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Analytical summary - Child and adolescent health

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Besides programmes for pregnant women, neonates and children aged under 5 years, the Government of Botswana has established policies, programmes and procedures to protect the health of older children and adolescents. The Early Childhood Care and Education Policy of 2001 aims to provide preschool children with stimulation and play.

The School health policy and procedure manual[1] provides a guide for monitoring the growth and health status of schoolchildren. Some of the major services provided in the school health programme are feeding and immunization.

As a result of HIV/AIDS and the associated decline in breastfeeding, malnutrition has become one of the major causes of child morbidity and mortality in Botswana. Guidelines for managing malnourished children have been put in place and a community-based management of acute malnutrition protocol was introduced in 2009, emphasizing the community level as a foundation for success in managing severe acute malnutrition.

Botswana has instituted a number of legal reforms aimed at improving the situation of children:

  • the Immunization Act was enacted in 2005 to make illegal parents’ refusal to have their children immunized;
  • the Education Act was reviewed to allow girls who become pregnant to continue with school within 6 months of childbirth;
  • the Marriage Act was revised in 2001 to make child marriage (under age 18 years) illegal.

Botswana has committed itself to the 1990 World Declaration on the Survival, Protection and Development of Children as well as the UN Convention of the Rights of the Child 1990.

Some of the common causes of morbidity in children under the age of 5 years, excluding neonatal conditions, include diarrhoea of infectious origin, pneumonia, bronchopneumonia, dehydration, respiratory diseases, anaemia, retrovirus infections and contact with and exposure to HIV. The commonest underlying cause of mortality in children is HIV, which accounted for 58% of under-five mortality in 2006.

Paediatric antiretroviral treatment is available nationwide with high-level specialized care available in the two general referral hospitals. DNA polymerase chain reaction testing for children under the age of 18 months has facilitated early diagnosis and treatment of paediatric HIV/AIDS.

In 1997, the Government adopted a comprehensive and holistic Integrated Management of Childhood Illnesses Strategy to reduce under-five mortality. Integrated Management of Childhood Illnesses preservice training has been incorporated in training institutions. The Accelerated Child Survival and Development Strategy specifically addresses the Millennium Development Goal on infant mortality and spells out high-impact low-cost interventions for disease, nutrition, growth and development monitoring, immunization and any special needs of the child.

Adolescents’ right to sexual reproductive health was first recognized internationally at the Convention on the Rights of the Child in 1989. Botswana has since made a commitment to transform its sexual and reproductive health services accordingly. Several policy initiatives put adolescents' sexual and reproductive health needs at the top of the agenda of health and development, and encouraged an enabling environment for adolescent-centred sexual and reproductive health programmes.

All government health facilities have broadened access to sexual and reproductive health services for adolescents. The Ministry of Education has incorporated sexual and reproductive health in the school curriculum at primary, secondary and teacher training level. It has also established guidance and counselling units in schools to address students’ needs and to support teachers in teaching sexual and reproductive health. Gender has been integrated in the planning of interventions, targeting males for greater involvement in gender-equitable sexual and reproductive health behaviours, and enhancing an enabling environment through sensitizing stakeholders on gender issues.

Service providers trained in youth-friendly services, 2003–2008. Source: Ministry of Health, 2008
Since 2003, the Government has made an effort to establish adolescent-friendly sexual and reproductive health services (see table), although resources constraints have slowed down progress.


References

  1. Botswana national school health policy and procedure manual. Gaborone, Government of Botswana, Government printers, 1999