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WHAT'S NEW THIS SUNDAY: CHILD MORTALITY REDUCTION IN THE REPUBLIC OF NIGER

Friday, 15th of February 2013

REDUCTION IN CHILD MORTALITY IN THE REPUBLIC OF NIGER

This discussion article refers to a previous article on the same subject, accessible at

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61376-2/fulltext

Original Text

Kumanan Rasanathan a , Theresa Diaz a, Julia C Kim a, Mark Young a

Agbessi Amouzou and colleagues' explanation of Niger's impressive reduction in under-5 mortality (Sept 29, p 1169)1 shows how health-sector interventions can dramatically improve child survival and reduce health inequities. It also supports calls to prioritise the most deprived communities.2 However, the study raises the question of how to continue this progress.

One in eight children in Niger is still likely to die before the age of 5 years, and neonatal survival has improved little.

If Niger, and other countries with high levels of child deaths, are to continue reductions in under-5 mortality (and even realise aspirations to reduce it to no more than 20 per 1000 livebirths by 20353), there will be diminishing returns if improvements are only made in the delivery of health services. For example, if the proportion of births to women with secondary education or higher remains at less than 5% in Niger, these further goals are unlikely to be achieved. To sustain the gains seen in Niger, continued efforts will be needed not only to expand interventions to pregnant women and neonates, but also to collaborate with those beyond the health sector to address social determinants.

Resolute efforts by the Government and communities of Niger have been aided by global partners to improve the delivery of health services.4 Yet these combined efforts seem to have had much less effect on reducing poverty or increasing maternal education, which are key contributors to ensuring child survival and development, with the latter especially important in the neonatal period.5 The global community needs to conceive efforts to improve social determinants as an integral part of efforts to reduce child deaths, at the same time as helping to replicate the improvements in health service delivery that Niger shows is possible even in challenging contexts.

All authors are staff members of UNICEF, which provided support for the original study. However, we were not involved with the original paper. These are the authors' views and do not necessarily reflect the views or policies of UNICEF.

References

1 Amouzou A, Habi O, Bensaïd Kfor the Niger Countdown Case Study Working Group. Reduction in child mortality in Niger: a Countdown to 2015 country case study. Lancet 2012; 380: 1169-1178. Summary | Full Text | PDF(777KB) | CrossRef | PubMed

2 Lake A. A tipping point for child survival, health, and nutrition. Lancet 2012; 380: 1286-1287. Full Text | PDF(427KB) | CrossRef | PubMed

3 Glass RI, Guttmacher AE, Black RE. Ending preventable child death in a generation. JAMA 2012; 308: 141-142. CrossRef | PubMed

4 Sanda S. Niger's success in child survival. Lancet 2012; 380: 1127-1128. Full Text | PDF(302KB) | CrossRef | PubMed

5 Gakidou E, Cowling K, Lozano R, Murray CJ. Increased educational attainment and its effect on child mortality in 175 countries between 1970 and 2009: a systematic analysis. Lancet 2010; 376: 959-974. Summary | Full Text | PDF(2855KB) | CrossRef | PubMed

a Health Section, UNICEF, New York, NY 10017, USA

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