Report Kenya DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 36,553 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 6,161 (2006) undernutrition Unmet need for family planning (%) 25 (2003) Births (000) 1,447 (2006) Other Measles Causes of neonatal Obstructed labor 5% Abortion Contraceptive 150 Malaria 3% deaths 4% prevalence rate 39 Pre-pregnancy Birth registration (%) 48 (2006) Diarrhoea 2% Antenatal visits for woman (4 or more visits, %) 52 (2003) Anaemia 4% 121 14% Injuries Tetanus 2% Congenital 7% 4% Antenatal visit (per 1000 live births) 121 (2006) 3% (1 or more) 88 Pregnancy Under-five mortality rate 120 97 Other 8% Intermittent preventive treatment for malaria (%) 4 (2003) Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 79 (2006) HIV/AIDS disorders Haemorrhage 42 Birth 90 Preterm 25% C-section rate (total, urban, rural; %) at birth 15% 9% 34% Neonatal mortality rate (per 1000 live births) 29 (2000) (Minimum target is 5% and maximum target is 15%) 4, 9, (2003) Neonatal 3 *Postnatal care Neonatal period 60 24% Total under-five deaths (000) 175 (2006) 32 Infection 27% Sepsis/Infections, Early initiation of breastfeeding (within 1 hr of birth, %) 52 (2003) including AIDS Exclusive breastfeeding 13 Infancy Maternal mortality ratio (per 100,000 live births) 560 (2005) 30 Diarrhoea 16% MDG Target 17% Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 39 (2005) Measles 77 0 Pneumonia Asphyxia 27% Other causes 7,700 (2005) 20% 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy 100 95 100 100 Stunting prevalence (moderate and severe, %) 36 (2003) Complementary feeding rate (6-9 months, %) 84 (2003) 92 88 Wasting prevalence (moderate and severe, %) 6 (2003) Low birthweight incidence (%) 10 (2003) 80 77 76 80 80 74

Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 50 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses 45 44 42 Percent Percent 40 Percent 40 40 At least one dose Two doses 100 100 100 90 90 91 20 20 20 80 80 80 80 69 0 0 63 1989 1993 1998 2000 2003 1989 1993 1998 2003 1985 1990 1995 2000 2006 69 DHS DHS DHS MICS DHS DHS DHS DHS DHS 60 60 60 Source: WHO/UNICEF 41 33 Percent Percent 40 40 Percent 40 46

20 18 17 20 20 12 12 13 20 WATER AND SANITATION EQUITY 0 0 0 0 0 0 0 1993 2000 2003 1993 1998 2003 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile DHS MICS DHS DHS DHS DHS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 91 100 100 CHILD HEALTH 83 80 80 80 61 Immunization Malaria prevention Prevention of mother to child 60 60 60 Percent of children immunised against measles 45 46 48 46 Percent children < 5 years sleeping under ITNs 41 43 transmission of HIV Percent Percent 40 Percent Percent of children immunised with 3 doses DPT 40 40 37 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 30 20 20 20 100 100 50 48 80 0 0 0 80 80 80 40 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest 77 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 60 30 1998 2000 2003 25 24 DHS MICS DHS Percent Percent 40 Percent 40 20 POLICIES SYSTEMS 20 20 10 5 Coverage gap (%) 34 39 39 3 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 0 Substitutes Partial Ratio 1990 1995 2000 2005 2006 2000 2003 2004 2005 2006 Per capita total expenditure on health (US$) 86 (2007) poorest/wealthiest 2.4 2.0 2.1 Source: WHO/UNICEF MICS DHS Other NS Other NS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Yes % of total government expenditure (%) 8 (2007) poorest-wealthiest (%) 27 26 29 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics No Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 47 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 1.3 (2002) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available Partial Official Development Assistance to child health 80 80 80 per child (US$) 9 (2005) 65 Midwives be authorised to administer a core set of 60 60 60 57 life saving interventions Yes Official Development Assistance to maternal and 52 49 43 neonatal health per live birth (US$) 15 (2005) Kenya Percent Percent 40 Percent Maternity protection in accordance with ILO 40 33 40 40 27 National availability of Emergency Obstetric Care 22 Convention 183 No 20 15 20 20 services (% of recommended minimum) --- Specific notification of maternal deaths Yes 0 0 0 1998 2000 2003 1998 2000 2003 1993 1998 2003 Countdown to 2015 DHS MICS DHS DHS MICS DHS DHS DHS DHS 2008 Report Korea DPR DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 23,708 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Asia, 1997-2002 Total under-five population (000) 1,606 (2006) undernutrition Measles Unmet need for family planning (%) --- Abortion Births (000) 321 (2006) Injuries HIV/AIDS Causes of neonatal 1% 1% Obstructed labor 6% Contraceptive 100 3% Malaria deaths prevalence rate 62 Pre-pregnancy Birth registration (%) 99 (2006) Antenatal visits for woman (4 or more visits, %) --- 9% Pneumonia 1% Antenatal visit Pregnancy Under-five mortality rate (per 1000 live births) 55 (2006) 80 15% (%) (1 or more) Intermittent preventive treatment for malaria --- Hypertensive Haemorrhage (per 1000 live births) 42 (2006) 55 55 disorders Skilled attendant Infant mortality rate 31% at birth 97 Birth 60 C-section rate (total, urban, rural; %) 9% Neonatal mortality rate (per 1000 live births) 22 (2000) (Minimum target is 5% and maximum target is 15%) ---, ---, Neonatal --- *Postnatal care Neonatal period 42% No data Total under-five deaths (000) 18 (2006) 40 Diarrhoea 19% Sepsis/Infections, Exclusive 18 Early initiation of breastfeeding (within 1 hr of birth,%) --- including AIDS 65 Infancy (2005) breastfeeding Maternal mortality ratio (per 100,000 live births) 370 20 12% MDG Target Postnatal visit for baby (within 2 days for home births, %) --- Other causes Measles Lifetime risk of maternal death (1 in N) 140 (2005) Other Anaemia 96 0 13% 21% 1,300 (2005) 19% Total maternal deaths 1990 1995 2000 2005 2010 2015 0 20 40 60 80 100 Source: UNICEF, 2006 Source: WHO, 2006 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy 97 97 Stunting prevalence (moderate and severe, %) 45 (2002) Complementary feeding rate (6-9 months, %) 31 (2004) 100 100 90 Wasting prevalence (moderate and severe, %) 9 (2002) Low birthweight incidence (%) 7 (2002) 80 80 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses No data Percent 40 Percent 40 At least one dose Two doses 100 99 99 100 100 100 96 95 95 95 20 20 99 96 99 99 95 95 95 80 80 80 0 65 2000 2004 1989 1994 1999 2004 2006 56 MICS Other NS 60 60 60 Source: WHO/UNICEF Percent Percent 40 40 Percent 40 25 21 20 18 20 20 WATER AND SANITATION EQUITY

0 0 0 1998 2000 2002 2004 2004 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile Other NS MICS Other NS Other NS Other NS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 CHILD HEALTH 100 100 100 100 100 100 80 80 60 Immunization Malaria prevention Prevention of mother to child 60 60 58 59 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs* No data

transmission of HIV Percent Percent Percent of children immunised with 3 doses DPT 40 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 20 20 96 100 0 0 80 89 1990 2004 2004 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 No data No data Percent 40 POLICIES SYSTEMS 20 Coverage gap (%) No data International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 Substitutes Partial Ratio 1990 1995 2000 2005 2006 Per capita total expenditure on health (US$) 47 (2007) poorest/wealthiest Source: WHO/UNICEF New ORS formula and zinc for management of *Very limited risk of malaria transmission General government expenditure on health as Difference diarrhoea Yes % of total government expenditure (%) 6 (2007) poorest-wealthiest (%) Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials* Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics --- Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 14 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age --- antibiotics Density of health workers (per 1000 population) 7.4 (2003) 100 Costed implementation plan(s) for maternal, 93 newborn and child health available --- Official Development Assistance to child health 80 per child (US$) 2 (2005) Midwives be authorised to administer a core set of 60 life saving interventions Partial Official Development Assistance to maternal and No data No data neonatal health per live birth (US$) 1 (2005) Korea DPR Percent 40 Maternity protection in accordance with ILO Convention 183 No National availability of Emergency Obstetric Care 20 services (% of recommended minimum) --- Specific notification of maternal deaths --- 0 2004 Countdown to 2015 Other NS *Very limited risk of malaria transmission 2008 Report Lao PDR DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 5,759 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Asia, 1997-2002 Total under-five population (000) 715 (2006) undernutrition Unmet need for family planning (%) 40 (2000) Abortion Births (000) 156 (2006) Measles Injuries Malaria Causes of neonatal 2% Obstructed labor 6% Contraceptive 200 6% 1% deaths prevalence rate 32 Pre-pregnancy Birth registration (%) 59 (2006) Antenatal visits for woman (4 or more visits, %) --- 9% 163 Diarrhoea HIV/AIDS Antenatal visit 0% 27 Pregnancy Under-five mortality rate (per 1000 live births) 75 (2006) 160 16% (%) (1 or more) Intermittent preventive treatment for malaria --- Hypertensive Haemorrhage (per 1000 live births) 59 (2006) disorders Skilled attendant Infant mortality rate 31% at birth 19 Birth 120 C-section rate (total, urban, rural; %) 9% Neonatal mortality rate (per 1000 live births) 35 (2000) 75 (Minimum target is 5% and maximum target is 15%) ---, ---, Neonatal --- *Postnatal care Neonatal period 35% No data Total under-five deaths (000) 12 (2006) 80 54 Sepsis/Infections, Exclusive Early initiation of breastfeeding (within 1 hr of birth, %) --- including AIDS 23 Infancy (2005) breastfeeding Maternal mortality ratio (per 100,000 live births) 660 40 MDG Target Pneumonia 12% 19% Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 33 (2005) Anaemia Other causes Measles 48 0 Other 13% 21% 1,300 (2005) Total maternal deaths 1990 1995 2000 2005 2010 2015 22% 0 20 40 60 80 100 Source: UNICEF, 2006 Source: WHO, 2006 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 48 (2000) Complementary feeding rate (6-9 months, %) 10 (2000) 100 100 100 Wasting prevalence (moderate and severe, %) 18 (2000) Low birthweight incidence (%) 14 (2000) 80 80 80

60 60 60 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 52 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent Percent 40 Percent 40 40 At least one dose Two doses 27 100 100 100 20 20 19 20 80 80 80 80 70 0 0 64 63 73 58 58 2000 2000 1985 1990 1995 2000 2006 60 60 60 70 48 MICS MICS 64 Source: WHO/UNICEF 58 62 Percent Percent 40 Percent 40 36 36 40 40 43 23 20 20 20 0 WATER AND SANITATION EQUITY 0 0 0 1993 1994 2000 2000 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile Other NS Other NS Other NS MICS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 100 CHILD HEALTH 80 79 80 80 67

Immunization Malaria prevention Prevention of mother to child 60 51 60 60 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs 43

transmission of HIV Percent Percent Percent Percent of children immunised with 3 doses DPT 40 40 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 30 20 20 20 20 100 100 0 0 0 80 80 2004 2004 Poorest 2nd 3rd 4th Wealthiest Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 57 60 60 2000 48 No data MICS Percent Percent 40 40 POLICIES SYSTEMS 20 20 18 Coverage gap (%) 70 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 Substitutes Partial Ratio 1990 1995 2000 2005 2006 2000 Per capita total expenditure on health (US$) 74 (2007) poorest/wealthiest 1.1 Source: WHO/UNICEF MICS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea No % of total government expenditure (%) 5 (2007) poorest-wealthiest (%) 10 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics --- Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 72 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age No antibiotics Density of health workers (per 1000 population) 1.6 (1996) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available No Official Development Assistance to child health 80 80 80 per child (US$) 8 (2005) Midwives be authorised to administer a core set of 60 60 60 life saving interventions --- Official Development Assistance to maternal and neonatal health per live birth (US$) 18 (2005) Lao PDR

Percent Percent Percent 36 40 37 40 40 Maternity protection in accordance with ILO Convention 183 No National availability of Emergency Obstetric Care 20 20 20 services (% of recommended minimum) --- 9 Specific notification of maternal deaths --- 0 0 0 2000 2000 2000 Countdown to 2015 MICS MICS MICS 2008 Report Lesotho DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 1,995 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 272 (2006) undernutrition Unmet need for family planning (%) 31 (2004) (2006) Causes of neonatal Births (000) 59 HIV/AIDS Obstructed labor Contraceptive 150 deaths Abortion 37 Pre-pregnancy (2006) 132 56% Diarrhoea 2% Antenatal visits for woman (4 or more visits, %) 70 (2004) Anaemia 4% 4% prevalence rate Birth registration (%) 26 Tetanus 2% Other 8% 4% Antenatal visit (per 1000 live births) 132 (2006) 120 (1 or more) 90 Pregnancy Under-five mortality rate 101 Congenital 8% Intermittent preventive treatment for malaria (%) --- Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 102 (2006) Infection 20% disorders Haemorrhage 55 Birth 90 C-section rate (total, urban, rural; %) at birth 9% 34% Neonatal mortality rate (per 1000 live births) 28 (2000) Neonatal (Minimum target is 5% and maximum target is 15%) 5, 8, 5 (2004) 33% *Postnatal care 23 Neonatal period 60 Other Asphyxia 27% Total under-five deaths (000) 8 (2006) 34 0% Sepsis/Infections, Early initiation of breastfeeding (within 1 hr of birth, %) 63 (2004) including AIDS Exclusive breastfeeding 36 Infancy Maternal mortality ratio (per 100,000 live births) 960 (2005) 30 MDG Target Measles 16% 0% Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 45 (2005) Preterm 34% Measles 85 0 Malaria Other causes 480 (2005) 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 0% Injuries Pneumonia 0 20 40 60 80 100 2% Diarrhoea 5% Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 4% for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy

Stunting prevalence (moderate and severe, %) 45 (2004) Complementary feeding rate (6-9 months, %) 79 (2004) 100 91 90 100 100 88 85 Wasting prevalence (moderate and severe, %) 6 (2004) Low birthweight incidence (%) 13 (2004) 80 80 80 72 61 60 55 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent Percent Percent 40 40 40 At least one dose Two doses 100 100 100 20 20 20

75 80 80 80 71 0 0 1993 1995 2000 2004 1993 2000 2004 75 1991 1996 2001 2006 Other NS Other NS MICS DHS Other NS MICS DHS 60 60 60 Source: WHO/UNICEF Percent 40 Percent 40 36 Percent 40 15 17 20 20 16 15 20 17 WATER AND SANITATION EQUITY 9 0 0 0 0 0 0 0 0 2 2000 2004 1996 2000 2004 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile MICS DHS MICS MICS DHS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 92 100 100 CHILD HEALTH 76 79 80 80 80 61 61 Immunization Malaria prevention Prevention of mother to child 60 60 60 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs*

transmission of HIV Percent Percent 37 37 Percent Percent of children immunised with 3 doses DPT 40 40 32 32 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 20 20 20 100 20 85 17 0 0 0 80 16 15 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest 83 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 3 60 12 2000 2004 No data MICS DHS Percent 40 Percent 8 7 POLICIES SYSTEMS 20 4 Coverage gap (%) 36 33 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 Substitutes Yes Ratio 1990 1995 2000 2005 2006 2004 2005 2006 Per capita total expenditure on health (US$) 139 (2007) poorest/wealthiest 1.7 2.0 Source: WHO/UNICEF Other NS Other NS Other NS New ORS formula and zinc for management of *Very limited risk of malaria transmission General government expenditure on health as Difference diarrhoea Yes % of total government expenditure (%) 13 (2007) poorest-wealthiest (%) 18 23 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials* Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics --- Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 3 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 0.5 (2003) 100 100 Costed implementation plan(s) for maternal, newborn and child health available Yes Official Development Assistance to child health 80 80 per child (US$) 5 (2005) Midwives be authorised to administer a core set of 59 life saving interventions Partial Official Development Assistance to maternal and 60 53 60 49 neonatal health per live birth (US$) 5 (2005) Lesotho

Percent No data Percent 40 40 32 Maternity protection in accordance with ILO 29 Convention 183 No National availability of Emergency Obstetric Care 20 20 services (% of recommended minimum) 29 (2004) Specific notification of maternal deaths Yes 0 0 2000 2004 2000 2004 Countdown to 2015 MICS DHS MICS DHS *Very limited risk of malaria transmission 2008 Report Liberia DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 3,579 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 690 (2006) undernutrition Unmet need for family planning (%) --- Births (000) 184 (2006) Measles HIV/AIDS Causes of neonatal Obstructed labor 6% Abortion Contraceptive 250 235 235 4% Injuries deaths 4% prevalence rate 10 Pre-pregnancy Birth registration (%) --- Diarrhoea 2% Congenital 4% Antenatal visits for woman (4 or more visits, %) --- Anaemia 4% Other 5% 4% Antenatal visit 17% 84 Pregnancy Under-five mortality rate (per 1000 live births) 235 (2006) 200 Other Diarrhoea 6% Intermittent preventive treatment for malaria (%) --- (1 or more) 0% Tetanus 14% Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 157 (2006) disorders Haemorrhage 51 Birth 150 C-section rate (total, urban, rural; %) at birth Asphyxia 19% 9% 34% Neonatal mortality rate (per 1000 live births) 66 (2000) Neonatal (Minimum target is 5% and maximum target is 15%) ---, ---, --- 100 78 Malaria 29% *Postnatal care Neonatal period Total under-five deaths (000) 43 (2006) 19% Sepsis/Infections, Infection 25% Early initiation of breastfeeding (within 1 hr of birth, %) --- including AIDS Exclusive breastfeeding 35 Infancy Maternal mortality ratio (per 100,000 live births) 1,200 (2005) 50 MDG Target 16% Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 12 (2005) Measles 94 0 Pneumonia Preterm 27% Other causes 2,100 (2005) 23% 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 45 (1999-2000) Complementary feeding rate (6-9 months, %) 70 (1999-2000) 100 100 100 83 84 Wasting prevalence (moderate and severe, %) 7 (1999-2000) Low birthweight incidence (%) --- 80 80 80 72 58 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 51 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent Percent Percent 40 40 40 At least one dose Two doses 100 100 100 93 95 95 20 20 20 83 100 79 80 80 80 0 0 83 1986 1999-2000 1986 1999-2000 1981 1986 1991 1996 2001 2006 DHS DHS DHS DHS 60 60 60 Source: WHO/UNICEF Percent Percent Percent 40 40 40 35 40 23 20 20 20 0 WATER AND SANITATION EQUITY 0 0 0 0 0 0 1999-2000 1999-2000 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile Other NS Other NS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 CHILD HEALTH 85 80 72 80 55 52 61 59 Immunization Malaria prevention Prevention of mother to child 60 60 49 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs No data

Percent Percent 39 Percent of children immunised with 3 doses DPT transmission of HIV 34 Percent HIV+ pregnant women receiving ARVs for PMTCT 40 40 Percent of children immunised with 3 doses Hib 24 27 20 20 7 100 94 100 10 0 0 75 80 88 80 8 1990 2004 1990 2004 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 6 60 60 5

53 Percent Percent Percent 40 40 4 3 POLICIES SYSTEMS 20 20 2 Coverage gap (%) No data 3 0.1 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 0 Substitutes --- Ratio 2000 2001 2002 2003 2004 2005 2006 2005 2004 2005 2006 Per capita total expenditure on health (US$) 22 (2007) poorest/wealthiest Source: WHO/UNICEF Other NS Other NS Other NS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Partial % of total government expenditure (%) 20 (2007) poorest-wealthiest (%) Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics No Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 36 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 0.3 (2004) 100 Costed implementation plan(s) for maternal, newborn and child health available Yes Official Development Assistance to child health 80 per child (US$) 8 (2005) 70 Midwives be authorised to administer a core set of 60 life saving interventions Yes Official Development Assistance to maternal and neonatal health per live birth (US$) 8 (2005) Liberia

No data No data Percent 40 32 Maternity protection in accordance with ILO Convention 183 No National availability of Emergency Obstetric Care 20 services (% of recommended minimum) --- Partial 2 Specific notification of maternal deaths 0 1986 1999-2000 Countdown to 2015 DHS DHS 2008 Report Madagascar DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 19,159 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 3,142 (2006) undernutrition Unmet need for family planning (%) 24 (2003-2004) Births (000) 714 (2006) Other Causes of neonatal Measles Injuries Obstructed labor Contraceptive 200 8% deaths Abortion 27 Pre-pregnancy 5% 2% Diarrhoea 3% Antenatal visits for woman (4 or more visits, %) 40 (2003-2004) Anaemia 4% 4% prevalence rate Birth registration (%) 75 (2006) Diarrhoea 168 Tetanus 4% 4% Antenatal visit 17% HIV/AIDS Congenital 6% 80 Pregnancy Under-five mortality rate (per 1000 live births) 115 (2006) 160 1% Other 7% Intermittent preventive treatment for malaria (%) --- (1 or more) Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 72 (2006) 115 disorders Haemorrhage 51 Birth 120 Infection 24% C-section rate (total, urban, rural; %) at birth 9% 34% Neonatal mortality rate (per 1000 live births) 33 (2000) Neonatal (Minimum target is 5% and maximum target is 15%) 1,2,1 (2003-2004) 80 26% *Postnatal care Neonatal period Total under-five deaths (000) 82 (2006) 56 Malaria Asphyxia 25% Sepsis/Infections, Early initiation of breastfeeding (within 1 hr of birth, %) 62 (2003-2004) including AIDS Exclusive 20% breastfeeding 67 Infancy Maternal mortality ratio (per 100,000 live births) 510 (2005) 40 MDG Target 16% Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 38 (2005) Preterm 31% Measles 59 0 Pneumonia Other causes 3,600 (2005) 21% 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 53 (2003-2004) Complementary feeding rate (6-9 months, %) 78 (2003-2004) 100 100 100 78 80 Wasting prevalence (moderate and severe, %) 15 (2003-2004) Low birthweight incidence (%) 17 (2003-2004) 80 77 80 80 71 67 57 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 51 60 47 46 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent Percent Percent 40 40 40 At least one dose Two doses 95 100 100 100 94 95 91 89 20 20 20 95 80 80 80 73 87 67 84 0 0 58 1992 1997 2000 2003-2004 1992 1997 2000 2003-2004 1982 1987 1992 1997 2002 2006 60 60 60 DHS DHS MICS DHS DHS DHS MICS DHS 48 Source: WHO/UNICEF 41 Percent 36 37 Percent 38 Percent 40 40 40 47 38 20 20 20 0 WATER AND SANITATION EQUITY 0 0 0 0 1992 2003-2004 1992 1997 2000 2003-2004 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile DHS DHS DHS DHS MICS DHS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 100 CHILD HEALTH 80 80 77 80 80

