At the heart of the MDGs is the notion of securing a safer and healthier future for our children. But we are significantly off-target for hitting the child health goal. While the number of under-five deaths has been halved since 1990, 6.55 million children still die every year, mostly from preventable diseases.
First, the good news. Since 1990 the annual number of under-five deaths has fallen from 12.6 million to 6.55 million in 2012. This means that 17,000 fewer children died each day in 2012 than did in 1990 thanks to the funding of effective and affordable prevention and treatment interventions, improved delivery systems and sustained political commitment. The world is currently reducing under-five deaths faster than at any other time during the past two decades. The global annual rate of reduction has steadily accelerated, more than tripling since the early 1990s. And to their great credit, many countries have already met their under-five morality rates by two-thirds or more since 1990, including Bangladesh, Cambodia, Ethiopia, Liberia, Malawi, Nepal and Tanzania.
Despite these gains, child survival remains an urgent concern, as without faster progress on reducing preventable diseases, the world will not meet MDG4 until 2028, which is 13 years later than the target deadline. This means that 35 million children will die between 2015 and 2028 who would otherwise have lived, had the goal been met on time. Progress depends on robust global funding, greater efforts by health ministries in the countries with the greatest burdens of child death and prioritizing the prevention and treatment of the leading causes of child death, including newborn-related causes, pneumonia, diarrhea, malaria and malnutrition. We can and must deliver on this promise of a healthier world for all children, which is within our reach.
Reduce under-five deaths from 6.55 million to 4.3 million per year by 31 December 2015, and in doing so save the lives of 3.5 million children whose lives would otherwise be lost.
Almost 80% of the 6.55 million child deaths are due to pneumonia, diarrhea, malaria and newborn-related causes. Malnutrition is an underlying factor in nearly 3 million of all of these deaths, which could be averted through affordable interventions.
Progress has been made, but we know we can do better. The commodities are available, the necessary incremental funding is being secured and the public health community knows how to implement high-impact interventions. Breaking down the numbers, we can see where and how we can accelerate progress.
Explore this UNICEF chart on causes of under-5 deaths.
To achieve MDG4, fewer than 4.3 million children can die before their 5th birthdays in 2015, leaving a 2.2 million gap from where we are now (6.55 million child deaths in 2012). At the beginning of 2014 we projected that the world is currently on track to prevent approximately 1.2 million child deaths in 2015, leaving a gap of 1 million additional deaths that must be prevented to reach the 2015 goal. At the World Economic Forum in January 2014, the Special Envoy’s Office, along with key child health partners, released an MDG4 Acceleration Roadmap that lays out the path to saving these lives in the final two years of the MDGs.
The Special Envoy’s Office supports several clear strategies that have the potential to save an additional 1 million children’s lives in 2015 and close the MDG4 achievement gap:
- Integrated Child Survival Campaigns: Targeting the greatest concentrations of children at risk of early death and delivering to them a package of interventions with the greatest life-saving potential could help close more than 30% of the MDG4 achievement gap in 2015. For example, if the most vulnerable sub-populations of children in India, Pakistan, Afghanistan, Nigeria, DRC, Angola, Ethiopia, Uganda and Kenya received vaccines and medicines to prevent pneumonia and diarrhea, as well as nutritional supplements and malaria medicines, and their mothers received breastfeeding promotion and tetanus vaccines while pregnant, more than 400,000 child deaths could be prevented across 2014–2015. Further, if these campaigns were delivered by leveraging the existing polio, child health week, measles and malaria bed net campaign infrastructures, efficiencies in delivery could dramatically improve the impact of every health dollar invested.
- Empowered and Equipped Community Health Workers (CHWs): Ensuring a supply of community health workers trained and equipped to prevent, diagnose and treat the leading causes of child death in the regions where child deaths are concentrated could prevent the deaths of 250,000 children in 2015, helping to close the MDG4 achievement gap. The Special Envoy’s Office, through its MDG Health Alliance leadership, will partner with and support the efforts of the key organizations focused on CHWs, and will advocate for increased focus on health workers in country planning.
- Home-Based Newborn Care and Messaging: India, Nigeria and Pakistan together account for 1.25 million or 44% of all newborn deaths. In these countries, most newborn deaths occur in the hours and days after birth, with the majority occurring at home. Studies have shown that reaching mothers and families with simple messages about the importance of early and exclusive breastfeeding, keeping the baby warm and dry, recognizing the danger signs of a sick newborn and avoiding practices that are harmful to newborns can halve the rate of newborn deaths. We estimate that essential newborn care behavior change and outreach targeted to the greatest concentrations of mothers most at risk of losing a newborn in can close up to 20% of the MDG 4 achievement gap in 2015.
- Nutrition Interventions: Under-nutrition is an underlying cause of 45% of all child deaths (nearly 3 million). In severe cases of acute malnutrition, children are six times more likely to die from diarrhea and almost nine times more likely to die from pneumonia than an adequately nourished child. The burden of malnutrition is highest in South Asia and Sub-Saharan Africa, specifically in countries such as India, Nigeria, and Pakistan, which combined contain more than 32 million acutely malnourished children. Nutrition will be an integral part of the achievement of MDG4, as improvements in nutrition can work synergistically to ameliorate a wide range of health problems in the world’s most vulnerable children. Our work supports interventions specifically aimed at the prevention and treatment of chronic and acute malnutrition, otherwise referred to as stunting and wasting, respectively. We support nutrition efforts to reduce child mortality that are aligned with the 2013 Lancet Series’ recommendations, including exclusive breastfeeding for children 0-6 months, the prevention and treatment of acute malnutrition through supplemental and therapeutic feeding programs, complementary feeding, micro-nutrient supplementation and more.
- Seasonal Malaria Chemoprevention (SMC) and Nutrition Interventions: Despite tremendous progress in averting an estimated 3.3 million deaths from malaria since 2001, malaria remains a leading driver of child mortality in Sub-Saharan Africa. In 2012, WHO issued a recommendation on seasonal malaria chemoprevention (SMC) for children aged 3-59 months. SMC is the intermittent administration of full treatment courses of an antimalarial medicine during the malaria season, aimed at preventing malarial illness throughout the period of greatest malarial risk. SMC coverage has been shown to be effective, affordable, safe and feasible for preventing malaria among children under 5 years of age in areas with highly seasonal malaria transmission. Both malaria and acute malnutrition are highly seasonal. Across the Sahel sub-region, childhood mortality and mortality from malaria spike during the rainy season, typically a two to four month period in the latter part of the calendar year. Further, the interplay between infectious disease and nutritional deficiency is particularly lethal. Undernourishment is the single most important risk factor for deaths of children under five years of age in Sub-Saharan Africa and is an underlying factor in an estimated 1.5 million child deaths on the continent each year.