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达不到减低儿童死亡率的目标,约3,500万名5岁以下儿童将有性命威胁

2013-09-13

纽约/香港,2013年9月13日—— 联合国儿童基金会(UNICEF)一份最新报告显示,若不积极改变现状,全球将无法实现「千禧发展目标4」 —— 在2015年前将5岁以下儿童死亡率降低2/3。更严重的是,按照目前的发展趋势,这个目标在2028年前仍将无法实现。
 
APR不采取积极行动,付出的代价势将更为沈重:如果国际社会不立即采取行动,加快进度,在2015至2028年间,预料会有多达3,500万名儿童死于可预防疾病。
 
这是一个坏消息,幸而这份报告也带来不少喜讯。报告显示,大幅降低儿童死亡率是切实可行的。据估计,全球每年5岁以下儿童死亡人数从1990年的1,260万降至2012年的约660万。在过去22年,全球约有9,000万濒死边缘的儿童得以倖存。
 
「是的,我们应庆祝已取得的成果。」UNICEF执行主任安东尼.雷克说,「但为了实现目标,我们还有更多工作要做,怎能庆祝呢?我们有能力加快工作进度—— 我们知道应该怎么做,但我们需要在更大的危机感驱使下,加快推进行动。」
 
就在1年多前,埃塞俄比亚、印度和美国政府与UNICEF共同发起「致力于儿童生存:重申承诺」的倡议运动,号召全球携手努力,避免儿童死于可预防的疾病。
 
截至目前,已有176个政府签署了这一承诺,並宣誓允诺会加快提高儿童生存率的工作进度。数百个民间团体、宗教组织和独立人士也承诺支援这个让每一名儿童获得良好人生开端的共同目标。
 
(Centre) Irma Irene Yat Chú, an indigenous Mayan woman, holds her 1-year-old daughter, Lisbeth Gaiela, at home in the community of Chivencorral in Cobán Municipality, in Alta Verapaz Department. Volunteer health workers from a community health centre, (left-right) Laura de Jesús Icoó Pop and Mario Cucul, prepare a measles vaccine for Lisbeth. The centre, run by the Ministry of Health with support from UNICEF, serves a population of 3,476 and is open twice a week. Through home visits, volunteer health workers provide routine health care and immunizations for pregnant women and children under age 5 who are unable to travel to the health centre. [#6 IN SEQUENCE OF EIGHT]  In November 2012 in Guatemala, the Government and other partners are continuing to assure sustained routine immunization of children – now reaching 92 per cent of all infants – against a range of vaccine-preventable diseases. The country’s last endemic case of measles was in 1997. In the entire Americas Region (covering North, Central and South America), the last endemic measles case was in 2002 and the last endemic case of rubella was in 2009 – part of global efforts to eradicate these diseases. Worldwide, measles remains a leading cause of death among young children: In 2010, an estimated 139,300 people – mainly children under the age of 5 – died from the disease. Nevertheless, these deaths decreased by 71 per cent from 2001 to 2011, thanks in part to the Measles & Rubella Initiative, a global partnership led by the American Red Cross, the United Nations Foundation, the United States Centers for Disease Control and Prevention (CDC), WHO and UNICEF. In Guatemala, despite this success, significant other challenges for children remain, much of it related to poverty levels that affect more than half of all children and adolescents. Poverty also contributes to chronic malnutrition affecting half of all under-5 children (with higher rates among indigenous populations); an average national education level of under six years of primary school (under three years for the rural poor); and high, though decreasing, rates of violence. Guatemala is also one of the world’s most vulnerable countries to climate change, suffering a major climate-related emergency every year since 2008. On the positive side, birth registration is improving, with more than 95 per cent of newborns now being registered. UNICEF is working with the Government and other partners to sustain achievements in health, address the high levels of malnutrition, strengthen responses to crimes against children and increase protection services for children throughout public services.《致力于儿童生存:重申承诺——2013年度进展报告》研究自1990年以来的儿童死亡率趋势,分析了5岁以下儿童死亡的主要原因,並点出各国和国际社会拯救儿童生命的努力。迄今所取得的进展,可归功于各国政府、民间团体和私营部门的共同努力,以及增加可负担、有实证可循的干预措施,例如:采用杀虫剂处理过的蚊帐、药品、疫苗、正确的母乳餵哺方式、营养补充品和医疗食品、口服防脱水盐以治疗腹泻、已改善的安全饮用水和衞生设施等等。
 