Immunization Malaria prevention Prevention of mother to child 60 60 60 50 48 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs

transmission of HIV Percent 40 Percent Percent Percent of children immunised with 3 doses DPT 40 35 40 34 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 27 27 26 20 20 14 20 10 100 100 0 0 0 80 80 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest 61 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 60 1997 2000 2004 59 No data DHS MICS DHS Percent Percent 40 40 POLICIES SYSTEMS 20 20 Coverage gap (%) 54 47 44 0.2 International Code of Marketing of Breastmilk 0 Financial Flows and Human Resources 0 Substitutes Partial Ratio 1990 1995 2000 2005 2006 2000 Per capita total expenditure on health (US$) 29 (2007) poorest/wealthiest 2.1 1.9 3.1 Source: WHO/UNICEF MICS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Yes % of total government expenditure (%) 9 (2007) poorest-wealthiest (%) 34 24 42 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics Yes Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 21 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 0.6 (2004) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available No Official Development Assistance to child health 80 80 80 per child (US$) 6 (2005) Midwives be authorised to administer a core set of 61 60 60 60 life saving interventions Partial Official Development Assistance to maternal and 47 47 47 48 neonatal health per live birth (US$) 7 (2005) 42 Madagascar Percent Percent Percent 37 38 35 Maternity protection in accordance with ILO 40 40 34 40 Convention 183 No National availability of Emergency Obstetric Care 19 20 20 20 20 services (% of recommended minimum) 30 (2002-2003) Specific notification of maternal deaths Partial 0 0 0 1997 2000 2003-2004 2000 2003-2004 1992 1997 2000 2003-2004 Countdown to 2015 DHS MICS DHS MICS DHS DHS DHS MICS DHS 2008 Report Malawi DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 13,571 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 2,425 (2006) undernutrition Unmet need for family planning (%) 28 (2004) Births (000) 566 (2006) Causes of neonatal Obstructed labor Measles Abortion Contraceptive 250 deaths 4% prevalence rate 42 Pre-pregnancy (%) --- 221 0% Pneumonia Diarrhoea 2% Antenatal visits for woman (4 or more visits, %) 57 (2004) Anaemia 4% Birth registration Injuries Tetanus 3% 2% 23% 4% Antenatal visit (2006) Other 6% 92 Pregnancy Under-five mortality rate (per 1000 live births) 120 200 Other Congenital 7% Intermittent preventive treatment for malaria (%) 45 (2006) (1 or more) 8% Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 76 (2006) disorders Haemorrhage 54 Birth 150 Asphyxia 23% C-section rate (total, urban, rural; %) at birth 120 9% 34% Neonatal mortality rate (per 1000 live births) 40 (2000) MDG Target Neonatal HIV/AIDS (Minimum target is 5% and maximum target is 15%) 3, 4, 3 (2004) *Postnatal care 100 14% 22% Neonatal period Total under-five deaths (000) 68 (2006) 74 Infection 29% Sepsis/Infections, (within 1 hr of birth, %) (2006) Exclusive Early initiation of breastfeeding 61 including AIDS 56 Infancy Maternal mortality ratio (per 100,000 live births) 1,100 (2005) breastfeeding 50 Malaria 16% Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 18 (2005) 14% Measles 85 0 Diarrhoea Preterm 30% Other causes 6,000 (2005) 18% 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy 100 94 100 100 Stunting prevalence (moderate and severe, %) 53 (2006) Complementary feeding rate (6-9 months, %) 89 (2006) 90 91 92 92 88 Wasting prevalence (moderate and severe, %) 4 (2006) Low birthweight incidence (%) 13 (2006) 80 80 80 61 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 55 56 56 54 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent Percent Percent 40 40 40 At least one dose Two doses 100 100 100 20 20 20 86 92 94 86 80 80 80 63 0 0 57 1992 2000 2002 2004 2006 1992 2000 2002 2004 2006 56 54 1983 1988 1993 1998 2003 2006 60 60 53 60 DHS DHS Other NS DHS MICS DHS DHS Other NS DHS MICS 44 Source: WHO/UNICEF Percent 40 Percent 40 Percent 40 24 22 20 18 15 20 20 WATER AND SANITATION EQUITY 0 0 0 0 14 0 0 0 0 1992 2000 2004 2006 2000 2004 2006 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile DHS DHS DHS MICS DHS DHS MICS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total 98 Rural Urban Total 100 90 100 100

CHILD HEALTH 73 80 68 80 80 64 61 62 61 Immunization Malaria prevention Prevention of mother to child 60 60 60 47 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs 40 45 transmission of HIV Percent Percent Percent Percent of children immunised with 3 doses DPT 40 33 40 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 20 20 20 99 100 99 100 20 0 0 0 85 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest 80 80 16 14 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 60 12 1992 2000 2004 2006 DHS DHS DHS MICS

Percent Percent Percent 8 40 40 8 23 POLICIES SYSTEMS 4 20 20 15 4 Coverage gap (%) 38 38 38 33 3 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 0 Substitutes Yes Ratio 1990 1995 2000 2005 2006 2000 2004 2006 2004 2005 2006 Per capita total expenditure on health (US$) 58 (2007) poorest/wealthiest 1.7 1.8 1.7 1.5 Source: WHO/UNICEF DHS DHS MICS Other NS Other NS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Partial % of total government expenditure (%) 29 (2007) poorest-wealthiest (%) 17 19 18 13 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics Yes Out-of-pocket expenditure as % of total therapy or increased fluids, with continued feeding appropriate health provider expenditure on health (%) 9 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 0.6 (2004) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available Partial Official Development Assistance to child health 80 80 80 per child (US$) 11 (2005) Midwives be authorised to administer a core set of Official Development Assistance to maternal and 60 54 60 60 54 life saving interventions Yes 51 51 neonatal health per live birth (US$) 14 (2005) Malawi Percent 40 Percent 40 Percent 40 37 Maternity protection in accordance with ILO 27 28 29 National availability of Emergency Obstetric Care 26 24 24 27 Convention 183 No 20 20 20 services (% of recommended minimum) 37 (2004) Specific notification of maternal deaths Partial

0 0 0 2000 2004 2006 2000 2004 2006 1992 2000 2004 2006 Countdown to 2015 DHS DHS MICS DHS DHS MICS DHS DHS DHS MICS 2008 Report Mali DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 11,968 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 2,247 (2006) undernutrition Unmet need for family planning (%) 29 (2001) Other Causes of neonatal Births (000) 579 (2006) 250 Measles HIV/AIDS Obstructed labor Contraceptive 250 6% 6% deaths Abortion 8 Pre-pregnancy 217 2% Diarrhoea 4% Antenatal visits for woman (4 or more visits, %) 30 (2001) Anaemia 4% prevalence rate Birth registration (%) 47 (2006) Malaria Congenital 4% 4% 4% Antenatal visit 17% Injuries Other 5% 57 Pregnancy Under-five mortality rate (per 1000 live births) 217 (2006) 200 1% Intermittent preventive treatment for malaria (%) --- (1 or more) Tetanus 10% Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 119 (2006) disorders Haemorrhage 41 Birth 150 Asphyxia 19% C-section rate (total, urban, rural; %) at birth 9% 34% Neonatal mortality rate (per 1000 live births) 55 (2000) Neonatal (Minimum target is 5% and maximum target is 15%) 1, 3, 0 (2001) 100 83 26% *Postnatal care Neonatal period Total under-five deaths (000) 126 (2006) Preterm 24% Sepsis/Infections, Early initiation of breastfeeding (within 1 hr of birth, %) 32 (2001) including AIDS Exclusive MDG Target Diarrhoea breastfeeding 25 Infancy Maternal mortality ratio (per 100,000 live births) 970 (2005) 50 18% 16% Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 15 (2005) Infection 34% Measles 86 0 Pneumonia Other causes 6,400 (2005) 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 24% 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 43 (2001) Complementary feeding rate (6-9 months, %) 32 (2001) 100 100 100 84 Wasting prevalence (moderate and severe, %) 13 (2001) Low birthweight incidence (%) 23 (2001) 80 80 80

60 57 60 60 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 47 Percent children < 3 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses 40 41 Percent Percent Percent 40 31 40 32 40 At least one dose Two doses 100 100 100 100 97 20 20 20

80 80 80 70 74 0 0 68 66 61 1987 1995-1996 2001 1987 1995-1996 2001 1981 1986 1991 1996 2001 2006 60 60 60 67 DHS DHS DHS DHS DHS DHS 61 66 Source: WHO/UNICEF 41 Percent 38 Percent Percent 40 40 40 29 31 25

20 20 8 20 24 WATER AND SANITATION EQUITY 0 10 0 0 0 1987 1995-1996 2001 1995-1996 2001 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile DHS DHS DHS DHS DHS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 100 CHILD HEALTH 78 80 80 80 59 Immunization Malaria prevention Prevention of mother to child 60 60 50 60 50 50 46 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs 39

transmission of HIV Percent Percent 36 Percent Percent of children immunised with 3 doses DPT 40 34 36 40 32 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 29 20 20 20 100 10 86 0 0 0 8 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest 80 85 8 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 6 3 60 5 1996 2001 No data DHS DHS Percent 40 Percent 4 POLICIES SYSTEMS 20 16 2 1 Coverage gap (%) 61 60 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 Substitutes Partial Ratio 1990 1995 2000 2006 2004 2005 2006 Per capita total expenditure on health (US$) 54 (2007) poorest/wealthiest 2.2 2.2 Source: WHO/UNICEF Other NS Other NS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Partial % of total government expenditure (%) 13 (2007) poorest-wealthiest (%) 42 36 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics Yes Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 51 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 0.7 (2004) 100 100 Costed implementation plan(s) for maternal, newborn and child health available Yes Official Development Assistance to child health 80 80 per child (US$) 7 (2005) Midwives be authorised to administer a core set of 60 60 life saving interventions Partial Official Development Assistance to maternal and 45 neonatal health per live birth (US$) 13 (2005) Mali

Percent No data Percent 36 Maternity protection in accordance with ILO 40 27 40 22 Convention 183 No National availability of Emergency Obstetric Care 20 20 services (% of recommended minimum) 38 (2003) 2 Specific notification of maternal deaths Yes 0 0 1995-1996 2001 1987 1995-1996 2001 Countdown to 2015 DHS DHS DHS DHS DHS 2008 Report Mauritania DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 3,044 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 456 (2006) undernutrition Unmet need for family planning (%) 32 (2000-2001) Other Causes of neonatal Births (000) 102 (2006) Injuries Measles Obstructed labor Contraceptive 150 6% 2% 2% deaths Abortion 8 Pre-pregnancy (2006) 133 Diarrhoea 3% Antenatal visits for woman (4 or more visits, %) 16 (2000-2001) Anaemia 4% 4% prevalence rate Birth registration (%) 55 125 Malaria Tetanus 6% HIV/AIDS Other 6% 4% Antenatal visit (per 1000 live births) 125 (2006) 120 12% 0% (1 or more) 64 Pregnancy Under-five mortality rate Congenital 7% Intermittent preventive treatment for malaria (%) --- Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 78 (2006) disorders Haemorrhage 57 Birth 90 Asphyxia 23% C-section rate (total, urban, rural; %) at birth 9% 34% Neonatal mortality rate (per 1000 live births) 70 (2000) Neonatal (Minimum target is 5% and maximum target is 15%) 3,6,1 (2000-2001) Diarrhoea 39% *Postnatal care Neonatal period 60 44 16% Total under-five deaths (000) 13 (2006) Preterm 26% Sepsis/Infections, Early initiation of breastfeeding (within 1 hr of birth, %) 61 (2000-2001) including AIDS Exclusive breastfeeding 20 Infancy Maternal mortality ratio (per 100,000 live births) 820 (2005) 30 MDG Target 16% Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 22 (2005) Infection 30% Measles 62 0 Pneumonia Other causes 1,000 (2005) 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 22% 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 40 (2000-2001) Complementary feeding rate (6-9 months, %) 78 (2000-2001) 100 100 100 Wasting prevalence (moderate and severe, %) 15 (2000-2001) Low birthweight incidence (%) --- 80 80 80 64 62 60 60 57 60 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 48 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses 40 Percent Percent Percent 40 40 40 At least one dose Two doses 95 96 100 100 100 89 20 20 20 83 81 98 92 80 80 80 0 0 89 1990-1991 2000-2001 1990-1991 2000-2001 1981 1986 1991 1996 2001 2006 60 60 60 Other NS DHS Other NS DHS 57 Source: WHO/UNICEF 43 Percent Percent Percent 40 30 40 40 20 20 20 20 20 0 WATER AND SANITATION EQUITY 0 0 0 0 0 0 1990 1996 2000-2001 2000-2001 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile Other NS MICS DHS DHS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 100 CHILD HEALTH 80 80 80 59 Immunization Malaria prevention Prevention of mother to child 60 53 60 49 60 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs* 43 44 42 transmission of HIV Percent 38 Percent Percent Percent of children immunised with 3 doses DPT 34 Percent HIV+ pregnant women receiving ARVs for PMTCT 40 32 40 31 40 Percent of children immunised with 3 doses Hib 22 20 20 20 8 100 100 0 0 0 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest 80 68 80 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 60 62 2001 No data DHS Percent 40 Percent 40 POLICIES SYSTEMS 20 20 Coverage gap (%) 58 2 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 Substitutes No Ratio 1990 1995 2000 2005 2006 2003-2004 Per capita total expenditure on health (US$) 43 (2007) poorest/wealthiest 2.0 Source: WHO/UNICEF DHS New ORS formula and zinc for management of *Sub-national risk of malaria transmission General government expenditure on health as Difference diarrhoea No % of total government expenditure (%) 5 (2007) poorest-wealthiest (%) 37 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials* Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics No Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 31 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age No antibiotics Density of health workers (per 1000 population) 0.8 (2004) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available No Official Development Assistance to child health 80 80 80 per child (US$) 3 (2005) Midwives be authorised to administer a core set of 60 60 60 life saving interventions Yes Official Development Assistance to maternal and neonatal health per live birth (US$) 8 (2005) 41 Mauritania Percent Percent Percent Maternity protection in accordance with ILO 40 40 33 40 Convention 183 Partial National availability of Emergency Obstetric Care 20 20 20 services (% of recommended minimum) 31 (2000) 9 Specific notification of maternal deaths Partial 0 0 0 2000-2001 2003-2004 2000-2001 Countdown to 2015 DHS DHS DHS *Sub-national risk of malaria transmission 2008 Report Mexico DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 105,342 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Latin America, 1997-2002 Total under-five population (000) 10,445 (2006) undernutrition Unmet need for family planning (%) 12 (2006) Sepsis/Infections, Diarrhoea HIV/AIDS Causes of neonatal Anaemia Births (000) 2,109 (2006) Malaria including AIDS Contraceptive 5% 0% 0% deaths 0% 74 Pre-pregnancy 60 53 Injuries Antenatal visits for woman (4 or more visits, %) --- 8% prevalence rate Birth registration (%) --- Measles Other 7% 7% 0% Antenatal visit 86 Pregnancy Under-five mortality rate (per 1000 live births) 35 (2006) 48 Asphyxia 14% Intermittent preventive treatment for malaria (%) --- Abortion Hypertensive (1 or more) Pneumonia 12% disorders 35 Skilled attendant Infant mortality rate (per 1000 live births) 29 (2006) 9% Infection 16% 26% 86 Birth 36 C-section rate (total, urban, rural; %) at birth (2000) Neonatal Neonatal mortality rate (per 1000 live births) 15 Congenital 18% (Minimum target is 5% and maximum target is 15%) ---, ---, --- Obstructed labor 24 18 53% *Postnatal care Neonatal period Total under-five deaths (000) 74 (2006) 13% Early initiation of breastfeeding (within 1 hr of birth, %) --- Exclusive Infancy Maternal mortality ratio (per 100,000 live births) 60 (2005) 12 MDG Target Other breastfeeding 27% Preterm 45% Postnatal visit for baby (within 2 days for home births, %) --- Haemorrhage Lifetime risk of maternal death (1 in N) 670 (2005) Measles 96 0 Other causes 21% 1,300 (2005) 21% Total maternal deaths 1990 1995 2000 2005 2010 2015 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 16 (2005) Complementary feeding rate (6-9 months, %) 36 (1987) 100 100 100 86 84 86 Wasting prevalence (moderate and severe, %) 2 (2005) Low birthweight incidence (%) 8 (2005) 78 80 80 80 87 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent Percent Percent 40 40 40 At least one dose Two doses 100 100 20 20 20

80 80 68 0 0 1987 1995 1990 1997 1980 1985 1990 1995 2000 2006 60 60 Other NS Other NS Other NS Other NS 63 Source: WHO/UNICEF No data Percent 40 Percent 40

20 14 20 WATER AND SANITATION EQUITY 6 3 0 0 1989 1998-1999 2006 2005 Water Sanitation Coverage gap by wealth quintile Other NS Other NS Other NS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 97 100 100 91 89 87 CHILD HEALTH 82 79 80 80 75 64 58 Immunization Malaria prevention Prevention of mother to child 60 60 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs* 41 No data

transmission of HIV Percent Percent Percent of children immunised with 3 doses DPT 40 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 98 20 20 13 100 98 15 96 0 0 80 12 1990 2004 1990 2004 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 9 No data Percent 40 Percent 6 5 POLICIES SYSTEMS 5 20 3 Coverage gap (%) International Code of Marketing of Breastmilk Financial Flows and Human Resources No data 0 0 Substitutes Yes Ratio 1990 1995 2000 2005 2006 2006 Per capita total expenditure on health (US$) 655 (2007) poorest/wealthiest Source: WHO/UNICEF Other NS New ORS formula and zinc for management of *Very limited risk of malaria transmission General government expenditure on health as Difference diarrhoea No % of total government expenditure (%) 13 (2007) poorest-wealthiest (%) Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials* Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics --- Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 51 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age No antibiotics Density of health workers (per 1000 population) 2.9 (2000) Costed implementation plan(s) for maternal, newborn and child health available No Official Development Assistance to child health per child (US$) 0 (2005) Midwives be authorised to administer a core set of life saving interventions Partial Official Development Assistance to maternal and neonatal health per live birth (US$) 1 (2005) Mexico No data No data No data Maternity protection in accordance with ILO Convention 183 Partial National availability of Emergency Obstetric Care services (% of recommended minimum) --- Specific notification of maternal deaths Yes

Countdown to 2015

*Very limited risk of malaria transmission 2008 Report Morocco DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 30,853 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 2,978 (2006) undernutrition Unmet need for family planning (%) 10 (2003-2004) Births (000) 635 (2006) InjuriesHIV/AIDS Causes of neonatal 0% Malaria Obstructed labor Contraceptive 100 4% 0% deaths Abortion 63 Pre-pregnancy (2006) 89 Diarrhoea Diarrhoea 1% Antenatal visits for woman (4 or more visits, %) 31 (2003-2004) Anaemia 4% 4% prevalence rate Birth registration (%) 85 Tetanus 2% 12% 4% Antenatal visit Measles Other 6% 68 Pregnancy Under-five mortality rate (per 1000 live births) 37 (2006) 80 0% Congenital 12% Intermittent preventive treatment for malaria (%) --- (1 or more) Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 34 (2006) Pneumonia disorders Haemorrhage 63 Birth 60 Asphyxia 22% at birth 14% C-section rate (total, urban, rural; %) 34% (2000) Neonatal 9% Neonatal mortality rate (per 1000 live births) 21 37 (Minimum target is 5% and maximum target is 15%) 5,9,2 (2003-2004) 40 45% *Postnatal care Neonatal period Total under-five deaths (000) 23 (2006) 30 Sepsis/Infections, Preterm 27% Early initiation of breastfeeding (within 1 hr of birth, %) 52 (2003-2004) including AIDS Exclusive breastfeeding 31 Infancy Maternal mortality ratio (per 100,000 live births) 240 (2005) 20 MDG Target 16% Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 150 (2005) Other Measles 95 0 24% Infection 29% Other causes 1,700 (2005) 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy 100 100 100 Stunting prevalence (moderate and severe, %) 23 (2003-2004) Complementary feeding rate (6-9 months, %) 66 (2003-2004) 85 Wasting prevalence (moderate and severe, %) 11 (2003-2004) Low birthweight incidence (%) 15 (2003-2004) 80 80 80 68 63 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses 45 42 Percent Percent Percent 40 40 32 40 31 40 25 24 26 100 100 20 20 20

80 80 0 0 1987 1992 1995 1997 2003-2004 1984 1987 1992 1995 2003-2004 1987 1992 1997 2002 2006 60 60 DHS DHS DHS Other NS DHS Other NS DHS DHS DHS DHS 50 Source: WHO/UNICEF No data Percent Percent 40 40 31 25 20 13 20 WATER AND SANITATION EQUITY 8 10 0 0 1987 1992 2003-2004 1992 1995 2003-2004 Water Sanitation Coverage gap by wealth quintile DHS DHS DHS DHS DHS DHS Percent population using improved drinking water sources Percent population using improved sanitation facilities

*Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 99 100 94 100 100 87 88 CHILD HEALTH 81 80 75 80 73 80 58 Immunization Malaria prevention Prevention of mother to child 60 56 60 56 52 60 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs*

transmission of HIV Percent Percent Percent Percent of children immunised with 3 doses DPT 40 40 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 27 20 20 20 97 100 95 0 0 0 80 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 1992 2004 No data No data DHS DHS Percent 40 POLICIES SYSTEMS 20 10 Coverage gap (%) 46 28 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 Substitutes No Ratio 1990 1995 2000 2005 2006 Per capita total expenditure on health (US$) 234 (2007) poorest/wealthiest 2.5 2.6 Source: WHO/UNICEF New ORS formula and zinc for management of *Very limited risk of malaria transmission General government expenditure on health as Difference diarrhoea No % of total government expenditure (%) 6 (2007) poorest-wealthiest (%) 38 25 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials* Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics No Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 50 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 1.3 (2004) 100 100 Costed implementation plan(s) for maternal, newborn and child health available Partial Official Development Assistance to child health 80 80 per child (US$) 2 (2005) Midwives be authorised to administer a core set of 60 60 life saving interventions --- Official Development Assistance to maternal and 46 neonatal health per live birth (US$) 6 (2005) Morocco

Percent No data Percent 38 Maternity protection in accordance with ILO 40 40 28 Convention 183 No National availability of Emergency Obstetric Care 17 20 20 services (% of recommended minimum) 69 (2000) 7 Specific notification of maternal deaths --- 0 0 2003-2004 1992 1997 2003-2004 Countdown to 2015 DHS DHS Other NS DHS *Very limited risk of malaria transmission 2008 Report Mozambique DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 20,971 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 3,670 (2006) undernutrition Unmet need for family planning (%) 18 (2003-2004) Births (000) 856 (2006) HIV/AIDS Injuries Causes of neonatal Obstructed labor 1% Measles Abortion Contraceptive 250 235 13% deaths 4% prevalence rate 17 Pre-pregnancy Birth registration (%) --- 0% Diarrhoea 2% Antenatal visits for woman (4 or more visits, %) 53 (2003) Anaemia 4% Diarrhoea Other Tetanus 5% 4% Antenatal visit (2006) 17% 0% Congenital 6% (1 or more) 85 Pregnancy Under-five mortality rate (per 1000 live births) 138 200 Other 6% Intermittent preventive treatment for malaria (%) --- Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 96 (2006) 138 disorders Haemorrhage 48 Birth 150 Asphyxia 23% C-section rate (total, urban, rural; %) at birth 9% 34% Neonatal mortality rate (per 1000 live births) 48 (2000) Neonatal (Minimum target is 5% and maximum target is 15%) 2,5,1 (2003) 100 78 29% *Postnatal care Neonatal period Total under-five deaths (000) 118 (2006) Sepsis/Infections, Malaria Preterm 26% Early initiation of breastfeeding (within 1 hr of birth, %) 65 (2003) including AIDS Exclusive breastfeeding 30 Infancy Maternal mortality ratio (per 100,000 live births) 520 (2005) 50 MDG Target 19% 16% (within 2 days for home births, %) Postnatal visit for baby --- Measles 77 Lifetime risk of maternal death (1 in N) 45 (2005) Infection 32% 0 Pneumonia Other causes 4,000 (2005) 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 21% 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 47 (2003) Complementary feeding rate (6-9 months, %) 80 (2003) 100 100 100 85 87 Wasting prevalence (moderate and severe, %) 5 (2003) Low birthweight incidence (%) 15 (2003) 76 80 71 80 80 60 60 60 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 48 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses 44 Percent Percent Percent 40 40 40 At least one dose Two doses 100 100 100 92 95 20 20 20 100 80 80 80 71 71 0 0 1997 2000 2003 1997 2003 1982 1987 1992 1997 2002 2006 DHS Other NS DHS DHS DHS 60 60 60 50 Source: WHO/UNICEF Percent Percent Percent 40 40 30 30 40 26 24 23 21

