Exemplars in Under-5 Mortality: Senegal Case Study Dr. Agnes Binagwaho1, Kelechi Udoh1, Kateri Donahoe1, Zaira Gasanova2, Dr. Mohamadou Sall3, Dr. Lisa R Hirschhorn1,2 1 University of Global Health Equity 2 Feinberg School of Medicine, Northwestern University 3 Université Cheikh Anta Diop de Dakar (UCAP), Institut de Population, Développement et Santé de la ReproduCtion 20 May 2018 Exemplars in U5M: Senegal Case Study 1 Table of Contents LIST OF TABLES .................................................................................................................................................... 4 LIST OF FIGURES ................................................................................................................................................... 6 ACKNOWLEDGEMENTS ........................................................................................................................................ 8 ABBREVIATIONS .................................................................................................................................................. 9 1 EXECUTIVE SUMMARY .................................................................................................................................. 12 1.1 Background .................................................................................................................................................... 12 1.1.1 Exemplars in Global Health Under-5 Mortality Project ......................................................................... 12 1.1.2 Senegal .................................................................................................................................................. 12 1.1.3 Methods ................................................................................................................................................ 13 1.2 Key Findings ................................................................................................................................................... 13 1.2.1 Coverage and Equity of Selected Under-5 Mortality Interventions ...................................................... 13 1.2.2 Common Implementation Strategies .................................................................................................... 16 1.2.3 Examples of Implementation of EBIs to Address Major Causes of Death ............................................. 16 1.3 Cross-Cutting Contextual Factors .................................................................................................................. 18 1.4 Challenges ...................................................................................................................................................... 20 1.5 Transferrable Knowledge for Other Countries .............................................................................................. 20 1.6 Conclusions .................................................................................................................................................... 25 2 INTRODUCTION ............................................................................................................................................ 42 2.1 Exemplars in Global Health ............................................................................................................................ 42 2.2 Exemplars in Under-5 Mortality ..................................................................................................................... 42 2.3 Senegal ........................................................................................................................................................... 43 3 METHODS ..................................................................................................................................................... 56 3.1 Project Framework ........................................................................................................................................ 56 3.2 Desk Review ................................................................................................................................................... 56 3.3 Primary Research ........................................................................................................................................... 57 3.4 Analysis and Synthesis ................................................................................................................................... 57 3.5 Human Subjects Review ................................................................................................................................. 58 3.6 Key Informants ............................................................................................................................................... 58 4 SPECIFIC CAUSES OF DEATH AND EVIDENCE-BASED INTERVENTIONS ............................................................. 59 4.1 Malaria, Diarrhea, and Pneumonia ................................................................................................................ 60 4.1.1 Facility-Based Integrated Management of Childhood Illness ................................................................ 61 4.1.2 Community-Based Integrated Management of Childhood Illness ........................................................ 68 4.1.3 Other Diarrhea Interventions ................................................................................................................ 76 4.1.3.1 Oral Rehydration Therapy and Zinc for Diarrhea .............................................................................................. 76 4.1.3.2 Rotavirus Vaccination ....................................................................................................................................... 79 4.1.4 Other Pneumonia Interventions ........................................................................................................... 83 4.1.4.1 Pneumococcal Vaccination ............................................................................................................................... 83 Exemplars in U5M: Senegal Case Study 2 4.1.5 Other Malaria Interventions ................................................................................................................. 87 4.1.5.1 Insecticide-Treated Nets ................................................................................................................................... 88 4.1.5.2 Intermittent Preventive Treatment for High Risk Groups ................................................................................ 92 4.1.5.3 Indoor Residual Spraying .................................................................................................................................. 97 4.2 Other Vaccine-Preventable Diseases ........................................................................................................... 100 4.2.1 Meningococcal .................................................................................................................................... 101 4.2.2 Haemophilus Influenzae Type B (Hib) Vaccination ............................................................................. 101 4.2.3 Measles Vaccination ............................................................................................................................ 103 4.3 HIV: Antiretroviral (ARV) for Prevention of Mother-to-Child Transmission and Treatment for Infants and Children .. 107 4.4 Malnutrition Interventions .......................................................................................................................... 113 4.5 Vitamin A ..................................................................................................................................................... 121 4.6 Neonatal Interventions ................................................................................................................................ 122 4.6.1 Improving Antenatal Care Services, Access, and Uptake .................................................................... 123 4.6.1.1 Improving Access to Antenatal Care ............................................................................................................... 123 4.6.1.2 Maternal Tetanus Vaccination ........................................................................................................................ 127 4.6.1.3 Iron and Folic Acid Supplementation .............................................................................................................. 129 4.6.1.4 Other Components of Antenatal Care ............................................................................................................ 130 4.6.2 Improving Child Birth Delivery Services, Access, and Uptake ............................................................. 131 4.6.2.1 Facility-Based Delivery .................................................................................................................................... 131 4.6.2.2 Neonatal Resuscitation ................................................................................................................................... 134 4.6.3 Care for Premature/Low Birth Weight Neonates ................................................................................ 136 4.6.3.1 Kangaroo Mother Care ................................................................................................................................... 137