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Sub-Saharan Africa saw unprecedented declines in child mortality over the past two decades. The under-five mortality rate in the region dropped from 177 deaths per 1,000 live births in 1990 to 98 per 1,000 in 2012. There has been an acceleration in the rate of child mortality decline during the MDG period; the pace of decline increased in 34 countries in Sub-Saharan Africa from 2000–2010 as compared to 1990–2000.
Current patterns indicate that high economic growth is not a prerequisite for improving child survival rates, as several low-income countries have managed to reduce child mortality in a short period of time. Niger reduced its child mortality rate from 226 in 2009 to 128 in 1998, a 5.1% annual rate of decline. Malaria prevention, vitamin A supplements, improved nutrition and treatment of diarrhoea, pneumonia, malaria and vaccinations are all given as factors leading to this success.
Some of the biggest gains in child survival in Sub-Saharan Africa came through increasing the coverage of childhood immunization, even in countries with weak health systems. Childhood immunization delivered through vertical programs has been able to circumvent limitations of weak health systems and is arguably the most successful health program in Africa.
A decrease in malaria-related mortality has been another significant contributor to the decline of child mortality in the region. Many countries have rapidly increased their malaria prevention coverage, particularly with greater use of insecticide-treated bed nets but also by indoor residual spraying and intermittent presumptive treatment for pregnant women. Treatments for acute respiratory infections and diarrhoea, two of the biggest childhood killer diseases, have also improved considerably in the region.
Successful programs in countries such as Ethiopia and Tanzania include deploying community health workers to provide primary health care in rural areas. Tanzania’s success has been attributed to scaling up several key child survival interventions and doubling public spending on health, as well as governance reforms such as greater decentralization, which gave districts substantial financial resources and opened opportunities for local problem-solving.
In Ethiopia the Health Extension Worker Program significantly increased the proportions of children vaccinated and of children and women using insecticide-treated bed nets. In Rwanda, the Mutuelles de Santé project increased access to child health services. Rwanda also introduced the pneumococcal vaccine to combat acute respiratory infections, which helped lower child mortality substantially.
Africa now needs greater efforts to sustain the current progress it’s making. Multipronged approaches are needed to upgrade human resources for health, improve work on family planning for birth spacing, which have not yet been used on a large scale but have been shown to be effective in other regions, can lead to further significant gains in reducing child mortality in the region.