20 20 20 16 WATER AND SANITATION EQUITY 0 0 0 0 0 0 0 0 0 1995 2000 2003 1997 2003 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile MICS Other NS DHS DHS DHS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 100 CHILD HEALTH 83 80 72 80 80 Immunization Malaria prevention Prevention of mother to child 60 60 60 49 53 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs 43 Percent of children immunised with 3 doses DPT transmission of HIV Percent 36 Percent Percent 40 40 32 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 24 26 20 19 20 20 12 20 100 20 0 0 0 77 80 16 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest 13 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 72 60 12 1997 2003 9 No data DHS DHS Percent 40 Percent 8 10 POLICIES SYSTEMS 20 4 3 Coverage gap (%) 56 40 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 Substitutes Yes Ratio 1990 1995 2000 2005 2006 2004 2005 2006 Per capita total expenditure on health (US$) 42 (2007) poorest/wealthiest 2.2 2.7 Source: WHO/UNICEF Other NS Other NS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Partial % of total government expenditure (%) 9 (2007) poorest-wealthiest (%) 39 35 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics Partial Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 12 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 0.4 (2004) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available Partial Official Development Assistance to child health 80 80 80 per child (US$) 9 (2005) 55 Midwives be authorised to administer a core set of 60 60 60 life saving interventions Yes Official Development Assistance to maternal and 47 (2005) 39 neonatal health per live birth (US$) 20 Mozambique Percent 40 33 Percent 40 Percent 40 Maternity protection in accordance with ILO Convention 183 No National availability of Emergency Obstetric Care 20 20 15 20 services (% of recommended minimum) --- Specific notification of maternal deaths Partial 0 0 0 1997 2003 2003 1997 2003 Countdown to 2015 DHS DHS DHS DHS DHS 2008 Report Myanmar DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 48,379 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Asia, 1997-2002 Total under-five population (000) 4,146 (2006) undernutrition Unmet need for family planning (%) 19 (2001) (2006) Measles Injuries Causes of neonatal Abortion Births (000) 897 Other 6% Contraceptive 6% 2% 2% deaths Obstructed labor 34 Pre-pregnancy 150 HIV/AIDS Antenatal visits for woman (4 or more visits, %) 22 (2001) prevalence rate Birth registration (%) 65 (2006) 130 1% 9% Malaria Antenatal visit 76 Pregnancy Under-five mortality rate (per 1000 live births) 104 (2006) 120 9% (%) (1 or more) 104 Intermittent preventive treatment for malaria --- Hypertensive Haemorrhage (per 1000 live births) 74 (2006) disorders Skilled attendant Infant mortality rate 31% at birth 57 Birth 90 C-section rate (total, urban, rural; %) 9% Neonatal mortality rate (per 1000 live births) 40 (2000) Neonatal (Minimum target is 5% and maximum target is 15%) ---, ---, --- *Postnatal care 60 43 39% No data Neonatal period Total under-five deaths (000) 93 (2006) Sepsis/Infections, Exclusive Early initiation of breastfeeding (within 1 hr of birth, %) --- including AIDS 15 Infancy (2005) Pneumonia breastfeeding Maternal mortality ratio (per 100,000 live births) 380 30 MDG Target 12% 19% Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 110 (2005) Anaemia Other causes Measles 78 0 Diarrhoea 13% 21% 3,700 (2005) Total maternal deaths 1990 1995 2000 2005 2010 2015 21% 0 20 40 60 80 100 Source: UNICEF, 2006 Source: WHO, 2006 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy 100 100 100 Stunting prevalence (moderate and severe, %) 41 (2003) Complementary feeding rate (6-9 months, %) 66 (2003) 87 Wasting prevalence (moderate and severe, %) 11 (2003) Low birthweight incidence (%) 15 (2000) 80 76 76 80 80 56 57 60 60 60 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 46 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent Percent Percent 40 40 31 40 At least one dose Two doses 96 100 100 100 92 95 20 20 20 97 87 96 96 95 92 80 80 80 67 87 0 0 1997 2001 1991 1997 2001 1980 1985 1990 1995 2000 2006 60 60 60 Other NS Other NS Other NS Other NS Other NS 42 Source: WHO/UNICEF Percent Percent Percent 40 30 30 40 40 20 20 15 20 WATER AND SANITATION EQUITY 0 0 0 0 0 2000 2003 2003 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile MICS MICS MICS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 100 86 88 80 CHILD HEALTH 77 78 77 80 80 72 80 57 Immunization Malaria prevention Prevention of mother to child 60 60 48 60 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs 47 Percent of children immunised with 3 doses DPT transmission of HIV Percent Percent Percent Percent HIV+ pregnant women receiving ARVs for PMTCT 40 40 40 Percent of children immunised with 3 doses Hib 24 16 20 20 20 100 50 82 0 0 0 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest 80 40 34 78 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 30 2000 No data 20 MICS Percent 40 Percent 20 POLICIES SYSTEMS 8 20 10 Coverage gap (%) 61 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 Substitutes No Ratio 1990 1995 2000 2005 2006 2004 2005 2006 Per capita total expenditure on health (US$) 38 (2007) poorest/wealthiest 1.1 Source: WHO/UNICEF Other NS Other NS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Yes 8 % of total government expenditure (%) 1 (2007) poorest-wealthiest (%) Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics Yes Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 87 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age --- antibiotics Density of health workers (per 1000 population) 1.4 (2004) 100 100 Costed implementation plan(s) for maternal, newborn and child health available --- Official Development Assistance to child health 80 80 per child (US$) 3 (2005) 65 66 Midwives be authorised to administer a core set of 60 60 life saving interventions --- Official Development Assistance to maternal and 48 48 neonatal health per live birth (US$) 2 (2005) Myanmar

Percent No data Percent Maternity protection in accordance with ILO 40 40 28 Convention 183 No National availability of Emergency Obstetric Care 17 20 20 services (% of recommended minimum) --- Specific notification of maternal deaths --- 0 0 2000 2003 2000 2003 Countdown to 2015 MICS MICS MICS MICS 2008 Report Nepal DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 27,641 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Asia, 1997-2002 Total under-five population (000) 3,626 (2006) undernutrition Unmet need for family planning (%) 25 (2006) Measles Malaria Causes of neonatal Abortion Births (000) 791 (2006) Injuries Contraceptive 142 Other 3% 2% 1% deaths Obstructed labor 6% 48 150 12% (4 or more visits, %) (2006) prevalence rate Pre-pregnancy Birth registration (%) 35 (2006) HIV/AIDS Antenatal visits for woman 29 9% Antenatal visit 0% 44 Pregnancy Under-five mortality rate (per 1000 live births) 59 (2006) 120 Intermittent preventive treatment for malaria (%) --- (1 or more) Pneumonia Hypertensive Haemorrhage (per 1000 live births) 46 (2006) disorders Skilled attendant Infant mortality rate 19% 31% at birth 19 Birth 90 C-section rate (total, urban, rural; %) 9% Neonatal mortality rate (per 1000 live births) 40 (2000) Neonatal (2006) 59 (Minimum target is 5% and maximum target is 15%) 3, 8, 2 *Postnatal care 24 60 44% No data Neonatal period Total under-five deaths (000) 47 (2006) 47 Sepsis/Infections, (2006) Exclusive Early initiation of breastfeeding (within 1 hr of birth, %) 35 including AIDS 53 Infancy (2005) breastfeeding Maternal mortality ratio (per 100,000 live births) 830 30 MDG Target 12% Postnatal visit for baby (within 2 days for home births, %) 2 (2006) Lifetime risk of maternal death (1 in N) 31 (2005) Anaemia Other causes Measles 85 0 Diarrhoea 13% 21% 6,500 (2005) Total maternal deaths 1990 1995 2000 2005 2010 2015 21% 0 20 40 60 80 100 Source: UNICEF, 2006 Source: WHO, 2006 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 49 (2006) Complementary feeding rate (6-9 months, %) 75 (2006) 100 100 100 83 Wasting prevalence (moderate and severe, %) 13 (2006) Low birthweight incidence (%) 21 (2001) 80 80 80 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses 44 Percent Percent Percent 40 40 40 At least one dose Two doses 27 28 24 20 98 96 97 96 15 19 100 100 100 90 20 20 20 7 9 12 11 82 83 96 96 96 74 96 80 80 68 80 85 0 0 73 1991 1996 2000 2001 2006 1991 1996 2000 2001 2003-2004 2006 1980 1985 1990 1995 2000 2006 53 Other NS DHS Other NS DHS DHS Other NS DHS Other NS DHS Other NS DHS 60 60 60 Source: WHO/UNICEF 43 38 Percent 39 Percent Percent 40 40 40

20 20 20 0 WATER AND SANITATION EQUITY

0 0 0 1997-1998 2001 2006 1996 2001 2006 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile Other NS DHS DHS DHS DHS DHS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 96 100 95 90 100 100 CHILD HEALTH 89 80 80 80 67 70 62 Immunization Malaria prevention Prevention of mother to child 60 60 60 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs* 48

Percent Percent 2 40 2 POLICIES SYSTEMS 20 1 Coverage gap (%) 63 50 41 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 Substitutes Yes Ratio 1990 1995 2000 2005 2006 2006 Per capita total expenditure on health (US$) 71 (2007) poorest/wealthiest 1.7 2.0 2.2 Source: WHO/UNICEF Other NS New ORS formula and zinc for management of *Sub-national risk of malaria transmission General government expenditure on health as Difference diarrhoea Yes % of total government expenditure (%) 8 (2007) poorest-wealthiest (%) 30 29 29 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials* Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics Yes Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 65 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Partial antibiotics Density of health workers (per 1000 population) 0.7 (2004) 100 100 Costed implementation plan(s) for maternal, newborn and child health available Yes Official Development Assistance to child health 80 80 per child (US$) 3 (2005) Midwives be authorised to administer a core set of 60 60 life saving interventions Partial Official Development Assistance to maternal and neonatal health per live birth (US$) 3 (2005) 43 No data 43 Nepal Percent 40 Percent 40 Maternity protection in accordance with ILO 26 25 Convention 183 No National availability of Emergency Obstetric Care 20 15 20 18 services (% of recommended minimum) 46 (2007) Specific notification of maternal deaths Partial 0 0 1996 2000 1996 2001 2006 Countdown to 2015 DHS DHS DHS DHS DHS *Sub-national risk of malaria transmission 2008 Report Niger DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 13,737 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 2,713 (2006) undernutrition Unmet need for family planning (%) 16 (2006) 320 Causes of neonatal Births (000) 683 (2006) Obstructed labor Contraceptive deaths Abortion 11 300 Diarrhoea 3% (2006) 4% prevalence rate Pre-pregnancy Birth registration (%) 32 (2006) 253 Diarrhoea Antenatal visits for woman (4 or more visits, %) 15 Anaemia 4% Pneumonia 20% Congenital 5% 4% Antenatal visit Other 7% 46 Pregnancy Under-five mortality rate (per 1000 live births) 253 (2006) 240 25% (%) (2006) (1 or more) Tetanus 10% Intermittent preventive treatment for malaria 0 Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 148 (2006) disorders Haemorrhage 33 Birth 180 Preterm 17% C-section rate (total, urban, rural; %) at birth 9% 34% Neonatal mortality rate (per 1000 live births) 43 (2000) HIV/AIDS Neonatal (Minimum target is 5% and maximum target is 15%) 1, 5, 0 (2006) 120 107 1% 17% *Postnatal care Neonatal period Total under-five deaths (000) 173 (2006) Asphyxia 23% Sepsis/Infections, Injuries Early initiation of breastfeeding (within 1 hr of birth, %) 48 (2006) including AIDS Exclusive MDG Target 1% breastfeeding 14 Infancy Maternal mortality ratio (per 100,000 live births) 1,800 (2005) 60 16% Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 7 (2005) Measles Infection 36% Measles 47 Other Other causes 0 7% Malaria 15% 14,000 (2005) 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 14% 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 55 (2006) Complementary feeding rate (6-9 months, %) 62 (2006) 100 100 100 Wasting prevalence (moderate and severe, %) 12 (2006) Low birthweight incidence (%) 13 (2000) 80 80 80 71 60 60 60 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 46 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses 39 41 Percent Percent Percent 40 30 40 33 40 At least one dose Two doses 94 15 18 16 100 100 100 92 20 20 20 100 89 95 94 92 77 80 80 80 88 0 0 80 77 1992 1998 2000 2006 1992 1998 2000 2006 68 1981 1986 1991 1996 2001 2006 60 60 60 DHS DHS MICS DHS DHS DHS MICS DHS 44 Source: WHO/UNICEF 41 40 Percent 40 Percent 40 Percent 40

20 20 14 20 0 WATER AND SANITATION EQUITY 3 1 1 0 0 0 1992 2000 2006 1992 1998 2000 2006 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile DHS MICS DHS DHS DHS MICS DHS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 100 CHILD HEALTH 80 80 80 80 62 Immunization Malaria prevention Prevention of mother to child 60 60 60 Percent of children immunised against measles 46 43 Percent children < 5 years sleeping under ITNs 39 transmission of HIV Percent 35 36 Percent 35 Percent Percent of children immunised with 3 doses DPT 40 40 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 13 20 20 20 7 100 100 10 2 4 0 0 0 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest 80 80 8 7 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 60 6 1998 2000 2006 47 DHS MICS MICS Percent 40 Percent 40 Percent 4 POLICIES SYSTEMS 39 2 20 20 2 7 Coverage gap (%) 70 67 60 1 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 0 Substitutes Partial Ratio 1990 1995 2000 2005 2006 2000 2006 2005 2006 Per capita total expenditure on health (US$) 26 (2007) poorest/wealthiest 2.0 1.8 1.8 Source: WHO/UNICEF MICS DHS Other NS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Yes % of total government expenditure (%) 10 (2007) poorest-wealthiest (%) 40 34 29 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics Yes Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 40 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 0.3 (2004) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available Yes Official Development Assistance to child health 80 80 80 per child (US$) 5 (2005) Midwives be authorised to administer a core set of 60 60 60 life saving interventions Yes Official Development Assistance to maternal and 43 48 neonatal health per live birth (US$) 5 (2005) Niger

Percent Percent Percent Maternity protection in accordance with ILO 40 40 33 40 27 26 27 Convention 183 Partial National availability of Emergency Obstetric Care 14 services (% of recommended minimum) 68 (2000) 20 12 20 20 9 Specific notification of maternal deaths No 0 0 0 1992 1998 2000 2000 2006 1992 1998 2000 Countdown to 2015 DHS DHS MICS MICS DHS DHS DHS MICS 2008 Report Nigeria DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 144,720 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 24,503 (2006) undernutrition Unmet need for family planning (%) 17 (2003) Births (000) 5,909 (2006) Measles HIV/AIDS Injuries Causes of neonatal Obstructed labor 230 Abortion Contraceptive 250 6% 5% 2% deaths 4% prevalence rate 13 Pre-pregnancy Birth registration (%) 33 (2006) Diarrhoea 4% Antenatal visits for woman (4 or more visits, %) 47 (2003) Anaemia 4% 191 Diarrhoea Other Congenital 7% 4% Antenatal visit 16% 1% 58 Pregnancy Under-five mortality rate (per 1000 live births) 191 (2006) 200 Other 8% Intermittent preventive treatment for malaria (%) 1 (2003) (1 or more) Tetanus 8% Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 99 (2006) disorders Haemorrhage 35 Birth 150 C-section rate (total, urban, rural; %) at birth Infection 22% 9% 34% Neonatal mortality rate (per 1000 live births) 53 (2000) Neonatal (Minimum target is 5% and maximum target is 15%) 2, 4, 1 (2003) 100 77 26% *Postnatal care Neonatal period Total under-five deaths (000) 1,129 (2006) Sepsis/Infections, Preterm 25% Early initiation of breastfeeding (within 1 hr of birth, %) 32 (2003) including AIDS Exclusive breastfeeding 17 Infancy Maternal mortality ratio (per 100,000 live births) 1,100 (2005) 50 MDG Target Pneumonia 16% 20% Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 18 (2005) Measles 62 0 Malaria Asphyxia 27% Other causes 59,000 (2005) 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 24% 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 43 (2003) Complementary feeding rate (6-9 months, %) 64 (2003) 100 100 100 79 Wasting prevalence (moderate and severe, %) 11 (2003) Low birthweight incidence (%) 14 (2003) 80 80 80 64 58 60 57 60 60 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 53 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses 42 Percent Percent Percent 40 40 35 40 31 At least one dose Two doses 100 100 100 20 20 20 85 79 77 79 73 80 80 80 0 0 60 76 73 1986 1990 1999 2003 1990 1999 2003 1981 1986 1991 1996 2001 2006 DHS DHS DHS DHS DHS DHS DHS 60 60 60 Source: WHO/UNICEF Percent 35 Percent Percent 31 27 40 40 40 27 23 20 20 17 17 20 WATER AND SANITATION EQUITY 0 1 0 0 0 0 0 1990 2003 1990 1999 2003 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile DHS DHS DHS DHS DHS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 100 CHILD HEALTH 80 80 67 80 80 60 60 53 60 Immunization Malaria prevention Prevention of mother to child 49 48 51 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs 44 Percent of children immunised with 3 doses DPT transmission of HIV Percent 33 Percent 39 36 Percent 40 40 33 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 31 20 20 20 100 100 10 0 0 0 80 80 8 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest 62 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 60 6 1990 2003 DHS DHS Percent 40 54 Percent 40 Percent 4 3 POLICIES SYSTEMS 20 20 2 0.6 Coverage gap (%) 65 62 1 0.3 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 0 Substitutes Yes Ratio 1990 1995 2000 2005 2006 2003 2004 2005 2006 Per capita total expenditure on health (US$) 53 (2007) poorest/wealthiest 1.9 2.4 Source: WHO/UNICEF DHS Other NS Other NS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Yes % of total government expenditure (%) 4 (2007) poorest-wealthiest (%) 35 45 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics No Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 63 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 2.0 (2003) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available Yes Official Development Assistance to child health 80 80 80 per child (US$) 2 (2005) Midwives be authorised to administer a core set of 60 60 60 life saving interventions Yes Official Development Assistance to maternal and neonatal health per live birth (US$) 3 (2005) 37 Nigeria Percent Percent Percent 33 40 40 34 40 Maternity protection in accordance with ILO 28 23 Convention 183 No National availability of Emergency Obstetric Care 20 20 20 services (% of recommended minimum) --- Specific notification of maternal deaths No 0 0 0 2003 2003 1990 2003 Countdown to 2015 DHS DHS DHS DHS 2008 Report Pakistan DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 160,943 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Asia, 1997-2002 Total under-five population (000) 19,012 (2006) undernutrition Malaria Unmet need for family planning (%) 33 (2000-2001) Abortion Births (000) 4,358 (2006) Measles Injuries Causes of neonatal 2% 1% HIV/AIDS 6% Contraceptive 150 2% deaths prevalence rate 28 Pre-pregnancy Birth registration (%) --- 130 0% Diarrhoea 4% Antenatal visits for woman (4 or more visits, %) 14 (1990-1991) Obstructed labor Other Other 6% 9% Antenatal visit 36 Pregnancy Under-five mortality rate (per 1000 live births) 97 (2006) 120 6% Tetanus 7% Intermittent preventive treatment for malaria (%) --- (1 or more) 97 Hypertensive Congenital 8% Haemorrhage Skilled attendant Infant mortality rate (per 1000 live births) 78 (2006) disorders 31 Birth 90 Diarrhoea C-section rate (total, urban, rural; %) 31% at birth 14% Preterm 20% 9% Neonatal mortality rate (per 1000 live births) 57 (2000) Neonatal (Minimum target is 5% and maximum target is 15%) 3,6,1 (1990-1991) 60 56% *Postnatal care Neonatal period Total under-five deaths (000) 423 (2006) 43 Sepsis/Infections, Asphyxia 22% (1996) Exclusive Early initiation of breastfeeding (within 1 hr of birth, %) 6 including AIDS 16 Infancy Maternal mortality ratio (per 100,000 live births) 320 (2005) 30 12% breastfeeding MDG Target Pneumonia Postnatal visit for baby (within 2 days for home births, %) --- Other causes Lifetime risk of maternal death (1 in N) 74 (2005) 19% Infection 33% Anaemia Measles 80 0 21% 15,000 (2005) 13% Total maternal deaths 1990 1995 2000 2005 2010 2015 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 42 (2001) Complementary feeding rate (6-9 months, %) 31 (1995) 100 100 100 80 Wasting prevalence (moderate and severe, %) 14 (2001) Low birthweight incidence (%) 19 (1991) 80 80 80 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses 43 Percent Percent Percent 36 40 28 40 31 40 At least one dose Two doses 26 26 19 23 100 100 100 95 95 95 95 95 20 20 18 18 20 88 100 95 95 95 95 95 80 80 80 0 0 1990-1991 1996-1997 1999 2001 2004-2005 1990-1991 1996-1997 1998-1999 2001 2004-2005 1981 1986 1991 1996 2001 2006 DHS Other NS Other NS Other NS Other NS DHS Other NS Other NS Other NS Other NS 60 60 60 Source: WHO/UNICEF 39 Percent Percent Percent 40 31 40 40 20 20 16 20 WATER AND SANITATION EQUITY 0 0 0 0 1990-1991 2001 1995 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile DHS Other NS MICS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 96 100 95 100 92 100 89 91 CHILD HEALTH 83 82 80 78 80 80 59 Immunization Malaria prevention Prevention of mother to child 60 60 60 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs 41

transmission of HIV Percent Percent 37 Percent Percent of children immunised with 3 doses DPT 40 40 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 20 20 17 20 100 5 83 0 0 0 80 4 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest 80 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 3 1991 No data DHS Percent 40 Percent 2 POLICIES SYSTEMS 20 1 0.4 Coverage gap (%) 60 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 Substitutes Partial Ratio 1990 1995 2000 2005 2006 2006 Per capita total expenditure on health (US$) 48 (2007) poorest/wealthiest 2.0 Source: WHO/UNICEF Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Yes % of total government expenditure (%) 2 (2007) poorest-wealthiest (%) 37 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics Yes Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 79 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 1.2 (2004) 100 100 Costed implementation plan(s) for maternal, newborn and child health available Yes Official Development Assistance to child health 80 80 per child (US$) 2 (2005) 66 Midwives be authorised to administer a core set of 60 60 life saving interventions Partial Official Development Assistance to maternal and neonatal health per live birth (US$) 4 (2005) Pakistan

