Real Help for Developing Countries

Poverty and child mortality are endemic across much of the world, notably in the African continent. Yet, simple measures can save countless lives. Today's Globe and Mail had a fascinating piece that highlights how simple measures tailored to the needs of local communities can bring about drastic changes in infant mortality.

The Globe and Mail article by Stephanie Nolen entitled "Simple as that, child mortality is at a record low" demonstrates how simple and very simple measures can drastically reduce infant mortality. According to the Nolen:

The application of a handful of simple, low-cost measures, from giving families $2 mosquito nets to encouraging breastfeeding, is spurring a sharp decline in child deaths around the world.

For the first time since the United Nations began to keep records in 1960, the number of child deaths fell below the 10-million mark, down to 9.7 million in 2006, the last year for which there is data.

“This really is a historic moment,” said Peter Salama, Unicef's chief medical officer, although he was quick to note that those 9.7 million deaths, almost all of them from preventable or easily treatable causes, are “in no way acceptable.”

Nevertheless, this is undeniable good news from developing countries, made even brighter by the fact that the biggest drops in child deaths have come in some of the poorest places: 20 per cent in Niger, 23 per cent in Mozambique, a stunning 41 per cent in Madagascar. (Sub-Saharan Africa accounts for 50 per cent of all child mortality, even though the region's total population is only half that of India. In West and Central Africa, more than 150 of every 1,000 children born die before the age of 5, compared with fewer than six in Canada.)

Mr. Malunga [a village health worker in Malawi] knows what's responsible for the drop in his area: The biggest reason is that all pregnant women are now given a free insecticide-treated mosquito net for themselves and their children to sleep under. The new access to bed nets – which, even at a heavily subsidized price, are too costly for people here to buy, he said – has cut malaria deaths by about a third in the past few years. “It is malaria that kills most of the children,” he said.

But he is going after more than malaria: He has vaccinated nearly every single child in his 16-village territory – measles used to be a big killer here too, but there hasn't been a case in seven years, he said. No polio since 1990. He gives most children a capsule of vitamin A at least once a year, sometimes twice, if he can get it – and that is enough to boost their immune systems so that if they do get diarrhea or malaria, they are much less likely to die.

He weighs the children every time he sees them, and plots their growth on a chart – in Malawi, 46 per cent of all children show signs of stunting, the result of chronic malnutrition – and refers any who aren't growing well to the emergency nutrition rehabilitation centre. He has persuaded more and more women to breastfeed their babies and delay any introduction of solid food until the age of six months. Traditionally women here give babies maize porridge from the age of one week.

Mr. Malunga has supervised the installation of cement-covered pit latrines and protected water sources in many of the villages, leading to a drop in water-borne illness. He has persuaded many women to take contraceptive pills or get the Depo-Provera injections he does in the clinic – because, he explained, children spaced at least two years apart have much higher chances of survival. He travels village to village talking to groups about HIV (with which 14 per cent of Malawi's adults are infected) and he offers them condoms.

These are all simple measures that cost very little to implement and they require working with communities and recognizing local needs. Simple measures such as providing free bed nets costing a mere $2 to pregnant women and children to use at night saves lives. Likewise, the simplest and most natural form of sustenance for children also saves lives:

Through simple education programs (sitting women down beneath the biggest tree in a village for a lecture), Malawi raised exclusive breastfeeding from 7 per cent of women to 63 per cent, between 2000 and 2004.

Breastfeeding ensures better nutrition for babies and breast milk transfers antibodies from the mother to the child promoting. It also reduces exposure to environmental contaminants: in places where sources of clean drinking water is not readily available, breast milk is the safer option.

Central to the success of these efforts is ensuring locally trained health care officials working in villages. This comes at a cost, but quite minimal:

Mr. Malunga, 31, has only a Grade 10 education and received just eight weeks of training when he began this job more than a decade ago. Often his small clinic lacks even Aspirin. But he is enough to guarantee good vaccination coverage, early diagnosis of respiratory infections and malnutrition – enough, in short, to cut child deaths by nearly a third.

Many developing countries have recognized that they need a way to get preventive health care and information out from district centres to rural and poorly educated populations, and there have been all manner of schemes to train community health volunteers. But very few countries have been willing to do what Malawi does: pay them. It's only $36 a month – not even enough, Mr. Malunga lamented, to buy a bicycle – but in a desperately poor country, it is enough to keep him showing up in a crisp blue polyester uniform to weigh and vaccinate babies each day.

The costs of improving the health of children does not require billions and it does not need high technology and expensive drugs, it begins with applied work in communities addressing basic issues of preventative health and nutrition. Later, there will be a need for more and better health care, but addressing basic issues can provide immediate results. All that is required is the political will of states to help their populations and the financial support of richer countries to ensure that fewer children die.