‘Children just do not have to die’

Simple, cheap interventions can reduce African mortality rates
From Africa Renewal: 
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Providing children with safe water can greatly cut waterborne illnesses Providing children with safe water can greatly cut waterborne illnesses.
Photograph: Panos / Giacomo Pirozzi

Seventeen-month-old Nana Moussa was on the verge of death, in a remote rural village in south-central Niger, far from medical facilities. Her frail body, which had shrunk to a mere 4.3 kilograms, could no longer prop itself up. Alarmed, Nana’s parents walked with her all night to reach a village with public transport, and then rode for six more hours in an overcrowded van to Maradi, a regional capital. Like many other poor parents in Niger struggling to provide adequate nutrition for their children, they finally reached the Centre de récupération nutritionnelle intensive, a therapeutic feeding centre operated by the non-governmental Médecins sans frontières and supported by the UN Children’s Fund (UNICEF).

Nana’s recuperation was difficult, but she started to progress four weeks into her treatment for kwashiorkor. She, like many children too weak to process solid food, was first given an easy-to-digest milk formula rich in nutrients. As she grew stronger and her appetite returned, Nana proceeded to the next phase, in which a vitamin-rich peanut paste, Plumpy Nut, was added to the diet. She would have to weigh at least 5.6 kg before returning home.

Interventions such as this “aren’t complicated, they aren’t expensive and they work,” said UNICEF Regional Director for Eastern and Southern Africa Per Engebak in July. “We know what treated mosquito nets, immunization and vitamin A supplements, for instance, can do. With these and other simple measures in place, children just do not have to die. What we need now is for countries to make sure that life-saving health interventions get to the children who need them.”

Leading child-support organizations affirm that cheap and simple treatments can cut by at least two-thirds the 11 million child deaths that occur worldwide each year. Some of these fatalities are caused by preventable diseases such as pneumonia, diarrhoea, measles and HIV/AIDS. Malnutrition, lack of safe water and poor sanitation contribute to more than half of them.

“We know what treated mosquito nets, immunization and vitamin A supplements can do.... What we need now is for countries to make sure that life saving health interventions get to the children who need them.”

— Per Engebak, UNICEF regional director

Every day, 5,500 children across 21 countries in Eastern and Southern Africa alone die before they reach their fifth birthday. Put in different terms: in the last two months, more children died in that region than in Asia’s December 2004 tsunami. And unless African governments and their international partners move quickly to redress the situation, 330,000 more children will die in the next two months.

Children key to development

While Nana struggled to reach her target weight, countries across Africa marked the annual Day of the African Child on 16 June. It was an opportunity to reflect on progress towards children’s welfare and, perhaps, to acknowledge the indispensable role children play in the progress of any nation. Ignore the needs of the smallest and most fragile, UNICEF warns, and you rob a country of future farmers, teachers, nurses and leaders.

The Millennium Development Goals (MDGs), adopted by world leaders in 2000, recognize this critical link. Six out of the eight MDGs address children. If attained, children would not have to die from treatable diseases and all could go to school on a full stomach and in good health. They would grow up in a protective family environment, free from abuse and exploitation.

Yet all the MDGs are running behind schedule. UNICEF reports that the goal to reduce by two-thirds the mortality rate among children less than five years of age lags farthest behind. Africa cannot meet this goal until well into the 22nd century, unless much more is done to preserve children’s lives.

“With the childhood of so many under threat, our collective future is compromised. Only as we move closer to realizing the rights of all children will countries move closer to their goals of development and peace,” UN Secretary-General Kofi Annan warns in a foreword to UNICEF’s State of the World’s Children Report 2005. While the family offers the first line of protection for children, many parents are simply too poor to provide all basic necessities for children to survive and develop, UNICEF stresses. Governments therefore must devote a bigger share of their budgets towards meeting children’s needs.