Percent No data Percent Maternity protection in accordance with ILO 40 33 40 Convention 183 No National availability of Emergency Obstetric Care 20 20 16 services (% of recommended minimum) --- Specific notification of maternal deaths No 0 0 1990-1991 1990-1991 Countdown to 2015 DHS DHS 2008 Report Papua New Guinea DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 6,202 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Asia, 1997-2002 Total under-five population (000) 898 (2006) undernutrition Unmet need for family planning (%) --- Births (000) 191 (2006) Injuries Measles Causes of neonatal Abortion 94 Malaria 6% Contraceptive 100 2% 2% 1% deaths prevalence rate 26 Pre-pregnancy Birth registration (%) --- HIV/AIDS Antenatal visits for woman (4 or more visits, %) --- Obstructed labor Diarrhoea 0% 9% Antenatal visit 73 78 Pregnancy Under-five mortality rate (per 1000 live births) 73 (2006) 80 15% Intermittent preventive treatment for malaria (%) --- (1 or more) Hypertensive Haemorrhage Skilled attendant Infant mortality rate (per 1000 live births) 54 (2006) disorders 41 Birth 60 (total, urban, ; %) 31% at birth C-section rate rural 9% Neonatal mortality rate (per 1000 live births) 32 (2000) Neonatal (Minimum target is 5% and maximum target is 15%) ---, ---, --- *Postnatal care 40 31 35% No data Neonatal period Total under-five deaths (000) 14 (2006) Sepsis/Infections, Exclusive Early initiation of breastfeeding (within 1 hr of birth, %) --- including AIDS 59 Infancy (2005) Pneumonia breastfeeding Maternal mortality ratio (per 100,000 live births) 470 20 MDG Target 19% 12% Postnatal visit for baby (within 2 days for home births, %) --- Other causes Lifetime risk of maternal death (1 in N) 55 (2005) Anaemia Measles 65 0 Other 21% 820 (2005) 13% Total maternal deaths 1990 1995 2000 2005 2010 2015 25% 0 20 40 60 80 100 Source: UNICEF, 2006 Source: WHO, 2006 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS

*See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 44 (2005) Complementary feeding rate (6-9 months, %) 74 (1996) 100 100 100 Wasting prevalence (moderate and severe, %) 5 (2005) Low birthweight incidence (%) 11 (1996) 78 80 80 80 57 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 53 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent

Percent 41 Percent 40 40 40 At least one dose Two doses 100 100 100 20 90 20 20 80 80 80 0 0 59 1996 1996 2000 1980 1985 1990 1995 2000 2006 60 60 60 DHS DHS Other NS Source: WHO/UNICEF Percent Percent Percent 40 40 40 32 25 18 20 20 20 WATER AND SANITATION EQUITY 0 0 0 0 1 0 0 0 0 0 1982-1983 2005 1996 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile Other NS Other NS DHS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 CHILD HEALTH 88 88 80 80 67 67 Immunization Malaria prevention Prevention of mother to child 60 60 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs 41 44 41 44 No data transmission of HIV Percent Percent Percent of children immunised with 3 doses DPT 40 39 39 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 32 32 20 20 100 10 0 0 80 1990 2004 1990 2004 75 8 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 65 6 60 5 No data Percent Percent 4 40 4 POLICIES SYSTEMS 20 2 Coverage gap (%) No data International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 Substitutes Partial Ratio 1990 1995 2000 2005 2006 2004 2005 Per capita total expenditure on health (US$) 147 (2007) poorest/wealthiest Source: WHO/UNICEF Other NS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Partial % of total government expenditure (%) 10 (2007) poorest-wealthiest (%) Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics No Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 7 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Partial antibiotics Density of health workers (per 1000 population) 0.6 (2000) 100 Costed implementation plan(s) for maternal, newborn and child health available No Official Development Assistance to child health 75 80 per child (US$) 3 (2005) Midwives be authorised to administer a core set of 60 life saving interventions Partial Official Development Assistance to maternal and neonatal health per live birth (US$) 6 (2005) Papua New Guinea No data No data Percent 40 Maternity protection in accordance with ILO Convention 183 Partial National availability of Emergency Obstetric Care 20 services (% of recommended minimum) --- Specific notification of maternal deaths --- 0 1996 Countdown to 2015 DHS 2008 Report Peru DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 27,589 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Latin America, 1997-2002 Total under-five population (000) 2,815 (2006) undernutrition Unmet need for family planning (%) 9 (2004) Sepsis/Infections, Births (000) 584 (2006) Injuries HIV/AIDS Malaria Causes of neonatal including AIDS Anaemia 0% 1 Contraceptive 100 10% 1% Measles deaths 8% 0% prevalence rate 71 Pre-pregnancy (2006) 0% Diarrhoea 1% Antenatal visits for woman (4 or more visits, %) 87 (2004) Birth registration (%) 93 Diarrhoea 78 Tetanus 2% Antenatal visit 12% 92 Pregnancy Under-five mortality rate (per 1000 live births) 25 (2006) 80 Other 8% Intermittent preventive treatment for malaria (%) --- Abortion Hypertensive (1 or more) Congenital 9% 12% disorders Skilled attendant Infant mortality rate (per 1000 live births) 21 (2006) 73 Birth 60 Pneumonia Infection 20% (total, urban, ; %) 26% at birth 14% C-section rate rural Neonatal Neonatal mortality rate (per 1000 live births) 16 (2000) (Minimum target is 5% and maximum target is 15%) 16, 23, 6 (2004) Obstructed labor 40 39% *Postnatal care Neonatal period Total under-five deaths (000) 15 (2006) 25 Asphyxia 27% 13% 26 (2004) Exclusive Early initiation of breastfeeding (within 1 hr of birth, %) 42 64 Infancy Maternal mortality ratio (per 100,000 live births) 240 (2005) 20 breastfeeding MDG Target Postnatal visit for baby (within 2 days for home births, %) --- Haemorrhage Lifetime risk of maternal death (1 in N) 140 (2005) Preterm 32% Measles 99 0 Other Other causes 21% 1,500 (2005) 21% Total maternal deaths 1990 1995 2000 2005 2010 2015 25% 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 30 (2004) Complementary feeding rate (6-9 months, %) 81 (2004) 100 92 100 100 84 82 Wasting prevalence (moderate and severe, %) 1 (2004) Low birthweight incidence (%) 11 (2004) 80 80 80 67 73 64 56 56 59 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 53 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent Percent Percent 40 40 40

100 100 20 20 20

80 80 0 0 67 64 1986 1991-1992 1996 2000 2004 1991-1992 1996 2000 2004 1981 1986 1991 1996 2001 2006 60 60 53 DHS DHS DHS DHS DHS DHS DHS DHS DHS No data Source: WHO/UNICEF Percent Percent 40 40 33 20 20 WATER AND SANITATION EQUITY 9 6 5 7 0 0 1991-1992 1996 2000 2004 1991-1992 1996 2000 2004 Water Sanitation Coverage gap by wealth quintile DHS DHS DHS DHS DHS DHS DHS DHS Percent population using improved drinking water sources Percent population using improved sanitation facilities

*Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 89 89 100 100 83 CHILD HEALTH 74 74 80 80 69 80 65 63 Immunization Malaria prevention Prevention of mother to child 60 60 52 60 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs* 41 transmission of HIV Percent Percent Percent Percent of children immunised with 3 doses DPT 40 40 32 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 15 99 20 20 20 100 100 94 0 0 0 94 80 80 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 60 1992 1996 2000 2004 No data DHS DHS DHS DHS Percent Percent 40 40 34 POLICIES SYSTEMS 20 20 10 12 Coverage gap (%) 35 32 25 19 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 Substitutes Yes Ratio 1990 1995 2000 2005 2006 2004 2005 2006 Per capita total expenditure on health (US$) 235 (2007) poorest/wealthiest 2.5 3.2 2.8 Source: WHO/UNICEF Other NS Other NS Other NS New ORS formula and zinc for management of *Sub-national risk of malaria transmission General government expenditure on health as Difference diarrhoea Partial % of total government expenditure (%) 9 (2007) poorest-wealthiest (%) 32 29 19 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials* Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics --- Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 42 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 1.9 (2004) 100 100 Costed implementation plan(s) for maternal, newborn and child health available No Official Development Assistance to child health 80 80 per child (US$) 5 (2005) 68 Midwives be authorised to administer a core set of 57 58 60 60 life saving interventions Yes Official Development Assistance to maternal and 46 46 neonatal health per live birth (US$) 12 (2005) Peru Percent No data Percent 33 Maternity protection in accordance with ILO 40 31 40 25 Convention 183 Partial National availability of Emergency Obstetric Care 20 20 services (% of recommended minimum) --- Specific notification of maternal deaths Yes 0 0 1991-1992 1996 2000 2004 1991-1992 1996 2000 2004 Countdown to 2015 DHS DHS DHS DHS DHS DHS DHS DHS *Sub-national risk of malaria transmission 2008 Report Philippines DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 86,264 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Asia, 1997-2002 Total under-five population (000) 11,027 (2006) undernutrition Unmet need for family planning (%) 17 (2003) Causes of neonatal Abortion Births (000) 2,295 (2006) Injuries Measles Contraceptive 1% deaths 6% 49 100 3% Malaria Obstructed labor prevalence rate Pre-pregnancy Birth registration (%) 83 (2006) Diarrhoea 0% Antenatal visits for woman (4 or more visits, %) 70 (2003) 12% 9% Antenatal visit 88 Pregnancy Under-five mortality rate (per 1000 live births) 32 (2006) 80 HIV/AIDS Intermittent preventive treatment for malaria (%) --- (1 or more) Hypertensive 62 Pneumonia 0% Haemorrhage Skilled attendant Infant mortality rate (per 1000 live births) 24 (2006) disorders 60 Birth 60 13% (total, urban, ; %) 31% at birth C-section rate rural 9% Neonatal mortality rate (per 1000 live births) 15 (2000) Neonatal (2003) (Minimum target is 5% and maximum target is 15%) 7, 10, 5 *Postnatal care 40 32 37% No data Neonatal period Total under-five deaths (000) 73 (2006) Sepsis/Infections, (2003) Exclusive 21 Early initiation of breastfeeding (within 1 hr of birth, %) 54 including AIDS 34 Infancy Maternal mortality ratio (per 100,000 live births) 230 (2005) 20 12% breastfeeding MDG Target Postnatal visit for baby (within 2 days for home births, %) --- Other causes Lifetime risk of maternal death (1 in N) 140 (2005) Other Anaemia Measles 92 0 34% 21% 4,600 (2005) 13% Total maternal deaths 1990 1995 2000 2005 2010 2015 0 20 40 60 80 100 Source: UNICEF, 2006 Source: WHO, 2006 Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 34 (2003) Complementary feeding rate (6-9 months, %) 58 (2003) 100 100 100 83 86 86 88 Wasting prevalence (moderate and severe, %) 6 (2003) Low birthweight incidence (%) 20 (2003) 80 80 80 60 64 56 58 60 60 53 60 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 46 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent Percent Percent 40 40 40 At least one dose Two doses 100 100 100 90 20 20 20 85 84 86 85 85 76 80 80 80 82 86 85 85 0 0 78 76 76 1993 1998 2000 2003 1993 1998 1999 2000 2003 1980 1985 1990 1995 2000 2006 DHS DHS MICS DHS DHS DHS MICS MICS DHS 60 60 60 Source: WHO/UNICEF Percent 40 Percent 40 37 34 Percent 40 29 30 26 25 27 26 21 20 20 20 WATER AND SANITATION EQUITY

0 0 0 1987 1989-1990 1993 1996 2001 2003 1993 1998 2003 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile Other NS Other NS Other NS Other NS Other NS Other NS DHS DHS DHS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 95 100 100 87 87 85 CHILD HEALTH 80 82 80 80 80 72 80 66 59 60 60 57 60 Immunization Malaria prevention Prevention of mother to child 48 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs*

transmission of HIV Percent Percent Percent Percent of children immunised with 3 doses DPT 40 40 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 20 20 20 100 92 0 0 0 88 80 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 1998 2003 No data No data DHS DHS Percent 40 POLICIES SYSTEMS 20 Coverage gap (%) 31 26 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 Substitutes Yes Ratio 1990 1995 2000 2005 2006 Per capita total expenditure on health (US$) 203 (2007) poorest/wealthiest 1.9 3.1 Source: WHO/UNICEF New ORS formula and zinc for management of *Sub-national risk of malaria transmission General government expenditure on health as Difference diarrhoea Yes % of total government expenditure (%) 6 (2007) poorest-wealthiest (%) 22 27 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials* Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics No Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 47 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age No antibiotics Density of health workers (per 1000 population) 2.7 (2000) 100 100 Costed implementation plan(s) for maternal, newborn and child health available No Official Development Assistance to child health 76 80 80 per child (US$) 0 (2005) 65 Midwives be authorised to administer a core set of 58 55 life saving interventions --- Official Development Assistance to maternal and 60 60 51 44 neonatal health per live birth (US$) 2 (2005) Philippines

Percent 37 Percent 36 40 No data 40 Maternity protection in accordance with ILO Convention 183 No National availability of Emergency Obstetric Care 20 20 services (% of recommended minimum) --- Specific notification of maternal deaths --- 0 0 1998 2003 1993 1998 2000 2003 Countdown to 2015 DHS DHS DHS DHS MICS DHS *Sub-national risk of malaria transmission 2008 Report Rwanda DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 9,464 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 1,617 (2006) undernutrition Unmet need for family planning (%) 38 (2005) Births (000) 420 (2006) Causes of neonatal Obstructed labor Pneumonia Abortion Contraceptive 250 23% deaths 4% prevalence rate 17 Pre-pregnancy Birth registration (%) 82 (2006) Diarrhoea 4% Antenatal visits for woman (4 or more visits, %) 13 (2005) Anaemia 4% Tetanus 4% 4% Antenatal visit 176 Other 94 Pregnancy Under-five mortality rate (per 1000 live births) 160 (2006) 200 Congenital 6% Intermittent preventive treatment for malaria (%) 0 (2005) (1 or more) 160 24% Other 7% Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 98 (2006) disorders Haemorrhage 39 Birth 150 Preterm 20% C-section rate (total, urban, rural; %) at birth 9% 34% Neonatal mortality rate (per 1000 live births) 45 (2000) Measles Neonatal (Minimum target is 5% and maximum target is 15%) 3, 8, 2 (2005) 2% 22% *Postnatal care Neonatal period (2006) 100 Sepsis/Infections, Total under-five deaths (000) 67 59 Asphyxia 26% Injuries Early initiation of breastfeeding (within 1 hr of birth, %) 41 (2005) including AIDS Exclusive breastfeeding 88 Infancy Maternal mortality ratio (per 100,000 live births) 1,300 (2005) 50 2% 16% MDG Target Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 16 (2005) Measles 95 Malaria Infection 32% Other causes 0 5% Diarrhoea 4,700 (2005) HIV/AIDS 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 19% 0 20 40 60 80 100 5% Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 52 (2005) Complementary feeding rate (6-9 months, %) 69 (2005) 100 94 92 94 100 100 82 Wasting prevalence (moderate and severe, %) 5 (2005) Low birthweight incidence (%) 6 (2005) 80 80 80 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses 39 Percent Percent Percent 40 40 31 40 At least one dose Two doses 100 26 100 100 100 93 95 20 20 20 88 94 83 83 86 93 99 80 80 80 75 0 0 59 1992 2000 2005 1992 2000 2005 1981 1986 1991 1996 2001 2006 60 60 60 DHS MICS DHS DHS DHS DHS 36 Source: WHO/UNICEF Percent 40 Percent 40 Percent 40 24 20 18 20 20 20 WATER AND SANITATION EQUITY 0 0 0 8 0 0 0 1992 2000 2005 1992 2000 2005 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile DHS DHS DHS DHS DHS DHS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 100 88 92 CHILD HEALTH 74 80 69 80 80 57 59 56 Immunization Malaria prevention Prevention of mother to child 60 60 49 60 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs 37 42 transmission of HIV Percent Percent 36 38 Percent Percent of children immunised with 3 doses DPT 40 40 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 99 20 20 20 100 99 100 75 95 0 0 0 80 80 60 55 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 60 45 38 2000 2005 DHS DHS Percent 40 Percent 40 Percent 30 25 POLICIES SYSTEMS 20 20 15 13 Coverage gap (%) 52 47 4 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 0 Substitutes No Ratio 1990 1995 2000 2005 2006 2000 2005 2004 2005 2006 Per capita total expenditure on health (US$) 126 (2007) poorest/wealthiest 1.4 1.5 Source: WHO/UNICEF DHS DHS Other NS Other NS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Yes % of total government expenditure (%) 17 (2007) poorest-wealthiest (%) 15 16 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics Yes Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 16 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 0.5 (2004) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available Yes Official Development Assistance to child health 80 80 80 per child (US$) 13 (2005) Midwives be authorised to administer a core set of 60 60 60 life saving interventions Yes Official Development Assistance to maternal and neonatal health per live birth (US$) 13 (2005) Rwanda

Percent Percent Percent Maternity protection in accordance with ILO 40 40 40 30 24 28 Convention 183 No National availability of Emergency Obstetric Care 20 16 services (% of recommended minimum) --- 20 20 13 12 20 4 Specific notification of maternal deaths No 0 0 0 2000 2005 2000 2005 1992 2000 2005 Countdown to 2015 DHS DHS DHS DHS DHS DHS DHS 2008 Report Senegal DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 12,072 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 1,913 (2006) undernutrition Unmet need for family planning (%) 32 (2005) Causes of neonatal Births (000) 435 (2006) Other Obstructed labor Contraceptive 200 HIV/AIDS 0% Malaria deaths Abortion 12 Pre-pregnancy Diarrhoea 2% Antenatal visits for woman (4 or more visits, %) 40 (2005) 4% prevalence rate Birth registration (%) 55 (2006) 1% 28% Anaemia 4% Tetanus 4% 4% Antenatal visit 149 87 Pregnancy Under-five mortality rate (per 1000 live births) 116 (2006) 160 Injuries Other 6% Intermittent preventive treatment for malaria (%) 9 (2005) (1 or more) 3% Congenital 6% Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 60 (2006) 116 Asphyxia 20% disorders Haemorrhage 52 Birth 120 C-section rate (total, urban, rural; %) at birth Measles 9% 34% Neonatal mortality rate (per 1000 live births) 31 (2000) 8% Neonatal (Minimum target is 5% and maximum target is 15%) 3, 7, 1 (2005) 80 23% *Postnatal care Neonatal period Total under-five deaths (000) 50 (2006) Preterm 28% Sepsis/Infections, 50 Exclusive Early initiation of breastfeeding (within 1 hr of birth, %) 23 (2005) including AIDS 34 Infancy (2005) breastfeeding Maternal mortality ratio (per 100,000 live births) 980 40 MDG Target Diarrhoea 16% 17% Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 21 (2005) Infection 33% Measles 80 0 Pneumonia Other causes 4,100 (2005) 21% 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 20 (2005) Complementary feeding rate (6-9 months, %) 61 (2005) 100 100 100 87 86 Wasting prevalence (moderate and severe, %) 9 (2005) Low birthweight incidence (%) 19 (2005) 82 79 80 74 80 80 63 58 58 60 60 52 60 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 47 47 48 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses 41 Percent Percent 40 Percent 40 40 At least one dose Two doses 93 95 95 100 100 100 87 85 20 20 20 83 80 80 80 93 93 0 0 83 86 1986 1992-1993 1997 2000 2005 1986 1993 1997 1999 2000 2002 2005 1985 1990 1995 2000 2006 DHS DHS DHS MICS DHS DHS DHS DHS DHS MICS Other NS DHS 60 60 60 Source: WHO/UNICEF Percent Percent 40 Percent 40 34 40 22 20 20 15 20 12 20 0 WATER AND SANITATION EQUITY 6 0 0 0 0 0 1992-1993 2000 2005 1992-1993 1997 2005 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile DHS MICS DHS DHS DHS DHS Percent population using improved drinking water sources Percent population using improved sanitation facilities

*Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 100 CHILD HEALTH 89 92 80 76 80 79 80 65 60 Malaria prevention Prevention of mother to child 60 60 57 60 Immunization 49 53 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs Percent of children immunised with 3 doses DPT transmission of HIV Percent Percent Percent 40 40 33 34 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 20 20 19 20 100 89 100 5 89 0 0 0 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest 80 80 80 4 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 60 3 2005 DHS Percent Percent Percent 2 40 40 2 POLICIES SYSTEMS 20 20 1 7 Coverage gap (%) 45 2 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 0 Substitutes Partial Ratio 1990 1995 2000 2005 2006 2000 2005 2005 Per capita total expenditure on health (US$) 72 (2007) poorest/wealthiest 1.8 Source: WHO/UNICEF MICS DHS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Yes % of total government expenditure (%) 10 (2007) poorest-wealthiest (%) 26 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics Yes Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 56 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age No antibiotics Density of health workers (per 1000 population) 0.4 (2004) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available Yes Official Development Assistance to child health 80 80 80 per child (US$) 10 (2005) Midwives be authorised to administer a core set of 60 60 60 life saving interventions Yes Official Development Assistance to maternal and 47 43 neonatal health per live birth (US$) 17 (2005) Senegal Percent Percent 36 Percent Maternity protection in accordance with ILO 40 34 40 40 31 27 27 Convention 183 Partial National availability of Emergency Obstetric Care 20 20 20 18 services (% of recommended minimum) 38 (2000) Specific notification of maternal deaths No 0 0 0 2000 2005 2000 2005 1992-1993 2000 2005 Countdown to 2015 MICS DHS MICS DHS DHS MICS DHS 2008 Report Sierra Leone DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 5,743 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 999 (2006) undernutrition Unmet need for family planning (%) --- Births (000) 262 (2006) HIV/AIDS Causes of neonatal Obstructed labor 290 Pneumonia Abortion Contraceptive 300 1% deaths 4% prevalence rate 5 Pre-pregnancy Birth registration (%) 48 (2006) 270 Injuries 26% Diarrhoea 4% Antenatal visits for woman (4 or more visits, %) --- Anaemia 4% 1% Congenital 4% 4% Antenatal visit Other 5% 81 Pregnancy Under-five mortality rate (per 1000 live births) 270 (2006) 240 Intermittent preventive treatment for malaria (%) 2 (2005) (1 or more) Measles Tetanus 8% Hypertensive 5% Skilled attendant Infant mortality rate (per 1000 live births) 159 (2006) disorders Haemorrhage 43 Birth 180 Asphyxia 19% C-section rate (total, urban, rural; %) at birth 9% 34% Neonatal mortality rate (per 1000 live births) 56 (2000) Neonatal 97 Malaria (Minimum target is 5% and maximum target is 15%) ---, ---, --- *Postnatal care 120 12% 22% Neonatal period Total under-five deaths (000) 71 (2006) Preterm 25% Sepsis/Infections, Early initiation of breastfeeding (within 1 hr of birth, %) 33 (2005) including AIDS Exclusive MDG Target breastfeeding 8 Infancy Maternal mortality ratio (per 100,000 live births) 2,100 (2005) 60 16% Other Postnatal visit for baby (within 2 days for home births, %) --- Measles Lifetime risk of maternal death (1 in N) 8 (2005) 13% Infection 35% 67 0 Diarrhoea Other causes 5,400 (2005) 20% 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy 100 100 100 Stunting prevalence (moderate and severe, %) 45 (2005) Complementary feeding rate (6-9 months, %) 52 (2005) 85 81 Wasting prevalence (moderate and severe, %) 10 (2005) Low birthweight incidence (%) 24 (2005) 80 80 80 68 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses 42 43 Percent Percent Percent 40 40 40 At least one dose Two doses 95 95 100 100 100 20 20 20 91 87 81 84 77 95 80 80 80 93 0 0 0 84 73 77 2000 2005 2000 2005 1980 1985 1990 1995 2000 2006 MICS MICS MICS MICS 60 60 60 Source: WHO/UNICEF Percent 40 Percent 40 Percent 40 25 25 20 20 20 8 WATER AND SANITATION EQUITY 4 20 0 0 0 0 2000 2005 2000 2005 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile MICS MICS MICS MICS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 100 CHILD HEALTH 80 75 80 80 57 Immunization Malaria prevention Prevention of mother to child 60 60 53 60 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs 46

transmission of HIV Percent Percent 39 Percent Percent of children immunised with 3 doses DPT 40 40 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 30 20 20 20 100 100 15 0 0 0 80 80 2004 2004 Poorest 2nd 3rd 4th Wealthiest 67 12 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 60 9 8 64 2000 2005 MICS MICS

