Dramatic drop in child deaths: Has The Gambia reached the Millennium Development Goal target seven years early?
Simple health service measures could cut the number of children dying in rural areas of Africa by the age of five by over two thirds, according to a new study.

In 2008, one in seven children in sub-Saharan Africa died before their fifth birthday; worldwide almost nine million children under five years die each year.  A study published in Tropical Medicine and International Health1 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.

Research conducted by The Medical Research Council Unit, The Gambia and the London School of Hygiene & Tropical Medicine has demonstrated that during  the 20 year period from 1989 to 2008 deaths in the under-fives in one rural area of The Gambia are estimated to have fallen by 56%, and in one to four year olds by 69%.  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.  The precise reasons for these improvements - which probably 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, of the London School of Hygiene & Tropical Medicine, said “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 - and is continuing to be -made.”

In 2000 world leaders signed up to the Millennium Declaration, agreeing to achieve eight MDGs, with the ultimate aim of improving the lives of the world’s poorest people.    Most child deaths are preventable or treatable, but many countries still have unacceptably high child mortality rates.  Progress has been made, with a 28% reduction in deaths in under fives between 1990 and 2008, equivalent to 10,000 fewer deaths each day.  Progress is varied, however, and out of the 67 countries with high child mortality rates only 10 are on course to achieve the 2015 target.  It is estimated that at the current rate of progress it will take until 2165 for the 2015 target to be achieved overall.

Commenting on The Gambia’s achievement of the MDG4 milestone, Dr Momodou Jasseh (MRC Unit The Gambia) said "The results of this study demonstrate that sustained national health programmes have the potential to reduce child mortality in poor rural African communities to levels that have never been recorded in such settings. However, despite the achievements documented, this piece of work also reveals that not much has changed over the past two decades in the rate at which children in the Farafenni area die in the first month of life.  The implication is that neonatal mortality continues to be a significant public health concern. Therefore, further research should be targeted at understanding and identifying strategies for preventing neonatal deaths to continue the reduction of child mortality levels in The Gambia and the wider developing world."

http://www.ncbi.nlm.nih.gov/pubmed?term=jasseh., http://www.ncbi.nlm.nih.gov/pubmed?term=jasseh, http://www.ncbi.nlm.nih.gov/pubmed?term=jasseh, http://www.ncbi.nlm.nih.gov/pubmed?term=jasseh, http://www.ncbi.nlm.nih.gov/pubmed?term=jasseh, http://www.ncbi.nlm.nih.gov/pubmed?term=jasseh, http://www.ncbi.nlm.nih.gov/pubmed?term=jasseh, http://www.ncbi.nlm.nih.gov/pubmed?term=jasseh, Reaching Millennium Development Goal 4 - The Gambia. Tropical Medicine and International Health doi:10.1111/j.1365-3156.2011.02809.x

http://www.ncbi.nlm.nih.gov/pubmed?term=jasseh

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