Elsevier

The Lancet

Volume 362, Issue 9377, 5 July 2003, Pages 65-71
The Lancet

Series
How many child deaths can we prevent this year?

https://doi.org/10.1016/S0140-6736(03)13811-1Get rights and content

Summary

This is the second of five papers in the child survival series. The first focused on continuing high rates of child mortality (over 10 million each year) from preventable causes: diarrhoea, pneumonia, measles, malaria, HIV/AIDS, the underlying cause of undernutrition, and a small group of causes leading to neonatal deaths. We review child survival interventions feasible for delivery at high coverage in low-income settings, and classify these as level 1 (sufficient evidence of effect), level 2 (limited evidence), or level 3 (inadequate evidence). Our results show that at least one level-1 intervention is available for preventing or treating each main cause of death among children younger than 5 years, apart from birth asphyxia, for which a level-2 intervention is available. There is also limited evidence for several other interventions. However, global coverage for most interventions is below 50%. If level 1 or 2 interventions were universally available, 63% of child deaths could be prevented. These findings show that the interventions needed to achieve the millennium development goal of reducing child mortality by two-thirds by 2015 are available, but that they are not being delivered to the mothers and children who need them.

Section snippets

Identifying effective child survival interventions

Child mortality is the result of a complex web of determinants at many levels.5 Although we recognise the important role played by distal determinants such as poverty and characteristics of the physical environment, we focus here on interventions addressing the more proximal determinants of child mortality and those that can be delivered mainly through the health sector. Interventions that addressed more distal determinants, or that would normally be implemented by sectors other than health,

Current coverage with effective child survival interventions

Table 1 shows estimates of global coverage for the preventive and therapeutic interventions with sufficient or limited evidence of effect on child mortality. These estimates were derived from UNICEF child health data sets2 and other sources (details are available at http://www.childinfo.org/bellagio.htm).53 Coverage rates are fairly high for a few interventions (breastfeeding, measles vaccine), but for most countries and most interventions coverage is low or very low. Haemophilus influenzae

Methods and assumptions

The starting point for this exercise is the 9·7 million children who died in the 42 countries with 90% of the 10·8 million child deaths in 2000.2 For each of these countries, we first calculated how many deaths from a specific cause could be prevented if present coverage levels were increased to universal coverage. Universal coverage was defined as 99% for all interventions except exclusive breastfeeding among children under 6 months of age, for which the target was set at 90%.

Assumptions about

Search strategy

Estimates of the effectiveness of the interventions were taken either from published articles that summarised previous research results or from systematic reviews by the authors or others in the Bellagio Child Survival Study Group. For the latter, the approach was generally to search for original research reports or reviews using MEDLINE, POPLINE, and other databases. The Cochrane database of randomised controlled trials and WHO Reproductive Health Library were also consulted.

References (63)

  • NA Cunliffe et al.

    Rotavirus vaccines: development, current issues and future prospects

    J Infect

    (2002)
  • D Schellenberg et al.

    Intermittent treatment for malaria and anaemia control at time of routine vaccinations in Tanzanian infants: a randomised, placebo-controlled trial

    Lancet

    (2001)
  • BJ Brabin et al.

    An analysis of anemia and child mortality

    J Nutr

    (2001)
  • State of the World's Children 2003

    (2003)
  • Bryce J, Arifeen SE, Lanata C, Pariyo G, Gwatkin D, Habicht JP. Can public health deliver Lancet (in...
  • General Assembly, 56th session. Road map towards the implementation of the United Nations Millennium Declaration: report of the Secretary-General

    (2001)
  • WH Mosley et al.

    An analytical framework for the study of child survival in developing countries

    Popul Dev Rev

    (1984)
  • Hill Z, Kirkwood B, Edmond K. Family and community practices that promote child survival, growth and development: a...
  • The optimal duration of exclusive breastfeeding. A systematic review

    (2001)
  • LE Caufield et al.

    Interventions to improve intake of complementary foods by infants 6 to 12 months of age in developing countries: impact on growth and on the prevalence of malnutrition and potential contribution to child survival

    Food Nutr Bull

    (1999)
  • SA Esrey et al.

    Interventions for the control of diarrhoeal diseases among young children: improving water supplies and excreta disposal facilities

    Bull World Health Organ

    (1985)
  • L Caulfield et al.

    Zinc deficiency

  • ZA Bhutta et al.

    Using evidence to save newborn lives. Policy brief

    (2003)
  • AL Rice et al.

    Vitamin A deficiency

  • Beaton GH, Martorell R. Aronson KJ, et al. Effectiveness of vitamin A supplementation in the control of young child...
  • DA Sack

    Use of oral rehydration therapy in acute watery diarrhea

    Drugs

    (1991)
  • CG Victora et al.

    Reducing deaths from diarrhea through oral rehydration therapy

    Bull World Health Organ

    (2000)
  • MA Salam et al.

    Antimicrobial therapy for shigellosis

    Rev Infect Dis

    (1991)
  • PK Muhuri et al.

    Treatment patterns for childhood diarrhoea: evidence from demographic and health surveys

    Bull World Health Organ

    (1996)
  • AH Baqui et al.

    Effect of zinc supplementation started during diarrhoea on morbidity and mortality in Bangladeshi children: community randomised trial

    BMJ

    (2002)
  • Cited by (1792)

    View all citing articles on Scopus

    Members listed at end of paper

    View full text