Counting Down the MDGS: What Do Continued High Neonatal Mortality Rates Mean for Africa?

07/09/2011 - According to a new study conducted in part by the UN, newborn survival rates in Africa lag behind the rest of the world's. With few countries "on track," Africa may not meet the MDGs by the 2015 deadline.

A new study by the United Nations (UN) and its partners has shown that, though global neonatal deaths are down overall, African countries still have yet to record fast enough progress in bringing down their own high rate of death among neonates. While the first few weeks of a child's life are both critical and risky, many countries have only just begun to reach new mothers and their newborns with special programmes.

The study under discussion, published in PloS Medicine journal, is acknowledged to have used the most extensive collection of data to date, following trends in 193 countries over 20 years. The study was undertaken by Save the Children, the London School of Hygiene and Tropical Medicine and the World Health Organization. The neonatal death rate refers to deaths among children who are less than four weeks old. Ultimately, the research showed that the number of worldwide newborn deaths decreased from 4.6 million to 3.3 million between 1990 and 2009. The rate of decline was slightly quicker after 2000, after countries began working towards the Millennium Development Goals (MDGs).

The fourth MDG aims to reduce child mortality (the under-five death rate) by two-thirds of the 1990 level by the year 2015. At present, more than 8 million children die before reaching their fifth birthdays. Children above this age are more likely to live into adulthood, but children in their first few weeks of life are more vulnerable. As more children are surviving past the age of five, a greater proportion of child deaths are among neonates (41 per cent). Given these consideration, failure to improve death rates among babies could jeopardize the achievement of the fourth MDG.

One of the key contributing factors to neonatal deaths are premature delivery, which is estimated to account for 29 per cent of neonatal deaths. Other factors include asphyxia during birth and infection. Sadly, many at-risk newborns would have survived if their births had been attended by a midwife. Too many of the 79 million babies who have lost their lives during the neonatal window since 1990 had zero or little access to medical services.

African countries in particular have not shared highly in the overall gains. Africa has reduced its neonatal mortality rate only 1 per cent per year, according to the WHO. The fact that deaths among neonates dropped 17.6 per cent on the African continent but dropped 50 per cent in the rest of the world is indicative of the unevenness of global trends.

While 27.8 per cent of neonatal deaths were in India, 7.2 per cent were in Nigeria. Nigeria has slipped three spaces since 1990 when it was ranked fifth in neonatal mortality. An increase in the total number of births in combination with only a slight decrease in the risk of newborn deaths has meant that Nigeria now ranks second in the world when it comes to the infant mortality rate (defined as neonatal deaths per 1,000 live births). Nigeria is currently "off-track" to meet the fourth MDG and a WHO official recently expressed concern that Africa will not meet the MDGs by the 2015 deadline.

India, Nigeria, Pakistan, the Democratic Republic of the Congo and China account for roughly half of all newborn deaths in the world.

At the present rate of progress, African countries could only expect to attain the survival rates of some Western countries in about a century and a half. Yet, many neonatal deaths are preventable with "well-documented, cost-effective solutions to prevent these deaths," said Dr. Flavia Bustreo, who is the WHO Assistant Director-General for Family, Women's and Children's Health. She added that with less than four years to go before the deadline for the MDGs, newborns need to receive much more attention and action.

In Nigeria, the Minister of State for Health, Professor Muhammed Ali Pate, told the Daily Trust (local paper) that 3,000 midwives had been dispatched to rural communities that were in desperate need of their life-saving services. Additional communities have had their primary health care facilities renovated in order to improve the quality of care. Another Ministry official confirmed that there are also plans in the works to help traditional birth attendants to meet standards of care.

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