Consultant Speak: Cost Effective Child Survival Strategies

“Children are the world’s most valuable resource and its best hope for the future”- (John F Kennedy).

Childhood mortality has been called a public health disaster. According to latest United Nations report, 5.5 million children under five years old died in 2017 which translated to 15,000 deaths per day. Children in developing countries are ten times more likely to die before their fifth birthday than those in developing countries. Most children under five years die from preventable or treatable diseases such as pneumonia, diarrhea, neonatal sepsis and malaria.

In light of the above, Child survival strategies were designed by WHO/UNICEF to save children’s lives and improve their survival. Child survival strategies are defined as steps taken for children under five years by individuals and communities to reduce risk, duration and severity of an adverse health condition that detrimentally affects the survival of infants and children (USAID,2012).

Childhood survival strategies include breastfeeding, immunization, oral rehydration therapy, growth monitoring and promotion, female education, family planning and food fortification. These are cost-effective strategies are that improve child survival at little or no cost to the carer.

Breastfeeding has tremendous advantages such as protection against diarrhoea, respiratory tract infections, otitis media, bacterial meningitis, necrotizing enterocolitis and botulism. Breast milk is cheap and costs nothing to the nursing mother. Hormones, growth factors, cytokines, and even whole cells are present in breast milk and act to establish biochemical and immunological communication between mother and child. Breastfeeding should be exclusive for six months, continued for up to two years. Adequate and safe complimentary feeds should be commenced from up to six months upwards. Breastfeeding has been shown to improve responses to vaccines by stimulating the immune system of children.

Immunization is one of the most beneficial and cost-effective disease prevention measures available. Childhood immunization remains an important strategy in the reduction of morbidity and mortality from common vaccine-preventable diseases. Since the introduction of the Expanded (Nigerian) Programme of Immunization (vaccinating children with measles, tetanus, diphtheria, pertussis, polio, BCG and hepatitis B vaccines), there has been an estimated annual reduction of 1-2 million deaths per year globally. To ensure protection among newborns against tetanus, the mothers are expected to receive two doses of tetanus toxoid vaccine during the current pregnancy or at least three doses of tetanus toxoid in the past. Vitamin A and deworming may also be delivered with immunization.

Disturbed by the rising mother and child deaths in Nigeria, leading telecommunications giant, MTN, has unveiled a service, MTN Audrey Care, to improve maternal and child health as well as nutrition behaviour nationwide.

Poor sanitary environment has been suggested as part of the reasons why diarrheal illness and consequent dehydration is common in low income countries. Good hygiene such as hand washing and use of oral rehydration therapy have been shown to reduce the burden of diarrhoea in the developing world. Also, frequent hand washing by caregivers has been shown to be effective in prevention of respiratory viral illness. In addition, strict compliance with hand washing has been proven to be effective in prevention of infection in premature infants given that the most common source of infection in a hospitalised newborn is hand contamination by healthcare providers. Strict attention to handwashing techniques is the most effective measure for preventing the spread of staphylococci from one individual to another.

Promoting gender equality, empowerment of women and women’s education is another important strategy. Gender gaps are widespread in access to and control of resources, as well as in economic opportunities, power and political voice. Promoting gender equality is an important part of any development strategy that enables both women and men to escape poverty and improve their standard of living. Economic development paves the way for increasing gender equality over the longer term. However, this must be coupled with an environment that provides equal opportunities for women and men, and policy measures that address persistent inequities. Evidence has shown that empowering women through education is likely to benefit the health of their children.

Birth spacing as a form of family planning has also been a useful child survival strategy. An estimated 38% of all pregnancies occurring globally each year are unintended, and more than one-half of such pregnancies result in induced abortions. Families require access to good reproductive health care as evidence has shown increased risk of infant mortality after short preceding birth intervals. Children born three to five years after a previous birth are about 2.5 times more likely to survive their infancy than children born earlier.

Malaria prevention is also another good strategy for child survival. The use of insecticide-treated bednets in malarious areas have
substantially reduced the burden of malaria in children.

These childhood survival strategies have at times been given the acronym “GOBIFFFA”. G-growth monitoring, O-Oral Rehydration therapy, B-Breast Feeding, I –Immunization, F Family planning, F-Female education, F- food supplementation, while A- Vitamin A supplementation.

In summary, child hood survival strategies are cost-effective measures designed to reduce the unacceptable high under-five mortality rate in the developing world.