Mortality rates tumble for African children

WASHINGTON -- Many African countries have sharply reduced the deaths of young children in recent years, saving hundreds of thousands of lives, according to new data from 46 nations that contradict the perception that the world's poorest continent was making little gain against killer diseases.

In addition, a report being issued today said even more lives could be spared if greater focus were paid to saving newborns.

Across sub-Saharan Africa, the mortality rates for children under age 5 in some countries have decreased by as much as 30 percent in the past five years because of increases in immunization and the use of vitamin A supplements and oral rehydration therapy; a rise in the number of women seeking prenatal care; and the end of regional conflicts, according to child-health specialists.

Twelve of 18 African countries that compiled data from both the mid-1990s and from the last few years have reported decreases in the deaths of infants in their first 28 days of life, according to charts based on household surveys. Some nations, such as Eritrea, Ethiopia, Guinea, and Mozambique, have reduced deaths among newborns by about 40 percent in the last decade.

"There has been a lot of progress," said Vinod Mishra , director of research at ORC Macro , a Maryland-based company that conducted the door-to-door surveys in Africa and has been researching population and health trends there since the mid-1980s. "There are improvements in delivery care . . . and we are finding that women who see a healthcare provider during pregnancy are four to five times more likely to receive postnatal care."

Mishra's findings suggest that programs not specifically aimed at reducing newborn and infant deaths also are having positive impacts on childhood survival.

Those programs, representing an infusion of billions of dollars in new investments, include HIV prevention outreach that brings pregnant women into clinics to try to lower the chance of passing the deadly virus to children at birth; and malaria initiatives that distribute bed nets to mothers in their homes or clinics.

A report issued today by the Partnership for Material, Newborn & Child Health , a group of nine international health groups, cites improvements in reducing child mortality in six nations -- Eritrea, Malawi, Burkina Faso, Madagascar, Tanzania, and Uganda. The report focuses on inexpensive interventions that could cut deaths in the first four weeks of life.

In Africa, an estimated 1.16 million die within the first month, about half of them in the first week. Even though Africa has 11 percent of the world's population, its newborn deaths account for a quarter of all such fatalities in the world. In addition, there are 1 million stillbirths on the continent.

Documents show that 164 of every 1,000 children in sub-Saharan Africa died before age 5 in 2004 and 2005, down from 176 in 2000.

The number of newborns dying in sub-Saharan Africa barely changed : 41 per 1,000 in recent years, from 42 in 1995. But that figure masks improvements in several countries; the number of newborn deaths for the continent rose due to poor performances in some of the most populous countries, notably Nigeria.

While some public health specialists cautioned drawing firm conclusions from the newborn data because of relatively small samplings, Mishra, whose company did the surveys, said the reports reflected an important trend. "Those decreases are real," he said.

The major causes of newborn deaths are infection, conditions related to premature delivery, and problems in breathing during and soon after birth. The interventions include keeping babies warm and clean, regular breast-feeding, treating infections with antibiotics, and basic resuscitation using a $5 self-inflating bag.

The report finds that interventions costing an additional $1.39 per capita annually could save 800,000 newborns -- a roughly three-quarter decrease in deaths.

"The message is very clear: We spend a lot of time saying Africa is failing, but it looks now like we are seeing a turnaround for under-5 mortality," Dr. Joy Lawn of Save the Children , one of the authors of the report on newborn deaths, said in a telephone interview from Cape Town.

While Lawn said the end of conflicts in Eritrea, Ethiopia, and Madagascar almost surely increased the survival rates of newborns and infants, other countries such as Tanzania and Malawi had improved basic health care.

In addition, national measles vaccination campaigns, the start of more aggressive malaria control programs, and immunization efforts funded by the GAVI Alliance -- a public-private partnership that has committed $1.2 billion to programs in 71 countries -- have all helped reduce childhood mortality, health specialists said.

Prabhat Jha , a professor of health and development at the University of Toronto, said the lesson should be that more progress is possible.

"It is quite surprising, in the face of AIDS and malaria, seeing overall declines in child mortality in Africa," he said. "I think it shows the value of putting basic public health programs in place and strengthening them."

John Donnelly can be reached at donnelly@globe.com