Highlights
Charting Paths of Hope
Two research groups provide compelling evidence and recommendations for reducing child mortality in low- and middle-income countries
In 2021, 5 million children under 5 years of age died. 99% of these deaths were in LMICs
The SDG target 3.2 is to end preventable deaths of newborns and children under five by 2030. The world has made progress towards this goal: from 12.8 million deaths in 1990 to 5 million in 2021. But many young lives are still being lost, most of them in low- and middle-income countries. Two of our research teams provide strong evidence that many of these deaths can be prevented by better understanding their causes and by addressing income inequalities.
Understanding the causes of death
“If we want to prevent these deaths, we need to know the causes, but the problem is that we lack reliable data,” says Quique Bassat, Director General of ISGlobal. It is also important to look beyond the immediate cause of death and consider the whole chain of events leading to death, which offers more opportunities for intervention.
8 out of 10
child deaths in LMIC
could be prevented
A study led by Bassat investigated the causes of death in 636 children aged 1-59 months in seven countries (Mozambique, Sierra Leone, Kenya, Mali, Ethiopia, South Africa and Bangladesh).
Malnutrition was the main trigger of death, followed by HIV, malaria, congenital defects and respiratory infections. An infectious agent was found in 87% of cases but most deaths resulted from a complex interaction of factors.
The study concluded that 82% of the deaths analysed could have been prevented, in many cases with simple and existing measures.
Bassat is part of an ISGlobal team that has developed and validated a minimally invasive approach to obtain biopsies from various organs to determine the causes of death through histopathological and microbiological analysis. This post-mortem minimally invasive tissue sampling (MITS) technique was adopted by CHAMPS, an international child mortality surveillance network launched in 2016.
Importantly, MITS allows the analysis of deaths that occur at home, thus providing valuable information on how to prevent deaths that escape the health system.
Our findings open up many opportunities for designing targeted interventions with high impact
says Bassat.
Alleviating poverty
Ultimately, poverty remains one of the main drivers of disease and death among children in low- and middle-income countries. “Poverty is a determinant that we can act on effectively, and the costs of poverty-reduction programmes are relatively low compared to their benefits,” says Davide Rasella, who leads the Health Impact Assessment group.
Conditional cash transfer (CCT) programmes are one of the most consolidated policies for reducing poverty: they give money to low-income families in exchange for meeting certain health and education requirements for their children.
Rasella and his team evaluated the health impact of these programmes in three Latin American countries (Mexico, Brazil and Ecuador) over the past two decades. The analysis shows that the programmes led to a 24% reduction in under-five mortality. This translates into 739,919 child deaths averted between 2000 and 2019. If the programmes are further expanded to cover those affected by the recent economic crisis, they could save an additional 150,000 lives in the three countries by 2030.
The researchers believe that this effect, which is stronger among children aged one month to five years, is due to improved socioeconomic conditions, such as better nutrition and housing, but also fewer economic barriers to accessing health services.
This is one of the largest impact evaluations of CCTs to date, and it provides solid evidence that these programmes are very effective in reducing child mortality
says Rasella.
Countries
Countries
Years
Years
Deaths averted
Deaths averted
References
- Bassat Q, Blau DM, Ogbuanu IU et al. Causes of death among infants and children in the Child Health 1 and Mortality Prevention Surveillance (CHAMPS) Network. JAMA Network Open. 2023. doi:10.1001/jamanetworkopen.2023.22494
- Medeiros-Cavalcanti D, Ordoñez JA, Aransiola T et al. Evaluation and forecasting analysis of conditional cash transfer an child mortality in Latin America. JAMA Network Open. 2023. doi: 10.1001/jamanetworkopen.2023.23489
