Maternal and Child Health I

Trends and Progress in Child Health

In this lecture we shall examine the trends in child survival and look at the priorities beyond 2015. The Millennium Development Goal IV relates to reducing child mortality. And the indicator for child mortality is the under-five mortality rate which is the number of deaths under the age of five per 1000 live births. So the target for MDG IV is to reduce by two-thirds the level of under-five mortality rate between the year 1990 as the base and 2015 as the timeline.

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This is MDG IV which has triggered a great deal of action in saving children. And we made remarkable progress in reducing child deaths in recent times. Although the challenge continues to be huge, but there are successes that we can celebrate. Under-five deaths worldwide have declined by 50%.They have been halved between the year 1990 and the year 2013. In the year 1990 there were 12.7 million under-five child deaths. And this number now stands at 6.3 million in the year 2013. And we must be proud to, to appreciate the fact that despite population growth, there are 17,000 fewer children dying every day in today’s time.

But the other side of the challenge is that another 17,000 children under the age of five continue to die every day till this date. When we examine the progress in the context of MDG IV we also note that there are huge inequalities. Most child deaths occur in sub-Saharan Africa and South Asia. Children from poor families are twice as likely to die as those from rich families. And social determinants such as mothers’ education influence child mortality in a very, very big way. And diarrhea and pneumonia, two causes of child death which are eminently amenable to prevention and treatment continue to kill as many as two million under-five children in the world today.

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Let’s examine the effect of the Millennium Development Goals on child mortality, which is truly phenomenal because global under-five mortality rate is falling faster than at any other time in the history of humankind during the last two decades. Since the year 1990, the under-five mortality rate worldwide has dropped by 49%. There were 90 deaths per 1000 live births in 1990 which is down to 46 per 1000 live births in the year 2013. And all regions except sub-Saharan Africa and Oceania have reduced the under-five mortality rate by 52% or more.

That’s very remarkable. And if you examine the global annual rate of decline in under-five mortality rate it is notable that there has been more than tripling in the annual rate of reduction in the under-five mortality rate. It was 1.2% annual decline between 1990 and ’95. It has now risen to 4% decline in the time segment of 2005 to 2013. And this has happened because the Millennium Development Goals triggered political commitment, greater resources for child health enabling research and evidence and above all a monitoring framework which drove action.413

We can see in this graph that there has been progress post-MDG in reduction in child mortality in all the regions of the world. But overall, despite these gains we as a global community shall not be able to reach the intended MDG IV goal. Only eight of the 60 burden countries would achieve the MDG IV goal in 2015 and that’s the unfinished agenda which will be now carried over to post-2015 scenario. This picture shows the distribution of under-five mortality rate worldwide. The blues are the regions with low under-five mortality rate, typically below 20. And the orange and red indicate areas where under-five mortality rate is very high. The red indeed is an under-five mortality rate of 100 per 1000 live births which is extremely high. You would see that globally areas with high under-five mortality rate are located in sub-Saharan Africa. And then there are intermediate areas in South Asia, the India subcontinent and parts of Africa. And the developed nations have much lower under-five mortality rate as you would expect. It’s also important to know that about half of under-five deaths occur in just five countries: India, Nigeria, Pakistan, DR Congo and China. And India and Nigeria put together account for one-third of the entire global burden. Clearly in order to address the unfinished agenda of child mortality there has to be a focus in five nations and in particular, India and Nigeria. It must be stated that immunization has had a vital role in bringing down child mortality in recent times.

414It’s estimated that since 2000 measles vaccine alone has averted as many as 14 million under-five child deaths. There is an important issue within the child health survival paradigm and that relates to the complexity of tackling neonatal mortality. Neonatal period is the period of infancy less than 28 days of life. The first four weeks of life are the newborn period or neonatal period. Neonatal mortality is the number of deaths per 1000 live births in the first four weeks of life. And this as you would note is a part of the overall under-five mortality as a sub-segment of that. Now neonatal mortality is tougher to tackle because it is influenced a great deal by maternal health and the care that the mother and the baby receive at childbirth,which is quite different from the care that is required for a child with diarrhea or pneumonia. Neonatal mortality has also declined in all parts of the world, as is obvious on this graph. The neonatal mortality rate in the year 1990 was 33 per 1000 live births, which is down to 20 in the year 2013. The absolute number of newborn deaths in the year 1990 was 4.7 million. It’s down to 2.8 million. That’s remarkable. So we have made progress in this regard. However when we see the progress in neonatal period vis-a-vis progress in reducing mortality after the neonatal period, the post-neonatal period something very significant stands out. That the progress in post-neonatal mortality reduction has been more remarkable, faster than that in the neonatal period. So it’s notable that the decline in neonatal mortality is lower than that in post-natal period. That means we have made less progress in reducing deaths occurring in the first four weeks of life. And that is therefore important for us to focus on as we move beyond 2015 agenda. We also note an epidemiological phenomenon that neonatal mortality component of under-five mortality has risen with time. Therefore future progress in child survival is linked to our progress in saving lives of infants in the earliest period of life, which is the riskiest period in humankind.


OpenEdition sugere que esta publicação seja citada da seguinte forma:
Pedro Pereira Leite (18 de Maio de 2015). Maternal and Child Health I. Global Heritages. Recuperado em 19 de Abril de 2026 de https://doi.org/10.58079/p2op


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