Deaths of children under five persists despite milestones in healthcare, study

The number of children dying before their fifth birthday is nearly half compared to 20 years ago. This is according to a research by the Institute for Health Metrics and Evaluation (IHME) that found that the deaths dropped to 59,914 in 2017 compared to 96,909 in 2000.

The study found that the death rates were not uniformly spread across Kenya but differed from area to area.

For instance Nyatike Sub-county in Migori County had the highest rate at 82 per 1,000 live births compared to Saku in Marsabit where the rate was only 26.

Notably, sub-counties in Northern Kenya did relatively better compared to other counties in Kenya.

For instance, in Saku, North Horr, Laisamis, Samburu North and Mandera North had low death numbers compared to Mbita, Suba, Ndhiwa, Suna East and Nyatike, which had high numbers.

Geographical heterogeneity

The study pointed out the flaws of looking at country statistics as a whole since this could be misleading as there are differences in several parts if the country.

With devolution of healthcare in Kenya, these differences are likely to be extrapolated depending on the priorities countries accord the different aspects of health like child health. Despite this drop, Kenya still has high child mortality rates in Africa.

“Country-level estimates facilitate international comparisons but mask important geographical heterogeneity,” the researchers state.

Despite the drop in death of children, the researchers pointed out that a common factor of death still remains. Neonatal disorders were the biggest cause of deaths before age five in both 2000 and 2017, according to the Global Burden of Disease study.

However, the study found that reduction in number of deaths from HIV and AIDS was perhaps the biggest reason why less children died in 2017. This accounted for almost one third of the decline in deaths during the period the research was done.

The study is the first of its kind, mapping child deaths in 99 low and middle-income countries at the level of individual districts, municipalities and provinces; the findings include precision maps illuminating health disparities within countries and regions often obscured by national-level analyses.

The research, conducted by the IHME at the University of Washington’s School of Medicine, looked at countries where more than 90 per cent of child deaths occurred in 2017.

Across all countries studied, the likelihood of a child dying before the age of five varied more than 40 times at district level.

Researchers estimated that if every district in the low and middle-income countries studied had met the Sustainable Development Goal (SDG) target of at least as low as 25 child deaths per 1,000 live births, 2.6 million fewer children would have died.

If every district within a country rose to the level of the best-performing district in that country, the estimated number of deaths averted rises to 2.7 million.

The vast majority of the 17,554 districts among the 99 nations studied saw improvement in lowering child deaths, but levels of inequality between districts were more variable over the study period.

Despite major gains in reducing child deaths over the past 20 years, the highest rates of death in 2017 were still largely concentrated where rates were highest in 2000.

Decreased inequalities

“It is as reprehensible as it is tragic that, on average, nearly 15,000 children under age five die every day,” said Dr Simon I Hay, the senior author on the study and Director of the Local Burden of Disease (LBD) group at IHME.

The study, funded by the Bill and Melinda Gates Foundation, reveals areas of success where strategies could be replicated across and within countries, according to Dr Hay.

For example, in Rwanda, the highest district-level rate of child deaths in 2017 was less than half that of the lowest district-level death rate in 2000 – gains partially attributed to investments in children’s health in the poorest communities, expansion of health insurance, and increasing numbers of community health workers.

Nigeria had the highest disparity between the areas with high deaths and low deaths of children. It also had high numbers of these deaths compared to the other African countries in the study.

Nepal significantly decreased inequalities among its districts over the study period.

And Peru made major strides in reducing child mortality and inequality after implementing sustained, cross-cutting anti-poverty and health programmes.