A glass half-empty, yet half-full

MDG 4: Reduce child mortality
From Africa Renewal: 
Maternity ward at the King Edward VIII Hospital in Durban, South Africa. Photo: AMO/John Robinson
Maternity ward at the King Edward VIII Hospital in Durban, South Africa. Photo: AMO/John Robinson

Measured against the Millennium Development Goal for 2015 of a two-thirds reduction in child mortality, which is the probability of death between birth and fifth birthday, Africa managed a reduction of 55%. Some people view Africa’s achievement as a glass half-full, others consider it a glass half-empty. In a sense, both views are correct.

Those who view the glass as half empty maintain that the continent did not meet the fourth MDG target, and that the number of child deaths was still unbearably high. With 81 deaths per 1,000 live births in Africa currently, an African child is seven times more likely to die before the age of five than a child in other regions of the world, according to the World Health Organization (WHO). In Europe, by comparison, the figure is 11 deaths per 1,000 live births.

Of the seven countries worldwide with more than 100 deaths per 1,000, the majority are in Africa, including Sierra Leone, the Democratic Republic of the Congo, Somalia and the Central African Republic, according to the MDG Report 2015: Lessons learned in implementing the MDGs, co-authored by the UN Economic Commission for Africa, the African Union, the African Development Bank, and UN Development Programme.

Globally, of the 6.6 million children under-5 who died in 2012, some 3.2 million were in Africa. Up to 16,000 children die every day in Africa, notes UNICEF, the UN Children’s Fund.

Although Africa did not meet the MDG target for 2015, the continent made significant gains since 1990, experts say. In that year, Africa recorded 146 deaths per 1,000 live births. In fact, of the 99 countries out of 188 that “observed significant decreases in child mortality during the 2000–2013 period, 43 are in sub-Saharan Africa”, notes the joint MDG report.

This time, Egypt, Ethiopia, Tunisia, Liberia and Malawi met or surpassed the MDG target while Algeria, Eritrea, Libya, Morocco and Rwanda achieved reductions of 60% or more in child mortality. In Botswana, Lesotho, Swaziland and Zimbabwe, however, the rate of child deaths increased, largely due to HIV/AIDS.

Policies put in practice, such as affordable treatment, innovative ways of attending to the poor in rural areas, combined with political commitment, were effective in preventing child deaths. In Ethiopia, for example, 38,000 health workers were hired, trained and sent to isolated parts of the country to treat malaria, malnutrition and diarrhea, which are responsible for many child deaths. Malawi, another country that met the target, effectively linked poor mothers with maternal resources. The result was an increase in child survival rates in both countries.

A national policy of affordable and quality health services, public education on the need to seek early care, and rewards for healthy behaviour will make an immediate impact, according to WHO experts. The joint report recommends social protection in the form of health insurance for children in very poor households.

Neonatal mortality, which is the probability of a child’s dying within the first month of birth, remains stubbornly high in Africa. The joint report states that many African countries made “slow progress or [had] stagnating neonatal rates,” especially in rural areas where there are no health services.”

WHO Assistant Director Flavia Bustreo says that newborn deaths can be prevented if there is “quality care around the time of childbirth, including simple affordable steps such as ensuring early skin-to-skin contact, the exclusive practice of breastfeeding and extra care for small and sick babies.”

Overall, progress made so far should be continued or even accelerated, says Wu Hongbo, UN under-secretary-general for economic and social affairs. And if the world is to achieve the target for child mortality, he adds, efforts must intensify “in high-mortality countries of sub-Saharan Africa.”