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March 29, 2010

Investing Wisely in Child Survival with the Lives Saved Tool (LiST)

The International Journal of Epidemiology published a special issue today chronicling the development and recent use of the Lives Saved Tool (LiST)—a user-friendly computer program that helps donor agencies and governments make investments in child survival programs for maximum impact. LiST was developed in the Child Health Epidemiology Research Group (CHERG) with funding from the Bill & Melinda Gates Foundation through the U.S. Fund for UNICEF. The special issue of International Journal of Epidemiology was edited by Neff Walker, PhD, a senior scientist with the Department of International Health at Johns Hopkins Bloomberg School of Public Health, and is now available online (

Millions of mothers and children die every year because they do not receive basic care. While it is currently impossible to provide comprehensive care to all of them, LiST shows what interventions have the potential to avert the most deaths. The computer program can provide information for specific countries and regions based on estimates of disease burden and intervention effectiveness. The articles in this issue present the underlying modeling approach used to develop LiST, reviews of specific intervention effectiveness incorporated into the program, and examples of LiST predictions compared to observed results.  

Years of work by the CHERG, an independent reference group for UNICEF and the World Health Organization (WHO), provide the foundation for calculations performed by LiST, and many of the articles included in the supplement address the effectiveness of specific interventions upon which estimates are based. In one analysis, Joy Lawn, MD PhD, of the Save the Children’s Saving Newborn Lives program, offers the first meta-analysis to show that “kangaroo mother care” (or constant skin-to-skin contact) substantially reduces neonatal mortality among preterm babies. “This new evidence shows 51 percent reduction in deaths for babies under 2000 grams (4 lbs.) from Kangaroo Mother Care, even compared to incubator care,” said Lawn. “For the lowest income countries, it’s a feasible alternative to intensive care.” In another article, a systematic review by Christa Fischer Walker, PhD, assistant scientist at the Bloomberg School of Public Health, highlights how zinc is a highly effective treatment for diarrhea that is still not at scale despite WHO and UNICEF guidelines.  

LiST’s performance is also assessed in several of the articles. In one analysis, Ingrid Friberg, PhD, also an assistant scientist at the Bloomberg School, compares the tool’s estimates of neonatal mortality reductions with those observed in South Asia as a result of community-based public health interventions. Results show that in the majority of cases the tool’s estimates are very close to actual results.

The Lives Saved Tool is a new way to help governments and international agencies push closer to Millennium Development Goals (MDGs) for maternal and child survival. For instance, in its 5th annual meeting, the African Science Academy Development Initiative used LiST to illustrate how countries could get on track to reach their MDGs. By providing fast and accessible information about impact and effectiveness, LiST can help policymakers direct resources to do the most good. “I share the enthusiasm of its developers about its potential impact on policies and programming,” said Cesar Victora, MD, PhD, professor, Post-Graduate Programme in Epidemiology, Federal University, Pelotas, Brazil.

Development and use of the Lives Saved Tool (LiST): A model to estimate the impact of scaling up proven interventions on maternal, neonatal and child mortality. International Journal of Epidemiology. Volume 39, Supplement 1, April 2010. Edited by Professor HPS Sachdev, Professor Andrew Hall and Neff Walker (   

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