报告显示,在世界各地、各收入阶层,包括在低收入国家,可预防的儿童死亡都大幅下降。事实上,一些世界上最贫困的国家,自1990年以来,在儿童生存方面所取得的进展最为明显。一些儿童死亡率高的低收入国家,如孟加拉、埃塞俄比亚、利比里亚、马拉维、尼泊尔和坦桑尼亚,当地的5岁以下儿童死亡率亦已较1990年的降低了2/3,甚至更多。这些国家在2015年最后期限来临前,成功实现了降低儿童死亡率的「千禧发展目标4」。
 
自上世纪90年代以来,全球已经加快降低儿童死亡率的步伐,年下降率增加超过4倍。撒哈拉以南非洲地区也加快了降低儿童死亡率的步伐,自20世纪90年代初以来,其年下降率增加超过5倍。过去7年里,东南部非洲地区更跻身全球取得最佳进展的地区之列,在2005至2012年间,5岁以下儿童死亡的年下降率为5.3%。
 
UNICEF Representative in the Central African Republic Souleymane Diabaté plays with a baby at the ADECOM (Association for Community Development) health post in the Bogbaya neighbourhood in Bangui, the capital, during the measles vaccination campaign. A woman and another child are seated nearby. Children are also receiving vitamin A and deworming tablets during the campaign. Mr. Diabaté’s shirt bears the UNICEF logo.  From 22 to 26 May 2013 in the Central African Republic, an emergency measles vaccination campaign is being held after eight children in Bangui, the capital, tested positive for the disease in April. The campaign is being implemented by the Ministry of Health, the World Health Organization (WHO), UNICEF and other partners and aims to immunize an estimated 125,000 children under age 5. Measles remains a leading cause of death among young children worldwide. In the Central African Republic, one of the world’s poorest countries, the measles vaccination rate stands at a low 62 per cent. Recent conflict has also contributed to a further eakdown in health and other services and put hundreds of thousands of children at risk of the disease. An estimated 246,500 vaccines have been despatched to Bangui in response to the outeak, and to improve routine measles vaccination in the country’s high-risk regions. In response to the current crisis, UNICEF is supporting emergency health activities in Bangui’s four main hospitals and at health centres throughout the country (including health supplies for up to 141,000 people for three months), as well as interventions in the areas of nutrition, water, sanitation and hygiene (WASH), education and child protection.相反,与全球其它地区相比,非洲中西部地区在儿童生存方面取得的进展却处于最低水平。同时,该地区的儿童死亡率亦为最高,每8名儿童中几乎就有1人在5岁前死亡。自1990年以来,中西部非洲地区每年死亡的儿童人数几乎沒有减少。
 
肺炎、腹泻、疟疾仍是全球儿童的主要死因,每天夺去约6,000名5岁以下儿童的生命。在所有的儿童死亡中,近半数与营养不良相关。
 
对于幼童而言,出生后的第1个月最为脆弱。在2012年,近300万名婴儿在出生后第1个月内死亡,大部分均死于能够简单预防的疾病。
 
要扭转这种灾难性趋势,必需立即在各个领域采取行动,正如「千禧发展目标」所述——减少贫困、降低孕产妇死亡率、改善教育和性別平等、促进环境的可持续发展。
 
「我们能够,並必需取得进展。」雷克先生说,「有协调一致的行动、有效的策略、充足的资源和坚定的政治意愿,就能够落实支持儿童和孕产妇生存,将大幅降低儿童死亡率变成可行的事;从道义上,也有必要这样做。」
 
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国家进展示例
 
• 在孟加拉,5岁以下儿童死亡率自1990至2012年下降了72%,主要归功于儿童防疫注射得到推广、采用口服防脱水盐治疗腹泻、以及提供维生素A补充剂。扩大的社区衞生工作者网路也提高了医疗服务质素,並促进了衞生设施的使用。女性地位和文化水准的提高、女性健康得到改善、扶贫政策的实施,也在降低儿童死亡率方面发挥了作用。
 
• 在巴西,运用综合策略下,5岁以下儿童死亡率自1990至2012年下降了77%。这些策略包括为社区提供医疗服务、改善衞生条件、提高女性文化知识水准、推广母乳餵哺和接种疫苗。
 
