Reducing Child Mortality
Abstract & Commentary
By Philip R. Fischer, MD, DTM&H
Dr. Fischer is Professor of Pediatrics, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN.
Dr. Fischer reports no financial relationships relevant to this field of study.
Synopsis: The United Nations targets achieving a two-thirds reduction in mortality of children under five years of age by 2015 as compared to 1990. Worldwide, mortality has dropped from 11,900,000 under-five deaths in 1990 to 7,700,000 under-five deaths in 2010. Several African countries have shown increased rates of improvement since 2000.
Source: Rajaratnam JK, Marcus JR, Flaxman AD, et al. Neonatal, postneonatal, childhood, and under-5 mortality for 187 countries, 1970-2010: A systematic analysis of progress towards Millennium Development Goal 4. Lancet 2010;375:1988-2008.
Murray and colleagues provide a rigorous description of child mortality in 187 nations of the world. The range among countries' mortality rates is vast. Currently, under-five mortality (per 1000) is 2.7 in Sweden, 3.3 in Japan, 4.7 in Australia, 6.7 in the United States, 13 in Libya, 15 in China, 20 in Brazil, 32 in Guatemala, 60 in Cambodia, 82 in Kenya, 111 in Somalia, and 169 in Chad.
Overall, there has been a 52% decrease in under-five mortality since 1970 and a 30% decrease since 1990. Decade-by-decade data reveal that many countries have shown dramatic reductions in under-five mortality. In the Maldives, for instance, under-five mortality has dropped from 247 in 1970, to 89 in 1990, to 34 in 2000, to 14 this year. India's under-five mortality has dropped from 198 in 1970 to 114 in 1990 to 63 now. In other countries, the decline in mortality has been less impressive Nigeria from 224 in 1970 to 194 in 1990 to 157 this year. However, in several sub-Saharan African countries, rates of decline in mortality have improved during the past decade as compared to previous decades; the relative "success stories" of Angola, Botswana, Liberia, Rwanda, and the Gambia might inform mortality-reduction efforts in countries where improvements are currently lagging.
The timing of death leads to classification of mortality as neonatal (during the first month of life), post-neonatal (during the second through twelfth months of life), childhood (between ages one and five years), and under-five (combination of neonatal, post-neonatal, and childhood) mortality. In wealthier countries, the majority of under-five deaths occur during the first month of life. In sub-Saharan African countries, the split is more even among neonatal, post-neonatal, and child mortality.
Commentary
All of the 191 member states of the United Nations have agreed to try to achieve eight Millennium Development Goals by 2015. Established in September 2000, these goals provide specific targets and indicators by which tangible improvements in health and welfare can be measured.1 The eight Millennium Development Goals are summarized in the table.
Table. Millennium Development Goals. |
|
Goal |
Representative Target |
1. Eradicate extreme poverty and hunger |
Halve proportion of hungry people |
2. Achieve universal primary education |
Provide for boys and girls |
3. Promote gender equality and empower women |
Eliminate gender disparity in schools |
4. Reduce child mortality |
Reduce under-five mortality by 2/3 |
5. Improve maternal health |
Reduce maternal mortality by 3/4 |
6. Combat HIV/AIDS, malaria, and other diseases |
Provide universal access to HIV treatment |
7. Ensure environmental sustainability |
Halve proportion without safe water |
8. Develop a global partnership for development |
Ensure access to essential medications |
Tremendous progress is being made toward attainment of the Millennium Development Goals. Nonetheless, as illustrated by the data in this paper from the University of Washington, increased rates of improvement will be required to fully meet the goals within the next five years.
Wide discrepancies in under-five death rates among various countries suggest that significant improvements are attainable within the range of available global resources. For instance, in the resource-rich United States, total under-five mortality (per thousand) is 6.7 in 2010; meanwhile, in resource-challenged Democratic Republic of the Congo, 131 of each 1,000 children die before reaching school age. Discrepant use of global resources leaves millions of children beyond the reach of life-saving health interventions.
The Democratic Republic of the Congo, however, has achieved a greater rate of improvement in under-five mortality than have many other sub-Saharan African countries. Working transnationally, best practices can be adapted across political boundaries so that similarly challenged countries can benefit from the experience of their neighbors.
In seemingly developed countries, remaining reductions in under-five mortality will probably come from improvements in maternal, peri-natal, and neonatal care. In developing countries where children continue to die throughout the pre-school years, multifaceted approaches are needed. Thus, even for young children, it is important that multiple Millennium Development Goals be targeted. Since about half of current under-five deaths are linked to malnutrition, attainment of Goal 1 will directly save lives. Goals 2 and 3 will keep girls in school, delay premature pregnancies, and prepare girls for eventual motherhood and child-care roles. Efforts to meet Goal 5 are already helping increase the safety of deliveries and reduce birth asphyxia. The bednet use and indoor residual insecticide spraying efforts linked to Goal 6 are reducing the toll of childhood malaria. Meeting Goal 7 provides safe water supplies, reduces diarrhea (which still leads to nearly a million under-five deaths each year), and improves child survival. Achieving Goal 8 would help many sick children who currently live beyond the reach of affordable medications. Holistically designed, specifically targeted goal-meeting activities must continue. In meeting the goals, an additional four million children per year will survive childhood and grow to contribute positively to their communities.
In Haiti, more than 10% of children die before reaching school age. As a recent report claimed, "Haiti was home to one of the worst disasters of our time... Then the earthquake hit."2 We are not oblivious to widespread suffering around us every day, and we must not be complacent. As members of the global community, travel medicine practitioners and their traveling patients care about improving the health of people throughout the world. Awareness of and engagement with the Millennium Development Goals is a worthy means by which we can demonstrate our concern.
References
- World Health Organization. Millennium Development Goals. http://www.who.int/topics/millennium_development_goals/en/, accessed 6-3-2010.
- Sheridan S. "Food for Haiti's Hungry." Compassion Magazine Summer 2010, 2010;4:7.
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