London School of Hygiene & Tropical Medicine

In 2008, one in seven children in sub-Saharan Africa died before their fifth birthday, and worldwide almost nine million children under five die each year.  A study published in Tropical Medicine and International Health has shown that deaths in under-fives in a rural area of Africa “dropped dramatically” through simple actions, such as effective immunisation and malaria control.  The findings are likely to provide important insight into effective measures to cut child deaths, which can be applied more widely and contribute to achieving the UN’s fourth Millennium Development Goal (MDG4), aiming to reduce by two thirds, between 1990 and 2015, the mortality rate in children under five years of age.

During the 20 year period from 1989 to 2008 deaths in the under-fives in the Farafenni area of The Gambia are estimated to have fallen by 56% (from 165 to 74 per 1,000 live births), and in one to four year olds by 69% (from 105 to 33 per 1,000 live births), according to research from the Medical Research Council Unit in The Gambia and the London School of Hygiene & Tropical Medicine .  The study, funded by the Medical Research Council, found that by 2008 the child mortality rate in this region had fallen sufficiently to meet MDG4 – from 159 per live births in 1990 to 45 per 1,000 live births in 2008. The precise reasons for these improvements, which potentially reflect the picture in The Gambia as a whole, are not clear, but improvements in control of malaria and its complications are likely to have been important contributory factors.  The study’s authors conclude that “whatever the exact mechanism of the reduction in child mortality observed, our findings are encouraging in that they suggest the deployment of simple health services such as effective immunisation and malaria control can allow even some of the poorest regions of Africa to reach the MDG4 goal”.

Professor Brian Greenwood, Professor of Clinical Tropical Medicine at LSHTM,  says: “When I helped to set up the Farafenni field site in 1982 one in four children living in the area died before reaching the age of five years.  That’s gone down dramatically to one in twenty in the period of just one person’s career.  It’s very encouraging to see that real progress has been, and is continuing to be, made.”

Professor Tumani Corrah, director of the MRC Laboratories in The Gambia, said: “We are extremely pleased to see that effectively managing conditions such as malaria and improving immunisation levels can dramatically increase a child’s chances of reaching adulthood in The Gambia. There is still a lot of work to do, however with the excellent scientists we have in place and our well developed relationships with the Gambian government and other organisations, we hope to continue to build on these results to further improve the health of people across the world.”