• 埃塞俄比亚是「行动号召」的共同发起国之一,在降低5岁以下儿童死亡率已取得巨大进展,自1990年以来儿童死亡率下降了67%。在埃塞俄比亚实施的衞生推广项目,充分体现了社区衞生工作者为偏远地区儿童和母亲提供优质医疗服务的重要性。该项目于2004年实施,目前组织有38,000名由政府支薪的女性衞生推广工作者。 UNICEF的支持,则包括提供疫苗存放装置、分娩床、药品等医疗用品,以至针对衞生工作者的培训。该项目还提供治疗严重急性营养不良、腹泻、疟疾和肺炎的儿童。
 

29 May 2011: A child is administered a dosage of  vitamin A from a red capsule at  Bharashakati Government Primary School, Ujirpur, during the UNICEF supported  National Vitamin A Plus Campaign, NVAC in Barisal.      The National Vitamin A Plus Campaign (NVAC) has been running for almost a decade and is one of the biggest in Bangladesh. In 2010, more than 95 per cent of children aged 12 to 59 months received Vitamin A supplementation and more than 93 per cent infants aged 9 to 11 months received Vitamin A supplementation. In 2011, as part of a new trial, infants aged six to eight months are eligible to receive the vaccination in seven districts. 900,000 infants between six and eight months were targeted during the one-day campaign. In the years prior, infants aged nine to 11 months received the vaccine as part of a wider immunization campaign against measles but following recommendations by the World Health Organisation, it was decided those aged between six and 59 months were to receive the vaccination as part of the specific Vitamin A campaign.  Bangladesh has a poor dietary intake of Vitamin A and less than 40 per cent of pregnant and lactating women receive enough Vitamin A as part of their diets. The supplement protects against night blindness, helps cells function, aids the production of protective red blood cells and boosts the body’s immune system. Because the campaign also aims to increase awareness around Vitamin A, more than 400,000 volunteers and 60,000 health service providers across Bangladesh assisted in getting people to distribution points, administering the droplets and disseminating information about the importance of Vitamin A and healthy living. Messages had been oadcast on television and radio as well as through megaphones attached to the back of moving vehicles. Posters were hung around villages and mosques delivered information to worshippers. Since 1997, the prevalence of night blindness in children has been maintained below the 1% threshold that signals a public health problem but on-going support is needed. The NVAC campaign targeting infants from six months is expected to run bi-annually for the next three years. It is being implemented by the Institute of Public Health Nutrition (IPHN), under the Ministry of Health and Family Welfare, in collaboration with the Expanded Programme on Immunization (EPI) and Primary Health Care. It is supported by UNICEF, the Micronutrient Initiative and WHO.

As her mother watches, a man health worker marks a girl's fingernail to indicate that she has received a dose of oral polio vaccine, during the door-to-door polio NIDs in the village of Beles in Tigray Region. [#5 IN SEQUENCE OF SIXTEEN]  From 1 to 5 April 2005 in Ethiopia, the first of two rounds of National Immunization Days (NIDs) against polio this year targeted 14.7 million children under five. Although Ethiopia had been polio-free for four years, the current NIDs are in response to two cases of polio detected in children in the Tigray Region in December 2004 and early January 2005. Some 100,000 volunteers and health workers are participating in the campaign which will go door-to-door in an effort to reach all children. UNICEF is providing 21 million doses of vaccine for the campaign. The Ethiopian outeak is part of a larger outeak in many previously polio-free African countries, following the suspension of polio immunization campaigns for several months in northern Nigeria in late 2003 and part of 2004 that caused a surge of new cases. Mass vaccinations resumed in Nigeria early this year and NIDs against the disease are now underway in 22 African countries, aimed at reaching 100 million children.

关于「致力于儿童生存:重申承诺」
 
「重申承诺」是一项全球运动,旨在配合「每个妇女、每个儿童」的倡议——这倡议由联合国秘书长潘基文发起,旨在动员和加强全球行动,改善妇女和儿童健康— —通过行动和宣传加速减少可预防的孕产妇、新生儿和儿童死亡。
 
埃塞俄比亚、印度和美国政府与UNICEF一同于2012年6月召开的高峰会议「儿童生存行动号召」上发起了这项运动。该会议旨在探讨促进儿童生存方面进展的途径。来自政府、民间团体和私营部门的合作伙伴也参与的「行动号召」会议,並致力改善儿童的生存情况。