Child Mortality Declines Globally

Dr. Nick Alipui – Director of Programs, UNICEF
Dr. Nicholas Alipui was appointed Director of UNICEF Programmes in 2008. In this capacity, he overseas the centrepiece of UNICEF’s work and is at the forefront of programme policy, guidance and management intended to assist staff in the implementation and success of UNICEF programmes and the achievement of the Millennium Development Goals.

Why would you consider the decline in child mortality a global health milestone in 2012?

Reductions in child mortality over recent years have been tremendous, as 14,000 fewer children die each day compared with two decades ago. Even sub-Saharan Africa, despite lagging behind other regions, has registered a significant decline. Today in 2012, we know more than ever before about which interventions and which equity-based implementation strategies can make a difference for these children. As a result, more and more countries are using innovative approaches to scale up coverage, and more children are being reached than ever before.

What are the key interventions that influenced the decline in child survival?

Expansion of effective preventive and treatment interventions such as immunization, improved water and sanitation services, prevention of maternal to child transmission of HIV, and integrated community case management of childhood illnesses including pneumonia, malaria and diarrhea have played an important role. In addition, several new tools, such as rapid diagnostic tests and mobile technologies, are being used to facilitate the rollout of these interventions in disadvantaged areas. Female education, especially of young girls, has also played an invaluable role in many areas, including child survival efforts worldwide.

Aside from specific interventions, the collective effort of governments, donors, nongovernmental organizations, UN agencies, scientists, practitioners, communities and families to reduce preventable child deaths must be acknowledged as having played a key role in reducing child mortality.

In light of these developments where do you think we should prioritize resources to continue the decline in child mortality? What message do you have for the global community?

In order to continue the decline in child mortality, resources should focus on reaching families within the most deprived settings of countries with the highest maternal and child mortality rates. Efforts should not only focus on expanding coverage of inexpensive and evidence-based interventions, but also on monitoring why these interventions are or are not effectively implemented. Within each setting, we need to better understand – and act on – the critical bottlenecks that prevent coverage. These include factors such as insufficient health workers, essential medicines, poor geographic access and, on the demand side, both financial and non-financial barriers. Further, it is important to invest in strategies that respond to the social determinants that influence a child’s health and nutritional status, including, for example, education, women’s empowerment and fulfillment of child rights and protection.

Following the recent World Health Organization recommendation on chlorhexadine, how do you see this intervention complementing existing efforts to reduce neonatal mortality, and how can PSI play a role to expand its use?

In spite of overall achievements in child mortality, progress in reducing neonatal deaths has lagged behind and so these now account for approximately 40 percent of all under-5 deaths. Along with prematurity and asphyxia/ birth trauma, infection is one of the leading causes of deaths among newborns. Globally, more than 1 million newborns die as a result of neonatal infections.

Through simple and cost-effective interventions, most of these deaths can be prevented. For example, immediate and exclusive breastfeeding, kangaroo mother care, hand washing, access to antibiotics and skilled attendance at birth are critical. In addition, it is critical to prevent infections from contaminating the umbilical cord stump. In many settings, this has remained a stubborn challenge, as mothers and those who provide them with care and support during the postnatal period may have harmful socio-cultural beliefs regarding what should be applied to the umbilical cord stump of their newborns.

The use of chlorhexadine will be a tremendous complement to other neonatal interventions by preventing umbilical cord stump infections. For this reason, UNICEF and its implementing partners, such as PSI, can play a key role in expanding its use, particularly in the most underserved areas of countries with a high burden of neonatal death due to infections. The focus of these efforts should be on making the right concentration of chlorhexadine available at local levels, training local health workers on its appropriate application and use, and on ensuring that chlorhexadine use is incorporated into an integrated package of effective newborn interventions through postnatal care home visits that occur within the newborn’s first day of life.

Because of its expertise in social marketing and integrated community-based care, PSI will be a key partner in ensuring that the world’s most vulnerable newborns can benefit from this important new recommendation.