How many child deaths can we prevent this year?

Abstract:

"...We review child survival interventions feasible for delivery at high coverage in low-income settings, and classify these as level 1 (sufficient evidence of effect), level 2 (limited evidence), or level 3 (inadequate evidence). Our results show that at least one level-1 intervention is available for preventing or treating each main cause of death among children younger than 5 years, apart from birth asphyxia, for which a level-2 intervention is available. There is also limited evidence for several other interventions. However, global coverage for most interventions is below 50%. If level 1 or 2 interventions were universally available, 63% of child deaths could be prevented. These findings show that the interventions needed to achieve the millennium development goal of reducing child mortality by two-thirds by 2015 are available, but that they are not being delivered to the mothers and children who need them."

This paper focusses on interventions that address the more immediate determinants of child mortality - rather than, say, poverty. It finds that the strategy of waiting for new vaccines, drugs, or technology to be developed is problematic, as supported by the following findings:

• Breastfeeding and oral rehydration therapy alone are estimated to be able to prevent 13% and 15% of all under-5 deaths, respectively.
• 6 other interventions could each further prevent a significant percentage of under-5 deaths:
  
  • insecticide-treated materials: 7%
  • complementary feeding (providing food in addition to breastmilk): 6%
  • antibiotics for sepsis: 6%
  • antibiotics for pneumonia: 6%
  • antimalarials: 5%
  • zinc to reduce diarrhoea and pneumonia deaths: 5%

Although the authors say that the development of new and newly validated interventions should remain on the agenda, they say their findings show that some of the most promising interventions can be delivered at the household level - and with limited need for external materials. The authors conclude that educating parents about, and promoting, the cost-effective things they can do at home to prevent their children's deaths is an important future direction (with the caveat that promoting breastfeeding in countries with a high prevalence of HIV among women of reproductive age may increase mother-to-child transmission of the virus. AIDS accounts for 3% of under-5 deaths).

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This paper is part of a 5-part series on child survival published by The Lancet. Click here to access an overview of that series.

Source:

Summarised and reprinted with permission from Elsevier (The Lancet, 2003, Vol No 362, pages 65-71). Click here for the Lancet Home Page.