Time is ripe for breakthrough on child mortality, says senior Unicef official

Unicef doctor says investment now could help meet millennium development goals on tackling child and maternal mortality • Explore our interactive on tackling child mortality

A mother and her children collect water in the Lira district of northern Uganda. Photograph: Jonathan Porter/Alamy. An intense focus on countries with the highest levels of child mortality combined with the availability of cheaper vaccines and medicines can lead to a development breakthrough, according to a senior UN health expert. Dr Mickey Chopra, chief health officer at Unicef, the UN children's agency, said investment now would lead to massive strides in meeting the millennium development goals of reducing maternal deaths by three-quarters (MDG4) and the deaths of children under five by two-thirds (MDG5), both by 2015. "If we make the kind of investment we need now, which is not huge, we could achieve a 'man on the moon' moment," Chopra told the Guardian. "We have a clearer idea why and where children are dying. Twenty-four countries account for 80% of the deaths. We know where they are dying within those countries. Combined with effective interventions such as vaccines and breastfeeding, we have the potential to reach kids in the most cost-effective manner." Since 1990, annual maternal deaths have declined by almost half and the deaths of young children have fallen from 12 million to 7.6 million in 2010. Some of the world's poorest countries have achieved impressive progress in reducing child deaths. Rates of child mortality in many African countries have been dropping twice as fast in recent years as during the 1990s. In Botswana, Egypt, Liberia, Madagascar, Malawi, Rwanda and Tanzania, the rate of decline was on average more than 5% a year between 2000 and 2010. Similar progress has been made in reducing maternal deaths, although in fewer developing countries: Equatorial Guinea, Nepal and Vietnam have each cut maternal deaths by 75%. However, many countries – especially in Africa and south Asia – are not making progress. According to Countdown 2015, an umbrella group of academics, donors and NGOs that tracks progress in maternal and child survival, only nine of 74 Countdown countries with available data are on track to achieve MDG5. Eight of them (Bangladesh, Cambodia, China, Egypt, Eritrea, Laos, Nepal and Vietnam) are also on track to achieve MDG4. Chopra said countries such as Niger and Nepal had made significant progress on child mortality even without fast economic growth or significant poverty reduction. "In Niger, child mortality dropped by 47% in 10 years," he said. "It went from 227 down to 125 per 1,000 births. Niger concentrated on getting health workers into rural areas with simple interventions. The exciting thing is that with the money we have now, we can buy more medicines and save far more lives." Countdown said analysis for 2010 showed that 64% of child deaths were attributable to infectious disease and 40% occurred during the neo-natal period. The leading causes of death among older children remain pneumonia, diarrhoea and malaria. Chopra said new, more effective and cheap anti-malaria drugs that can be delivered by community workers to people's homes held out great potential. "The new drugs are much more effective and can be delivered quickly to kids who need it most," he said. Over the course of the decade, global malaria deaths have dropped by an estimated 38%, with 43 countries (11 of them in Africa) cutting cases or deaths by 50% or more. This is down to more effective drugs (artemisin combination therapies) – although there are reports of growing resistance to the new drugs, rapid diagnostic tests, long-lasting insecticidal nets (developed since 2000), better policies, and increased resources (human and financial), including distribution of enough bednets to cover nearly 80% of the population at risk in sub-Saharan Africa. Other means of reducing child mortality, such as handwashing and breastfeeding, come down to education rather than money. Modifying behaviour can be difficult, but not impossible. Chopra pointed to Uganda, where education has led to a significant increase in breastfeeding. "It is possible to change behaviour and it is being done and can be done in a short period of time," he said. The promotion of handwashing in schools in China, Colombia and Egypt has led to a drop in primary school absenteeism due to diarrhoea or respiratory infections of between 20% and 50%. Still, money will be needed to help achieve MDGs on child and maternal mortality, but official development assistance for maternal and child health appears to have plateaued in 2009 after increasingly steadily over the past decade, according to Countdown. In 2009, total official development assistance for maternal, infant and child health increased by 14.1% to $4.5bn from 2008. This compared with increases of 17.1% from 2006 to 2007 and 21.2% from 2007 to 2008. http://www.guardian.co.uk/global-development/2012/aug/28/breakthrough-child-mortality-unicef-official?newsfeed=true