Policy Brief Success Stories: Reaching the Child Survival Millennium Development Goal Overview It is tragic that more than 10 million children under age five will die this year, particularly since most of these deaths will result from preventable and treatable causes. Although individual countries have undertaken efforts to reduce child mortality, improved child survival became a global aspiration in 2000 through the Millennium Development Goals (MDGs).1 MDG 4 calls for countries to reduce their 1990 under-five child mortality rate by two-thirds by 2015. Of the 60 countries that account for 94 percent of all child deaths, only seven are currently on track to achieve their MDG target for child survival: Bangladesh, Brazil, Egypt, Indonesia, Mexico, Nepal and the Philippines.2 This brief will describe how two countries – Bangladesh and Mexico – have succeeded. It will highlight some of the lessons learned that may be helpful for other countries trying to achieve MDG 4. Under-5 Child Mortality Rate (per 1,000 live births)
www.globalhealth.org
Countries On Track to Achieve MDG 4 Target
Countries on Track to Achieve MDG 4 Target
180 160 140 120 100 80 60 40 20 0 Bangladesh
Brazil
Egypt Eqypt
U5MR 1990
Indonesia U5MR 2004
Mexico
Nepal
Philippines
U5MR Target for 2015
Background Globally, most deaths to children under five are due to neonatal causes (38 percent), pneumonia (19 percent), diarrhea (17 percent), and malaria (8 percent).3 However, large geographic differences exist: malaria, for example, causes 18 percent of child deaths in sub-Saharan Africa but less than 1 percent in Southeast Asia.4 Malnutrition contributes to more than half of all child deaths.3 Regional variability, risk factors, and the need for coordination of interventions necessitate a multifaceted approach tailored to the country’s disease burden.3-5 Cost-effective prevention and treatment interventions that can be readily implemented in low-
income countries have been identified to address the major causes of death.5 Such interventions include many low-tech solutions, including vitamin A supplementation, oral rehydration therapy (ORT) for diarrhea, insecticide-treated bednets to prevent malaria, and promoting full and exclusive breastfeeding for the first 6 months.
Case Study #1: Bangladesh Bangladesh, a low-income country of 138 million people, spends 3 percent of GDP and $14 per capita on health expenditures.6 Despite widespread poverty and poor infrastructure, Bangladesh has succeeded in cutting its 1990