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Preventable Deaths in Children Under-five
Globally, it is estimated that 5 million children die every year before reaching the age of 5 years old. Nearly half of these are from preventable or treatable diseases.
This is a short article that aims to raise awareness of this problem, focus on those preventable diseases and then discusses the way forward.
Contextualising and explaining the current situation
I'm going to begin by quickly summarising our human story. A brief sojourn into humankind's social and technological progress over the last few hundred thousand years will give context and greater understanding of today's situation with child mortality.
Our amazing planet has supported human life for almost 300,000 years, and what a successful 300,00 years it has been for our species. The transition from hunter-gatherers to farmers occurred about 6000 years ago. The human population back then was about 5 million. Agricultural innovation meant humans had access to more food. Language, learning, and culture began to flourish; civilisations grew and trade developed. Technological advancements allowed humans to travel faster, safer and more efficiently. The result was a steady increase in human population over the next few thousand years to around 1 billion souls in 1800.
The world would then experience a seismic jolt - an industrial earthquake that sent tremors cascading through just about every corner of the planet. A ferocious race began to seek bigger, better, more efficient ways of working. The Industrial Revolution saw an unprecedented acceleration in innovation and productivity. New scientific discoveries and the unveiling of engineering masterpieces became a regular feature in a world where humankind was growing in confidence. Medical advancements, the ever increasing availability, quantity and quality of foods, domestic heating and sanitation was to have a direct effect on lowering death rates. The human population expanded rapidly over the next 200 years from 1 billion to over 7 billion today.
'What has this got to do with childhood mortality?' you may ask.
Not everyone on our planet has benefited from the fruits of the Modern Age. There are still those areas of the world that have limited access to adequate sanitation, medication and technological/scientific expertise. Food is still scarce in many regions. We will see later in this article that these factors have a direct and proportional effect on preventable early child mortality.
The causes inequality of health care, wealth, and physical and social safety can and should not be over-simplified. It is only possible to provide a basic summary here. We can start with focussing on those cruel accidents of geography, where local climate, water supply and landscape can all conspire to hinder nutrition, hygiene and healthcare provision. Then there are the often chaotic activities of local and national legislators that can impede progress to improving infrastructure. The great international powers of the world have also had an impact in draining the resources of those poorer areas with little wealth being fed back. Civil war and conflicts with neighbours have also taken their toll.
We can look at many things when we take stock of how we're doing as a species. There are the obvious indicators, such as average life expectancy, provision and attainment of education, and economical and physical security. A key indicator could and should be preventable death rates that occur in children under 5 years old. We should ask 'How well are we doing as a species in providing mothers and young children with basic healthcare and support? How many preventable deaths occur in this age group each year?'
According the World Health Organisation (WHO), today approximately 5.3 million children die each year before reaching five years old. This accounts for 1 in every 26 children, and nearly half of these died before reaching the end of their first month. Approximately, half of these are from preventable and/or treatable causes.
Incredibly, there have been massive improvements on early childhood mortality over recent years. It was estimated, 30 years ago, that nearly 12 million children under the age of 5 died every year. Improvements in access to vaccinations, basic antenatal and postnatal care, and medications, have contributed to this. But, there is much more that can be done.
Globally, not all areas are affected equally. The poorest regions have higher rates of preventable early childhood deaths - not surprising, you might say. The areas of the world that are most affected are Sub-Saharan Africa and Southern Asia. India and Nigeria account for nearly one-third of all under-5 child deaths.
the main causes of death in children under five years old
Here is a brief list of the most common causes of preventable deaths in children under 5 years old:
Respiratory Tract Infections, including pneumonia
According to an article published in The Lancet, approximately 2 million children under the age of 5 die from respiratory tract infections every year - making this the leading cause of death in this age group.
Infections that cause diarrhoea.
It is estimated that about 500,000 children die every year under the age of 5 due to infection that causes diarrhoea. The WHO states that these illnesses are the second leading cause of death in children under 5.
These infections can be caused by viruses, bacteria or parasites.
Malaria
This is a parasitic infectious disease that is passed to humans by female Anopheles mosquitos. It can cause a fever, headache, shivers, muscle pains and loose bowels. If left untreated, malaria can cause death.
Malaria is a treatable disease and most will recover if they have prompt access to anti-malarial medication.
According to UNICEF, a child under five dies every two minutes from malaria, and over 60% of all deaths from malaria are in children under five. The WHO estimates that in 2018, malaria caused 272,000 deaths in this age group. Most deaths occur in Sub-Saharan Africa.
Birth complications, including preterm births
Approximately, 1.1 million preterm babies die each year. The countries with the highest rates include Malawi, Zimbabwe, Mozambique and Pakistan. A document for Save The Children and WHO suggests 75% of these could be saved with relatively inexpensive treatment and preventions, such as better equipment, training and access to medicines.
It is estimated that over 700,000 newborns die each year from birth complications. Birth asphyxia is the leading cause of death in this group - where neonatal oxygen supply is interrupted during birth. At least some of these deaths can be prevented with better supply of resuscitation equipment and increasing the expertise in the attending healthcare staff.
