This proves there is much to celebrate in child health development. However, in its progress report ‘Committing to Child Survival: a promise renewed’, the United Nations child agency says there is also plenty of unfinished business remaining; on average, around 19,000 children still die each day from largely preventable causes. Many of these live in sub-Saharan Africa, where one in nine children will not reach their fifth birthday.
The leading causes of death among the under-fives are infections such as pneumonia, diarrhoea and malaria, where a child’s condition is often worsened by malnutrition. And around 40% of under-five deaths are neonatal, occurring during the first 28 days of a baby’s life. Sub-Saharan Africa has one of the highest neonatal mortality rates, as well as the largest number of annual births. This makes the outlook for child mortality in the future uncertain. If current trends persist, by the middle of this century 1 in 3 children in the world will be born in sub-Saharan Africa.
Yet even in the poorest countries, child mortality rates can be significantly reduced. Highlighting the successes, UNICEF refers to nine low-income nations which have reduced their under-five mortality rates by 60% or more. One of these is Malawi. The country is on track to meet its millennium development goal on child mortality, despite high fertility rates (women have an average of six children), the burden of high HIV/AIDS infections and a severe shortage of health professionals (there are just 0.5 doctors for every 10,000 Malawians).
Because of the lack of medics, the country has been training up ordinary people as ‘health surveillance assistants’. Around 10,000 lay people give first line advice to mothers on illnesses such as malaria and diarrhoea. These health assistants have been a key factor in reducing child mortality rates. Speaking to The Guardian’s reporter, one assistant, herself the mother of one, says “it is very satisfying work”. She earns around 80 dollars each month, but for that, she says, her community expects her to be available at all times, day or night.
Now the government is focusing on neonatal deaths, where more progress needs to be made. Currently, around a third of under-five deaths in Malawi occur in the first 28 days. With only eight paediatricians across the entire country, health officials have their work cut out for them. The focus for improvement will be on trying to ensure more mothers deliver babies within health facilities and getting mothers to attend antenatal clinics more than once. There will also be a role for the health surveillance assistants, where the government hopes to expand their duties to include antenatal home visits. The new president of Malawi, Joyce Banda, is fully supportive of the drive for improvements. Earlier this year, just a month after being sworn into office, Ms Banda launched a ‘presidential initiative on maternal health and safe motherhood’ and laid the foundation stone of a new maternity home in central Malawi.