10 Steps Toward Child Survival

10 Steps Toward Child Survival

Three Afghan children. {Photo credit: MSH.}Photo credit: MSH.

About 7.6 million children under age five die each year of preventable causers; 3 million — 40 percent — are newborns (under 28 days old). Ninety-nine percent of these occur in developing countries; three-quarters are mainly due to preventable causes such as neonatal conditions, pneumonia, diarrhea, malaria, and measles. Many of these under-five deaths could be averted by known, affordable, low-technology interventions.

Any preventable child death is one too many.

Here are 10 important interventions for child survival --- a list that is by no means exhaustive:

  1. Exclusive breastfeeding

    Could keep 1.3 million infants from dying (including by preventing pneumonia)

  2. Long-lasting, insecticide-treated bednets

    Would save more than 500,000 children by preventing malaria

  3. Vaccines, such as PCV, Hib, and rotavirus

    Would help prevent common childhood illnesses, such as measles, and save children’s lives

  4. Micronutrient supplements, such as vitamin A and zinc

    Would fight malnutrition. (While not a direct cause of death, malnutrition contributes indirectly to more than one-third of these deaths.)

  5. Integrated community case management (ICCM) of childhood illness

    Including oral rehydration salts (ORS with zinc) and antibiotics --- to manage malaria, diarrhea and pneumonia and prevent childhood deaths

  6. Family planning and maternal health

    Women must have knowledge and access to family planning services to time and space pregnancies. When they do choose to become pregnant, they must have quality antenatal care, obstetric and delivery services, and post-delivery care, including addressing postpartum hemorrhage and pre-eclampsia and eclampsia management.

  7. Option B+ for prevention of mother to child transmission (PMTCT) of HIV

    The B+ option -- putting pregnant women on ART for life, regardless of the level of HIV in her body -- recognizes mothers’ indispensable role in child survival not only during her pregnancy but also throughout her child’s life.

  8. Address newborn mortality

    Through expansion of health facility-based care, better use of skilled birth attendants, and inclusion/involvement of frontline health workers, to address preterm birth, asphyxia, healthy baby breathing and newborn sepsis

  9. Safe drinking water and improved sanitation

    Basics for reducing common childhood illnesses, such as diarrhea

  10. Amoxicillin

    Would help prevent and treat pneumonia, the leading cause of child deaths worldwide (1.4 million annually)

What are your 10? What interventions are you or your community using? Add your comment below.

Sara A. Holtz, DrPH, MPH, contributed to this post.

Ciro Franco, MD, MPH, is country lead and global technical lead of maternal, newborn, and child health, at Management Sciences for Health.



Femi Owoeye
For me maternal health is crucial and reducing maternal mortality is key. When mothers survive and are well the children have much higher chances of survival. So EMOC has to come to the fore. But with the huge gaps in health workforce in sub-saharan Africa, I believe we should think seriously and advocate for shifting the task of EMOC from obstetricians to midwives and other experienced nurses who could be trained to deliver EMOC.
Nilufar Kamorez Jaha
Dear Dr CIRO Franco Nice to see your 10 steps towards Child survival. Yes I do agree all the points. Only I would like to express my feeling here that prioritation of steps varies in the individual country needs. Like for Bangladesh Step 2 and step7 could be placed in priority position 9 and 10. Adress Newborn Mortality could be placed in priority step -3 position. With all the best regards Dr NilufarKamorez Jaha
David Akpan
Many thanks for sharing this. I believe that Community Health Education is also important especially when the local language is used to explain the dos in improving child survival. Community Health Education can also be done through local drama, folks, songs... This could also be ways community can learn to ensure child mortality is reduced.
Aaron Menta
Exclusive breastfeeding and delivery under skilled attendance is what we are advocating for. Attending at least 4 antenatal visits helps a mother understand that she has to sleep under an insecticide treated mosquito net and take anti-malaria drugs.
Cecilia Barbosa
I like that Dr. Franco has placed exclusive breastfeeding at the top of the list. An underlying theme, including community health workers, should be a solid public health infrastructure to support these interventions. Lastly, the education of women can go a long way to improving the health and wellbeing of families and children.

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