$3 bed nets

Even modest investments can bring significant results. A simple $3 insecticide-treated mosquito net for every African child, for example, could reduce overall child mortality rates by 20 per cent by protecting against malaria, the number-one killer of children in Africa. The net works as a barrier between the body and mosquitoes that carry malaria.

Insecticide-treated bed nets By protecting against malaria, insecticide-treated bed nets can reduce African child mortality by one fifth.
Photograph: Getty Images / Per-Anders Pettersson

Even when they are available, these nets are beyond the means of the average African family, yet some donors recommend selling them under an approach known as “social marketing.” However, Professor Jeffrey Sachs, the UN Secretary-General’s special adviser on the MDGs, argues that they should be heavily subsidized or given away free. “Mothers and children are dying of a completely preventable disease because we are trying to sell bed nets. Let me urge the end of social marketing today.”

UNICEF is following Prof. Sachs’ recommendation. In the village of Chatowa in Malawi, malaria wreaked havoc for many years, killing children and rendering adults too ill to work. Fed up, the villagers have rallied to stop this deadly disease. In June 2004 they formed, with government support, a health committee to sell insecticide-treated mosquito nets, subsidized by UNICEF. Thanks to the new initiative, the number of cases of malaria has been cut by half.

“I used to get attacks at least three times a year. My whole family suffered. I couldn’t do housework and my husband would have to leave work to take me to the health clinic,” Ms. Christina Yokoniya, secretary of the village health committee, told UNICEF. “People no longer complain about malaria attacks and we have seen that we are not bitten by mosquitoes so often.”

Because of UNICEF’s subsidy, Malawians have been able to purchase nets for 50 kwacha (less than 20 US cents) each. In 2002 alone, UNICEF provided over 4.4 mn mosquito nets to 25 African countries, at a total value of $9.5 mn. It also purchased $3 mn worth of insecticide to treat the nets. While UNICEF is the global leader in procuring and distributing lifesaving nets at an affordable price, communities themselves are finding creative ways to ensure that those in need have access, no matter how low their income.

“When a family is too poor to pay cash for the net, committee members accept bartered goods, such as maize or groundnuts as payment,” noted Mr. Evance Chambakata, chairman of the Chatowa village committee. “We feel very proud because we are helping to save lives.”

No safe water for 43 per cent of children

Other simple solutions, such as providing a bucket of clean water, can also drastically improve child survival. It is estimated that about 20 litres of water is the bare minimum that a child needs for drinking, washing and basic sanitation. Yet some 4,000 children worldwide die every day simply because they lack clean water. UNICEF warns that the MDG target of cutting in half by 2015 the number of people (1 billion) who do not have a safe water supply within 15 minutes walk of their home will not be met unless the international community steps up its efforts.

In sub-Saharan Africa, 43 per cent of children drink unsafe water, and as a result millions suffer from waterborne illnesses.

Ms. Fatima Kituxi knows well the hardships of growing up without enough fresh water. She has spent many hours searching for water in and around Mabuia village, just north of Angola’s capital. She also has had to care for brothers and sisters who have often suffered from typhoid, diarrhoea and other waterborne diseases. Her first child, Isabel, died in 1999 after a series of diarrhoea attacks. “Isabel was always sick. She could just never get strong,” Ms. Kituxi said, hugging her second child, 13-month-old Fernando. “By the time Isabel was Fernando’s age, she had been sick a dozen times.”

In 2000, UNICEF responded to Mabuia’s appalling child mortality rates by helping the Angolan government to build a pipeline from a river to the community. A filtering system was added to ensure that the water was clean and safe. Latrines, washbasins, taps and showers were also installed to improve sanitation. The community created a committee that now maintains the system. People were also taught good hygiene practices.

The results were exceptional. Diarrhoea rates dropped to almost zero and child deaths plummeted. Girls were suddenly freed from hours of walking to and from the river, which allowed them to better concentrate on their schoolwork. Mothers found more time to grow crops, which could be sold to boost the family income.

“A mother must take care of her children, but we cannot do that when we have only dirty water,” Ms. Kituxi said. “This project has changed the fortunes of this village. Look at my son — he is healthy. This is what every mother prays for: that there will be no more tears.”