Percent Percent Percent 2 40 40 6 POLICIES SYSTEMS 20 20 3 1 Coverage gap (%) 53 49 2 5 0.5 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 0 Substitutes No Ratio 1999 2001 2003 2005 2006 2000 2005 2004 2005 2006 Per capita total expenditure on health (US$) 34 (2007) poorest/wealthiest 1.4 Source: WHO/UNICEF MICS MICS Other NS Other NS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Partial % of total government expenditure (%) 8 (2007) poorest-wealthiest (%) 17 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics Yes Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 41 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 0.5 (2004) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available Partial Official Development Assistance to child health 80 80 80 per child (US$) 5 (2005) Midwives be authorised to administer a core set of 61 life saving interventions Partial Official Development Assistance to maternal and 60 60 52 60 50 48 neonatal health per live birth (US$) 6 (2005) Sierra Leone

Percent 39 Percent Percent 40 40 40 Maternity protection in accordance with ILO 31 Convention 183 No National availability of Emergency Obstetric Care 21 20 20 20 services (% of recommended minimum) --- Specific notification of maternal deaths Partial 0 0 0 2000 2005 2000 2005 2000 2005 Countdown to 2015 MICS MICS MICS MICS MICS MICS 2008 Report Somalia DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 8,445 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 1,507 (2006) undernutrition Unmet need for family planning (%) --- Births (000) 371 (2006) 203 HIV/AIDS Causes of neonatal Obstructed labor Abortion Contraceptive 200 1% Pneumonia deaths 4% prevalence rate 15 Pre-pregnancy Birth registration (%) 3 (2006) Injuries 24% Diarrhoea 4% Antenatal visits for woman (4 or more visits, %) --- Anaemia 4% 3% Other 7% 4% Antenatal visit 26 Pregnancy Under-five mortality rate (per 1000 live births) 145 (2006) 160 Malaria Tetanus 8% Intermittent preventive treatment for malaria (%) 1 (2006) (1 or more) Hypertensive 145 5% Congenital 8% Skilled attendant Infant mortality rate (per 1000 live births) 90 (2006) disorders Haemorrhage 33 Birth 120 C-section rate (total, urban, rural; %) at birth Measles Preterm 22% 9% 34% Neonatal mortality rate (per 1000 live births) 49 (2000) 7% Neonatal (Minimum target is 5% and maximum target is 15%) ---, ---, --- *Postnatal care Neonatal period 80 68 23% Total under-five deaths (000) 54 (2006) Sepsis/Infections, Asphyxia 25% Early initiation of breastfeeding (within 1 hr of birth, %) 26 (2006) including AIDS Exclusive MDG Target breastfeeding 9 Infancy Maternal mortality ratio (per 100,000 live births) 1,400 (2005) 40 16% Diarrhoea Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 12 (2005) 19% Measles 35 0 Other Infection 26% Other causes 5,200 (2005) 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 20% 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 42 (2006) Complementary feeding rate (6-9 months, %) 15 (2006) 100 100 100 Wasting prevalence (moderate and severe, %) 13 (2006) Low birthweight incidence (%) 11 (2006) 80 80 80 74 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent Percent Percent 40 32 40 34 33 40 At least one dose Two doses 26 25 100 100 100 100 20 20 20

80 80 80 0 0 63 62 60 1999 2006 1999 2002 2006 1981 1986 1991 1996 2001 2006 MICS MICS MICS Other NS MICS 60 60 60 Source: WHO/UNICEF Percent Percent Percent 56 40 40 40 50 32 45 23 20 16 20 20 9 9 6 WATER AND SANITATION EQUITY 0 0 15 0 0 0 1997 1999 2006 1999 2006 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile MICS MICS MICS MICS MICS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 CHILD HEALTH 80 80

Immunization Malaria prevention Prevention of mother to child 60 60 48 No data Percent of children immunised against measles Percent children < 5 years sleeping under ITNs Percent of children immunised with 3 doses DPT transmission of HIV Percent Percent Percent HIV+ pregnant women receiving ARVs for PMTCT 40 32 40 Percent of children immunised with 3 doses Hib 27 29 26 20 20 14 100 100 5 0 0 80 80 4 2004 2004 Source: WHO/UNICEF JMP, 2006 60 60 3

Percent 40 35 Percent 40 Percent 2 POLICIES SYSTEMS 35 20 20 1 9 0.6 Coverage gap (%) International Code of Marketing of Breastmilk Financial Flows and Human Resources No data 0 0 0 Substitutes No Ratio 1990 1995 2000 2005 2006 2006 2006 Per capita total expenditure on health (US$) --- poorest/wealthiest Source: WHO/UNICEF MICS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea --- % of total government expenditure (%) --- poorest-wealthiest (%) Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics --- Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) --- Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age No antibiotics Density of health workers (per 1000 population) 0.2 (1997) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available No Official Development Assistance to child health 80 80 80 per child (US$) 4 (2005) Midwives be authorised to administer a core set of 60 60 60 life saving interventions --- Official Development Assistance to maternal and neonatal health per live birth (US$) 4 (2005) Somalia

Percent Percent Percent Maternity protection in accordance with ILO 40 40 40 32 Convention 183 No National availability of Emergency Obstetric Care 20 20 20 services (% of recommended minimum) 56 (2005) 7 8 13 Specific notification of maternal deaths --- 0 0 0 2006 2006 2006 Countdown to 2015 MICS MICS MICS 2008 Report South Africa DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 48,282 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 5,254 (2006) undernutrition Unmet need for family planning (%) --- Births (000) 1,102 (2006) Causes of neonatal Obstructed labor Abortion Contraceptive 100 deaths 4% prevalence rate 60 Pre-pregnancy Birth registration (%) --- Diarrhoea 1% Antenatal visits for woman (4 or more visits, %) 73 (1998) Anaemia 4% Tetanus 1% 4% Antenatal visit Other 6% 92 Pregnancy Under-five mortality rate (per 1000 live births) 69 (2006) 80 69 Congenital 10% Intermittent preventive treatment for malaria (%) --- (1 or more) 60 HIV/AIDS Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 56 (2006) Infection 19% disorders Haemorrhage 92 Birth 60 57% C-section rate (total, urban, rural; %) at birth 9% 34% Neonatal mortality rate (per 1000 live births) 21 (2000) Neonatal (Minimum target is 5% and maximum target is 15%) 16,19,12 (1998) 40 35% Asphyxia 23% *Postnatal care Neonatal period Total under-five deaths (000) 76 (2006) Sepsis/Infections, 20 Early initiation of breastfeeding (within 1 hr of birth, %) 45 (1998) including AIDS Exclusive breastfeeding 7 Infancy Maternal mortality ratio (per 100,000 live births) 400 (2005) 20 16% MDG Target Malaria (within 2 days for home births, %) Preterm 39% Postnatal visit for baby --- Measles 85 Lifetime risk of maternal death (1 in N) 110 (2005) 0% Injuries 0 Other Other causes 4,300 (2005) Measles 5% 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 1% 0 20 40 60 80 100 0% Diarrhoea Pneumonia Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 1% 1% for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy 100 94 100 100 Stunting prevalence (moderate and severe, %) 31 (1999) Complementary feeding rate (6-9 months, %) 46 (2003) 89 92 84 92 82 Wasting prevalence (moderate and severe, %) 4 (1999) Low birthweight incidence (%) 15 (1998) 80 80 80 73 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent Percent Percent 40 40 40 At least one dose Two doses 100 100 100 20 20 20

80 80 80 0 0 1994-1995 1998 2003 1995 1998 2003 1992 1997 2002 2006 Other NS DHS DHS Other NS DHS DHS 60 60 60 Source: WHO/UNICEF Percent Percent Percent 37 33 40 40 40 29 20 20 20 WATER AND SANITATION EQUITY 8 10 7 0 0 0 0 0 0 0 0 0 1994 1999 2003 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile Other NS Other NS DHS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 99 100 100 98 88 85 CHILD HEALTH 83 79 80 73 80 80 69 69 65 Immunization Malaria prevention Prevention of mother to child 60 60 53 60 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs* 46

transmission of HIV Percent Percent Percent Percent of children immunised with 3 doses DPT 40 40 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 20 20 20 99 100 100 99 0 0 0 80 85 80 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 60 50 1998 No data DHS Percent Percent 40 40 34 POLICIES SYSTEMS 20 20 15 Coverage gap (%) 23 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 Substitutes Partial Ratio 1990 1995 2000 2005 2006 2004 2005 2006 Per capita total expenditure on health (US$) 748 (2007) poorest/wealthiest 1.9 Source: WHO/UNICEF Other NS Other NS Other NS New ORS formula and zinc for management of *Sub-national risk of malaria transmission General government expenditure on health as Difference diarrhoea Yes % of total government expenditure (%) 11 (2007) poorest-wealthiest (%) 15 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials* Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics No Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 10 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age --- antibiotics Density of health workers (per 1000 population) 4.9 (2004) 100 100 Costed implementation plan(s) for maternal, newborn and child health available --- Official Development Assistance to child health 80 80 75 per child (US$) 4 (2005) Midwives be authorised to administer a core set of 60 60 life saving interventions --- Official Development Assistance to maternal and No data neonatal health per live birth (US$) 6 (2005) South Africa Percent 40 37 Percent 40 Maternity protection in accordance with ILO Convention 183 No National availability of Emergency Obstetric Care 20 20 services (% of recommended minimum) --- Specific notification of maternal deaths --- 0 0 1998 1998 Countdown to 2015 DHS DHS *Sub-national risk of malaria transmission 2008 Report Sudan DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 37,707 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 5,483 (2006) undernutrition Unmet need for family planning (%) 26 (1992-1993) Births (000) 1,225 (2006) Measles Injuries Causes of neonatal Obstructed labor 5% deaths Abortion Contraceptive 150 5% HIV/AIDS 4% prevalence rate 7 Pre-pregnancy Birth registration (%) 64 (2006) Other Diarrhoea 1% Antenatal visits for woman (4 or more visits, %) --- Anaemia 4% 120 6% 3% Tetanus 3% 4% Antenatal visit Other 5% 60 Pregnancy Under-five mortality rate (per 1000 live births) 89 (2006) 120 Congenital 8% Intermittent preventive treatment for malaria (%) --- (1 or more) Diarrhoea Hypertensive 89 13% Infection 14% Skilled attendant Infant mortality rate (per 1000 live births) 61 (2006) disorders Haemorrhage 87 Birth 90 C-section rate (total, urban, rural; %) at birth 9% 34% Neonatal mortality rate (per 1000 live births) 29 (2000) Neonatal Asphyxia 19% (Minimum target is 5% and maximum target is 15%) 20,19,24 (1992-1993) 60 HIV/AIDS 31% *Postnatal care Neonatal period Total under-five deaths (000) 109 (2006) 40 57% Sepsis/Infections, Early initiation of breastfeeding (within 1 hr of birth, %) --- including AIDS Exclusive breastfeeding 16 Infancy Maternal mortality ratio (per 100,000 live births) 450 (2005) 30 Pneumonia 16% Preterm 50% MDG Target 16% Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 53 (2005) Measles 73 0 Malaria Other causes 5,300 (2005) 21% 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 48 (2000) Complementary feeding rate (6-9 months, %) 47 (2000) 100 100 100 86 87 Wasting prevalence (moderate and severe, %) 18 (2000) Low birthweight incidence (%) 31 (1999) 80 75 80 80 70 72 60 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent Percent Percent 40 40 40 At least one dose Two doses 100 100 100 92 93 90 20 20 20 99 79 93 90 80 80 80 88 70 0 0 1989-1990 1992-1993 2000 1988-1993 2000 1981 1986 1991 1996 2001 2006 DHS Other NS MICS Other NS MICS 60 60 60 Source: WHO/UNICEF 34 Percent 38 Percent Percent 40 31 40 40 20 17 20 13 16 20 31 WATER AND SANITATION EQUITY 15 0 0 0 0 0 1986 1992 2000 1990 2000 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile Other NS Other NS MICS DHS MICS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 85 CHILD HEALTH 78 80 70 80 64 64 60 57 60 Immunization Malaria prevention Prevention of mother to child 53 50 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs No data Percent of children immunised with 3 doses DPT transmission of HIV Percent Percent 34 Percent HIV+ pregnant women receiving ARVs for PMTCT 40 40 33 Percent of children immunised with 3 doses Hib 26 24 20 20 100 100 0 0 80 78 80 1990 2004 1990 2004 73 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 60 No data Percent 40 Percent 40 POLICIES SYSTEMS 20 20 Coverage gap (%) No data 0.4 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 Substitutes Partial Ratio 1990 1995 2000 2005 2006 2000 Per capita total expenditure on health (US$) 54 (2007) poorest/wealthiest Source: WHO/UNICEF MICS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Yes % of total government expenditure (%) 7 (2007) poorest-wealthiest (%) Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics Yes Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 63 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age No antibiotics Density of health workers (per 1000 population) 1.1 (2004) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available Yes Official Development Assistance to child health 80 80 80 per child (US$) 9 (2005) Midwives be authorised to administer a core set of 60 60 60 57 life saving interventions --- Official Development Assistance to maternal and 50 neonatal health per live birth (US$) 15 (2005) Sudan Percent 40 38 Percent 40 Percent 40 Maternity protection in accordance with ILO Convention 183 No National availability of Emergency Obstetric Care 20 20 20 services (% of recommended minimum) 35 (2005) Specific notification of maternal deaths --- 0 0 0 2000 2000 2000 Countdown to 2015 MICS MICS MICS 2008 Report Swaziland DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 1,134 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 147 (2006) undernutrition Unmet need for family planning (%) --- Causes of neonatal Births (000) 33 (2006) Obstructed labor Contraceptive deaths Abortion 48 Pre-pregnancy 200 Tetanus 2% (4 or more visits, %) 4% prevalence rate Birth registration (%) 53 (2006) 164 HIV/AIDS Antenatal visits for woman --- Anaemia 4% 47% Diarrhoea 3% 4% Antenatal visit Other 7% 90 Pregnancy Under-five mortality rate (per 1000 live births) 164 (2006) 160 Congenital 8% Intermittent preventive treatment for malaria (%) --- (1 or more) Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 112 (2006) 110 disorders Haemorrhage 74 Birth 120 Infection 23% C-section rate (total, urban, rural; %) at birth 9% 34% Neonatal mortality rate (per 1000 live births) 38 (2000) Neonatal (Minimum target is 5% and maximum target is 15%) ---,---,--- 80 Measles HIV/AIDS 27% *Postnatal care Neonatal period Total under-five deaths (000) 5 (2006) 0% 57% Asphyxia 25% Sepsis/Infections, 37 Early initiation of breastfeeding (within 1 hr of birth, %) --- including AIDS Exclusive Malaria breastfeeding 24 Infancy Maternal mortality ratio (per 100,000 live births) 390 (2005) 40 0% 16% MDG Target Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 120 (2005) Other Preterm 32% Measles 57 0 1% Pneumonia Other causes Total maternal deaths 120 (2005) Injuries Diarrhoea 12% 30% 1990 1995 2000 2005 2010 2015 4% 10% 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 37 (2000) Complementary feeding rate (6-9 months, %) 60 (2000) 100 100 100 87 90 Wasting prevalence (moderate and severe, %) 2 (2000) Low birthweight incidence (%) 9 (2000) 74 86 80 80 70 80 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 56 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent Percent 40 Percent 40 40 At least one dose Two doses 100 100 100 20 20 20 86 80 80 80 80 0 0 68 59 2000 2002 1994 2000 2002 1989 1994 1999 2004 2006 MICS Other NS Other NS MICS Other NS 60 60 60 Source: WHO/UNICEF

Percent 40 Percent 40 Percent 40 40 24 20 20 20 9 9 WATER AND SANITATION EQUITY 0 0 0 0 0 0 0 0 0 1983 2000 2000 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile Other NS MICS MICS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 CHILD HEALTH 87 80 80 62 Immunization Malaria prevention Prevention of mother to child 60 54 60 59 48 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs* 44 No data

transmission of HIV Percent Percent Percent of children immunised with 3 doses DPT 40 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 20 20 100 100 100 0 0 80 80 80 2004 2004 68 62 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 60 60 2000 57 50 MICS Percent 40 Percent 40 Percent 40 36 POLICIES SYSTEMS 20 20 20 Coverage gap (%) 35 0.1 5 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 0 Substitutes Partial Ratio 1990 1995 2000 2005 2006 2000 2004 2005 2006 Per capita total expenditure on health (US$) 367 (2007) poorest/wealthiest Source: WHO/UNICEF MICS Other NS Other NS Other NS New ORS formula and zinc for management of *Sub-national risk of malaria transmission General government expenditure on health as Difference diarrhoea --- % of total government expenditure (%) 11 (2007) poorest-wealthiest (%) Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials* Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics No Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 15 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age No antibiotics Density of health workers (per 1000 population) 6.5 (2004) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available No Official Development Assistance to child health 80 80 80 per child (US$) 15 (2005) Midwives be authorised to administer a core set of 60 60 60 60 life saving interventions Yes Official Development Assistance to maternal and neonatal health per live birth (US$) 1 (2005) Swaziland Percent 40 Percent 40 Percent 40 Maternity protection in accordance with ILO 24 26 Convention 183 No National availability of Emergency Obstetric Care 20 20 20 services (% of recommended minimum) --- Specific notification of maternal deaths Yes 0 0 0 2000 2000 2000 Countdown to 2015 MICS MICS MICS *Sub-national risk of malaria transmission 2008 Report Tajikistan DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 6,640 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Asia, 1997-2002 Total under-five population (000) 858 (2006) undernutrition Unmet need for family planning (%) --- Births (000) 185 (2006) Causes of neonatal Abortion Other 6% Contraceptive 150 deaths prevalence rate 38 Pre-pregnancy Birth registration (%) 88 (2006) 30% Diarrhoea 2% Antenatal visits for woman (4 or more visits, %) --- Obstructed labor HIV/AIDS Other 6% 9% Antenatal visit 115 77 Pregnancy Under-five mortality rate (per 1000 live births) 68 (2006) 120 0% Congenital 11% Intermittent preventive treatment for malaria (%) --- (1 or more) Hypertensive Measles Haemorrhage Skilled attendant Infant mortality rate (per 1000 live births) 56 (2006) 0% disorders 83 Birth 90 Infection 20% (total, urban, ; %) 31% at birth 68 C-section rate rural 9% (per 1000 live births) 38 (2000) Malaria Neonatal mortality rate 1% Neonatal (Minimum target is 5% and maximum target is 15%) ---, ---, --- 60 30% *Postnatal care Neonatal period Total under-five deaths (000) 13 (2006) 38 Asphyxia 23% Sepsis/Infections, Injuries Exclusive 3% Early initiation of breastfeeding (within 1 hr of birth, %) 61 (2005) including AIDS 25 Infancy Maternal mortality ratio (per 100,000 live births) 170 (2005) 30 12% breastfeeding MDG Target Diarrhoea Postnatal visit for baby (within 2 days for home births, %) --- Other causes Lifetime risk of maternal death (1 in N) 160 (2005) 16% Preterm 34% Anaemia Measles 87 0 Pneumonia 21% 320 (2005) 13% Total maternal deaths 1990 1995 2000 2005 2010 2015 20% 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 33 (2005) Complementary feeding rate (6-9 months, %) 15 (2005) 100 100 83 Wasting prevalence (moderate and severe, %) 9 (2005) Low birthweight incidence (%) 10 (2005) 77 79 80 71 80 71 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent 40 Percent 40 No data At least one dose Two doses 98 98 100 100 100 20 20 96 98 80 80 80 0 0 2000 2005 1996 2000 2005 60 60 60 MICS MICS Other NS MICS MICS

Percent 40 Percent 40 Percent 40 25 20 14 20 14 20 WATER AND SANITATION EQUITY 0 0 0 0 0 0 0 0 2005 2000 2005 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile MICS MICS MICS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 92 100 100 CHILD HEALTH 80 80 70 80 59 Immunization Malaria prevention Prevention of mother to child 60 60 60 48 51 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs* 45

transmission of HIV Percent Percent Percent Percent of children immunised with 3 doses DPT 40 40 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 20 20 20 100 100 87 0 0 0 2004 2004 Poorest 2nd 3rd 4th Wealthiest 80 86 80 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 60 2000 2005 No data MICS MICS Percent 40 Percent 40 POLICIES SYSTEMS 20 20 Coverage gap (%) 37 31 1 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 Substitutes No Ratio 1992 1997 2002 2006 2005 Per capita total expenditure on health (US$) 54 (2007) poorest/wealthiest 1.4 1.4 Source: WHO/UNICEF MICS New ORS formula and zinc for management of *Sub-national risk of malaria transmission General government expenditure on health as Difference diarrhoea Yes % of total government expenditure (%) 5 (2007) poorest-wealthiest (%) 12 10 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials* Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics No Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 76 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 7.2 (2003) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available Yes Official Development Assistance to child health 80 80 80 per child (US$) 5 (2005) 64 Midwives be authorised to administer a core set of life saving interventions Yes Official Development Assistance to maternal and 60 60 60 51 neonatal health per live birth (US$) 5 (2005) 41 Tajikistan Percent 40 Percent 40 Percent 40 Maternity protection in accordance with ILO 29 Convention 183 National availability of Emergency Obstetric Care 22 Partial 20 20 20 services (% of recommended minimum) 86 (2005) 2 Specific notification of maternal deaths Yes 0 0 0 2000 2005 2005 2000 2005 Countdown to 2015 MICS MICS MICS MICS MICS *Sub-national risk of malaria transmission 2008 Report Tanzania, United Republic of DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 39,459 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 6,953 (2006) undernutrition Unmet need for family planning (%) 22 (2004-2005) Causes of neonatal Births (000) 1,589 (2006) HIV/AIDS Injuries Obstructed labor Contraceptive 200 9% 2% Measles deaths Abortion 26 Pre-pregnancy Diarrhoea 2% Antenatal visits for woman (4 or more visits, %) 62 (2004-2005) Anaemia 4% prevalence rate Birth registration (%) 8 (2006) 161 Diarrhoea 1% 4% Tetanus 2% 4% Antenatal visit 17% Other 78 Pregnancy Under-five mortality rate (per 1000 live births) 118 (2006) 160 0% Congenital 7% Intermittent preventive treatment for malaria (%) 22 (2004-2005) (1 or more) 118 Other 7% Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 74 (2006) disorders Haemorrhage 43 Birth 120 Asphyxia 26% C-section rate (total, urban, rural; %) at birth 9% 34% Neonatal mortality rate (per 1000 live births) 43 (2000) Neonatal (Minimum target is 5% and maximum target is 15%) 3,8,2 (2004-2005) 80 27% *Postnatal care Neonatal period Total under-five deaths (000) 188 (2006) 54 Sepsis/Infections, Preterm 27% Early initiation of breastfeeding (within 1 hr of birth, %) 67 (2004-2005) including AIDS Exclusive breastfeeding 41 Infancy Maternal mortality ratio (per 100,000 live births) 950 (2005) 40 Pneumonia 16% MDG Target 21% Postnatal visit for baby (within 2 days for home births, %) --- Measles 93 Lifetime risk of maternal death (1 in N) 24 (2005) Infection 29% 0 Malaria Other causes 13,000 (2005) 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 23% 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 44 (2004-2005) Complementary feeding rate (6-9 months, %) 91 (2004-2005) 100 100 100 87 Wasting prevalence (moderate and severe, %) 4 (2004-2005) Low birthweight incidence (%) 10 (2004-2005) 80 78 80 80 62 60 60 60 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 50 49 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses 44 43 Percent Percent 40 Percent 40 38 36 40 At least one dose Two doses 94 94 95 100 100 100 93 91 20 20 20 91 93 95 80 80 80 90 0 0 81 55 1991-1992 1996 1999 2004-2005 1991-1992 1996 1999 2004-2005 1980 1985 1990 1995 2000 2006 60 60 60 DHS DHS DHS DHS DHS DHS Other NS DHS 45 Source: WHO/UNICEF 41 Percent Percent Percent 40 40 32 40 27 29 25 23 20 17 20 20 WATER AND SANITATION EQUITY 21 22 0 0 0 1991-1992 1996 2004-2005 1991-1992 1996 1999 2004-2005 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile DHS DHS DHS DHS DHS DHS DHS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 100 CHILD HEALTH 85 85 80 80 80 62 Immunization Malaria prevention Prevention of mother to child 60 60 53 60 49 52 47 47 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs 46 45 43

