Double Entry Journals

Source: https://www.unicef.org/health/index_maternalhealth.html

“In 2015, it is estimated that about 800 girls and women died every 800 mother mortalities are due
day as a result of pregnancy and child birth-related complications. to child birth, inadequate
Maternal deaths are now increasingly concentrated in sub-Saharan maternal care and large
Africa, where high fertility rates combine with inadequate access to pregnancy rates leads to higher
quality antenatal care and skilled attendance at birth to substantially risks of these deaths.
elevate the risk of death in this region.”

“While the world has achieved impressive reductions in mortality of Although healthcare for
children aged under five since 1990, the survival of newborns (young children is poor, it is getting
infants in the first month of life) has lagged behind. It is estimated better. But newborn care is
that in 2015, about 1 million newborns died, equivalent to 2,740 per falling behind on these
day.” improvements. Around 2,740
newborn mortalities occurred in
2015.
“A child born in 2015 was approximately 500 times more likely to In 2015, 2.6 million stillborn
die on the first day of life that at one month of age. The high burden births were estimated. This is a
of still births is also an increasingly recognized problem, with 2.6 very large number and has been
million estimated still births in 2015.” recognized as a large burden.

“This means development programs should anticipate risks and Programs need to be developed
deliberately build systems that can flexibly respond to changing to make informed risks and be
circumstances. In addition, emergency programs, including for public prepared for them.
health emergencies and outbreaks, should be designed to “build back
better,” or enact reforms that make the health system more effective
even after the disaster has passed.”
“UNICEF’s approach to health emphasizes the importance of multi- UNICEF aims to work on
sector approaches to enhance child development and address healthcare system
underlying causes and determinants of poor health outcomes. It aims strengthening and merging
to shift UNICEF from vertical disease programmes to strengthening humane and development
health systems and building resilience, including calling for better efforts. They also plan to
integration of humanitarian and development efforts and encouraging promote risk-informed
risk-informed programming in all contexts.” programming.
In 2015 alone, there were 214 million new cases of malaria reported, In these developing nations,
and approximately 438,000 people died of this preventable and Malaria is a leading cause of
treatable disease, 70 per cent of whom are children under five, still death from disease. In children,
die from this preventable disease every year. 90% of malaria deaths this number is even greater.
occur in Sub-Saharan Africa. About 3.2 billion people – almost half Out of all the people who died
of the world’s population – are at risk of malaria. The disease also from this disease, 70% of them
contributes greatly to anaemia among children — a major cause of were kids. This can also lead to
poor growth and development. anaemia.
 Diarrheal diseases account for roughly 530,000 deaths a year, 9% of Out of all the leading causes of
total deaths among children under-five years of age, making them the death for children in
second most common cause of child deaths worldwide. Over half of developing nations, diarrheal
the deaths occur in just five countries: India, Nigeria, Afghanistan, diseases are the second leading
Pakistan and Ethiopia. Despite this heavy toll, progress is being killer. Even though this is a
made. From 2000 to 2015, the total annual number of deaths from leading cause of death, they are
diarrhea among children under 5 decreased by more than 50 per cent concentrated in only 5
– from over 1.2 million to half a million counrties.9% of all deaths from
these diseases are among
children under the age of 5.

Pneumonia is still a single leading cause of child death, killing 1 child Pneumonia care has made
every 35 seconds. Pneumonia accounts for almost one million deaths progress but still falls behind
every year, 922,000 in 2015 which is 16% of total deaths among the progress of other illnesses.
children under-five years of age, 5% of which are neonatal. This This sickness is a leading cause
makes it the single most common cause of child deaths worldwide. of children mortalities. In 2015,
Despite having made some progress, a 51% decrease in pneumonia 16% of child and infants were
due to pneumonia.
from 2000 to 2015, it is nowhere near the greater than 86% decrease
in mortality from malaria-related under five mortalities in the same
time frame. There is still a significant road ahead to make a marked
reduction in the preventable, treatable deaths due to pneumonia.

