THE LANCET: Special release to mark opening of United Nations Assembly


Child mortality in Niger

Niger, one of the world’s poorest countries, has bucked regional trends to achieve dramatic reductions in child mortality in recent years, according to a Countdown country case study published in The Lancet.

Researchers examined changes in child mortality and other aspects of child health, such as wasting from malnutrition, in Niger from 1998–2009. They found that mortality in children younger than five years nearly halved during this period, from 226 deaths per 1000 live births in 1998 to 128 deaths per 1000 live births in 2009. Severe wasting also declined across all age groups during this period, with the largest decrease in children aged 6–11 months—from 15•8% of babies in 1998 to 6•3% in 2009.

Niger, situated in West Africa, ranks 186 of 187 on the Human Development Index*, with an economy largely based on subsistence and periodically threatened by drought and food insecurity. However, despite the fact that there have been no considerable increases in the country’s gross domestic product (GDP) over the last decade, the country has managed to implement substantial improvements in the health of its mothers and children.

The authors estimate that nearly 60 000 children’s lives were saved in 2009 alone, highlighting the government’s commitment to supporting universal access to health care, free for pregnant women and children, as one of the keys to this success. The researchers also highlight the effectiveness of low-cost interventions such as insecticide treated bed nets for the prevention of malaria, vitamin A supplementation, and treatment of diarrhoea with oral rehydration salts as contributing to the recent improvements in child health.

The study provides invaluable evidence for other low-income countries as to how child health can be improved in a comparatively short space of time, at relatively low cost. According to one of the studies’ authors, Agbessi Amouzou of Johns Hopkins University in the USA, “This study codifies, for the first time, policies, programmatic strategies, and what was actually done on the ground in Niger to achieve the dramatic reductions in child mortality and wasting that we’ve seen there in the last ten years.”

Writing in a linked Comment, Niger’s Minister of Health, the Honourable Soumana Sanda, says: “These results are a source of enormous pride on the part of the Government of Niger, and especially the Ministry of Health, for having moved Niger from its position in 1990, when the country had the highest child mortality rate in the world, to where we are today. Our success provides evidence that it is possible to reduce child mortality substantially in an incredibly hard socioeconomic context.”

Dr Agbessi Amouzou, Department of International Health, Johns Hopkins University, Baltimore.

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