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September 20, 2013

Johns Hopkins Studies Examine Feasibility of Reaching Child Mortality Reduction Goals

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Two studies led by researchers at the Johns Hopkins Bloomberg School of Public Health examine the feasibility of developing nations to meet the proposed targets for reducing child mortality by 2015 and beyond. Both articles are included in a special issue of The Lancet focusing on the Countdown to the 2015 Millennium Development Goals.

The Millennium Development Goals for 2015 were established by the United Nations and its member nations as targets for improving global health, education and prosperity. Millennium Development Goal 4 aims to reduce by two-thirds, between 1990 and 2015, the mortality rate of children under 5.

As 2015 approaches, an analysis led by Neff Walker, PhD, a senior scientist with Bloomberg School’s Department of International Health, examines the likelihood of further reductions in child mortality rates over the next 20 years. Walker and colleagues estimated that just 9 of the 74 Countdown countries could meet internationally agreed targets to reduce the number of deaths of children under 5 to less than 20 deaths per 1000 births by 2035, if current trends continue. Under a “best case scenario,” where all countries match the improvements made by the best performing countries in recent years, Walker and colleagues estimated that fifteen countries would achieve targets to reduce child deaths by 2035.

“While falling rates of maternal and child deaths are to be welcomed, our analysis shows that if historical trends continue, there will still be 5·4 million deaths in children under five in 2035,” said Walker. “This number could be more than halved if all countries were able to match the performance of countries which have made the best improvements in recent years.  Governments—both of the countries most affected by maternal and child deaths, and of nations providing development assistance—must redouble their efforts to deliver known and proven interventions at high and sustained levels, and search for new interventions that will save the lives of more children.”

According to the study, the number deaths of children under 5 in the 74 Countdown countries would decrease from over 7 million in 2010 to 5·4 million in 2035 if current trends continue. Deaths would fall to 2·3 million if all countries could match the improvements in coverage of the best performing countries. In both scenarios, decreases in fertility were attributed to declines in child mortality.

In a second paper, Jennifer Bryce, EdD, MED, also a senior scientist in Department of International Health, and Johns Hopkins professor Robert Black, MD, and Cesar Victora, MD, PhD, from the University of Pelotas in Brazil, were invited to examine the progress and impediments to reducing child mortality over the last decade. They concluded that while child mortality rates have improved in the last decade, over 7 million children under age 5 are estimated to have died in 2010. The majority of these deaths were preventable, often through low-cost, simple interventions, such as adequate nutrition and treatment of childhood diarrhea or pneumonia, with the majority of these child deaths concentrated in sub-Saharan Africa.

“The millions of children who are dying each year continue to represent the biggest missed opportunity in public health, and attention to this issue should not wane until new knowledge about epidemiology, interventions, and service delivery systems has been fully used,” Bryce and her colleagues wrote. “Many countries, including those that started the MDG period with the highest rates of under-5 mortality, are now making good progress and should be given the time and support needed to finish the task. The global health community should take this opportunity to show steadfast commitment to child survival and its ability to amass knowledge and experience as a basis for ever more effective programs.”

The authors suggest, providing free medicine and health care in coming years as a vital measure for improving child mortality rates globally. Moreover they noted, global leadership in child survival needs to become less fragmented, and that countries be allowed to allocate health funding according to need, rather than donor priorities.

Johns Hopkins Bloomberg School of Public Health media contact: Tim Parsons at 410-955-7619 or tmparson@jhsph.edu.