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5864848/

“Pediatric critical care is an important component of
reducing morbidity and mortality globally. Currently,
pediatric critical care in low middle-income countries
(LMICs) remains in its infancy in most hospitals. The
majority of hospitals lack designated intensive care
units, healthcare staff trained to care for critically ill
children, adequate numbers of staff, and rapid access
to necessary medications, supplies and equipment. In
addition, most LMICs lack pediatric critical care
training programs for healthcare providers or
certification procedures to accredit healthcare
providers working in their pediatric intensive care
units (PICU) and high dependency areas.”
“PICU can improve the quality of pediatric care in
general and, if properly organized, can effectively
treat the severe complications of high burden
diseases, such as diarrhea, severe malaria, and
respiratory distress using low-cost interventions.”
Low middle-income countries suffer from lack of
critical healthcare for children. This comes from not
having sufficient units to care for children, not
enough staff trained specifically for pediatric
intensive care, and not sufficient access to
medications, tools, and other medical supplies
needed. Also, in these nations there is not adequate
programming to train people to become PICU
workers.
Many leading causes of child mortality could be
prevented by the use of PICUs in low middle-income
countries. Diarrhea and malaria could be drastically
treated with PICUs by using low cost interventions.
 “In LMIC settings, the burden of pediatric mortality
remains high and a largely undocumented burden of
critical illness exists (14). The “three delays” model,
first developed to explain why maternal deaths occur
may be applied to identify factors that are significant
contributors to childhood mortality in LMICs (15).
The three delays are (1) delay in deciding to seek
care, (2) delay in reaching the appropriate facility,
and (3) delay in receiving quality care at the facility.”
Effective critical care in LMICs relies on having a
dedicated area, where close observation and frequent
monitoring of pediatric patients leads to the provision
of rapid, timely, appropriate interventions.
In most developing nations, child mortality is a large
burden. There has been model developed to explain
significant reasons for this called the “three delays.”
These three reasons are; delay in seeking care, delay
in arriving to a capable facility, and delay in getting
the best care possible.
For critical care units in LMICs, having an area
dedicated to the constant observation of patients and
care that is given as soon as needed is what is needed
for PICUs to function at the best capacity.

A thoughtful approach to developing pediatric critical
care services starts with fundamental skills and
knowledge, inexpensive, but effective equipment, and
supportive leadership. These fundamentals can be
built on in a sustainable manner, having the potential
to significantly decrease pediatric morbidity and
mortality in LMICs through excellent, but appropriate
critical care in the context of public health goals as
we reach toward the 2030 SDGs.
When developing pediatric critical care units, service
can start when background knowledge, effective
equipment, and effective leadership are in place. A
plan with these factors involved could lead to a
decrease in the deaths of children in developing
nations.

