There is a dearth of up-to-date data on infectious diseases in children and adolescents in the Region (as illustrated by missing data for a number of key indicators in this chapter), which means that some of the subregional averages should be interpreted with caution. Pneumonia and diarrhoea nevertheless are still among the most common causes of death in children under 5 in the Region (8) and globally (12).
Complete and updated data are needed to better assess the burden in the Region and tackle it appropriately.
Data on children under 5 with pneumonia who are taken to a health-care provider are available only in 13 countries, and pneumonia hospitalization in children under 5 in 22. Only 16 countries reported on the treatment of diarrhoea with oral rehydration therapy. Indicators related to pneumonia and diarrhoea are included in monitoring of the global strategy for women’s, children’s and adolescents’ health (3) (Annex 2). They are also critical for monitoring progress on the integrated global action plan for the prevention and control of pneumonia and diarrhoea targets (12), one of which, the target of having over 90% of the population having access to a water supply and a hygienic sanitation facility, has been met by most countries in the Region; the countries with the lowest coverage rates are mostly in the CIS and SEEHN. WHO’s IMCI recommends oral rehydration therapy, increased fluid intake and continuous feeding in the management of diarrhoea (5). Efforts to increase rates of exclusive breastfeeding would also be beneficial in reducing the rates of childhood diarrhoea.
The lack of available data also affects:
● HIV, for which only two countries reported on prevalence in children aged 0–14 years and 16 on rates in adolescents;
● rotavirus infection, which causes more than 10 000 deaths in children under 5 in the Region and is a major cause of morbidity and mortality globally (13), for which rates were reported in only eight countries;
● HPV vaccine coverage, which is available for only one third of countries;
● PCV, for which less than half of countries in the Region reported coverage rates; and
● tuberculosis prevalence in children under 14 years, which is available for just over half of the Region.
The European strategy (1), target 3 of the SDGs (2) and the global strategy for women’s, children’s and adolescents’ health (3) rely on indicators such as these to meet agreed goals (Annex 2). Surveys such as USAID’s Demographic and Health Survey (DHS) (14) and UNICEF’s Multiple Indicator Cluster Survey (MICS) (15) provide systematic population-based information on vaccinations, pneumonia and diarrhoea for children under 5. Countries that do not participate in them should develop comparable means of collecting such data.
Conclusion
This chapter has highlighted the inadequacy of available data in tackling the first priority of the European child and adolescent health strategy and the subregional effort to meet the expected targets of the 2030 Agenda, including the SDGs and the global strategy for women’s, children’s and adolescents’ health. Improving vaccine coverage, and the inclusion of critical vaccines to reduce preventable causes of under-5 mortality and cervical cancers in adulthood, must remain a regional priority. Adequate monitoring, surveillance and reporting of data are necessary.
Table 9.1 includes all indicators used in this chapter, and data from the country profiles and the survey displayed by country with summary statistics.
Table 9.1. Infectious diseases and environmental health: summary table
Country
Country code Pneumonia hospitalization rate under 5 years per 1 000 Pneumonia symptoms under 5 years taken to health-care provider Homes conected to water supply system (%) Access to sewage system (%) Measles vaccination under 2 years (%) Hib vaccination under 1 year (%) PCV vaccination under 1 year (%) Rotavirus vaccination under 1 year (%) Estimated child HIV rates per 100 000 (0–14 years) Adolescent HIV rates (15–24 years) females (%) Adolescent HIV rates (15–24 years) males (%) Oral rehydration therapy for diarrhoea 0–4 years (%) DTP3 immunization coverage among 1-year-olds (%) Tuberculosis cases per 100 000 (0–14 years) HPV vaccination 3rd dose young people (%)°
Country HPV vaccinetion available free of charge
Albania ALB – 70 95 93 98 99 99 – – – – 63 98 – – Albania -
aMKD: the former Yugoslav Republic of Macedonia (MKD is an abbreviation of the ISO).
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Introduction
This chapter presents indicators and policies related to the nutrition and physical activity of children and adolescents in the European Region. It covers the whole age range, from breastfeeding in newborns to nutrition and physical activity in adolescents. The chapter delves into topics related to the European child and adolescent health strategy’s first priority of addressing the unfinished agenda of preventable death and infectious disease, and directly addresses its third priority, protecting and reducing risk – promoting healthy nutrition and physical activity through the life-course (1). The aim of this chapter is to help identify areas for action in the Region.
Key findings
● Most countries report having a policy in place to initiate exclusive breastfeeding, but there is wide subregional variability around exclusive and partial breastfeeding rates, which indicates weak adherence to WHO guidelines.
● Less than a quarter of countries collect information on marketing of complementary feeding products for infants and young children.
● Marketing to children is not regulated in half of countries, with several having plans to initiate regulations.
● Data on undernutrition in young children are infrequently collected in the Region and are often outdated; they therefore do not allow a good estimation of the size of the problem to be made.
● High childhood obesity and low physical activity rates abound in the Region, with adolescents’
physical activity being far below the recommended level.