Prevention : environmental health interventions to sustain child survival

The USAID approach to Child Survival, which stressed childhood immunizable diseases and the treatment of diarrhoea through oral rehydration, has undoubtedly contributed to the substantial decline in infant and childhood mortality globally in the last twenty years. However, today many fear that a ceiling has been reached with regard to Child Survival successes and believe that a purely curative approach is not as effective as eliminating the problem through prevention. This concept paper advocates a paradigm shift in Child Survival from an exclusive focus on case management and facility-based service to include a focus on household and community-level environmentally based prevention. The paper reviews the history of primary health care, its evolution into Child Survival, the successes and limitations of Child Survival, the advent of integrated case management, and the need to add prevention to the Sick Child Initiative. A conceptual framework for understanding environmentally based prevention is provided. The paper focuses on the three major Child Survival diseases - diarrhoea, malaria, and acute respiratory infection or ARI - and suggests specific environmental health interventions that can be integrated into current Child Survival programmes. What is known from the literature regarding the effectiveness of these measures is summarized, and ideas are provided as to how the measures can be packaged. A discussion of methods for integrating environmental health interventions into Child Survival programming concludes the paper.