Interventions that improve nutrition and environmental conditions can help decrease child deaths worldwide

Interventions that improve nutrition and environmental conditions can also provide substantial gains toward the goal of reducing child mortality, especially when the interventions prioritize the poor, according to a study in the October 24/31 issue of JAMA: The Journal of the American Medical Association, a theme issue on poverty and human development.

This issue of JAMA is being released early because of JAMA's participation in an international collaboration of more than 200 medical and scientific journals to publish articles simultaneously to raise awareness on the topic of the relationship between poverty and human development. This initiative is coordinated by the Council of Science Editors, and presentations regarding some of the studies in this Global Theme Issue will be webcast live from the National Institutes of Health (http://videocast.nih.gov/summary.asp?live=6239), including this study, presented by co-author Majid Ezzati, Ph.D., of the Harvard School of Public Health, Boston.

The United Nations Millennium Development Goals (MDGs) were established in 2000 in a declaration adopted unanimously by U.N. member countries to focus resources and efforts toward critical global poverty, health, and sustainability problems. The MDGs set numerical targets to be achieved by 2015 and use socioeconomic, environmental, nutritional, and health indicators to monitor progress toward these targets, according to background information in the article. There are concerns that the progress toward some of the health-related MDGs has been slow in many countries, making it very difficult to achieve them by the target date.

Emmanuela Gakidou, Ph.D., formerly of the Initiative for Global Health, Harvard University, Cambridge, Mass., and colleagues conducted an assessment to estimate the reduction in child mortality as a result of interventions related to environmental and nutritional MDGs. They analyzed data on economic status, child underweight, water and sanitation, and household fuels from the Demographic and Health Surveys for 42 countries in Latin America and the Caribbean, South Asia, and sub-Saharan Africa. Data on disease-specific child mortality were from the World Health Organization, and data on hazardous effects of MDG-related risk factors were from systematic reviews and meta-analyses of epidemiological studies.

“Implementing interventions that improve child nutrition and provide clean water and sanitation and clean household fuels to all children younger than five years would result in an estimated annual reduction in child deaths of 49,700 (14 percent) in Latin America and the Caribbean, 0.80 million (24 percent) in South Asia, and 1.47 million (31 percent) in sub-Saharan Africa,” the authors report.

“These benefits would close 30 percent to 48 percent of the current regional gaps toward the MDG target for reducing child mortality,” they continue.

The analysis found that environmental and nutritional interventions would have larger benefits for reducing deaths among children if the interventions were targeted to the poor first.

“Fifty percent coverage of the same environmental and nutritional interventions, as envisioned by the MDGs, would have 30 percent to 75 percent larger benefits for reducing child mortality if the interventions were targeted to the poor first than it would if the interventions benefited wealthier households, who nonetheless are also in need of MDG-related interventions,” the authors write.

“Pro-poor interventions have larger aggregate benefits, especially in sub-Saharan Africa, because they deliver environmental and nutritional interventions to children who are most susceptible to dying of such exposures, possibly because of limited access to medical services,” they conclude.

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