This article in the Global Health series assesses international progress toward achieving the Millennium Development Goals for the health of women and children. With less than 3 years to go, many countries are failing to reach targets set for maternal and child mortality.
The largest numbers and highest rates of maternal, neonatal, and child deaths are in countries of sub-Saharan Africa and South Asia. A total of 10 countries account for almost two thirds of the global burden of maternal and newborn deaths, as well as stillbirths.
• What might explain the decline in child mortality in the majority of countries in the decade from 2000 to 2011?
Lozano et al. compared the rates of decline from 1990 through 2000 with the rates of decline from 2000 through 2011 and found that the majority of countries (106 of 193 countries) had accelerated declines in child mortality in the decade from 2000 through 2011. Much of the decline was related to a reduction in postneonatal mortality, whereas the reduction in neonatal mortality was much lower. Lozano et al. also reported an estimated decline in maternal mortality, from 409,100 deaths worldwide in 1990 (uncertainty range, 382,900 to 437,900) to 273,500 deaths in 2011 (uncertainty range, 256,300 to 291,700), which was broadly consistent with the estimate calculated by a United Nations interagency group.
• According to the Child Health Epidemiology Reference Group, what were the primary causes of death globally in 2010 among neonates and children under 5 years of age?
The Child Health Epidemiology Reference Group estimated that 40.3% of 7.6 million deaths among children younger than 5 years of age in 2010 (3.1 million deaths) occurred in neonates. Major causes of death in newborns included complications of premature birth (14.1% of deaths among children younger than 5 years of age [1.1 million deaths; uncertainty range, 0.9 to 1.3 million]); intrapartum-related complications, previously labeled as birth asphyxia (9.4% [0.7 million deaths; uncertainty range, 0.6 to 0.9 million]); and sepsis or meningitis (5.2% [0.4 million deaths; uncertainty range, 0.3 to 0.6 million]). Other leading causes of death among children younger than 5 years of age included pneumonia (18.4% of deaths [1.4 million deaths; uncertainty range, 1.2 to 1.6 million]), diarrhea (10.4% [0.8 million deaths; uncertainty range, 0.6 to 1.2 million]), and malaria (7.4% [0.6 million deaths; uncertainty range, 0.4 to 0.8 million]).
Morning Report Questions
Q: How does poverty impact child mortality?
A: A sizable proportion of deaths occur among the urban poor, who live in slum conditions with limited social-support networks and abysmal living conditions. It has been noted that environmental health factors such as overcrowding, poor air quality, and poor sanitary conditions may be much worse in urban slums than in many rural areas and can adversely affect women and children. These conditions also reflect the lack of access to quality health services in both rural and urban settings for a number of reasons, including the paucity of trained medical personnel and transportation facilities in rural populations and the lack of knowledge about health services among migrant families in urban slums. The close link between poverty and undernutrition is also well recognized. It has been estimated that 45% of all deaths among children younger than 5 years of age may be associated with undernutrition, as manifested by fetal growth restriction, stunting, wasting, deficiencies of vitamin A and zinc, and suboptimal breast-feeding.
Q: Using the Lives Saved Tool, which two potential packages of care would have the highest impact on maternal and fetal mortality if implemented?
A: Emergency neonatal resuscitation and immediate newborn care was estimated by the authors to be associated with an estimated 688,089 lives saved by 2020, with an estimated 9.4% of maternal and child deaths averted. The interventions would involve clean practices and immediate essential newborn care in the home; clean postnatal practices; thermal care; Kangaroo Mother Care (skin-to-skin care); full supportive care; immediate assessment and stimulation; and neonatal resuscitation. Detection and management of severe childhood illness (diarrhea, pneumonia, meningitis, and malaria) was estimated by the authors to be associated with 570,244 lives saved and 7.8% of maternal and child deaths averted. Interventions would include oral rehydration solution for diarrhea treatment; zinc for diarrhea treatment; antibiotics for dysentery treatment; oral antibiotics for case management of pneumonia; and antimalarial agents (e.g., artemisinin compounds).