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Guest Blog by Philip R. Fischer, MD, DTM&H, Professor of Pediatrics, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN.
SOURCE: Bhutta ZA, et al. Global maternal, newborn, and child health – so near and yet so far. New Engl J Med 2013;369(23):2226-2235.
At the dawn of this century, world leaders signed a Millennium Declaration with the target of reaching eight specific health-related goals by 2015. There have been great gains toward meeting these goals, but rates of child and maternal mortality (the subjects of the 4th and 5th goals) remain unacceptably high. Significant opportunity for improvement still remains, especially in sub-Saharan Africa (for maternal and child mortality) and in the Indian sub-continent (for neonatal mortality).
Bhutta et al, report that infectious diseases are still responsible for nearly half of child and maternal mortality. Improvements in health care systems will be needed to decrease the risk of infectious disease
The authors make the excellent point that we should not merely consider the causes of death but also the “causes of the causes” — the underlying social determinants that still allow women and children to die of these more direct causes. Poverty, undernutrition, poor sanitation, and inadequate medical services underlie the tangible infectious and non-infectious causes of death. In fact, undernutrition contributes to 45% of the childhood deaths. Sadly, more than a third of maternal and childhood deaths occur in countries where there is active armed conflict.
Application of existing evidence-based interventions could markedly reduce the current rates of maternal and child mortality. Only about half of women in the “Countdown Countries” (the 75 countries that account for 95% of maternal and child deaths) receive desired family planning, at least four antenatal visits, the presence of a skilled attendant at birth, and postnatal care. In these countries, only 40% of babies benefit from exclusive breastfeeding in the initial months of life; 80% get basic vaccines; less than 40% get antibiotics when they have pneumonia. Clearly, health care system changes will be needed to improve the world’s currently unacceptable child and maternal mortality rates.
For more on this story see the March 2014 issue of Infectious Disease Alert.