funded Tanzania Essential Health Interventions Project (TEHIP). By the end of 2005, the strategy had been rolled out to 107 districts (94% average of districts). 154. Evidence from IMCI and TEHIP suggests that with training and health systems support, productivity of health workers is improved and the greater burden of disease in under-fives can be addressed cost-effectively. Findings from IMCI evaluations demonstrated that: (a) After two years, mortality levels were 13% lower in the two TEHIP/IMCI districts compared with control Districts, and there was also a significant reduction in stunting. (b) IMCI costs less than conventional care. The cost of under-five care per child was estimated at US$11.19 in IMCI districts compared with US$16.09 in non-IMCI districts. (c) Children in IMCI districts received more thorough assessments, and were more likely to be correctly diagnosed and to receive appropriate treatment. (d) Supportive supervision of health workers was much more common in IMCI districts. Case management of sick children is improved by IMCI training – those caring for sick children were routinely informed of how to look after the children and how to administer medicines. (e) Improved quality of care provided to children in health facilities with IMCI-trained health workers resulted in greater utilisation of health facilities; in Morogoro Rural and Rufiji districts, the utilization increased from 30% in 1997 to 70% in 2001. 143. Introduction of a series of practical management, priority-setting tools for19 District Health Management (vi) Immunization 155. The Expanded Programme of Immunization (EPI) has performed well from the last reporting period with the immunization coverage of 75 percent of children age 12-23 months were fully immunized (TDHS 2010), a modest increase relative to the proportion reported in the 2004-05 TDHS (71 percent) and the 1999 TRCHS (68 percent) (NBS and Macro International Inc., 2000; NBS and ORC Macro, 2005). At least nine of ten children received BCG, DPT/DPT-HB 1 and 2 (or DPT-HB-Hib 1 and 2), and Polio 1 and However, the proportion of children receiving the third dose of DPT/DPT-HB (or DPT-HB-Hib) and polio vaccine is lower (88 and 85 percent, respectively), as is the proportion receiving measles vaccine (85 percent). The decrease in vaccination coverage between the first and third doses of DPT/DPT-HB/DPT-HB-Hib and polio are 8 and 12 percentage points, respectively. Only 3 percent of children have not received any vaccinations at all. With the exception of measles, more than 80 percent of the vaccinations were received by 12 months of age, as recommended. Overall, 66 percent of children were fully vaccinated at 12 months, a small increase from that reported in the 2004-05 TDHS (62 percent). 144. Vaccination status among children age 12-23 months does not differ significantly by the child’s sex. The proportion fully vaccinated is lower for children of birth order 6 or higher than for children at lower parities. There is significant variation by residence: 86 percent of urban children are fully immunised compared with 73 percent of rural children. In contrast, vaccination coverage in Zanzibar is slightly higher than that in the Mainland (77 and 75 percent, respectively). Coverage in the Western zone (58 percent) is substantially lower than in other zones, at least in part because of the low coverage of measles vaccination (68 percent) (vii) Nutrition 157. Malnutrition particularly Severe Acute Malnutrition (SAM), Iron Deficiency Anemia (IDA), Iodine Deficiency Disorders (IDD) and Vitamin A Deficiency (VAD) are among the major nutrition problems affecting infants and young children in Tanzania. Other nutritional disorders also exist, including diseases such as pellagra, beriberi, scurvy, rickets, and deficiencies of some minerals like zinc and excess intake of fluorine, which leads to flourisis. SAM reduce survival and productivity while in school children it is a major cause of lower cognitive test scores, delayed enrollment in school, increased absenteeism and more repetition of classes. IDA affects both physical capacity and intelligence of pregnant women resulting into intellectual impairment of the unborn baby. IDD leads into several disorders including mild mental retardation, cretinism, severe brain damage, deafness and dwarfism. VAD lowers body immunity, increases incidence and severity of diseases and thus increases child mortality. (viii) Severe Acute Malnutrition (SAM). 145. SAM is caused by inadequate energy and protein intake and is often accompanied by deficiencies of other essential nutrients namely minerals and vitamins. SAM affects all age groups but is most common among under five years old children. SAM manifests itself in the form of low levels of mental and 40