Improving child survival around the globe is key goal of United Nations

Reducing child mortality rates for children under 5 — which in 2004 was 6.5 (per 1,000 children annually) in Latin America and the Caribbean, about 20 in South Asia, and 39 in sub-Saharan Africa — is one of the United Nations Millennium Development Goals (MDGs). These goals were established at the beginning of this decade to address the problems of global poverty, health, and sustainability. Targets were set related to these issues, to be achieved by 2015. However, there are concerns at the midway point that the targets will not be achieved.

Researchers at the Harvard School of Public Health (HSPH) and the University of Washington set out to determine, first, whether programs to improve child nutrition and provide clean water, sanitation, and fuels (three of the MDGs) could also impact the MDG of reducing child mortality; and, second, how the benefits of those interventions varied based on how poor the targeted populations were.

The researchers found that achieving complete coverage of interventions related to nutritional and environmental sustainability MDGs could lead to large reductions in child deaths in Latin America and the Caribbean, South Asia, and sub-Saharan Africa — the three regions the researchers studied. The biggest reduction would take place in sub-Saharan Africa, where the rate might be reduced by an estimated 31 percent, equivalent to about 1.47 million fewer child deaths each year. In all the regions, the current regional gap toward the MDG child mortality target could be reduced by 30 percent to 48 percent.

The researchers also looked at whether giving priority to the poor in nutrition and sanitation improvements had a greater impact than distributing interventions equally among all levels of wealth. They found that prioritizing the poor did have a much greater impact, even though the better-off children were also in need of better nutrition, and cleaner water and fuel.

“Our finding that greater health gains can be achieved by prioritizing the poor provides new evidence on how policies and programs should be packaged and targeted to achieve the MDGs,” said lead author Emmanuela Gakidou, formerly of the Harvard Initiative for Global Health and now with the Institute for Health Metrics and Evaluation, University of Washington, Seattle.

Gakidou, associate professor of international health at HSPH Majid Ezzati, and colleagues analyzed data from the Demographic and Health Surveys program (nationally representative household surveys in developing countries with large sample sizes), the World Health Organization’s (WHO) Comparative Risk Assessment Project, and WHO Mortality Data. They also used novel methods to measure the economic status of households in the three regions and to model the benefits of nutritional and environmental programs.

Some of the key findings follow:

n An estimated 56 percent of the children in Latin America and the Caribbean, 87 percent in South Asia, and 83 percent in sub-Saharan Africa were exposed to preventable risks associated with undernutrition, unsafe water, sanitation, and fuels, and, as a result, were in need of interventions.

n Child mortality declined in all regions as wealth increased. At similar levels of wealth, and especially among the poor, children in sub-Saharan Africa were worse off than those in Asia and Latin America.

n If the three nutritional and environmental MDGs reached all the children who needed them, it’s estimated that annual child deaths would be reduced by 49,700 (14 percent) in Latin America and the Caribbean, 0.80 million (24 percent) in South Asia, and 1.47 million (31 percent) in sub-Saharan Africa.

n The difference in mortality rate between poor and wealthier families would be reduced by the nutritional and environmental interventions, and would be reduced further if the interventions prioritized the poor.

The researchers believe that it may be time to rethink the MDG implementation and monitoring system. “We recommend that MDG interventions be implemented and monitored as packages rather than individually,” said Ezzati, given that the study found packaging multiple interventions provided very large reductions in child mortality. “We also recommend that governments and aid agencies be held accountable for how much they improve environmental MDGs among the poor,” he added.

Ezzati also noted the importance of taking into account the economic status of intervention recipients, which the MDGs currently don’t do. “We found that delivering the same intervention to a poor person will have greater health benefits than it would if it were given to a wealthier person in need of the same intervention. For example, it’s quite likely that dealing with a whole range of health and environment issues in urban slums can save many more lives than dealing with the same issues in better-off communities,” he said.

The study was sponsored by the National Science Foundation, the Grand Challenges in Global Health, and the Center for International Development at Harvard.