Olivia Roberts: More tales from the UN number-crunchers

Quick follow on from the last blog post on the wonderful world of UN statistics. This time the Inter-agency Group for Child Mortality Estimation (IGME) has ploughed through country data.

Good news: The estimated global mortality for children under-5 in 2008 is 65 per 1,000 live births, versus 90 in 1990.
Bad news: Due to high fertility in the African region, combined with high mortality, numbers of deaths have actually increased from 4.0 million in 1990 to 4.4 million in 2008.

So far, so statistics but what the data also tell us is that under-5 mortality is increasingly concentrated: 75% of the world’s under-5 deaths in 2008 occurred in only 18 countries. Half of the deaths occurred in only five countries: India, Nigeria, Democratic Republic of the Congo, Pakistan, and China. And India and Nigeria together account for nearly one-third of the total number of under-5 deaths worldwide (21% and 12%, respectively). The best performers (based on the average annual rate of reduction among countries with under-5 mortality of 40 or higher) include Nepal, Bangladesh, Eritrea, Lao, Mongolia, Bolivia, and Malawi, which have all consistently achieved annual rates of reduction of under-5 mortality of 4•5% or higher. Additionally, Niger, Malawi, Mozambique, and Ethiopia have achieved absolute reductions of more than a 100 per 1000 live births since 1990.

There are some significant changes taking place in these countries and while no programme should be transposed directly from one to another the socio-economics, health infrastructure and health worker levels mean that best practice models can be established. The data increasingly support high-impact intervention packages such as nutritional supplements, immunisation, insecticide-treated mosquito nets and prevention of mother-to-child transmission of HIV.  Even better news is that the monitoring and reporting systems in these countries seem to be holding up to scrutiny.

In these financially challenging times, data help to justify maintaining and scaling-up activities. These data provide support for funding programmes to focus on and draw on the lessons from those countries with some strong and sustained changes. The authors call for use of data for action and advocacy. It may be time-consuming but trawling through the data can generate powerful messages as well as practical actions. Next up: individual country reports due to be published on November 20 2009.

Olivia Roberts is senior research officer in the International Department, British Medical Association, London WC1H 9JP