Achievement of Millennium Development Goal Four

Too frequently we view poignant images of children who are malnourished or seriously ill. The children of the world are the hope of the future, but how much does the world actually value them? Unfortunately, not very much, because these are the stark realities regarding global health in children under age 5:

* Globally, 10.5 million children die each year from largely preventable causes

* Forty percent of the deaths occur within the first month of life

* More than 99% of these deaths are concentrated among the most economically disadvantaged population

* Malnutrition and subnutrition are correlated strongly, with 53% of deaths in children under age 5

* Rates of preventable newborn and child deaths are double the number for people globally who die each year from HIV/AIDS, malaria, and tuberculosis

* The leading causes of death in children under age 5 are neonatal causes (27%), pneumonia (19%), neonatal infections (pneumonia/sepsis;10%), diarrheal diseases (17%), other (10%), malaria (8%), measles (4%), injuries (3%), and AIDS (3%)

The United Nations Millennium Development Goal Four (MDG-4) is to reduce child mortality in children under age 5 by two thirds between 1990 and 2015. A recent UNICEF conference, "Child Survival Countdown to 2015" tracked progress in meeting MDG-4, and a recent issue of The Lancet focused on achievement of MDG-4. There is a sense that MDG-4 is the one MDG that is achievable through concerted effort, but much needs to be done. Countries with the highest under-5 mortality rates per thousand births include Sierra Leone (283), Angola (260), Niger (259), Afghanistan (257), Liberia (235), Somalia (225), Mali (219), Congo (205), Equatorial Guinea (204), and Guinea-Bissau and Rwanda (203). Out of the 60 countries targeted for reduction in under-5 mortality, seven countries have made considerable progress toward meeting MDG-4, including Bangladesh, Brazil, Egypt, Indonesia, Mexico, Nepal, and the Philippines. Indicators include nutritional markers, immunization, other prevention interventions, newborn health, and case management.

Maternal and child health are inextricably linked, and healthcare for childbearing women means healthier newborns and children. For example, India has the highest number of births and the highest number of neonatal deaths in the world. This country is making a concerted effort to reduce neonatal deaths through various initiatives. For example, education and assessment skills are provided to women in the Barul Zopadpatti village in Maharashtra's Osmanabad district, who then teach other women and assess the health of their children. This initiative is called Integrated Management of Neonatal and Childhood Illness (IMNCI). Dhondiba, one of these community health workers, said

"When I had my first child, my mother-in-law asked me not to give the colostrum to the baby. She said it would make the baby sick. I did not give my child breast milk for the first three days. Now I know what harm that can do and how it can affect the growth and immunity of the infant. After the training, I also know the basics of home-based care for children and can deal with mild problems. My job profile has changed-earlier, I only weighed and fed children. Now, the villagers think I am a mini doctor!!" (Chatterjee, 2006, p. 1055)

Sustainable, low-technology, low-cost, evidence-based initiatives are proving to be effective in the reduction of mortality rates for children under age 5. Oral rehydration therapy and food supplementation of macro- and micronutrients have been used effectively for decades. Newer advances that have the potential to reduce child mortality rates include rotavirus and pneumococcus vaccines, low osmolarity oral rehydration therapy, the use of zinc for treatment of diarrhea, insecticide-treated bed nets, and artemesinin-combination treatments for malaria. All these initiatives can assist in the achievement of MDG-4. More important, these initiatives can reduce suffering in innocent children. How much do we value children? The infusion of and redistribution of resources globally can make a difference in ensuring a bright future for the children of the world.

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