transmission of HIV Percent Percent Percent Percent of children immunised with 3 doses DPT 40 35 40 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 20 20 20 100 93 100 20 0 0 0 80 90 80 16 15 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 60 12 1996 1999 2004 DHS DHS DHS Percent Percent Percent 40 40 8 6 POLICIES SYSTEMS 20 20 16 4 2 Coverage gap (%) 35 36 33 2 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 0 Substitutes Yes Ratio 1990 1995 2000 2005 2006 1999 2004-2005 2004 2005 2006 Per capita total expenditure on health (US$) 29 (2007) poorest/wealthiest 2.0 2.3 Source: WHO/UNICEF DHS DHS Other NS Other NS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Yes % of total government expenditure (%) 9 (2007) poorest-wealthiest (%) 23 25 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics No Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 49 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 0.4 (2002) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available Yes Official Development Assistance to child health per child (US$) 16 (2005) 80 80 80 70 65 68 Midwives be authorised to administer a core set of 58 59 life saving interventions Yes Official Development Assistance to maternal and 60 54 53 60 53 60 neonatal health per live birth (US$) 15 (2005) Tanzania, United Republic of Percent 40 38 Percent 40 Percent 40 Maternity protection in accordance with ILO National availability of Emergency Obstetric Care 22 Convention 183 No 20 20 20 services (% of recommended minimum) 21 (2005) Specific notification of maternal deaths Yes 0 0 0 1996 1999 2004-2005 1999 2004-2005 1991-1992 1996 1999 2004-2005 Countdown to 2015 DHS DHS DHS DHS DHS DHS DHS DHS DHS 2008 Report Togo DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 6,410 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 1,045 (2006) undernutrition HIV/AIDS Injuries Unmet need for family planning (%) 32 (1998) Births (000) 242 (2006) 149 Measles Causes of neonatal Obstructed labor 6% 3% Abortion Contraceptive 150 7% deaths 4% prevalence rate 17 Pre-pregnancy Birth registration (%) 78 (2006) Other Diarrhoea 2% Antenatal visits for woman (4 or more visits, %) 46 (1998) Anaemia 4% Diarrhoea Tetanus 4% 4% Antenatal visit 0% Other 6% 84 Pregnancy Under-five mortality rate (per 1000 live births) 108 (2006) 120 14% Intermittent preventive treatment for malaria (%) 18 (2006) (1 or more) 108 Congenital 6% Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 69 (2006) disorders Haemorrhage 62 Birth 90 C-section rate (total, urban, rural; %) at birth Asphyxia 21% 9% 34% Neonatal mortality rate (per 1000 live births) 40 (2000) Neonatal (Minimum target is 5% and maximum target is 15%) 2, 5, 1 (1998) 60 50 29% *Postnatal care Neonatal period Total under-five deaths (000) 26 (2006) Preterm 30% Sepsis/Infections, Early initiation of breastfeeding (within 1 hr of birth, %) 36 (2006) including AIDS Exclusive MDG Target breastfeeding 28 Infancy Maternal mortality ratio (per 100,000 live births) 510 (2005) 30 Pneumonia 16% 17% Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 38 (2005) Measles 83 Infection 30% Other causes 0 Malaria 1,200 (2005) 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 25% 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 28 (2006) Complementary feeding rate (6-9 months, %) 35 (2006) 100 100 100 84 82 85 84 Wasting prevalence (moderate and severe, %) 16 (2006) Low birthweight incidence (%) 12 (2006) 80 73 80 80 61 62 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 51 49 60 Percent children < 3 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses 43 Percent Percent Percent 40 40 40 At least one dose Two doses 100 100 100 95 95 95 20 20 20 100 100 84 77 94 92 80 80 80 0 0 1998 2003 72 1988 2000 2006 1998 2000 2003 2006 1988 1993 1998 2003 2006 DHS DHS MICS Other NS MICS DHS MICS Other NS MICS 60 60 60 Source: WHO/UNICEF Percent 40 Percent 40 Percent 40 28 21 23 22 20 20 18 20 10 7 WATER AND SANITATION EQUITY 0 0 18 0 0 0 1988 1998 2006 1998 2000 2006 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile DHS MICS MICS DHS DHS MICS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 100 CHILD HEALTH 81 80 80 80 71 71 80

Immunization Malaria prevention Prevention of mother to child 60 50 52 60 60 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs Percent of children immunised with 3 doses DPT transmission of HIV Percent 37 36 Percent 37 35 Percent Percent HIV+ pregnant women receiving ARVs for PMTCT 40 40 40 Percent of children immunised with 3 doses Hib 24 20 20 15 20 100 100 15 87 0 0 0 12 80 80 12 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest 83 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 9 60 60 9 1998 2000 2006 DHS MICS MICS

Percent Percent 38 Percent 2 2 40 40 6 POLICIES SYSTEMS 20 20 3 2 Coverage gap (%) 54 53 49 2 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 0 Substitutes Partial Ratio 1990 1995 2000 2005 2006 2000 2006 2004 2005 2006 Per capita total expenditure on health (US$) 63 (2007) poorest/wealthiest 1.7 1.8 1.6 Source: WHO/UNICEF MICS MICS Other NS Other NS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Yes % of total government expenditure (%) 7 (2007) poorest-wealthiest (%) 27 28 22 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics Partial Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 67 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age No antibiotics Density of health workers (per 1000 population) 0.4 (2004) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available Partial Official Development Assistance to child health 80 80 80 per child (US$) 6 (2005) Midwives be authorised to administer a core set of 60 60 60 60 life saving interventions Partial Official Development Assistance to maternal and 48 neonatal health per live birth (US$) 5 (2005) Togo Percent 40 Percent 40 Percent 40 Maternity protection in accordance with ILO 30 National availability of Emergency Obstetric Care 25 25 22 26 23 26 Convention 183 No 20 20 20 services (% of recommended minimum) --- Specific notification of maternal deaths Yes 0 0 0 1998 2000 2006 2000 2006 1998 2000 2006 Countdown to 2015 DHS MICS MICS MICS MICS DHS MICS MICS 2008 Report Turkmenistan DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 4,899 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Asia, 1997-2002 Total under-five population (000) 491 (2006) undernutrition Unmet need for family planning (%) 10 (2000) Births (000) 108 (2006) Injuries Malaria HIV/AIDS Causes of neonatal Abortion 99 1% 0% 6% Contraceptive 100 5% deaths prevalence rate 48 Pre-pregnancy Birth registration (%) 96 (2006) Measles Diarrhoea 2% Antenatal visits for woman (4 or more visits, %) 83 (2000) Obstructed labor Diarrhoea Other 6% 9% Antenatal visit 0% 99 Pregnancy Under-five mortality rate (per 1000 live births) 51 (2006) 80 16% Congenital 11% Intermittent preventive treatment for malaria (%) --- (1 or more) Hypertensive Haemorrhage Skilled attendant Infant mortality rate (per 1000 live births) 45 (2006) Infection 20% disorders 100 Birth 60 51 (total, urban, ; %) 31% at birth C-section rate rural 9% Neonatal mortality rate (per 1000 live births) 35 (2000) Neonatal (Minimum target is 5% and maximum target is 15%) 3, 4, (2000) 2 *Postnatal care Neonatal period 40 33 38% Asphyxia 22% Total under-five deaths (000) 6 (2006) Sepsis/Infections, Early initiation of breastfeeding (within 1 hr of birth, %) 60 (2006) including AIDS Exclusive breastfeeding 11 Infancy Maternal mortality ratio (per 100,000 live births) 130 (2005) 20 MDG Target Pneumonia 12% 19% Postnatal visit for baby (within 2 days for home births, %) --- Other causes Lifetime risk of maternal death (1 in N) 290 (2005) Preterm 35% Anaemia Measles 99 21% 0 Other 140 (2005) 13% Total maternal deaths 1990 1995 2000 2005 2010 2015 22% 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy 98 99 96 97 100 Stunting prevalence (moderate and severe, %) 19 (2006) Complementary feeding rate (6-9 months, %) 54 (2006) 100 100 Wasting prevalence (moderate and severe, %) 7 (2006) Low birthweight incidence (%) 4 (2006) 80 80 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses No data Percent Percent 40 40 At least one dose Two doses 100 100 100 20 20

80 80 80 0 0 2000 2006 1996 2000 2006 60 60 60 DHS MICS Other NS DHS MICS Percent 40 Percent 40 Percent 40

20 20 20 11 8 13 11 WATER AND SANITATION EQUITY 0 0 0 0 0 0 0 0 0 0 2000 2006 2000 2006 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile DHS MICS DHS MICS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 93 100 100 CHILD HEALTH 77 80 72 80 80 62 Immunization Malaria prevention Prevention of mother to child 60 54 60 50 60 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs*

transmission of HIV Percent Percent Percent Percent of children immunised with 3 doses DPT 40 40 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 99 20 20 20 100 98 0 0 0 80 2004 2004 Poorest 2nd 3rd 4th Wealthiest Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 2006 No data No data MICS Percent 40 POLICIES SYSTEMS 20 Coverage gap (%) 16 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 Substitutes --- Ratio 1992 1997 2002 2006 Per capita total expenditure on health (US$) 245 (2007) poorest/wealthiest 0.9 Source: WHO/UNICEF New ORS formula and zinc for management of *Very limited risk of malaria transmission General government expenditure on health as Difference diarrhoea Partial % of total government expenditure (%) 15 (2007) poorest-wealthiest (%) -2 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials* Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics Yes Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 31 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age No antibiotics Density of health workers (per 1000 population) 13.2 (2002) 100 100 Costed implementation plan(s) for maternal, newborn and child health available Yes 83 Official Development Assistance to child health 80 80 per child (US$) 2 (2005) Midwives be authorised to administer a core set of life saving interventions Yes Official Development Assistance to maternal and 60 60 51 50 neonatal health per live birth (US$) 1 (2005) Turkmenistan Percent 40 No data Percent 40 Maternity protection in accordance with ILO National availability of Emergency Obstetric Care 21 25 Convention 183 No 20 20 services (% of recommended minimum) --- Specific notification of maternal deaths No 0 0 2000 2006 2000 2006 Countdown to 2015 DHS MICS DHS MICS *Very limited risk of malaria transmission 2008 Report Uganda DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 29,899 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 5,840 (2006) undernutrition Unmet need for family planning (%) 41 (2006) Births (000) 1,406 (2006) 160 HIV/AIDS Measles Injuries Causes of neonatal Obstructed labor 3% 2% Abortion Contraceptive 150 8% deaths 4% prevalence rate 24 Pre-pregnancy Birth registration (%) 4 (2006) 134 Other Diarrhoea 2% Antenatal visits for woman (4 or more visits, %) 42 (2000-2001) Anaemia 4% Diarrhoea Tetanus 2% 4% Antenatal visit 2% Congenital 7% 94 Pregnancy Under-five mortality rate (per 1000 live births) 134 (2006) 120 17% Intermittent preventive treatment for malaria (%) 17 (2006) (1 or more) Other 7% Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 78 (2006) disorders Haemorrhage 42 Birth 90 Preterm 25% C-section rate (total, urban, rural; %) at birth 9% 34% Neonatal mortality rate (per 1000 live births) 32 (2000) Neonatal 53 (Minimum target is 5% and maximum target is 15%) 3,9,2 (2006) 23 60 24% *Postnatal care Neonatal period Total under-five deaths (000) 188 (2006) Asphyxia 26% Sepsis/Infections, Early initiation of breastfeeding (within 1 hr of birth, %) 32 (2000) including AIDS Exclusive MDG Target breastfeeding 60 Infancy Maternal mortality ratio (per 100,000 live births) 550 (2005) 30 Pneumonia 16% 21% Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 25 (2005) Measles 89 Infection 31% Other causes 0 Malaria 8,100 (2005) 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 23% 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy (moderate and severe, %) (2006) (6-9 months, %) (2006) 100 100 100 Stunting prevalence 38 Complementary feeding rate 80 87 88 92 94 Wasting prevalence (moderate and severe, %) 6 (2006) Low birthweight incidence (%) 12 (2000-2001) 80 91 80 80 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses 42 Percent Percent Percent 39 40 40 38 38 40 At least one dose Two doses 100 100 100 20 20 20 79 78 80 80 80 68 0 0 0 63 1988-1989 1995 2000-2001 2006 1988-1989 1995 2000-2001 2006 57 60 78 1981 1986 1991 1996 2001 2006 60 60 60 DHS DHS DHS DHS DHS DHS DHS DHS 46 Source: WHO/UNICEF 42 55 Percent Percent Percent 37 40 40 40 20 19 16 20 20 20 31 WATER AND SANITATION EQUITY 0 0 0 0 0 0 0 1988-1989 2000-2001 2006 1995 2000-2001 2006 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile DHS DHS DHS DHS DHS DHS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 100 87 CHILD HEALTH 80 80 80 80 60 Immunization Malaria prevention Prevention of mother to child 60 56 60 54 54 60 Percent of children immunised against measles 44 Percent children < 5 years sleeping under ITNs 40 41 42 41 43 transmission of HIV Percent Percent Percent Percent of children immunised with 3 doses DPT 40 40 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 20 20 20 100 89 100 30 25 0 0 0 80 80 80 24 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest 80 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 18 60 60 15 1995 2001 2006 DHS DHS DHS

Percent Percent Percent 2 2 40 40 12 9 POLICIES SYSTEMS 20 20 6 2 10 Coverage gap (%) 48 46 43 0.2 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 0 Substitutes Yes Ratio 1990 1995 2000 2005 2006 2000-2001 2006 2004 2005 2006 Per capita total expenditure on health (US$) 135 (2007) poorest/wealthiest 1.8 1.9 1.6 Source: WHO/UNICEF DHS DHS Other NS Other NS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Yes % of total government expenditure (%) 10 (2007) poorest-wealthiest (%) 25 25 19 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics Partial Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 35 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 0.8 (2004) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available Yes Official Development Assistance to child health 80 80 80 per child (US$) 10 (2005) 67 Midwives be authorised to administer a core set of 62 61 60 60 60 life saving interventions Partial Official Development Assistance to maternal and neonatal health per live birth (US$) 8 (2005) Uganda

Percent Percent Percent Maternity protection in accordance with ILO 40 29 40 40 23 Convention 183 No National availability of Emergency Obstetric Care 20 20 20 services (% of recommended minimum) 34 (2002-2003) Specific notification of maternal deaths Partial 0 0 0 1995 2000-2001 2006 1995 2000-2001 Countdown to 2015 DHS DHS DHS DHS DHS 2008 Report Yemen DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 21,732 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Asia, 1997-2002 Total under-five population (000) 3,639 (2006) undernutrition Unmet need for family planning (%) 39 (1997) Births (000) 839 (2006) Malaria Injuries Measles Causes of neonatal Abortion 139 4% 6% Contraceptive 150 8% 2% HIV/AIDS deaths prevalence rate 23 Pre-pregnancy Birth registration (%) --- Diarrhoea 3% Antenatal visits for woman (4 or more visits, %) 11 (1997) Obstructed labor 0% Other 6% 9% Antenatal visit Tetanus 7% 41 Pregnancy Under-five mortality rate (per 1000 live births) 100 (2006) 120 Diarrhoea Intermittent preventive treatment for malaria (%) --- (1 or more) 100 16% Congenital 8% Hypertensive Haemorrhage Skilled attendant Infant mortality rate (per 1000 live births) 75 (2006) disorders 27 Birth 90 (total, urban, ; %) 31% at birth Asphyxia 21% C-section rate rural 9% Neonatal mortality rate (per 1000 live births) 37 (2000) Neonatal (Minimum target is 5% and maximum target is 15%) 1, 2, 1 (1997) 60 46 33% *Postnatal care Neonatal period Total under-five deaths (000) 84 (2006) Sepsis/Infections, Infection 25% Early initiation of breastfeeding (within 1 hr of birth, %) 47 (1997) including AIDS Exclusive breastfeeding 12 Infancy Maternal mortality ratio (per 100,000 live births) 430 (2005) 30 MDG Target Other 12% 17% Postnatal visit for baby (within 2 days for home births, %) --- Other causes Lifetime risk of maternal death (1 in N) 39 (2005) Anaemia Measles 80 Preterm 29% 21% 0 Pneumonia 3,600 (2005) 13% Total maternal deaths 1990 1995 2000 2005 2010 2015 20% 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy Stunting prevalence (moderate and severe, %) 58 (2003) Complementary feeding rate (6-9 months, %) 76 (2003) 100 100 100 Wasting prevalence (moderate and severe, %) 14 (2003) Low birthweight incidence (%) 32 (1997) 80 80 80 61 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses 41 Percent Percent Percent 40 34 40 40 26 27 At least one dose Two doses 22 16 100 100 100 20 20 20 100 100 95 80 80 80 0 0 0 1991-1992 1997 2003 1991-1992 1997 2003 1985 1990 1995 2000 2006 60 60 60 DHS DHS Other NS DHS DHS Other NS 48 49 Source: WHO/UNICEF 42 36 Percent Percent 40 Percent 40 40 20 18 15 20 20 13 12 20 WATER AND SANITATION EQUITY 0 0 0 0 0 0 15 0 0 0 1997 2003 1991-1992 1997 2003 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile DHS Other NS DHS DHS Other NS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 100 100 CHILD HEALTH 84 82 86 80 71 71 80 80 68 65 67 Immunization Malaria prevention Prevention of mother to child 60 60 60 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs* 43

transmission of HIV Percent Percent Percent Percent of children immunised with 3 doses DPT 40 40 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 32 28 19 20 20 20 100 85 85 0 0 0 80 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest 80 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 1997 No data No data DHS Percent 40 POLICIES SYSTEMS 20 Coverage gap (%) 67 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 Substitutes Yes Ratio 1990 1995 2000 2005 2006 Per capita total expenditure on health (US$) 82 (2007) poorest/wealthiest 1.8 Source: WHO/UNICEF New ORS formula and zinc for management of *Sub-national risk of malaria transmission General government expenditure on health as Difference diarrhoea Partial % of total government expenditure (%) 6 (2007) poorest-wealthiest (%) 36 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials* Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics Partial Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 59 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age No antibiotics Density of health workers (per 1000 population) 1.0 (2004) 100 100 Costed implementation plan(s) for maternal, newborn and child health available Yes Official Development Assistance to child health 80 80 per child (US$) 6 (2005) Midwives be authorised to administer a core set of 60 60 life saving interventions --- Official Development Assistance to maternal and 47 neonatal health per live birth (US$) 17 (2005) Yemen Percent 40 No data Percent 40 Maternity protection in accordance with ILO 28 32 23 Convention 183 No National availability of Emergency Obstetric Care 18 20 20 services (% of recommended minimum) 14 (2004-2005) 7 Specific notification of maternal deaths --- 0 0 1991-1992 1997 1991-1992 1997 2003 Countdown to 2015 DHS DHS DHS DHS Other NS *Sub-national risk of malaria transmission 2008 Report Zambia DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 11,696 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 2,012 (2006) undernutrition Unmet need for family planning (%) 27 (2001-2002) Births (000) 470 (2006) HIV/AIDS Measles Causes of neonatal Obstructed labor Injuries Abortion Contraceptive 200 16% 1% deaths 4% prevalence rate 34 Pre-pregnancy Birth registration (%) 10 (2006) 180 182 1% Tetanus 3% Antenatal visits for woman (4 or more visits, %) 72 (2001-2002) Anaemia 4% Diarrhoea 3% 4% Antenatal visit Other 93 Pregnancy Under-five mortality rate (per 1000 live births) 182 (2006) 160 Diarrhoea 0% Congenital 7% Intermittent preventive treatment for malaria (%) 61 (2006) (1 or more) 18% Other 7% Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 102 (2006) disorders Haemorrhage 43 Birth 120 Preterm 25% C-section rate (total, urban, rural; %) at birth 9% 34% Neonatal mortality rate (per 1000 live births) 40 (2000) Neonatal (Minimum target is 5% and maximum target is 15%) 2,4,1 (2001-2002) *Postnatal care 80 60 23% Neonatal period Total under-five deaths (000) 86 (2006) Sepsis/Infections, Asphyxia 25% Early initiation of breastfeeding (within 1 hr of birth, %) 51 (2001-2002) including AIDS Exclusive Malaria breastfeeding 40 Infancy Maternal mortality ratio (per 100,000 live births) 830 (2005) 40 MDG Target 19% 16% Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 27 (2005) Measles 84 0 Pneumonia Infection 31% Other causes 3,900 (2005) 22% 30% Total maternal deaths 1990 1995 2000 2005 2010 2015 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy 96 Stunting prevalence (moderate and severe, %) 55 (2004) Complementary feeding rate (6-9 months, %) 87 (2001-2002) 100 92 93 100 100 83 90 Wasting prevalence (moderate and severe, %) 7 (2004) Low birthweight incidence (%) 12 (2001-2002) 80 80 80

60 60 60 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 51 47 47 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses 43 Percent Percent 40 Percent 40 40 At least one dose Two doses 100 100 100 20 20 20 86 83 80 73 80 80 80 66 0 0 75 1992 1996 1999 2001-2002 1992 1996 1999 2001-2002 1986 1991 1996 2001 2006 71 75 50 60 60 60 DHS DHS MICS DHS DHS DHS MICS DHS 73 66 Source: WHO/UNICEF Percent Percent Percent 40 40 40 40 50 27 23 21 20 18 19 20 20 10 20 0 WATER AND SANITATION EQUITY 0 0 0 0 1992 1996 2001-2002 2004 1992 1996 1999 2001-2002 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile DHS DHS DHS Other NS DHS DHS MICS DHS Percent population using improved drinking water sources Percent population using improved sanitation facilities

*Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 100 90 100 100 CHILD HEALTH 86 80 80 80 63 58 59 55 Immunization Malaria prevention Prevention of mother to child 60 50 60 52 60 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs 44

transmission of HIV Percent 40 Percent Percent Percent of children immunised with 3 doses DPT 40 40 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 27 31 20 20 20 100 100 50 84 0 0 0 80 80 80 40 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest 80 35 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 60 30 1996 1999 2001 DHS MICS DHS Percent Percent 40 40 Percent 20 18 19 POLICIES SYSTEMS 23 20 20 10 7 Coverage gap (%) 32 51 33 1 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 0 Substitutes Yes Ratio 1990 1995 2000 2005 2006 1999 2001-2002 2006 2004 2005 2006 Per capita total expenditure on health (US$) 63 (2007) poorest/wealthiest 2.3 2.5 Source: WHO/UNICEF MICS DHS Other NS Other NS Other NS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Yes % of total government expenditure (%) 13 (2007) poorest-wealthiest (%) 24 26 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics Partial Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 32 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 2.1 (2004) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available Partial Official Development Assistance to child health 80 80 80 per child (US$) 27 (2005) 71 69 Midwives be authorised to administer a core set of 62 60 60 58 58 60 life saving interventions Partial Official Development Assistance to maternal and 48 52 43 neonatal health per live birth (US$) 45 (2005) Zambia Percent 40 Percent 40 Percent 40 Maternity protection in accordance with ILO 24 Convention 183 Partial National availability of Emergency Obstetric Care services (% of recommended minimum) 41 (2004-2005) 20 20 20 14 14 Specific notification of maternal deaths No 0 0 0 1996 1999 2001-2002 1999 2001-2002 2006 1992 1996 1999 2001-2002 Countdown to 2015 DHS MICS DHS MICS DHS Other NS DHS DHS MICS DHS 2008 Report Zimbabwe DEMOGRAPHICS MATERNAL AND NEWBORN HEALTH

