Of the countries with highest child mortality, only one-quarter are on track to meet the millennium development goals for reducing child mortality says a recent analysis. The authors examined 68 countries that together have 97 percent of maternal and child deaths worldwide. They concluded that the majority of these most critical sites haven't made significant progress toward the U.N.'s goal of reducing under-5 child mortality by two-thirds by 2015. Some countries have even seen reversals of progress. However, two countries which have successfully lowered child deaths -- India and Tanzania -- took two very different approaches to beat the odds.
Worldwide, 1200 children under 5 die every hour. The leading causes of childhood death are perinatal conditions, which result from poor maternal health or inadequate care in utero and during infancy.
Many of the other leading causes of childhood death are infectious and parasitic diseases, including malaria, measles, diarrhoeal diseases, and HIV/AIDS. Immunization against disease, thanks to strong funding, has seen more rapid expansion than treatment of diseases or availability of skilled clinical care, according to the study. Though preventative measures like immunization have gone far, the authors say, treatment measures have not yet gotten the comparable international attention that they need.
Since the Millennium Development Goals project began in 2000, though, some countries have actually seen an increase in childhood mortality (see map). Contributing to this increase is the HIV/AIDS epidemic. Though HIV prevalence is dropping in some countries due to successful interventions, the study says, it is still a major cause of child deaths in southern Africa. Another reason some countries are losing ground in the fight against childhood mortality is the impact of war.
Best and Worst Progress in Reducing Child Mortality, 1990-2006
*Countries in orange are top ten with most progress toward reducing childhood mortality; ten countries in blue have seen an increase in child deaths.
Source: EarthTrends, 2008 using data from Countdown Coverage Writing Group, 2008
Among the countries that have been successful, India and Tanzania present two different approaches. In Tanzania, more governmental funding created a reformed health system from the top down. In India, local health workers were trained to become grassroots instructors in better infant care. Read on for those countries' stories.
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Tanzania Governs for Better Health Despite the struggles its neighboring countries have had in reducing child mortality, Tanzania has been very successful -- reducing its child mortality rate by 24 percent between 2000 and 2004. A key factor in the reduction was Tanzania's doubling of public spending on health over the same period. The government increased the country's coverage of mosquito nets, supplements, and immunizations. In addition, the country's health system changed practices. It instituted a national program to better train health workers and parents, and it decentralized much of the decision-making on health spending, so that individual districts could address their most urgent needs. Although Tanzania still has work to do, structural and financial changes have put the country on track to meet the goal of reducing childhood mortality by two-thirds by 2015. |
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India Instructs from the Bottom Up A program begun four years ago in the northern Indian state of Uttar Pradesh takes a different approach to infant health. There, 400,000 newborn babies die yearly, many of their deaths caused by poor practices in hospitals and at home. The program to reduce infant deaths in the Uttar Pradesh district of Shivgarh was led by two U.S. researchers, Gary Darmstadt and Vishwajeet Kumar from Johns Hopkins University. The researchers developed a strategy with local health workers, who in turn trained residents in simple practices such as close contact between mother and baby, breastfeeding, and hygiene. A prevalent problem in Uttar Pradesh at the program's outset was infant hypothermia. Right after birth newborns weren't held, and sometimes weren't even wrapped in blankets. The health workers found that part of the problem was that residents in Shivgarh had no concept of hypothermia, so the workers invented a word for it: thandabukar, which in Hindi means "cold fever." The word took hold and spread among villagers. The hands-on, personal approach of the community health workers over time changed practices -- in the rural villages where they instructed, newborn deaths were halved as of last fall. The Uttar Pradesh government is now considering expanding the program. |
Top photo by World Bank Photo Collection via Flickr
RELATED LINKS:
U.N. Millennium Development Goals
UNICEF "Countdown to 2015" Series
Visualize the Millennium Development Goals on Gapminder
EarthTrends
Tanzania: Population, Health, and Human Well-Being
India: Population, Health, and Human Well-Being