Mabuia, however, remains the exception rather than the rule in Angola. Nearly three decades of civil war devastated water systems across the country. Sanitation coverage declined in urban areas from 62 to 56 per cent and in rural areas from 19 to 16 per cent. A mere $100 to $125 could provide a household with a pit latrine, UNICEF estimates. It would cost about $8,000 to drill a borehole that could supply water to about 400–500 people in Angola. Once installed, only $250 a year would be needed to maintain the infrastructure. A well costs even less, an estimated $2,000–$2,500.

Immunization frees children from disease

More than 2 million children worldwide die annually from diseases that could be prevented at a cost of less than $30 per child, according to UNICEF’s experience. Expanded inoculation against scourges such as measles, polio, and maternal and neonatal tetanus would reduce child mortality, improving maternal health and reversing the spread of killer diseases.

Polio immunization in Nigeria Polio immunization in Nigeria: Since early 2005, millions of African children have been immunized against the polio virus.
Photograph: Associated Press / Saurabh Das

Vaccines protect nearly three-quarters of the world’s children against major illnesses, but mostly in richer countries. Immunization against polio, for example, has virtually wiped out the disease in industrialized countries, while it remains a menace to Africa. The continent accounts for 75 per cent of polio cases reported worldwide.

Polio is caused by a virus which results in acute infection of the central nervous system, leading to paralysis. The virus is passed through contact with the feces of an infected person, for example by shaking someone’s dirty hands and then contaminating food. Polio can be easily prevented by an oral vaccine and many African countries were, in the past, able to defeat the disease. But it began to spread once again in 2003 in West Africa and beyond, after local authorities halted vaccinations for a number of months. So far, there have been outbreaks in 16 formerly polio-free countries.

Many countries are now redoubling efforts to reach as many children as possible in a series of three immunization drives. “In late 2002 and early 2003, all African nations with the exception of Nigeria and Niger were polio-free. African nations have had great success and sound positive experience in stopping polio virus transmission,” UNICEF Senior Technical Advisor on Polio Eradication Dennis King explained in May.

Early reports indicate that the first round, from 25 February to 1 March, reached as many as 95 million children. The second round in April aimed to reach 100 million children before the virus began to spread more rapidly during the most virulent months stretching from July to September.

For the first time in many months, vaccination teams were able to reach children in some of the continent’s most troubled spots, such as Côte d’Ivoire and Sudan. Border territories, refugee camps and conflict zones are among the areas at highest risk for transmission, as well as the hardest to reach. Not only must the vaccinators find the children, they must find them while the vaccine is still cold and effective. Organizers create “cold chains” — a series of relay points that have freezers and cold boxes to maintain the vaccine’s potency. Because some villages are remote and lack good roads, volunteers travel by any means necessary — motorcycle, canoe and, most often, foot.

“It is truly an inspiration to witness the commitment of the tens of thousands of health workers, volunteers and Rotary members who are going house-to-house and village to village to hand-deliver the oral polio vaccine to every child,” says Mr. Ambroise Tschimbalanga-Kasongo, Rotary International’s chairman of the African Regional PolioPlus Committee. Campaigns also use the opportunity to deliver other lifesaving packages, such as vitamin A drops, an immunity-boosting remedy that has saved an estimated 1.2 million lives over the last 12 years.

Significant gaps in coverage exist, in some areas as large as 20 per cent. Funds are running short. Some $200 mn will be required in 2006. But major donors are not stepping up fast enough to provide vital funding, UNICEF’s representative in Ethiopia, Mr. Bjorn Ljungqvist, said in July.

“A cloud of cynicism has settled over Africa — cynicism caused by everything from corruption to armed conflicts, cynicism felt by everyone from donors to the general public,” Mr. Ljungqvist noted. “But this cloud hides the fact that innocent children are dying unnecessarily. There are simple things that we can do and must do to save these children.”