Magazine article UN Chronicle

Reducing Child Mortality: The Challenges in Africa

Magazine article UN Chronicle

Reducing Child Mortality: The Challenges in Africa

Article excerpt

In 1960, Africa contributed to approximately 14 per cent of the global child mortality burden. Today, sub-Saharan Africa alone accounts for almost 50 per cent of child mortality, although it constitutes only 11 per cent of the world population. If Millennium Development Goal 4--reduce child mortality by two thirds--is to be achieved, Africa has the challenge of accelerating the narrowing of this gap. On average, children under-five mortality dropped from 188 per 1,000 live births in 1990 to only 171 in 2003. This corresponds to an overall decline of just 9 per cent (0.7% annually), while the MDGs target an average annual rate of reduction of 4.3 per cent. It is clear that a number of challenges needs to be overcome in Africa to reduce child mortality.

Low coverage of interventions and weak delivery systems. Our analysis in 13 eastern and southern African countries shows that universal coverage of scientifically proven cost-effective interventions would reduce child deaths from the current 2 million to just 650,000. Even if partial coverage of the 60-per-cent target for malaria--as agreed in the Abuja Declaration--and 70 per cent for other interventions were achieved, mortality would be reduced by almost 50 per cent. Coverage of child survival interventions remains extremely low in many countries. Of the 24 preventive and treatment interventions reviewed in 2000, only four (measles, breastfeeding, vitamin A and clean delivery) had a regional coverage of above 50 per cent. In fact, eight interventions had coverage below 5 per cent. (1) At the same time, observations in southern Africa indicated a deterioration of caring capacities among caregivers as poverty levels and food insecurity increased. A survey of coverage of interventions in 2006 found that a number of countries are making progress in scaling up coverage, but this remains insufficient to meet MDG 4 for Africa as a continent. (2)

Community and household-level interventions have highest impact, but are given lowest priority. Interventions delivered at community and household levels were found to have the highest impact (61%). Unfortunately, most health systems are set up in such a way that allocation of human, material and financial resources favours facility-based, curative care. Where community-based programmes have been set up, they tend to operate on a small scale, with little support from the formal health system. (3) The low coverage and poor performance of the health system contribute to a high mortality rate of otherwise preventable deaths, including neonatal conditions (27%), pneumonia (21%), malaria (18%), diarrhoea (16%), HIV/AIDS (6%), measles (5%), injuries (2%) and others (5%). Malnutrition is an underlying cause of mortality in more than 54 per cent of deaths. (4)

Linkages with maternal health. Child mortality is inextricably linked with maternal mortality. In Africa, at least 25 per cent of all deaths in children under-five occur within the first month, 75 per cent of these during the first week. Causes include infection, asphyxia, and preterm and low birth weight. MDG 4 cannot be achieved without reducing newborn mortality. The average maternal mortality rate for Africa is as high as 1,000 for every 100,000 live births. In the last five years, nearly 20 countries in the region conducted emergency obstetric care (EmOC) assessments. While coverage of comprehensive EmOC is generally adequate, that of basic EmOC in most countries assessed remains extremely low. Only about half of all women give birth in health facilities and less than one in three women with obstetric complications receives timely life-saving service.

Disempowering policies. Certain legal restrictions on medical practice are derived from outdated colonial rules that continue to guide clinical practices in some countries. In Malawi, the vast majority of health centres have enrolled or registered nurse-midwives. At the health-centre level, these nurse-midwives are authorized to perform four out of six basic EmOC signal functions, but are not authorized to perform the removal of retained products nor assist in vaginal child delivery. …

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