Niger has nearly halved the death rate of children below five years old since 1998, a significant drop highlighting the benefits of free universal health care for children and pregnant women as well as increased donor funding for health, The Lancet said in a study released on 20 September.
The mortality rate reduced from 226 deaths per 1,000 live births in 1998 to 128 deaths in 2009, an annual rate of decline of 5.1 percent, said the study, noting that the slump bettered the fourth Millennium Development Goal (MDG) to cut the child mortality rate by two-thirds between 1990 and 2015. Niger’s achievement was also far better than its neighbours in West Africa.
The prevalence of stunting in children aged 24-35 months slowed slightly. Wasting reduced by about 50 percent, with the largest decrease recorded among children under two. Provision of insecticide-treated bednets, improved nutrition, giving vitamin A supplements, treatment of diarrhoea, fevers, malaria, childhood pneumonia, and vaccinations also boosted child survival, the study found.
“The research demonstrates the success of the strategy implemented by the government and its partners, an important step toward the well-being of the Niger population,” Agbessi Amouzou, one of the study’s authors, told IRIN.
However, the UN Children’s Fund (UNICEF) said in a recent statement that Niger had the greatest number of malnourished children in the Sahel region in 2012 and high levels of food insecurity. More than 330,000 children under the age of five were at risk of malnutrition, it noted. A harsh drought and high food prices have left more than 18 million people in the Sahel facing starvation.
The Lancet released a series of reports in the run-up to the 2015 MDG deadline to assess progress towards attaining those targets as part of its collaboration with Countdown to 2015, an initiative monitoring maternal, newborn and child survival progress. Only 23 of the 74 Countdown countries are on track to achieve the MDG-4.
From the mid-1990s, the government embarked on efforts to attain universal access to primary health care for women and children, with the focus on expanding measures to reduce deaths from malaria, pneumonia, diarrhoea and measles. It also built more health centres in remote regions and trained staff. Between 1998 and 2010, official development assistance increased by 77 percent to US$744.5 million, said the study, entitled Reduction in child mortality in Niger: A Countdown to 2015 country case study.
|Maternal and child health aid trends|
|Official development aid to maternal, newborn and child health increased by 2.5 times between 2003 and 2009 to reach US$6.511 billion, according to the Lancet. But following year-on-year rises, aid to these sectors in 75 priority MDG countries dipped to $6.48 billion in 2010, concurrent with overall drops in development aid growth, said the report’s author, Justine Hsu of the London School of Hygiene and Tropical Medicine.
A large share of aid to maternal, newborn and child health tends to be allocated to the same countries year-on-year, with India, Pakistan, the Democratic Republic of Congo, Tanzania and Nigeria consistently in the top 10.
These aid flows are increasingly needs-based - that is, they correspond with the highest maternal and infant mortality rates per country.
Estimates of how much is needed to reach maternal and child health MDGs range from US$10 billion to $33.9 billion per year (World Health Organization and The Partnership for Maternal, Newborn and Child Health, 2010).
Pneumonia, malaria and diarrhoea accounted for almost 60 percent of deaths among children under five before Niger took measures to reverse the trend, said Amouzou of the Department of International Health, Johns Hopkins Bloomberg School of Public Health.
“Many unnecessary deaths from these causes are now being prevented. But that means that higher proportions of deaths will occur for causes that are not yet being addressed - notably deaths in the neonatal period. We know how to prevent deaths in the first month of life, and the Niger government and partners are planning to translate their success to date into even more effective programmes for newborns,” Amouzou explained.
Rheal Drisdelle, the director of Plan International in Niger, told IRIN that while the study’s findings were “extremely consoling” given the Sahel food crisis, malnutrition among children remained high.
“The malnutrition figures continue to be extremely high, but what we have noticed is that the figures of severely malnourished children have gone down. But it is good news that mortality rates due to malnutrition have gone down,” he said, adding that malaria and malnutrition were the main threats to child survival in Niger.
“There has been a lot of progress in getting health care closer to people in need. It is not where it should be, but there has been some progress and there has been progress on how people view health care.”
Free medical care for children under five
Isselmou Boukhary, UNICEF’s deputy representative in Niger, said more health centres had been built across the country, slashing the population-to-health centre ratio from 30,000: 1 to 5,000: 1.
“There is free medical care for children under five. This is something we are witnessing,” Boukhary said. “Sub-Saharan Africa is often associated with the images of malnourished children. But in Niger the [health improvement] programme has been a success story.”
The study said Niger has “achieved great reductions in child mortality by responding forcefully to opportunities and constraints in their context.”
“The basic principles, that is, reaching high proportions of mothers and children with the interventions that can save their lives, using strategies that provide services at community level, can and should be applied in other countries,” said Amouzou.