Almost everywhere, fewer children are dying

Two decades ago, nearly 10 million children did not live until the age of 5.

By 2017, that number – about 1 in 16 – had almost halved, even as the world's population had grown by more than a billion people.

The sharp drop in child mortality reflects the efforts of governments and international humanitarian organizations to tackle child poverty and the most deadly diseases for poor children: neonatal disorders, pneumonia, diarrhea and malaria. But the results are also very unbalanced. In some places, children's health has improved dramatically. In others, many still die very early.

According to a report released Tuesday by the Bill and Melinda Gates Foundation, between 2000 and 2017, all 97 low-to-middle income countries that are behind the vast majority of early childhood deaths have lowered their mortality rates Infant, as well as a research team from the Institute of Metrology and Health Assessment of the University of Washington, led by Stephen Lim, Senior Director of Science and Technology. 39, engineering of the institute.

The data reveal a wide disparity of results in terms of early infant mortality, from one country to another and within the same country. Researchers predict that if current rates of progress continue, nearly two-thirds of children in the poorest countries will still live in districts that will not achieve the United Nations development goals by 2030.

"The inequality in this progress is still quite striking," Gates said in an appeal to reporters.

By combining detailed survey data with statistical models, researchers were able to map infant mortality with much more detailed geographic detail than previous estimates. Syria, which experienced a devastating civil war, was an exception to the trend of improvement.

Experts say reducing child mortality is also a marker of healthier and more stable conditions for adults. Lawrence Gostin, Professor of Global Health Law at Georgetown University and Director of the World Health Organization's Center for Health Law, described it as a healthier version of the "canary in the coal mine" .

Mothers who lose fewer young children tend to have fewer children, which reduces their own risk of death in childbirth and increases their ability to improve the economic prospects of their household, said Ashish Jha, Harvard TH doctor. Chan School of Public Health and Director of the Harvard World Health Institute. "It has huge implications for the family," he said.

The vast majority of child deaths can be prevented. Adequate nutrition, water, sanitation, vaccines and antibiotics can save many lives. And it's not always a question of money; there are often cultural or political obstacles. Malnutrition has been a contributing factor in almost half of these deaths.

Dean Jamison, emeritus professor of global health at the University of California at San Francisco, warned against over-specifying the estimates or their use to measure the success of specific health policies.

But, he said, to give an overall idea of ​​how things have changed over time and in the place, estimates like these are "probably what you can do best".

Below, what is behind the changes in five parts of the world.

India

More than a quarter of the global decline in child mortality reflects progress in India, the second most populous country in the world. There, 1.2 million fewer children died in 2017 than in 2000.

But the gains are not evenly distributed. South of India has seen considerable improvements. Through the combination of economic growth and state policy, barely a child under five years of age 50 dies. In the northern states of India, child death rates are relatively high, nearly one in ten.

"If you look at India's health statistics, I can quote places that look like Eastern Europe and countries that look like sub-Saharan Africa," he said. Dr. Jha. "It's not that Southern India is so rich. They have invested heavily in the education of women and girls. "

Nigeria

Regional inequalities are particularly pronounced in Nigeria. A child born in districts around Lagos, the largest city in the country, has about 1 in 16 chance of dying before the age of 5. But things are very different for children from the far north of the country, along the border with Niger, who are experiencing higher mortality rates. than almost anywhere else in the world. There, 1 in 5 children die before the age of 5.

Nigeria's divergent experiences reflect the trends that experts believe permeate the map of infant mortality. Northern Nigeria has endured prolonged violence and political instability that has displaced many residents. "If they are forced to leave their homes and communities because of violence, it is more difficult for them to access the essential services they need, such as health care, in the event of illness." said Christopher Tidey, spokesman for Unicef. "If they are traveling, it has implications for food security."

Northern Nigeria, which is part of the Sahel belt, has also suffered from drought and food shortages, in part because of climate change.

Thailand

Thailand, on the other hand, is a leader in national equality among the countries studied. Each of its districts achieves the developmental goal that only 1 in 40 children die before the age of 5. Thailand's economy is stronger than that of its neighbors. But it also owes some of its success to its investments in health care and its focus on primary care for its citizens.

Thailand's regional neighbors have also made significant improvements. Vietnam, in particular, infant mortality rates are relatively similar in most parts of the country.

South Africa

In many countries of southern Africa, the reductions of H.I.V. the dead made the difference. South Africa and Botswana experienced one of the largest reductions. In 2017, about 77,000 children died from H.I.V. worldwide, compared to around 246,000 In 2000.

Haiti

The devastating earthquake that struck Haiti in 2010 was a serious setback for the country's infant mortality rate. It has aggravated many factors that can lead to the death of children: increased risk of infectious diseases; less food and safe housing; greater difficulties in obtaining medical care.

Li Liu, Population Health Researcher John Hopkins said the country's experience was an opportunity for researchers to understand how natural disasters can affect public health. "Global health has limited experience in understanding child mortality in this context," she said.

Challenges ahead

The United Nations set new development goals in 2015. Continued progress in child mortality may depend not only on the health systems, but also on the policies and environmental stability of the countries that are still struggling.

Dr. Jha expressed concern that the experience in northern Nigeria is a telling story. Climate change can make access to good nutrition more difficult in some parts of the world and cause violence. He expressed concern that progress would "slow down or even reverse if climate change continues unabated".

Nevertheless, the general trend is positive. And new granular data could help governments and development groups to better focus their resources on addressing inequities within countries.

"This is not a very long list of things that kill children in large numbers," Jamison said. "Most of the items on this list can be tackled cheaply."