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

Comment – The Countdown for 2015

The Countdown for 2015: what lies ahead?

“As the 2015 deadline for achieving the Millennium Development Goals (MDGs) approaches, there is a growing sense of urgency to accelerate progress, especially for reducing child and maternal deaths. The most recent Countdown Report1 suggests that at the present rate of progress 23 (31%) of 75 countries are on track to achieve the MDG 4 target for child survival, whereas only nine (12%) are projected to reach the MDG 5 target for maternal mortality. Other estimates from the Institute of Health Metrics and Evaluation2 suggest that only nine and four of the 75 countries are expected to reach the MDG 4 and MDG 5 targets, respectively, by 2015.

“Two Countdown papers in The Lancet provide some insights on critical elements that are needed to further accelerate progress on maternal and child health. Cesar Victora and colleagues3 analysed the relation between rates of change in coverage of key interventions (skilled birth attendants, measles vaccine, use of insecticide-treated bednets for children, and a composite coverage index) and socioeconomic inequity measures in 35 low-income and middle-income countries and found a range of changes in equity of coverage as countries scaled up these interventions. However, Victora and colleagues’ analysis shows that countries that achieved rapid national-level increases in coverage are primarily driven by how rapidly coverage increased in the poorest quintiles. Countries with rapid increases in coverage for insecticide-treated bednets and measles vaccination were able to reduce the equity gaps.

“Agbessi Amouzou and colleagues’ in-depth case study4 from Niger—one of the most impoverished and geographically challenged countries in the world— shows that increases in coverage of high-impact child survival interventions, notably insecticide-treated bednets, nutrition interventions, care seeking, and treatment for childhood diarrhoea and pneumonia, can reduce mortality quickly. The mortality rate in children younger than 5 years declined significantly from 226 deaths per 1000 livebirths in 1998 to 128 deaths in 2009, an annual rate of decline of 5•1%—a rate many times higher than that in similar neighbouring countries....”