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SOUTH AMERICA: Uneven Progress in Child Health

BUENOS AIRES, Sep 16 2011 (IPS) - Argentina, Bolivia, Brazil, Chile, Paraguay and Uruguay have all made progress in the area of child health. But some are celebrating significant achievements while others are plodding slowly towards the goals adopted by the U.N. member countries in 2000.

This was the outlook reflected by the reports of representatives of the paediatric societies of the six countries of the Southern Cone of the Americas who met in Buenos Aires at an Argentine Paediatrics Society (SAP) congress.

The Sep. 13-16 meeting, held on the 100th anniversary of the founding of SAP, reported on child health indicators and discussed ways of improving them to help meet the fourth of the eight Millennium Development Goals (MDGs), a series of targets agreed on by global leaders at the U.N. Millennium Summit in 2000.

MDG4 is to reduce the under-five mortality rate by two-thirds, between 1990 and 2015.

Despite pending challenges, Argentina, Brazil, Chile and Uruguay have made good progress in fighting child malnutrition, cutting child mortality, and expanding vaccination coverage.

But in Bolivia and Paraguay, where poverty rates are still high although they are slowly coming down, child health indicators are still poor.

“Bolivia has the highest infant mortality rate in Latin America,” said Dr. Darwin Martínez, president of that country’s paediatric society. “We are 50 years behind Uruguay,” for example, he lamented in his address to the congress.

Poverty still affects 64 percent of Bolivia’s population of 10.5 million, but the proportion rises to 75 percent among children under 13. And 37 percent of children under five are malnourished, while 60 percent have anaemia, Martínez said.

He added that infant mortality is 50 per 1,000 live births; only 50 percent of children are up-to-date on their vaccinations; five percent of children under two have never been immunised; and one out of three young women under 20 have at least one child.

Martínez told IPS that progress has been made in the last 10 years, such as a reduction in malnutrition, an increase in childhood vaccinations, and policies that encourage exclusive breastfeeding for six months.

He also mentioned a programme that makes regular payments to mothers before, during and after childbirth, conditional on prenatal check-ups, medical attention during childbirth, and postnatal check-ups for the mother and child. In addition, the Health Ministry launched a universal mother and child insurance plan, which guarantees free care for mothers giving birth in any hospital in the country. But there is still a long way to go, he said.

Paraguay is also moving forward slowly. Dr. Luis Moreno pointed out that 35 percent of the country’s 6.5 million people are poor and 19 percent live in extreme poverty, infant mortality stands at 24 per 1,000 live births, and malnutrition affects 14 percent of children.

In Paraguay, which like Bolivia has a young population because it has not yet undergone the demographic transition to a reduced birth rate, fertility stands at 3.5 children per woman, one of the highest rates in the region.

But the rest of the countries are making strides. In Brazil, infant mortality plunged from 80 per 1,000 live births in 1983 to 19 per 1,000 today, paediatrician Eduardo da Silva Vaz reported.

Wasting (low weight-for-height) and stunting (low height-for-age) “in under-fives are no longer a problem in Brazil,” said the doctor, although he added that there is now concern about growing obesity rates among children, an issue that was frequently mentioned by representatives at the congress.

Brazil’s vaccination programme “is a success” because it has achieved near universal coverage, da Silva Vaz told IPS. The fertility rate, meanwhile, stands at just under two births per woman, although there are wide disparities based on educational level and socioeconomic status.

He expressed concern, however, that the failure to achieve universal preschool in his country of 192 million people means many children under five are “abandoned” or are taken care of by older siblings who are not in a position to provide them with early learning stimulation.

He also called attention to the high number of preventable deaths among adolescents, pointing out that 72 percent of deaths among 15 to 19 year olds are due to unnatural causes, particularly violence, accidents and suicide.

The president of SAP, Dr. Margarita Ramonet, explained that while Argentina’s infant mortality rate is 12.1 per 1,000 live births,that average conceals huge disparities. For example, in the northeast province of Formosa, which borders Paraguay, the rate stands at 20.5 per 1,000, while it is only 8.5 per 1,000 in the city of Buenos Aires.

Meanwhile, between 92 and 99 percent of the population is immunised, depending on the vaccination in question. But the teen pregnancy rate remains high, at 14.5 percent of teenage girls and women, despite numerous sex education programmes and free access to birth control methods in the public health system.

Like the representative from Brazil, the Argentine paediatrician said there was concern about the high level of adolescent deaths, with 60 percent of deaths among 15 to 17-year-olds due to “reducible causes”. She also noted that 46 percent of teenagers have already begun to drink alcohol by the age of 13.

In Chile and Uruguay there have also been significant advances, although there are still unmet challenges. In the case of Chile, Dr. Francisco Moraga said infant mortality was 7.7 per 1,000 live births, and the number of births per woman was just under two, like in Brazil.

But these indicators, which are similar to those seen in the industrialised North, hide serious disparities. “Chile is the most unequal country in Latin America,” the paediatrician said, pointing out that infant mortality is seven times higher among women with low levels of education.

He also noted that, although the population of Chile is ageing and few children are born, 25 percent of births are to girls and women under the age of 20, 16 percent of whom are under 14.

And while malnutrition is no longer a concern in that country of 16 million people, 30 percent of children under seven are overweight, and 22 percent are obese.

Alicia Fernández, president of the Uruguayan paediatrics society, said that in her country of 3.3 million people, infant mortality has dropped to 7.7 per 1,000 live births, the lowest in the region, while childhood immunisation coverage is 99 percent.

She observed that one of the main problems in child health coverage in Uruguay is the heavy concentration of paediatricians in Montevideo, while there is a shortage in the rest of the country.

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