Total population (000) 13,228 (2006) Under-five mortality rate Causes of under-five deaths Causes of maternal deaths Coverage along the continuum of care Deaths per 1000 live births Globally more than one third of child deaths are attributable to Regional estimates for Africa, 1997-2002 Total under-five population (000) 1,703 (2006) undernutrition Unmet need for family planning (%) 13 (1999) Births (000) 372 (2006) Causes of neonatal Obstructed labor Abortion Contraceptive 100 deaths 4% prevalence rate 60 Pre-pregnancy Birth registration (%) 42 (2006) 105 HIV/AIDS Tetanus 2% Antenatal visits for woman (4 or more visits, %) 64 (1999) Anaemia 4% 41% Diarrhoea 2% 4% Antenatal visit Other 7% 95 Pregnancy Under-five mortality rate (per 1000 live births) 105 (2006) 80 Congenital 9% Intermittent preventive treatment for malaria (%) 6 (2005-2006) (1 or more) 76 Hypertensive Skilled attendant Infant mortality rate (per 1000 live births) 68 (2006) disorders Haemorrhage 80 Birth 60 Other Infection 23% C-section rate (total, urban, rural; %) at birth 9% 34% Neonatal mortality rate (per 1000 live births) 33 (2000) 0% Neonatal (Minimum target is 5% and maximum target is 15%) 5,9,3 (2005-2006) 30 40 Malaria 28% *Postnatal care Neonatal period Total under-five deaths (000) 39 (2006) 25 0% Asphyxia 24% Sepsis/Infections, Early initiation of breastfeeding (within 1 hr of birth, %) 69 (2005-2006) including AIDS Exclusive Injuries breastfeeding 22 Infancy Maternal mortality ratio (per 100,000 live births) 880 (2005) 20 1% 16% MDG Target Postnatal visit for baby (within 2 days for home births, %) --- Lifetime risk of maternal death (1 in N) 43 (2005) Measles Preterm 33% Measles 90 0 3% Pneumonia Other causes Total maternal deaths 3,400 (2005) Diarrhoea 30% 1990 1995 2000 2005 2010 2015 12% 15% 0 20 40 60 80 100 Source: Lawn JE, Cousens SN Source: UNICEF, 2006 Source: WHO, 2006 for CHERG (Nov 2006) Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74 Source: DHS, MICS, Other NS *See Annex for indicator definition Antenatal care Skilled attendant at delivery Neonatal tetanus protection INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN Percent women aged 15-49 years attended at least once by a Percent live births attended by skilled health personnel Percent of newborns protected against tetanus NUTRITION skilled health provider during pregnancy 100 93 93 95 100 100 Stunting prevalence (moderate and severe, %) 36 (2005-2006) Complementary feeding rate (6-9 months, %) 79 (2005-2006) 91 88 80 80 Wasting prevalence (moderate and severe, %) 7 (2005-2006) Low birthweight incidence (%) 11 (1999) 80 80 73 80 70 69 Underweight prevalence Exclusive breastfeeding Vitamin A supplementation 60 60 60 Percent children < 5 years underweight for age* Percent infants < 6 months exclusively breastfed Percent children 6-59 months receiving vitamin A doses Percent Percent Percent 40 40 40 At least one dose Two doses 100 100 100 20 20 20 78 81 80 80 80 0 0 81 1988 1994 1997 1999 2005-2006 1988 1994 1999 2005-2006 1984 1989 1994 1999 2004 2006 60 60 60 DHS DHS Other NS DHS DHS DHS DHS DHS DHS 46 Source: WHO/UNICEF Percent Percent Percent 40 40 32 40 20 22 20 12 14 20 20 WATER AND SANITATION EQUITY 8 11 0 0 0 0 0 20 0 0 0 1988 1999 2005-2006 1994 1999 2005-2006 1999 2000 2001 2002 2003 2004 2005 Water Sanitation Coverage gap by wealth quintile DHS DHS DHS DHS DHS DHS Source: UNICEF Percent population using improved drinking water sources Percent population using improved sanitation facilities *Based on 2006 WHO reference population Rural Urban Total Rural Urban Total 98 100 100 100 100 CHILD HEALTH 81 80 78 80 80 69 72 69 63 Immunization Malaria prevention Prevention of mother to child 60 60 60 50 47 53 Percent of children immunised against measles Percent children < 5 years sleeping under ITNs 42 transmission of HIV Percent Percent Percent Percent of children immunised with 3 doses DPT 40 40 40 Percent of children immunised with 3 doses Hib Percent HIV+ pregnant women receiving ARVs for PMTCT 20 20 20 100 90 100 20 17 0 0 0 80 90 80 16 1990 2004 1990 2004 Poorest 2nd 3rd 4th Wealthiest 13 Source: WHO/UNICEF JMP, 2006 Source: WHO/UNICEF JMP, 2006 60 60 12 1994 1999 2006 DHS DHS DHS

Percent Percent Percent 8 2 2 40 40 8 POLICIES SYSTEMS 20 20 4 Coverage gap (%) 27 22 30 3 International Code of Marketing of Breastmilk Financial Flows and Human Resources 0 0 0 Substitutes Yes Ratio 1990 1995 2000 2005 2006 2005-2006 2004 2005 2006 Per capita total expenditure on health (US$) 139 (2007) poorest/wealthiest 1.9 2.3 1.9 Source: WHO/UNICEF DHS Other NS Other NS Other NS New ORS formula and zinc for management of General government expenditure on health as Difference diarrhoea Yes % of total government expenditure (%) 9 (2007) poorest-wealthiest (%) 16 15 19 Diarrhoeal disease treatment Malaria treatment Pneumonia treatment Percent children < 5 years with diarrhoea receiving oral rehydration Percent febrile children < 5 years using antimalarials Percent children < 5 years with suspected pneumonia taken to Community treatment of pneumonia with antibiotics No Out-of-pocket expenditure as % of total appropriate health provider therapy or increased fluids, with continued feeding expenditure on health (%) 26 (2007) Percent children < 5 years with suspected pneumonia receiving IMCI adapted to cover newborns 0-1 week of age Yes antibiotics Density of health workers (per 1000 population) 0.9 (2004) 100 100 100 Costed implementation plan(s) for maternal, newborn and child health available Partial Official Development Assistance to child health 80 80 80 80 per child (US$) 7 (2005) Midwives be authorised to administer a core set of life saving interventions Yes Official Development Assistance to maternal and 60 60 60 50 42 neonatal health per live birth (US$) 18 (2005) Zimbabwe Percent 40 Percent 40 Percent 40 Maternity protection in accordance with ILO Convention 183 No National availability of Emergency Obstetric Care 20 20 20 services (% of recommended minimum) --- 5 Specific notification of maternal deaths Yes 0 0 0 1994 1999 2005-2006 1999 Countdown to 2015 DHS DHS DHS DHS 2008 Report References Noji, E.K. 2000. “The public health consequences of disasters. UNICEF, New York. Graham, W.J., J.S. Bell and C.H.W. Bullough. 2001. “Can skilled Prehospital Disaster Medicine 15(4): 147–57.Ronsmans C., and Graham Al Gasseer, N., E. Dresden, G.B Keeney and others. 2004. “Status of attendance at delivery reduce maternal mortality in developing W. 2006. “Maternal mortality: who, when, where, and why?” Lancet ———. 2007b. Progress for Children: A World Fit for Children Statistical women and infants in complex humanitarian emergencies.” Journal of countries?” In V. de Brouwere and W. van Lerberghe, eds., Safe 368: 1189–1200. Review. New York. Midwifery & Women’s Health 49(4, Supplement 1): 7–13. motherhood strategies: a review of the evidence . Antwerp: ITG Press, pp.97–129. OFDA (Office of U.S. Foreign Disaster Assistance) and CRED ———. 2007c. The State of the World’s Children, 2008: Child Survival. (Collaborating Centre for Research on the Epidemiology of Disasters). New York. Arimond, M, B. Daelmans and K. 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middle income countries. Canada: WHO. © UNICEF/HQ07-0119/Giacomo Pirozzi TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT 190 191 introduction.html). Each year the report focuses on a key issue addressing Goal monitoring. (More information is available at http://www.devinfo.org/.) Annex A population, reproductive and maternal health and development concerns and provides statistical tables on a range of key demographic, health and The World Development Indicators Online (WDI) provide direct access to socioeconomic indicators. Past reports have addressed such topics as more than 700 development indicators, with time series for 208 countries Initiatives, resources and databases for urbanization, adolescent health, poverty, the environment, international and 18 country groups from 1960 to 2006, where data are available for migration, gender equality and changing population age structures. The interactive queries and can be downloaded by users (http://go.worldbank. monitoring progress towards the health- relation of the thematic focus to maternal and reproductive health is a org/6HAYAHG8H0). feature of every report. related Millennium Development Goals, with a The website for the Millennium Development Goals Indicators is special focus on maternal, newborn and child Resources and monitoring activities maintained by the United Nations Statistics Division. The home page states that the site presents the official data, definitions, methodologies and survival Millennium Development Goal monitoring occurs within the United Nations sources for the 48 indicators to measure progress towards the Millennium system. The UN Statistics Division (UNSD) coordinates the preparation of Development Goals. The data and analyses are the product of the work the UN Secretary General’s report on progress towards the Millennium of the Inter-agency and Expert Group (IAEG) on Millennium Development Development Goals and is responsible for maintaining the Millennium This list is not comprehensive but includes important resources, reports Goal Indicators, coordinated by the United Nations Statistics Division Indicators database. The UN Statistics Division also coordinates the Inter- and databases related to monitoring progress towards the Millennium (http://mdgs.un.org/unsd/mdg/Host.aspx?Content=Indicators/OfficialList. Agency and Experts Group on Millennium Development Goal reporting Development Goals for women, newborns and children. htm). (IAEG), which is responsible for the preparation of data and analysis to monitor progress towards the Millennium Development Goals. The Group Reports Household survey protocols also reviews and defines methodologies and technical issues in relation The State of the World’s Children is UNICEF’s flagship publication. Each to the indicators, produces guidelines and helps define priorities and The Multiple Indicator Cluster Survey (MICS) is a household survey year the report focuses on a key issue affecting children and provides a strategies to support countries in data collection, analysis and reporting on programme developed by UNICEF to assist countries in filling data gaps set of detailed statistical tables that include individual country and regional Millennium Development Goals. to monitor the situation of children and women. It is capable of producing estimates on a range of key indicators for monitoring the situation of statistically sound data that are internationally comparable. The Multiple women and children in the world. The report’s focus in 2008 is child Lead agencies have been assigned to report on progress towards specific Indicator Cluster Survey was developed after the World Summit for survival (http://www.unicef.org/sowc/). This publication is the primary goals and targets. UNICEF and World Health Organization are the lead Children to measure progress towards an internationally agreed-upon set source for the coverage estimates used in the Countdown. agencies for reporting on the health-related Millennium Development of mid-decade goals. The first round of Multiple Indicator Cluster Surveys Goals. United Nations Population Fund is also involved in reporting on was conducted around 1995 in more than 60 countries. A second round Progress for Children (PFC) is a UNICEF flagship publication reporting on Millennium Development Goal 5. UNDP is responsible for providing of about 65 surveys was conducted in 2000. The 2005–06 round of progress towards the Millennium Development Goals. The World Fit for support to countries in the preparation of country reports on progress Multiple Indicator Cluster Surveys was planned to provide a monitoring Children (WFFC) Statistical Review was a special issue of PFC to report towards the Millennium Development Goals. tool for the Millennium Development Goals and other major international on progress towards the WFFC goals and targets included in the May commitments including the publication of A World Fit for Children, the UN 2002 Special Session of the United Nations General Assembly outcome The Child Health Epidemiology Reference Group (CHERG) was established General Assembly Special Session on HIV/AIDS, and the Abuja targets document. Heads of state and government committed themselves to in 2001 and has worked since that time to improve the quality of global for malaria. Multiple Indicator Cluster Surveys are usually carried out by targets in vital areas of children’s well-being and development to be estimates on maternal and child mortality and morbidity, intervention government organisations, with the support and assistance of UNICEF and achieved by 2010, and UNICEF was specifically called upon to prepare coverage and the potential effects of health services and interventions. other partners. Results from the different rounds of surveys, as well as a mid-decade progress report (http://www.unicef.org/publications/files/ The coverage estimates reported through the Countdown process related technical background materials, are available at www.childinfo.org. Progress_for_Children_ No_6.pdf). are reviewed by the Child Health Epidemiology Reference Group for consistency with mortality estimates. The USAID-supported Demographic and Health Surveys (DHS) have State of the World’s Mothers has been published by Save the Children been conducted in many countries over the last 20 years. They provide each year since 1999, as a complement to UNICEF’s The State of the The Country Profiles on Maternal and Newborn Health produced in 2008 national and subnational data on family planning, maternal and child health, World’s Children report. This document brings together information on by the World Health Organization Department of Making Pregnancy child survival, HIV/AIDS and sexually transmitted infections, infectious the world’s mothers and newborns, with the aim of bringing attention to Safer (MPS) complements the Countdown with country-specific reports diseases and reproductive health and nutrition. More information is the urgent need to reduce maternal and infant mortality around the world. focusing specifically on maternal and newborn health indicators, including available at www.measuredhs.com. The MICS and DHS programmes The report also identifies countries that are succeeding in improving the subnational distributions and disaggregated reporting by measures of have coordinated efforts both in terms of standardizing survey questions health and saving the lives of women and babies and shows that effective equity and location. In 2007 the Department initiated creation of a maternal and methods for data analysis, as well as data collection on the ground. solutions to this challenge are affordable – even in the world’s poorest and neonatal health epidemiology reference group (MNHERG) of global Coordinating both the countries surveyed and the questions included in countries. (http://www.savethechildren.org/publications/mothers/2006/ experts to catalyze improved capacity and use of country-level data to the questionnaire modules ensures maximum coverage of countries and SOWM_2006_final.pdf) guide implementation and decisionmaking. provides comparability across surveys.

The World Health Report is published annually by the World Health The Partnership for Maternal, Newborn and Child Health has collaborated Organization (World Health Organization) (http://www.who.int/whr). Each closely with the Countdown in its efforts to monitor progress and to year the report combines an expert assessment of global health, including promote the use of the monitoring results for political advocacy related to statistics relating to all countries, with a focus on a specific subject (in maternal, newborn and child health. 2008, primary health care). Some of the data and benchmarks presented here on health policy and health systems, including human resources and Publicly accessible databases financial flows, were taken from previous reports. UNICEF maintains a series of publicly accessible databases for tracking the situation of children and women globally. These databases contain both the World Health Statistics Report (http://www.who.int/whosis): “This annual current (presented in The State of the World’s Children) and trend data for report presents comprehensive health data on all of the 193 World Health tracking progress on the situation of women and children. UNICEF’s global Organization Member States. The data, selected on the basis of quality and databases include only statistically sound and nationally representative data availability, relevance to global health, and comparability across member from household surveys and other sources. These databases are updated nations, cover over 50 core health indicators, which are organized into six annually through a process that draws on the wealth of data maintained by major areas: mortality and burden of disease, health service coverage, risk UNICEF’s wide network of 140 field offices and other sources. All these factors, health system inputs, differentials in health outcome and coverage, data have undergone a rigorous data quality review based on a series of as well as basic sociodemographic statistics.” objective criteria. UNICEF includes survey data in global estimates after The World Development Report, published by the World Bank, aims to reviewing them for quality based on the following criteria: provide a “guide to the economic, social and environmental state of the The survey is based on a nationally representative sampling frame. world today” (http://go.worldbank.org/LOTTGBE9I0, accessed 2 February • 2008). Each year the WDR provides in-depth analysis of a specific aspect of development. Past reports have considered such topics as youth, equity, • Standard protocols for collecting and analyzing data for the Countdown public services delivery, the role of the state, transition economies, labour, indicators were used in the survey. infrastructure, health, the environment and poverty. The most recent report examines the role of agriculture in development. • To the extent determinable, the survey was carried out The Global Millennium Development Goal Monitoring Report is published using procedures to ensure data quality in the recruitment, annually by the World Bank (http://go.worldbank.org/XE4070LV80m). This training and supervision of data collection teams and in publication focuses on the responsibilities and accountability of donor the transfer and management of the survey data. countries, developing countries and the international financial institutions to support achievement of the Millennium Development Goals and monitors progress towards the Millennium Development Goal targets. The 2007 report focuses on gender equality and the empowerment of women. One of the databases maintained by UNICEF is DevInfo, a technical platform designed for use in monitoring progress towards the Millennium State of the World Population Report is the United Nations Populations Development Goals. Nationally, 103 countries are now using DevInfo to Fund flagship publication (http://www.unfpa.org/swp/2007/english/ develop national socioeconomic databases for Millennium Development

TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT 192 193 Annex B Micronutrient Vitamin A supplementation (at least 1 National Immunisation Days, United Nations Children’s Fund dose & 2 doses) Demographic and Health Surveys, Multiple Indicator supplementation Indicators and data sources Cluster Survey CHILD HEALTH

Indicators Data Source Global Database Immunisation Measles immunisation coverage Routine, Multiple Indicator United Nations Children’s Fund/ Cluster Survey, Demographic World Health Organization and Health Surveys DEMOGRAPHICS DPT3 immunisation coverage Routine, Multiple Indicator United Nations Children’s Fund/ Cluster Survey, Demographic World Health Organization Demographics Total population United Nations Population United Nations Population and Health Surveys Division Division Hib3 immunisation coverage Routine, Multiple Indicator United Nations Children’s Fund/ Total under-five population United Nations Population United Nations Population Cluster Survey, Demographic World Health Organization Division Division and Health Surveys Total births United Nations Population United Nations Population Malaria Under-fives sleeping under ITNs Demographic and Health United Nations Children’s Fund Division Division Surveys, Multiple Indicator Birth registration Multiple Indicator Cluster United Nations Children’s Fund Cluster Survey, Survey, Demographic and Health Surveys Antimalarial treatment (under-fives) Demographic and Health United Nations Children’s Fund Surveys, Multiple Indicator Child Mortality Under-five mortality rate United Nations Children’s Fund United Nations Children’s Fund/ Cluster Survey, World Health Organization/World Bank/United Nations Population Pneumonia Careseeking for pneumonia Demographic and Health United Nations Children’s Fund Division Surveys, Multiple Indicator Cluster Survey Infant mortality rate United Nations Children’s Fund/ United Nations Children’s Fund/ World Health Organization/World World Health Organization/World Antibiotic treatment for pneumonia Demographic and Health United Nations Children’s Fund Bank/United Nations Population Bank/United Nations Population Surveys, Multiple Indicator Division Division Cluster Survey Neonatal mortality rate World Health Organization World Health Organization Diarrhoeal diseases Oral rehydration and continued feeding Demographic and Health United Nations Children’s Fund Surveys, Multiple Indicator Total children under five deaths United Nations Children’s Fund/ United Nations Children’s Fund Cluster Survey World Health Organization/World Bank /United Nations Population AIDS HIV+ pregnant women receiving ARVs MOH, Joint United Nations United Nations Children’s Fund Division for PMTCT Programme on HIV/AIDS Cause of death of children under five Child Health Epidemiology World Health Organization MATERNAL AND NEWBORN HEALTH Reference Group Maternal Mortality Maternal mortality ratio United Nations Children’s United Nations Children’s Antenatal care Antenatal care (at least one visit) Demographic and Health United Nations Children’s Fund Fund/World Health Organization/ Fund/World Health Organization/ Surveys, Multiple Indicator United Nations Population Fund/ United Nations Population Fund/ Cluster Survey, Reproductive World Health Organization World Bank Health Survey, Family Health Survey Lifetime risk of maternal death United Nations Children’s United Nations Children’s Fund/World Health Organization/ Fund/World Health Organization/ Antenatal care (4 or more visits) Demographic and Health United Nations Children’s Fund/ United Nations Population Fund/ United Nations Population Fund/ Surveys, Multiple Indicator World Health Organization World Health Organization World Bank Cluster Survey, Reproductive Health Survey, Family Health Total maternal deaths United Nations Children’s United Nations Children’s Survey Fund/World Health Organization/ Fund/World Health Organization/ United Nations Population Fund/ United Nations Population Fund/ IPTp for malaria Intermittent preventive treatment for Demographic and Health United Nations Children’s Fund World Health Organization World Bank pregnant women Surveys, Multiple Indicator Cluster Surveys Maternal deaths by cause (regional) World Health Organization World Health Organization Neonatal tetanus Neonatal tetanus protection Demographic and Health United Nations Children’s Fund/ NUTRITION protection Surveys, Multiple Indicator World Health Organization Cluster Survey Anthropometric Underweight prevalence Demographic and Health United Nations Children’s Fund/ Delivery care Skilled attendant at birth Demographic and Health United Nations Children’s Fund Surveys, Multiple Indicator World Health Organization Surveys, Multiple Indicator Cluster Survey, National Survey Cluster Survey, Reproductive Stunting prevalence Demographic and Health United Nations Children’s Fund/ Health Survey, Family Health Surveys, Multiple Indicator World Health Organization Survey Cluster Survey, National Survey C-section C-section rate Demographic and Health United Nations Children’s Fund Wasting prevalence Demographic and Health United Nations Children’s Fund/ Surveys, Multiple Indicator Surveys, Multiple Indicator World Health Organization Cluster Survey, Reproductive Cluster Survey, National Survey Health Survey, Family Health Survey Infant feeding Exclusive breast-feeding rate (<6 Demographic and Health United Nations Children’s Fund months) Surveys, Multiple Indicator Postnatal visit Postnatal visit for mother Demographic and Health Special data analysis by SNL Cluster Survey, National Survey Surveys, Multiple Indicator Cluster Survey, Reproductive Complementary feeding rate (6-9 Demographic and Health United Nations Children’s Fund Health Survey, Family Health months) Surveys, Multiple Indicator Survey Cluster Survey, National Survey Postnatal visit for baby Demographic and Health Special data analysis by SNL Low birth weight Low birth weight incidence Demographic and Health United Nations Children’s Fund Surveys, Multiple Indicator Surveys, Multiple Indicator Cluster Survey, Reproductive Cluster Survey, National Survey Health Survey, Family Health Survey

TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT 194 195 Breast-feeding Early initiation of breast-feeding Demographic and Health United Nations Children’s Fund Annex C Surveys, Multiple Indicator Cluster Survey, NS Contraceptive Contraceptive prevalence rate Demographic and Health United Nations Children’s Fund Defining currentCountdown indicators Surveys, Multiple Indicator Cluster Survey, Reproductive prevalence Health Survey, Family Health NO. INDICATOR NAME INDICATOR DEFINITION NUMERATOR DENOMINATOR Survey Unmet need Unmet need for family planning Demographic and Health United Nations Population Fund NUTRITION Surveys, National Survey 1 Exclusive breast-feeding (<6 Percentage of infants aged Number of infants aged Total number of infants MATERNAL AND NEWBORN HEALTH months) 0-5 months who are exclusively 0-5 months who are aged 0-5 months breastfed exclusively breastfed surveyed Water Use of improved drinking water United Nations Children’s Fund/ United Nations Children’s Fund/ sources World Health Organization World Health Organization 2 Breast-feeding plus Percentage of infants aged 6-9 Number of infants aged Total number of infants Sanitation Use of improved sanitation facilities United Nations Children’s Fund/ United Nations Children’s Fund/ complementary food (6-9 months who are breastfed and 6-9 months who are aged 6-9 months World Health Organization World Health Organization months) receive complementary food breastfed and receive surveyed complementary food POLICIES, SYSTEMS AND EQUITY

