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Against the odds, Tanzania on target to meet millennium development goal for child mortality

Lancet

Whilst many African nations have made little or no progress towards meeting the Millennium Development Goal for reducing Child Mortality (MDG4), Tanzania is on target to meet the goal thanks to a combination of key interventions in child health. These are the conclusions of an Article in this week's Countdown Special Edition of The Lancet.

MDG4 for Tanzania means a reduction from its under-5 child mortality rate of 141 per 1000 live births in 1990 to 47 per 1000 by 2015 - ie, a reduction of two thirds. Between 2000 and 2004, this mortality rate reduced by 24%, with most of this gain occurring after 1999. Dr Hassan Mshinda, Ifakara Health Research and Development Centre, Tanzania, and colleagues analyse how Tanzania achieved this remarkable progress and ask if it can be sustained in order for the country to meet MDG4.

The authors found that between 1999 and 2004, Tanzania more than doubled its public expenditure on health. They say: "Such increased expenditure has been strongly correlated with increased survival in children younger than five years in developing countries, especially in poor people." Further, the government implemented policy shifts towards greater decentralisation in 2000, by introducing grants that gave individual districts substantial financial resources. This opened opportunities for local problem solving and allowed districts to selectively increase resources for key interventions.

These funding improvements worked in unison with increased coverage of key child-survival interventions, such as integrated management of childhood illness, insecticide-treated nets to prevent malaria, vitamin A supplementation, immunisation, and exclusive breastfeeding. Together these funding changes and interventions reduced mortality in children under-5-years in Tanzania by 24% between 2000 and 2004.

There is optimism among the authors that Tanzania can maintain this mortality reduction, since there are a number of child health interventions that have recently been implemented whose effects will have barely shown up in the latest estimates, if at all. Firstly the increased funding to the nation from the Global Fund to fight HIV/AIDS, Tuberculosis and Malaria - grants were announced in 2002 but only took effect in late 2004. Secondly, the scaling up of the Prevention of Mother to Child Transmission (HIV) programme and antiretroviral therapy started in 2005. Thirdly, programmes for Zinc Supplementation and oral rehydration therapy started in 2007 which will reduce deaths due to diarrhoeal illness; and finally access to improved antimalarial treatment through artemisinin combination therapy also started in 2007. All of these factors are expected to substantially reduce child mortality in the remaining years of Countdown to 2015. However, the authors note that there has been no significant reduction in neonatal deaths (deaths in the first month of life) and that these now account for almost one third of child deaths in Tanzania. In addition there is no measurable change in maternal mortality ratio, so MDG 5 is not on track. More systematic attention to maternal and neonatal interventions is vital.

The authors conclude: "Broad, multifaceted progress in stewardship, public expenditure on health, decentralised financing, resource allocation, and better coverage of essential child-survival services can work synergistically to effect important progress towards MDG4 in low-income countries such as Tanzania. Increased health resources combined with strengthening of decentralised health systems to ensure that life-saving interventions reach those in need is a key child-survival strategy."

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Dr Hassan Mshinda, Director, Ifakara Health Research and Development Centre, Tanzania T) +255 784 78 22 10 E) hmshinda@ihrdc.or.tz (not attending press conference)

Dr Elizabeth Mason, WHO, Geneva, Switzerland, Tel +41227913281, mobile +41793089873. masone@who.int (attending press conference)

http://www.eurekalert.org/jrnls/lance/pdfs/countdowntanzaniafinal.pdf

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