Exemplars in Under-5 Mortality: Cambodia Case Study Dr. Lisa R Hirschhorn1,2, Amelia VanderZanden1, Kelechi Udoh1, Jovial Thomas Ntawukuriryayo1, Dr. Agnes Binagwaho1 1 University of Global Health Equity 2 Feinberg School of Medicine, Northwestern University 28 February 2020 Table of Contents LIST OF TABLES .................................................................................................................................................... 3 LIST OF FIGURES .................................................................................................................................................. 5 ACKNOWLEDGEMENTS ........................................................................................................................................ 6 ABBREVIATIONS .................................................................................................................................................. 7 1 EXECUTIVE SUMMARY ..................................................................................................................................... 10 1.1 Background ............................................................................................................................................................ 10 1.2 Key Findings ........................................................................................................................................................... 12 1.3 Cross-Cutting Contextual Factors ......................................................................................................................... 16 1.4 Challenges ............................................................................................................................................................. 16 1.5 Transferrable Knowledge for Other Countries ..................................................................................................... 16 1.6 Conclusions ........................................................................................................................................................... 17 2 INTRODUCTION ............................................................................................................................................... 18 2.1 Exemplars in Global Health ................................................................................................................................... 18 2.2 Exemplars in Under-5 Mortality ............................................................................................................................ 18 2.3 Cambodia .............................................................................................................................................................. 19 3 METHODS FOR CASE STUDY ............................................................................................................................. 35 4 SPECIFIC CAUSES OF DEATH AND EVIDENCE-BASED INTERVENTIONS ............................................................... 37 4.1 Malaria, Diarrhea, and Pneumonia ....................................................................................................................... 40 4.1.1 Facility-Based Integrated Management of Childhood Illness ....................................................................... 40 4.1.2 Community-Based Integrated Management of Childhood Illness ................... 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Bookmark not defined. 4.1.3 Other Diarrhea Interventions ........................................................................................................................ 49 4.1.4 Other Pneumonia Interventions ................................................................................................................... 52 4.1.5 Other Malaria-Prevention Interventions ...................................................................................................... 56 4.2 Other Vaccine-Preventable Diseases .................................................................................................................... 59 4.2.1 Haemophilus Influenzae Type B Vaccination ................................................................................................ 60 4.2.2 Measles Vaccination ...................................................................................................................................... 63 4.3 Tuberculosis .......................................................................................................................................................... 65 4.4 HIV ......................................................................................................................................................................... 68 4.4.1 Antiretroviral Therapy for Prevention of Mother-to-Child Transmission and Treatment for Infants and Children ................................................................................................................................................................... 69 4.5 Malnutrition .......................................................................................................................................................... 72 4.5.1 Severe Acute Malnutrition Interventions ..................................................................................................... 71 4.6 Vitamin A ............................................................................................................................................................... 74 4.7 Neonatal Interventions ......................................................................................................................................... 75 4.7.1 Improving Antenatal Care Services, Access, and Uptake ............................................................................. 76 4.7.2 Improving Childbirth Delivery Services, Access, and Uptake ........................................................................ 84 4.7.3 Improving Postpartum Care .......................................................................................................................... 91 4.8 Common Implementation Strategies ................................................................................................................... 98 5 CROSS-CUTTING CONTEXTUAL FACTORS FACILITATING UNDER-5 MORTALITY REDUCTION ............................ 100 5.1 Effective Leadership and Accountability: Setting Clear Goals and Priorities (Facilitator) ................................. 100 5.2 Culture and Process of Donor and Implementing Partner Coordination and Donor Resources (Facilitator) ... 101 5.3 Economic Growth and Poverty Reduction (Facilitator) ...................................................................................... 101 5.4 Other Public Health Initiatives with Impact on U5M Reduction Including WASH (Facilitator and Barrier) ...... 102 5.5 Community Health System and Structure (Facilitator) ...................................................................................... 102 5.6 Health Systems Structure and Strengthening (Facilitator and Barrier) ............................................................. 102 5.7 Data Availability and Culture of Use (Facilitator) ............................................................................................... 103 5.8 Existence of In-Country Research Capacity and Prioritization of Local Research (Facilitator) .......................... 103 5.9 Expanding Private Health Sector (Facilitator and Barrier) ................................................................................. 103 5.10 End of Conflict (Facilitator) ............................................................................................................................... 103 5.11 Health Insurance (Facilitator) ........................................................................................................................... 104 5.12 Nutrition-Targeted Interventions (Facilitator and Barrier) .............................................................................. 104 5.13 Women’s Empowerment/Education (Facilitator and Barrier) ......................................................................... 105 5.14 Reproductive Health (Facilitator) ..................................................................................................................... 106 6 CROSS-CUTTING AND REMAINING CHALLENGES ............................................................................................ 107 6.1 Quality of Care ..................................................................................................................................................... 107 6.2 Ongoing Health Inequity ..................................................................................................................................... 107 6.3 Out-of-Pocket Spending ...................................................................................................................................... 107 6.4 Neonatal Mortality .............................................................................................................................................. 107 6.5 Government Funding for Health ......................................................................................................................... 108 6.6 Air Pollution ......................................................................................................................................................... 108 6.7 Lack of Qualified