30 October 2013
Children have been at the centre of recent global efforts to improve well-being conditions in developing countries. Since 1990--the year when Millennium Development Goal 4 (MDG4) began to be monitored, and which called for a two-thirds reduction in the under-five mortality rates by 2015--developing countries have made important strides towards reducing child mortality. Over the last 20 years, child mortality rates have fallen considerably, from 87 deaths per 1,000 live births to 51. In absolute terms, this means a reduction from 12 to 6.9 million in the number of children dying every year (Unicef 2012).
Despite this remarkable achievement, more than 19,000 children still die every day, most of them of preventable and treatable infectious diseases. Recent estimates suggest that nearly 80 per cent of under-five deaths occur in sub-Saharan Africa and South Asia, and about half of the deaths, in one of five countries: India, Nigeria, Democratic Republic of the Congo, Pakistan, and China (Black et al. 2010). India and Nigeria alone account for more than one-third of child deaths worldwide. The fact that a large proportion of child deaths are caused by preventable and treatable infectious diseases is symptomatic of dysfunctional health systems in the developing world.
Assessing 'what works' in tackling the main cause of child morbidity and mortality is thus fundamental for effective policy actions.
Acute respiratory infections, notably pneumonia, and diarrhoeal diseases are the first and second leading causes of death among young children, respectively. Pneumonia and diarrhoea alone lead to 1.6 and 1.3 million child deaths per year respectively, amounting to almost 3 million deaths in total. Young children are particularly vulnerable to the negative health implications of diarrhoeal infections, including poor nutritional absorption, dehydration, and susceptibility to infections. Prolonged periods of diarrhoea can cause malnutrition and micronutrient deficiencies that increase the risk of contracting pneumonia while impairing children's growth and development (World Health Organization 2003). Early malnutrition is also linked to poor cognitive functioning and learning capacity, which in the longer term leads to lower labour productivity, and poverty (Grosse and Roy 2008; Hoddinott et al. 2008).
The good news is that there is evidence of a decline in incidence and mortality rates--due to diarrhoea and pneumonia--among young children...