The latest child mortality figures from UNICEF are published in a Comment in this week's Alma Ata Special Issue of The Lancet. They continue to show the huge disparity between rich and poor countries worldwide, and reveal that 9.2 million children died in 2007 before they reached their fifth birthday.
Millennium Development Goal (MDG) 4 calls for a two-thirds (67%) reduction in mortality of children aged less than 5 years between 1990 and 2015, and these latest figures show that on the whole, but not exclusively, high-income countries are on target to meet this goal while poor countries are not. When the poor countries are grouped into regions, it is clear that some areas are definitely doing better than others. Latin America and the Caribbean (53% reduction), Central and Eastern Europe and Commonwealth of Independent States (53%) and East Asia and Pacific (52%) are all on target for 2015. But Western and Central Africa (18%), sub-Saharan Africa (21%), and Eastern and southern Africa (26%), are all not on track to meet MDG4. Child mortality in Western and Central Africa, at 169 deaths per 1000 live births, is the highest in the world, and dwarfs that of industrialised nations, at 6 per 1000. In the world as a whole, mortality in children under five has reduced from 93 deaths per 1000 in 1990 to 68 in 2007 — a 27% decrease, again insufficient to hit MDG4.
Yet among the low-income countries, there are examples of real progress. The 10 countries which are making the most progress in reducing child mortality — Haiti, Eritrea, Laos, Bangladesh, Bolivia, Nepal, Turkmenistan, Mongolia, Botswana, and Azerbaijan — are all on course to meet MDG4. The authors say: "Substantial progress has been made towards the achievement of MDG4; indeed, since the Alma-Ata Declaration in 1978, around 5.5 million children aged less than five years are dying every year." They add that the data shows the positive effects of primary health care interventions delivered through outreach or basic health services — such as immunisation or insecticide-treated bednets — coverage for other interventions is lagging, eg, services for pneumonia and diarrhoea.
The authors conclude: "In keeping with the original principles of Alma-Ata, more attention will be given to ensure equity for the most underserved as intervention coverage increases. Furthermore, stronger links are being made between UNICEF-assisted health, water and sanitation, nutrition, and HIV programmes. Finally, more investments will be made to monitor, assess, and improve estimation methods to include issues, such as HIV, that were not pressing problems when the declaration was made…We call upon others to join us in redoubling our efforts to meet these goals, by translating the laudable aspirations of Alma-Ata into the concrete investments and specific evidence-based actions at the country level, that will make the principles of primary health care a reality for the world's underserved."
Brian Hansford, UNICEF Media New York, USA, T) +1 212 326 7269 E) bhansford@unicef.org
Full Comment: http://press.thelancet.com/AAunicef.pdf
Journal
The Lancet