Less than one quarter of 68 priority countries* are on track to reach millennium development goals (MDGs) on maternal and child mortality**. And while some countries, notably China, have made significant progress, many more, mostly in sub-Saharan Africa, have seen no progress or even reversals of progress. But rapid progress in many of these nations is achievable and would get them on track. These are the conclusions of authors of the Countdown Report Article in this week's Countdown Special Edition of The Lancet.
The Countdown to 2015 for Maternal, and Child Survival periodically monitors coverage of priority interventions to achieve the millennium MDGs for reduction of maternal and child mortality. The Article focuses on the 68 countries which have 97% of maternal and child deaths worldwide, and examines interventions that have been proven to improve maternal, newborn, and child survival.
Peter Salama, (UNICEF, New York, USA) and Jennifer Bryce (Johns Hopkins School of Public Health, USA), and colleagues from the Countdown Core Group say that of the 16 countries on track to meet MDG4, seven were already on track when countdown was launched in 2005, including Brazil, Bangladesh, Mexico, and Indonesia. Six of the 16 were included in the Countdown process for the first time in 2008, including Eritrea, Peru, and Morocco. Only three -- China, Haiti, and Turkmenistan -- had made demonstrable progress to move them from "not on track" in 2005 to on track in 2008. The authors say: "The achievement of China, as the world's largest country, is important, as are encouraging signs that several countries, many of which are in East Africa, have reduced mortality in children under-5 since 2005." While data showing trends for maternal mortality were not available to say definitively whether countries were on track to reach MDG5, actual maternal mortality was high or very high in 56 of 68 countries (82%), suggesting these countries were not on track.
The researchers found that interventions that could be routinely scheduled, such as immunisation and antenatal care, had much higher coverage than those that rely on functional health systems and 24-hour availability of clinical services, such as skilled or emergency care at birth and care of ill newborn babies and children. They noted that the most rapid increases in coverage were seen in immunisation, which has received significant investment in recent years. They say: "Priority attention in health-system strengthening should be given to establishment of a functional continuum of care that encompasses women before pregnancy, pregnancy, childbirth, the postnatal period, and the first 24 months of a child's life."
The effects of HIV prevalence -- which is some countries has peaked and is beginning to drop -- may not have been captured by the most recent estimates of mortality in children under 5 years. But the authors say: "Expanded and sustained efforts are needed to scale up comprehensive programmes for prevention of mother-to-child transmission of HIV, including treatment for pregnant and postnatal women and treatment for paediatric HIV."
The 2008 Countdown report suggests that many factors are in place to accelerate progress towards health-related MDGs -- including consensus on priority interventions, commitment from countries and donors, programmes in place, and some increases in funding. The authors suggest a framework to cement agreement on priorities and processes, especially strengthening of health systems. They conclude: "In the seven years until 2015, the next two years before the next Countdown Report will be the most crucial. With strategic decisions and investments, and a focus on partnerships for results, we have the opportunity to see unprecedented progress in these 68 countries. Or will the 2010 report show more of the same gaps and lives lost""
Notes to editors:
*for 68 countries see p1272 full Article
**MDG4 = Reduce mortality rate in children under-five by two thirds (67%) MDG5= Reduce maternal mortality ratio by three quarters (75%)
Jessie Malter, UNICEF Media Relations, New York, USA T) +1 212 326 7412 / +1 646 732 0047 (mobile) E) firstname.lastname@example.org
Jennifer Bryce, Johns Hopkins School of Public Health, Baltimore, USA T) +1 607 280 4800 E) email@example.com (attending press conference)