Policies International code of marketing of United Nations Children’s Fund/ Special data compilation by 3 Vitamin A supplementation Percentage of children aged 6-59 Number of children Total number of children breast milk substitutes World Health Organization World Health Organization coverage months who received at least one aged 6-59 months aged 6-59 months New ORS formula and zinc for World Health Organization/ Special data compilation by high done vitamin A supplement in receiving at least one management of diarrhoea United Nations Children’s Fund/ World Health Organization the last six months (and at least two high dose vitamin A Zinc task force doses in the last 12 months). supplement in the 6 months prior to the Community treatment of pneumonia United Nations Children’s Fund/ Special data compilation by survey (and at with antibiotics World Health Organization World Health Organization

IMCI adapted to cover newborns 0-1 World Health Organization Special data compilation by least two doses in the week of age World Health Organization last 12 months). Costed implementation plan for MNCH World Health Organization Special data compilation by CHILD HEALTH available World Health Organization 4 Measles immunisation Percentage of children aged 12-23 Number of children Total number of children Midwives authorised to administer a World Health Organization Special data compilation by coverage months who are immunized against aged 12-23 months aged 12-23 months core set of life saving interventions World Health Organization measles who are immunized surveyed Maternity protection in accordance against measles with ILO convention 183 ILOLEX International Labor Organization 5 DPT3 immunisation Percentage of children aged 12-23 Number of children Total number of children Specific notification of maternal deaths World Health Organization Special data compilation by coverage months who received 3 doses of aged 12-23 months aged 12-23 months WHO DPT vaccine receiving 3 doses of surveyed DPT vaccine Systems Per capita total expenditure on health World Health Stat 2007 World Health Organization 6 HiB3 immunisation coverage Percentage of children aged 12-23 Number of children Total number of children General government expenditure World Health Stat 2007 World Health Organization months who received 3 doses of aged 12-23 months aged 12-23 months on health as % of total government HiB vaccine. receiving 3 doses of surveyed expenditure Haemophilus influenzae type B (HiB) vaccine Out-of-pocket expenditure as % of World Health Stat 2007 World Health Organization total expenditure on health 7 Oral rehydration and Percentage of children aged 0-59 Number of children Total number of children continued feeding months with diarrhoea receiving aged 0-59 months aged 0-59 months with Density of health workers per 1000 Global Atlas on Human World Health Organization oral rehydration and continued with diarrhoea in the diarrhoea in the 2 weeks population Resources feeding 2 weeks prior to the prior to the survey Official development assistance to Development Assistance London School of Health and survey receiving oral child health per child Committee Tropical Medicine rehydration therapy (oral rehydration Official development assistance to Development Assistance London School of Health and solution and/or maternal and neonatal health per live Committee Tropical Medicine recommended birth homemade fluids or increased fluids) and Availability of emergency obstetric care EMOC Assessments, Health Averting maternal death and continued services Information System disability/United Nations Children’s Fund 8 Insecticide-treated net Percentage of children aged Number of children Total number of children coverage 0-59 months sleeping under an aged 0-59 months aged 0-59 months Equity Coverage gap by wealth quintile Multiple Indicator Cluster Special data analysis by World insecticide-treated mosquito net sleeping under an surveyed Survey/Demographic and Health Health Organization insecticide-treated Surveys mosquito net the night Coverage gap (%) Multiple Indicator Cluster Special data analysis by World before the survey Survey/Demographic and Health Health Organization 9 Antimalarial treatment Percentage of children aged Number of children Total number of children Surveys 0-59 months with fever receiving aged 0-59 months aged 0-59 months Ratio poorest/wealthiest Multiple Indicator Cluster Special data analysis by World appropriate antimalarial drugs reported to have fever reported to have fever in Survey/Demographic and Health Health Organization in the 2 weeks prior the 2 weeks prior to the Surveys to the survey who survey were treated with an Difference poorest - wealthiest (%) Multiple Indicator Cluster Special data analysis by World appropriate antimalarial Survey/Demographic and Health Health Organization within 24 hours of the Surveys onset of symptoms 10 Prevention of mother-to- Percentage of all HIV-positive Number of HIV-positive Estimated number of child transmission of HIV pregnant women who received a pregnant women given HIV-positive pregnant transmission complete course of ART prophylaxis ART prophylaxis in the women giving birth in the preceding 12 months preceding 12 monthsa

TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT 196 197 11 Careseeking for pneumonia Percentage of children aged 0-59 Number of children Total number of children 20 C-section rate Percentage of live births delivered Number of live births Total number of live months with suspected pneumonia aged 0-59 months with aged 0-59 months with by Caesarean section to women aged 15-49 births to women aged taken to an appropriate health suspected pneumonia suspected pneumonia in years in the X years 15-49 years in the X years provider in the 2 weeks prior to the 2 weeks prior to the prior to the survey prior to the survey the survey who were survey delivered by Caesarean taken to an appropriate section health provider 21 Early initiation of breast- Percentage of newborns put to the Number of women Total number of women 12 Antibiotic treatment for Percentage of children aged 0-59 Number of children Total number of children feeding breast within one hour of birth with a live birth in the with a live birth in the X pneumonia months with suspected pneumonia aged 0-59 months with aged 0-59 months with X years prior to the years prior to the surveyc receiving antibiotics suspected pneumonia suspected pneumonia in survey who put the in the 2 weeks prior to the 2 weeks prior to the newborn infant to the the survey receiving survey breast within 1 hour antibiotics of birth 22 Postnatal care for mothersd Percentage of mothers who Number of women who Total number of women MATERNAL AND NEWBORN HEALTH received postnatal care visit within received a postnatal aged 15-49 years with two days of childbirth care visit within two a last live birth in the x 13 Contraceptive prevalence Proportion of women currently Number of women Total number of women days of childbirth years prior to the survey married or in union aged 15-49 currently married or aged 15-49 years that (regardless of place of (regardless of place of that are using (or whose partner in union aged 15-49 are currently married or delivery) delivery) is using) a contraceptive method years that are using in union (either modern or traditional) (or whose partner is 23 Postnatal care for babies Percentage of babies born outside Number of babies born Total number of last-born using) a contraceptive who were born at home a facility who received a postnatal outside of a health babies born outside of method (either modern care visit within two days of birth. facility who received a health facility in the x or traditional) a postnatal care visit years prior to the surveyf within two days of 14 Unmet need for family Proportion of women that are Number of women that Total number of women birthe planning currently married/in union that have are currently married or interviewed that are an unmet need for contraception in union that are fecund currently married or in WATER AND SANITATION and want to space union their births or limit the 24 Use of improved drinking Percentage of the population using Number of household Total number of number of children water sources improved drinking water sources members living in household members in they have and that are households using households surveyed not currently using improved drinking contraception water sources 15 Antenatal care (at least one Percent of women attended at least Number of women Total number of women (including household visit) once during pregnancy by skilled attended at least once who had a live birth connections, public health personnel for reasons related during pregnancy by occurring in the same standpipe, borehole, to the pregnancy in the X years prior skilled health personnel period protected dug well, to the survey for reasons related to protected spring, the pregnancy in the rainwater collection) X years prior to the 25 Use of improved sanitation Percentage of the population using Number of household Total number of survey facilities improved sanitation facilities members using household members in 16 Antenatal care (4 or more Percent of women attended at least Number of women Total number of women improved sanitation households surveyed visits) four times during pregnancy by any attended at least four who had a live birth facilities (including provider (skilled or unskilled) for times during pregnancy occurring in the same connection to a public reasons related to the pregnancy in by any provider period sewer, connection to the X years prior to the survey (skilled or unskilled) a septic system, pour- for reasons related to flush latrine, simple pit the pregnancy in the latrine, or a ventilated X years prior to the improved pit latrine) survey 17 Neonatal tetanus protection Percentage of newborns protected Number of mothers Total number of women against tetanus with a live birth in aged 15-49 with a live Notes the year prior to the birth in the year prior to survey who received 2 the survey a. More details on the HIV estimates methodology can be found at www.unaids.org. does of TT within the b. This reference period may differ between surveys. appropriate interval c. This reference period may differ between surveys. prior to the infant’s birth d. As used for postnatal care in the continuum of care figure. e. Information on postnatal care for babies who were born in health facilities is not collected because it is assumed by DHS that mothers would not know 18 Intermittent preventive Proportion of women who received Number of women Total number of women whether or not their newborn received specific aspects of immediate care, for example early bathing. treatment intermittent preventive treatment at risk for malaria surveyed at risk for f. This denominator differs from the all births denominator used for the indicator for postnatal care for mother. Therefore, the coverage for mother and for malaria during their last who received two malaria who delivered a baby cannot be compared. Data for both mothers and babies that is comparable (home birth denominator) is available for only four countries. pregnancy or more doses of live baby within the last a recommended two years. antimalarial drug treatment to prevent malaria during their last pregnancy that led to a live birth 19 Skilled attendant at delivery Percentage of live births attended Number of live births Total number of live by skilled health personnel (doctor, to women aged 15-49 births to women aged nurse, midwife or auxiliary midwife) years in the X years 15-49 years in the X years prior to the survey prior to the surveyb attended during delivery by skilled health personnel (doctor, nurse, midwife or auxiliary midwife)

TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT 198 199 Community National policy adopted Yes: community Yes: 18 Yes: 16 Annex D management of authorizing community health workers pneumonia with health workers to identify authorized to give antibiotics and manage pneumonia antibiotics for Partial: 11 Partial: 2 Definitions of policy and health systems indicators with antibiotics pneumonia No: 31 No: 41 Partial: no national policy but some INDICATOR CRITERIA FOR 2007 RESULTS 2005 RESULTS implementation of No data: 8 No data: 1 NO. POLICY DEFINITION RANKING (68 Countries) (60 Countries) community-based management of POLICIES pneumonia 1 Midwives National policy adopted Yes: midwives Yes: 27 authorized to authorizing midwives to authorized for all No: no national administer a administer the following: tasks policy and no core set of Partial: 25 implementation life saving interventions a. perenteral antibiotics Partial: midwives Maternity ILO Convention 183 Yes: ILO Convention Yes: 10 authorized for some No: 5 protection in ratified by the country 183 ratified tasks accordance with b. perenteral oxytocics ILO Convention Partial: 21 No data: 11 183 Partial: ILO No: midwives not Convention 183 not c. perenteral authorized for any of ratified but previous No: 47 anticonvulsants these tasks maternity convention ratified No data: 0 d. manual removal of placenta No: No ratification of any maternity protection convention e. removal of retained products of conception International National policy adopted Yes: all provisions of Yes: 25 Yes: 15 Code of on all provisions the International Code Marketing of stipulated in the adopted in legislation f. assisted vaginal Breast milk International Code of Partial: 28 Partial: 39 delivery Substitutes Marketing of Breast milk Substitutes Partial: voluntary agreements or some No: 13 No: 3 g. newborn resuscitation provisions of the international Code Specific National policy adopted Yes: national Yes: 23 No data: 2 No data: 3 notification of requiring health policy adopted and adopted in legislation maternal deaths professionals to notify implemented any maternal death Partial: 14 No: no legislation Partial: national and no voluntary policy adopted No: 18 agreements adopted but no systematic in relation to the implementation International Code No data: 13 FINANCIAL FLOWS AND HUMAN RESOURCES No: no national policy Costed National plan or plans Yes: costed plan or Yes: 31 Data obtained from IMCI adapted to National IMCI guidelines Yes: National IMCI Yes: 39 implementation for scaling up maternal, plans to scale up expert opinion in cover newborns adapted to cover major guidelines adapted on plan for newborn and child health maternal, newborn countries 0-1 week of age conditions affecting and in line with WHO maternal, interventions available and child health Partial: 18 Partial: 3 newborn survival in the generic guidelines newborn and and costed interventions available first week of life generic 2006 child health at national level Variability between guidelines 2006 No: 14 countries in No: 21 interpretation of Partial: National IMCI Partial: costed the indicator with guidelines adapted No data: 5 No data: 5 plan available for respect to the but not fully in line either maternal and scope of costing with WHO generic newborn health or (programme costs guidelines 2006 child health versus programme and recurrent costs) and the time period No: National IMCI No: no costed covered by the plan guidelines not implementation plan adapted for MNCH available New ORS National policy guidelines Yes: low osmolarity Yes: 34 Yes: 6 Per capita total Numerical World Health formula and zinc adopted on management ORS and zinc expenditure Statistics 2007 for management of diarrhoea with low supplements in on health (at Partial: 17 Partial: 17 of diarrhoea osmolarity ORS and zinc national policy international supplements US$ rate) Partial: low No: 10 No: 36 Per capita Numerical World Health osmolarity ORS or expenditure Statistics 2007 zinc supplements in No data: 7 No data: 1 on health as national policy % of total government expenditure No: low osmolarity ORS and zinc supplements not promoted in national policy

TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT 200 201 Out-of-pocket Numerical World Health Annex E expenditure Statistics 2007 as % of total expenditure on health Countdown to 2015 measuring equity in maternal, newborn and child health through the coverage gap index: technical notes Density of Total number of Numerical Minimum Above minimum WHO Global atlas health workers physicians, nurses and Standard: 2.5 health standard: 14 of the health work per 1000 midwives relative to the workers per 1000 force (http://www. population overall population people needed to who.int/globalatlas/ 1. Coverage indicators deliver basic maternal Below minimum default.asp) and child health standard: 54 The measure of equity constructed for this report is called the ‘coverage gap index’. For guidance on interpreting services the coverage gap graphs in the country profiles, please see section 4 below. The coverage gap index combines HEALTH SYSTEM information on four intervention areas across the Continuum of Care: family planning, maternal and newborn care, immunisation and treatment of sick children. Data from Demographic and Health Surveys and Multiple Indicator Availability of Minimum recommended Availability is 27 countries UNICEF/AMDD data Emergency is five EmOC facilities expressed as a had comparable base of Emergency Cluster Survey on eight coverage indicators in these four intervention areas was used to construct the coverage Obstetric per 500,000 people. percentage of the data from EmOC Obstetric Care gap index. Table E1 defines the indicators. Care (EmOC) This should include 1 minimum acceptable Assessments. 2 of Assessments, Services % of Comprehensive and number of EmOC these countries had Bangladesh National recommended 4 Basic Emergency facilities. additional updates EmOC Inventory, Table E1. Coverage gap index indicator definitions minimum Obstetric Care facilities. from national HIS for Nepal and The breakdown of inventory or health Bangladesh for No. Indicator Definition Comprehensive and The minimum system reports updates Basic by population acceptable number 1a. Need for family planning satisfied (FP) Percentage of currently married women who say that they do not want any more and geographic area of EmOC facilities children or that they want to wait two or more years before having another child, is available in country (C-EmOC and B- Of the 27 countries and are using contraception Assessment Reports, EmOC) is calculated with data: 1b. Contraceptive prevalence rate (CPR) Percentage of women currently married or in union aged 15–49 that are using (or but not included in the by dividing the • 4 had over 80% of whose partner is using) a modern contraceptive method Countdown. population by 500,000 the recommended and multiplying by 5. minimum number of 2. Antenatal care (ANC) Percentage of women attended at least once during pregnancy by skilled health EmOC facilities. personnel for reasons related to the pregnancy in the three years prior to the • 7 countries had survey The percentage 50-79% of recommended • 14 countries had 3. Skilled birth attendance (SBA) Percentage of live births in the three years prior to the survey attended by skilled minimum number 25-49% health personnel (doctor, nurse, midwife or auxiliary midwife) of EmOC facilities • 2 countries had 4. Measles vaccination (MSL) Percentage of children aged 12–23 months who are immunized against measles is calculated by 14-21% dividing the number 5. Diphtheria, pertussis and tetanus Percentage of children aged 12–23 months who received three doses of DPT of functioning vaccination (three doses of combined vaccine EmOC facilities by 18 additional diphtheria/pertussis/tetanus vaccine) the recommended countries have number and data from EmOC 6. BCG vaccination Percentage of children age 1–23 months currently vaccinated against BCG multiplying by 100. Assessments for To qualify as fully specific geographic 7. Oral rehydration therapy (ORT) Percentage of under-five children with diarrhoea in the last two weeks who functioning Basic regions or using received ORT (ORS packets, recommended home solution or increased fluids) and or Comprehensive different criteria. continued feeding EmOC a facility must 8. Treatment of acute respiratory infection Percentage of children aged 0–59 months with suspected pneumonia (cough and provide a standard set (ARI) dyspnoea) who sought care from a health provider of signal functions. 23 countries had no data

2. Calculation of the coverage gap index The coverage gap index was calculated using the formula:

100 per cent – ([ORT+ARI]/2 + FP +[SBA+ANC]/2 +[MSL+2*DPT3+BCG]/4)/4

Each of the four intervention areas is given equal weight.

Note: If need satisfied for family planning (FP) was not available, the contraceptive prevalence rate (CPR) among married women 15–49 years was used to estimate the need satisfied according to the following formula: FP = CPR*1.07 +27. This formula was derived from analysis of more than 100 Demographic and Health Surveys with data on both unmet need and contraceptive prevalence rate.

3. Wealth index The coverage gap index was calculated for the total sample for each country and data point. To measure equity, one needs to divide the total sample into groups by socioeconomic status. The Demographic and Health Surveys and Multiple Indicator Cluster Survey do not collect information on income and expenditure, which could be used to divide the sample into socioeconomic groups. However, the Demographic and Health Surveys and Multiple Indicator Cluster Survey do collect information on asset ownership and availability of basic household services. For the purposes of analyzing socioeconomic inequalities in health, it has been shown that using such variables to develop an index of socioeconomic status leads to similar results as using income and/or expenditure data.1

For coverage of health interventions in the Demographic and Health Surveys, we used data from an analysis conducted by Gwatkin and colleagues (2005). They used information in Demographic and Health Surveys on household assets and access to basic household services to construct a wealth index.2 The index was used to

TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT TRACKING PROGRESS IN MATERNAL, NEWBORN & CHILD SURVIVAL THE 2008 REPORT 202 203 rank households and then divide the household population into quintiles. Results from recent Demographic and Health Surveys results were also included. For Multiple Indicator Cluster Surveys, we used data provided by Annex F UNICEF through the MICS website (http://childinfo.org) for those countries and data points for which a wealth index had been constructed.3 Countdown priority countries considered to be malaria endemic

4. Explanation and interpretation of coverage gap graph Table F1. Plasmodium falciparum transmission risk in Countdown priority countries. This table indicates which of the Countdown The x-axis shows the wealth quintiles; from the poorest 20 per cent to the best-off 20 per cent. The y-axis priority countries are malaria endemic – defined as having a documented risk of Plasmodium falciparum transmission nationwide and shows the coverage gap, which is measured as a percentage as explained in section 2. No percentage gap throughout the year – and, of the remainder, which countries have subnational risk, mostly p. vivax, no risk or very limited risk. implies maximum coverage for all interventions. A 20 per cent gap means that the coverage as calculated in Countries with mostly p. vivax, no Countries with subnational risk of the index is 80 per cent. Given that the gap is measured as maximum coverage minus actual coverage, a low Malaria endemic countries (n=45) Plasmodium falciparum or very limited risk Plasmodium falciparum transmission (n=14) figure is preferable to a high figure. (n=9) The difference between the poorest and richest quintiles and shape of the line show the patterns of inequality Afghanistan Bolivia Azerbaijan within a country. First, the greater the inequality between the poorest and richest quintiles, the steeper the Angola Brazil Egypt downward slope. With a few exceptions, the coverage gap line declines as one moves from the poorest quintile to Bangladesh China Guatemala Benin Haiti Iraq the best-off quintile in the country profiles. A horizontal line indicates relative equity, which was observed in some Botswana India Korea Democratic Republic of of the surveys in Central Asian Republics. Burkina Faso Indonesia Lesotho Burundi Mauritania Mexico Cambodiaa Nepal Morocco 4 The shape is equally important. The way the lines are curved can illustrate where inequities are concentrated. Cameroon Peru Turkmenistan There are three main patterns. First, bottom inequity occurs when the poorest lag behind. Second, top inequity Central African Republic Philippines occurs when the richest do substantially better than the other quintiles. The intermediate pattern is more or less Chad South Africa Congo Swaziland linear. The coverage gap increases by a similar fraction as one goes from the richest to the poorest quintile. Congo Democratic Republic of the Tajikistan Cote d’Ivoire Yemen Djibouti The shape of the coverage gap line can inform policies to address inequities. Many country graphs have relatively Equatorial Guinea straight downward-sloping lines from the poorest to the best-off quintile, which would suggest that efforts Eritrea should be made to increase the overall coverage of interventions, but with special attention paid to the poor. A Ethiopiaa top inequity pattern, as illustrated in the Burkina Faso and Niger country profiles, with a relatively small coverage Gabon Gambia, The gap among the best off 20 per cent, suggests that inequities would be reduced by raising the overall population Ghana coverage of interventions. Guinea Guinea-Bissau Kenyaa A downward slope from the poorest quintile to the second-poorest quintile and then a more or less straight line (or Lao People’s Democratic Republic at least less steep) to the best-off quintile would be an example of bottom inequity, as shown in the Brazil country Liberia Madagascar profile. Such a pattern indicates that inequities are concentrated among the poorest and that the most appropriate Malawi policy response would be to target that particular group. Mali Mozambique Myanmara For coverage gap graphs with data from two or more surveys, it can also be used to analyze trends, both by overall Niger levels by wealth quintile and patterns between quintiles. A good example of the change from top inequity to linear Nigeria pattern to bottom inequity as the overall coverage gap is reduced over time is Nepal between 1996 and 2006. Pakistana Papua New Guineaa Rwanda 5. Explanation and interpretation of coverage gap ratio Senegala Sierra Leone The ‘coverage gap ratio’ was derived by dividing the coverage gap for the poorest quintile with that of the best- Somalia off quintile. A ratio of 1 indicates equity in coverage in terms of comparing those two quintiles (there could still be Sudana Tanzania, United Republic of inequities with regards to the three middle quintiles). A ratio of less than 1 indicates a lower coverage gap (higher Togo coverage of interventions) among the poor, while a ratio of more than 1 indicates a lower coverage gap among the Uganda best-off. The higher the ratio, the more inequity there is in coverage of interventions. Zambia Zimbabwe Note: 6. Explanation and interpretation of coverage gap difference a. Countries having lower risk of Plasmodium falciparum transmission in identifiable areas (such as certain urban centres), but with highest The difference is derived by subtracting the coverage gap of the best-off quintile from that of the poorest quintile. prevention strategy still recommended nationwide. A positive difference implies that the coverage gap is larger among the poor; that is, coverage of interventions is lower among the poor. A relatively large poorest–best-off difference can occur in all patterns: top or bottom Source: World Health Organization International Travel and Health Report inequality or linear patterns. A small difference tends to occur in countries with smaller coverage gaps.

Notes: 1 Wagstaff and Watanabe 2003. 2 Gwatkin, Rutstein, Johnson, and others 2005. 3 For more information on the calculation of the wealth index from DHS and MICS data, please refer to Rutstein and Johnson 2004. 4 Victora, Fenn, Bryce and Kirkwood 2005.

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pantone pantone 382 C 322 C 381 U 321 U

CMYK (process) CMYK (process) DS 302-3 C DS 249-3 C C 25, Y 95 C 95, Y 25, K 35 DS 302-5 U DS 248-2 U C 20, Y 65 C 100, Y 30, K 30

www.countdown2015mnch.org

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