Are we on track to meet the target?

Infant and child mortality rates are considered two of the most complex indicators in development. They reflect both the efficiency of the health system and the influence of socio-economic and cultural factors on child survival.

Close to 11 million children under the age of five died in 20021, 97 per cent of them in developing countries. Levels of under-five mortality vary widely across countries from 4 to over 280 deaths per 1,000 live births. The latter is equivalent to over 28 per cent of children dying before reaching the age of 5.

Five diseases - pneumonia, diarrhoea, malaria, measles, and HIV infection - account for over 50 per cent of these deaths. Malnutrition is a contributing factor in over 60 per cent of cases.

Millennium Development Goal (MDG) number 4 calls for the reduction of child mortality by two thirds, between 1990 and 2015. A strategy to reduce child mortality rates needs to consider both the specific diseases that threaten children's lives as well as the functioning of health systems as a whole.

Status of Progress

Progress during the 1990-2002 period has been uneven. The largest reduction in child mortality was achieved in Northern Africa, where the rate in 2002 was less than half the rate estimated for 1990-an annual average decrease of 6.3 per cent. There was also significant progress in South-Eastern Asia, Latin America and the Caribbean where child mortality decreased on average by 4 per cent annually.

Obstacles to Improvement

Challenges to making faster progress include the HIV and AIDS epidemic, economic decline, conflict, inequality, persistent poverty in some parts of the world, and lack of progress in reducing the number of deaths of newborn babies.

At the Country level

Egypt is on track to achieve the MDG of reducing infant mortality by two-thirds. The Egyptian Ministry of Health and Population (MOHP) has focused on strengthening programs with direct impact on improving infant and child mortality indicators2. The "Healthy Mother, Healthy Child" project is focusing on Upper Egypt. Providing neonatal and maternal care, it positively affects neonatal and maternal mortality rates. Nutritional programs such as iron supplements for pregnant mothers, fortifying subsidized bread with iron, iodization of salt, and breastfeeding programs are improving the nutritional status and reducing nutritional deficiencies. Still, they do not fully address the problem of malnutrition, which contributes to ill health and repeated infections. Such problems could be captured with better implementation of growth monitoring activities.

Egypt's introduction of the child insurance scheme and the inclusion of childhood illness in the basic benefits package of the health sector reform pilot project allow a more comprehensive approach for health care provision and access to care for children in the different stages of development. The family physician concept is expected to play a role in improving access to quality care for the family.

The Diarrhoeal Disease Control Program and components of the Child Survival Project started as donor funded programs but became fully institutionalized in the Ministry and were integrated with existing initiatives. Other programs such as family planning, antenatal care, and immunization of pregnant mothers against neonatal tetanus play a major role in lowering neonatal mortality.

Memoranda of Cooperation were signed with 13 medical schools, eight nursing schools, and six secondary nursing schools to implement revised obstetric and neonatal curricula. Clinical protocols and service standards for Essential Obstetric Care and the National Perinatal Care Program were completed and approved by the MOHP for implementation nationwide.

Those protocols and standards are being introduced into some medical and nursing schools to train future house officers and Residents. The National Breastfeeding Training Center was established and breastfeeding training materials were developed for health providers and NGOs. Five hundred service providers were trained, thirteen modules on lactation management education be in integrated into post-graduate medical institution curricula.

The comprehensive program titled Integrated Management of Childhood Illness (IMCI) was adapted for the Egyptian situation using the generic WHO materials.

On the other hand, the progress towards the MDG target is uneven. Without more action, the international and national death rate for under-fives will only have fallen by one quarter worldwide.

"It is incredible that in an age of technological and medical marvels, child survival is so tenuous in so many places, especially for the poor and marginalized. We can do better than this."
- Immediate Executive Director of UNICEF, Carol Bellamy

1. United Nations Children's Fund, The State of the World's Children 2004
2. UNDP Human Development Report (2001) World Bank Group - Egypt "Country at a Glance" http://www.worldbank.org/data/countrydata/aag/egy_aag.pdf
3. www.un.org/esa/population/publications/PopAspectsMDG/16_UNICEF1.pdf

Mohamed Ali (Egypt), Organizing Committee Member, AM2005, workshops@am2005-eg.com