Congenital abnormalities
These include structural or functional problems that occur and develop in the preterm infant. These can be due to genetics, maternal infections, maternal exposure to toxins and socioeconomic factors (such as low income).
Congenital abnormalities result in approximately 300,000 deaths every year in infants.
Neonatal sepsis
This simply refers to a blood infection that occurs in babies in the first few weeks of life. Most fatal cases occur within the first week. There is some cross-over here with birth complications, respiratory tract infections and those causing diarrhoea, as they are common causes of sepsis. Other causes include kidney infections and meningitis. Commonly used antibiotics and basic medical provision can vastly reduce the number of these deaths across the world.
Discussion
It would be quite easy to be completely overwhelmed by the immense scale of preventable and treatable early childhood deaths around the world. Where do we start when faced with such disturbing statistics? Well, we should begin with looking at the root causes. Let us focus on those underlying factors that continue to drive these troubling figures into the millions every year.
When analysing the stats and the locations where mortality is at its highest there is one thing that becomes obvious. A word that appears immediately and never really leaves our field of view - poverty. This is poverty in finances, causing a dearth of healthcare expertise and equipment, and not to mention limited supply of effective medicines and treatments. Childhood mortality is at its worst in poorer areas of the world - Sub-Saharan Africa and Southern Asia. Civil war, tribal rivalries, political corruption and disputes with international neighbours often muddy the situation and add to the problem.
Let's look at a country such as Malawi - one of the world's poorest countries and compare it with the USA. The stats from UNICEF show that about 1 in 20 children will die in Malawi before reaching 5 years old. In the USA the figure is less than 1 in 100. Malawi leads the global statistics for preterm birth, and deaths within the first month of life are over 5 times more likely in Malawi than the USA. It is not hard to see why when we compare the levels of healthcare provision. Only 51% of expectant mothers receive 4 or more antenatal visits in Malawi, compared to 97% in the USA.
Poverty is not all about money and the access to healthcare, though is it. The impoverished society will tend to have restricted access to clean water and sanitation. This then impacts on the safety of food supply and preparation, leading to bowel infections - a major cause of diarrhoea and malnutrition.
It is tempting to think that preventable child deaths is only a third world problem. It is not. The Office of National Statistics (ONS) stated that 34% of all deaths in children in the U.K. in 2017 were from preventable causes - 1653 deaths in total.
How is the international community responding to these challenges?
For many years, international charities and organisations like UNICEF, Save The Children, Medecins Sans Frontieres, Red Cross, Red Crescent, Wateraid and Oxfam et al. have all taken an active interest in addressing the factors that compound to increase child mortality.
In 2015, the UN adopted the Sustainable Development Goals (SDG) - a list of objectives tasked to improve child well-being. Goal 3 was an ambitious aim to end preventable deaths by 2030 - in other words, to reduce under-5 mortality rates to less than 25 in 1000 births or less than 1 in 40. The focus was to be mainly on Sub-Saharan and South Asian countries. Another target of the SDG is to end all forms of malnutrition - poor nutrition was related to 45% of all deaths in children under 5.
The Four Pillars of Early Childhood Health
It is my opinion that complex problems are usually best solved by taking a simple, stepwise approach. Concentrating on four key areas will continue to improve early childhood mortality:
- Ensure the supply of clean water.
- Give universal access to vaccinations.
- Provide basic provision of perinatal care and services.
- End the scandal of starvation and nutritional deficit.
Let's call this list 'The Four Pillars Of Early Childhood Health'. If we can build and maintain these four pillars, the number of preventable deaths in early childhood will surely continue to fall in all areas of the globe - and with the right approach, this can even be done in areas that are experiencing conflict.
What are we waiting for? We have the chance to save a further 2 million lives of children under-five every year. This is the prize. I can think of no more valuable trophy on Earth.
Final Thoughts
It is unclear how much impact the current Covid-19 pandemic will have on the goals set out to further reduce preventable early childhood deaths. Perhaps, one thing is for certain - it will have some impact - time will tell on the extent and depth. It could even be conceivable that mortality figures may even get worse in the short to medium terms.
A recent report published by Imperial College London has highlighted the global problem of missed vaccinations during the Covid-19 pandemic - 9% of respondents having missed or delayed vaccinations, with most countries being affected.
Governments and health systems will prioritise combatting the pandemic to the likely detriment of providing universal health care to all. Resources will be diverted and the quality of healthcare will be compromised. I have seen the signs of this myself working as a primary care doctor in the U.K, where new mothers have had restricted contact with health professionals in those important first few weeks and months after giving birth.
It is my opinion that losing over 2 million young children from preventable deaths each year should be classed as a global health emergency - a pandemic of neglect and indifference from the international community. It is a public health problem that should carry the same amount of attention, and call on the same amount of resources, as Covid-19.
While in the midst of Covid-19, let us not forget this 'other' continuing global health emergency. With loud determination and a quite resolve, and through these difficult times, we can continue to save millions of lives - young lives that have yet to have the chance to experience what our wonderful planet has to offer.
Dr Darren Cousins
Primary Healthcare Physician, UK.
Published July 23rd, 2020.