Source: http://www.who.int/heli/risks/ehindevcoun/en/

“Unsafe water, and poor sanitation and hygiene kill an estimated
1.7 million people annually, particularly as a result of diarrheal
disease (2).”
“Malaria kills over 1.2 million people annually, mostly African
children under the age of five (3). Poorly designed irrigation and
water systems, inadequate housing, poor waste disposal and
water storage, deforestation and loss of biodiversity, all may be
contributing factors to the most common vector-borne diseases,
including malaria, dengue and leishmaniasis.”
“MDG 4 – Reduce Child Mortality. Shifting to cleaner
household fuels and/or to improved cook stoves can reduce
indoor air pollution, and thus have a direct impact on child
mortality from acute respiratory disease, a key childhood killer
(2). Improved water and sanitation provision as well as better
household water management can potentially have an impact on
childhood mortality and morbidity both from diarrheal and
vector-borne diseases (2)”
Unsafe water is the underlying cause for
diarrheal diseases. These types of diseases
are one of the leading causes of death of
children in developing nations.
Malaria has a large impact on the amount
of children mortalities. Many factors
contribute to the worsening of Malaria.
These factors are things like poor water and
disposal systems.
To make a change in child mortality rates,
a change needs to be made. Cleaner fuels in
homes could lower air pollution rates and
causing a decrease in respiratory diseases.
Proper water sanitation can help improve
diarrheal and vector-borne diseases.
 Source: https://www.voanews.com/a/new-plan-provides-better-health-care-in-developing-
countries/1809104.html
“Major donors are changing the way they fund
health programs in low-income countries. The
results in maternal and child health have been so
successful that the World Bank and the Global
Fund are working together to add programs on
AIDS, tuberculosis and malaria. The change in
financing focuses on motivating health care
workers to provide better care and on helping
patients obtain it.”
“Children born in sub-Saharan Africa have the
greatest risk of dying in their first five years. Most
of the deaths are preventable.”
“The plan is called "results-based financing." It
links incentives with results. For example, in some
countries, women are paid to have their babies in a
hospital. Midwives get extra money for delivering
healthy babies. Doctors might get extra pay if they
immunize a certain number of children.”
“The program provides incentives to direct medical
care to patients or get the patient to the clinic. It’s a
function of giving an incentive to those people on
the ground to solve those problems, because the
incentive for them is to achieve the results," said
Evans.”
“Since 2007, the World Bank has funded results-
based programs in 31 countries, enough to see that
the program saves lives and stretches donor funds.
The Bank is now collaborating with the Global
Fund to Fight AIDS, Tuberculosis and Malaria - to
help it adopt results-based financing in fighting
these deadly diseases.”
With funding from large donors, improvements
are being made in the healthcare lives of
children in low income nations. There are now
programs being put in place to lower the rates
of some of the largest childhood killers.
Programs like this focus on motivation for both
the healthcare worker and the patient.
Many children are dying from preventable
causes. They just do not have sufficient ways to
care for all these kids.
Results-based financing is a plan put in place to
motivate healthcare workers to achieve
healthcare goals for children. Their motivation
comes from extra pay to meet certain goals.
Incentives can be received even for getting a
patient to a clinic, so they can obtain the proper
care needed. Giving incentives to those who
work directly with the children helps to fix
problems at the source. Achieving the desired
results acts as a incentive.
This program is effective and is saving lives
globally. Funds are being maximized and spent
to make a major difference. Big organizations
are now shifting to a focus on large childhood
killers with the incentive program to get
positive results.
 Source: https://med.stanford.edu/news/all-news/2014/04/health-care-aid-for-developing-
countries-boosts-life-expectancy-study-finds.html
“The researchers examined both public and private health-
aid programs between 1974 and 2010 in 140 countries and
found that, contrary to common perceptions about the waste
and ineffectiveness of aid, these health-aid grants led to
significant health improvements with lasting effects over
time.”
“Countries receiving more health aid witnessed a more rapid
rise in life expectancy and saw measurably larger declines in
mortality among children under the age of 5 than countries
that received less health aid, said Eran Bendavid, MD, an
assistant professor in the Division of General Medical
Disciplines and lead author of the study.”
“If health aid continues to be as effective as it has been, we
estimate there will be 364,800 fewer deaths in children
under 5,” he said. “We are talking about $1 billion, which is
a relatively small commitment for developed countries.”
“The researchers found that these funds were used
effectively, largely because of the targeting of aid to disease
priorities where improved technologies — such as new
vaccines, insecticide-treated bed nets for malarial prevention
and antiretroviral drugs for HIV — could make a real
difference.”
“He said the results are not surprising if one considers some
of the new health technologies made available to developing
nations as a result of foreign aid. Childhood vaccines,
including those for diphtheria, tetanus, polio and measles,
have all but wiped out what used to be among the top killers
of young children in the developing world. Health aid
directed to providing insecticide-treated malarial bed nets
also has been credited in recent studies with reducing
malarial deaths among young children, he noted.”
Many belive that aid from large investors
aren’t making a difference. But on the
contrary, they are making huge steps in
improving children’s healthcare in
developing nations.
The more aid a nation receives, life
expectancy rates rise for children.
Countries with more aid see more
positive outcomes in child mortality that
those without aid.
With continued aid, child mortality
numbers are said to be 364,800 fewer.
This comes at a cost of 1 billion dollars,
which is a small sum in the grand
scheme of things.
These funds are going to such a good use
because they are being used to improve
healthcare tools like vaccines, malaria
nets, and HIV drugs.
The great results are due to vaccinations
eliminating what used to be the top child
killers in developing areas. Malaria death
rates have lowered thanks to the positive
outcomes of the Malaria nets.