Summary Points
- Millennium Development Goal (MDG) “success” is based on relatively arbitrary targets, yet countries are coming under close scrutiny as the 2015 deadline approaches and the world’s focus moves on to new Sustainable Development Goals.
- Some countries may fail to meet MDG targets, for example, because of low baseline figures, despite making considerable advances in mortality reduction.
- In South Africa, under-five mortality was already low in 1990 as democracy advanced and the HIV epidemic emerged; thus, despite considerable mortality reduction in recent years, there was no appreciable net change from start to end of the MDG period.
- Understanding changes in childhood mortality depends on having detailed data over time, which can be interpreted in a more nuanced way than simply the achievement of arbitrary targets.
What Is “Success” in Terms of Reducing Under-Five Mortality?
When generic criteria to assess achievements are formulated
long in advance of endpoints, unforeseen consequences may follow in particular
instances. The Millennium Development Goals (MDGs) were fairly arbitrarily
defined to be measured over the period from 1990 to the end of 2015, and now
countries are being widely classified as meeting or failing those targets [1]. Achieving the MDG4 goal of reducing
mortality in children under five years of age by two-thirds was always likely
to be very difficult for some countries, particularly those with low mortality
in 1990 [2]. The relevant, newly adopted third
Sustainable Development Goal (SDG) now calls for under-five mortality to fall
below 25 per 1,000 live births by 2030 [3], maintaining a global focus on achieving low
childhood mortality.
Taking South
Africa as an example, under-five mortality for the country in 1990 was the
lowest in sub-Saharan Africa. But the intervening period has been pivotal, as
the transition to democracy coincided with the start of the HIV pandemic. South
Africa’s under-five mortality trajectory from 1980 to 1990 was effectively on
track for the 2015 target, until a sharp rise in mortality was observed in the
mid-1990s, as shown in Fig 1, using mortality estimates from UNICEF [4]. Nevertheless, South African child mortality
levels remained substantially lower than in sub-Saharan Africa as a whole,
despite neither the country nor the region being on track for their respective
2015 targets, and very rapid reductions in mortality were estimated for South
Africa around 2010. Thus, South Africa apparently made progress before 1990,
despite the iniquitous policies of the apartheid regime, and went on to record
considerable reductions in child mortality during the latter part of the MDG period.
Below: Under-five mortality
estimates (with 90% uncertainty bounds) from UNICEF [4] for
sub-Saharan Africa and South Africa from 1980 to 2013, together with respective
MDG4 target levels for 2015 (two-thirds reduction from 1990).
Below: Under-five mortality rates at the Agincourt site from 1992 to 2013, by age group and by cause of death category
Full article at: http://goo.gl/3hNhmV
By:
MRC-Wits Rural Public Health and
Health Transitions Research Unit (Agincourt), School of Public Health, Faculty
of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Peter Byass, Paul Mee, Mark A. Collinson, Stephen M.
Tollman, Kathleen Kahn
Umeå Centre for Global Health
Research, Division of Epidemiology and Global Health, Department of Public
Health and Clinical Medicine, Umeå University, Umeå, Sweden
Chodziwadziwa W. Kabudula, F. Xavier Gómez-Olivé, Mark A.
Collinson, Stephen M. Tollman, Kathleen Kahn
INDEPTH Network, Accra, Ghana
Paul Mee
Department of Global Health and
Development, Faculty of Public Health and Policy, London School of Hygiene and
Tropical Medicine, London, United Kingdom
Aviva Tugendhaft, Karen Hofman
PRICELESS/PEECHi, School of
Public Health, Faculty of Health Sciences, University of the Witwatersrand,
Johannesburg, South Africa
More at: https://twitter.com/hiv_insight
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