Cutting child mortality by half by 2015 is “still possible,” says Unicef

BMJ 2008; 336 doi: (Published 24 January 2008) Cite this as: BMJ 2008;336:175
  1. John Zarocostas
  1. 1Geneva

    Stepping up effective interventions against specific diseases, combined with integrated health strategies and more investment in national health systems, could reduce the annual number of deaths in children under 5 years from 9.7 million in 2006 to less than five million by 2015, a Unicef report says.

    But the report states that the enormity of meeting this millennium development goal, MDG-4, “should not be underestimated.”

    Unicef says that, for the goal to be achieved, specific intervention packages and targets for coverage and delivery will be needed. Services will have to be delivered in a variety of ways and will require periodic oversight from skilled professionals.

    The MDG-4 target, which calls for a reduction of two thirds in the number of deaths among under 5s between 1990 and 2015, “is still possible,” Unicef says, “but the challenge is formidable.”

    “Meeting MDG-4 implies that during the next seven years the number of child deaths must be cut in half—to fewer than 13 000 child deaths per day, or fewer than five million per year,” it continues.

    “Stepping up investment in health systems will be crucial if we are to meet the child health targets set by the United Nations, but progress can be made even when health systems are weak,” said Margaret Chan, director general of the World Health Organization.

    “Innovative programmes in many countries show that an integrated approach, where each child is reached with a package of interventions at one time, can bring benefits,” Dr Chan added.

    Ann Veneman, executive director of Unicef, agreed. She said, “Community level integration of essential services for mothers, newborns, and young children, and sustainable improvements in national health systems, can save the lives of many of the more than 26 000 children under 5 who die each day.

    “Simple, affordable life saving measures such as exclusive breast feeding, immunisation, insecticide treated bed nets, and vitamin A supplementation all have helped to reduce child death in recent years.”

    Unicef’s report says that many of the efforts need to focus on the most difficult situations and circumstances, especially in sub-Saharan Africa, which in 2006 accounted for 49% of world mortality among children aged under 5 years, and also South Asia, which accounted for 32%.

    The report says that of 191 countries with available data 129 are on track to meet the MDG-4 target, but of the 46 in sub-Saharan Africa only three—Cape Verde, Eritrea, and the Seychelles—are on track.

    But nearly half the countries in the region have registered “no change or an increase in child mortality since 1990,” it continues.

    The study draws on data from the multiple MDG indicators survey and the household health survey carried out in about 50 countries in 2005-6 and other material from WHO and the World Bank.

    Elizabeth Mason, director of WHO’s department of child and adolescent health and development, told the BMJ that the MDG-4 target was “actually possible.”

    She said, “The challenge is to implement all the interventions at a high average.”

    At least a third of the 50 least developed countries, including Bangladesh, Eritrea, Malawi, Cape Verde, Mozambique, and Ethiopia, have reduced child mortality by 40% or more, since 1990.

    The report estimates that to meet the MDG-4 target the death rate in children aged under 5, which was 72 per 1000 live births in 2006, needs to fall to 31 per 1000 by 2015. But it notes that this will require an average annual reduction in child mortality of 9.4% between 2007 and 2015 and an ambitious 10.5% in sub-Saharan Africa—substantially greater than the annual reduction of 1.6 % and 1% registered, respectively, from 1990 to 2006.

    Pascal Villeneuve, Unicef’s assistant director for programme partnerships, said that the report has taken the position that any estimate, including assessment of what does and doesn’t work, has to be country based.


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