Millennium Development Goal 4 (MDG4) aims to reduce child mortality from its 1990 level by two thirds by 2015. Globally the child mortality rate has been reduced significantly. However, at a national level success in achieving the MDG 4 targets have been highly variable. Disparities have been found both within and between regions. While child mortality rates remain stubbornly high for some countries, three of the least developed countries in the Commonwealth have made impressive gains, achieving their MDG 4 targets. Despite facing similar health issues and socio-economic concerns as their neighbours, these countries have witnessed considerable success. According to UNICEF progress can be made “when concerted action, sound strategies, adequate resources and strong political will are harnessed in support of child survival”. Reversing these trends requires action on multiple fronts – reducing poverty, decreasing maternal mortality, boosting education and gender equality and environmental sustainability. With this in mind we will consider the case of Malawi, which has met its MDG 4 target, seeing the fastest rate of reduction for child mortality in Africa.
In 1990 Malawi's under-five mortality rate stood at 244 deaths per 1000 live births, placing it firmly in the top ten countries globally with the highest rate of child mortality. Since then the country has made huge progress. Of all low-income, high mortality countries, Malawi is second only to Bangladesh in achieving the highest annual rate of reduction, with a score of 5.6%. It now registers a lower level of child mortality than its neighbours Zambia, Zimbabwe and Mozambique. The provision of healthcare has been a central theme in the Presidency of Joyce Banda – who rose to prominence as a relentless women's rights advocate. Through numerous initiatives for maternal healthcare and engagement with traditional leaders she continues to promote gender equality in largely male dominated society. UNICEF indicates that during President Banda's administration there has been a dramatic decline in the rate of under-five mortality
Public health experts attribute the continuing decline to increased use of key health interventions. These include immunisations, the use of insecticide treated bed nets to prevent malaria, rehydration tablets, improved sanitation and Vitamin A supplements. Innovative technologies have also contributed to the reduction. Fast delivery of HIV test results through mobile phones has allowed for quicker treatment. Further, the “baby bubble” - an adaptation of western respiratory devices - has been used to help babies in respiratory distress due to acute infections such as pneumonia. The device uses air pressure to keep babies' airways open and has been designed to work on its own as hospitals may not have wall mounted air supplies.
Despite these gains, the health system, as in many developing countries, is weak. This has affected the availability, access, utilisation and quality of health services. Supply chain management is poor and there is a shortfall of qualified staff. Meeting the needs of the population outside urban centres has proved particularly difficult. In 2002 Malawi adopted the Essential Health Package (EHP) which aims to reduce poverty and improve equity of access to health services. It addressees the major causes of disease and death: vaccine-preventable diseases, malnutrition, infections and common injuries.
Currently pneumonia is the most prominent cause of death among under-fives, accounting for 14% of deaths. This is followed by premature birth and HIV/AIDS which stand at 13%. Birth asphyxia and diarrhoea are also responsible for a significant number of deaths. Of particular concern is the relationship between acute malnutrition and HIV/AIDS, with up to 50% of identified acute malnutrition is associated with HIV/AIDS.
Malawi has made rapid progress in reducing its child mortality levels. Further gains will require ongoing investment, targeted responses and the continued support of a strong leadership. Current efforts need to be sustained and scaled up in order to continue recent positive trends.
Written by Michael Cavanagh