Study: Lowering Child Death Rate Not Costly

The money to do it could come from many sources, especially the countries where the children are dying. Private donors and wealthier nations could help fill the gap in countries like India, which leads the child mortality list with 2.4 million per year. Other countries, particularly in Africa and southern Asia, may need more help, Black says, because the level of poverty is so devastating.

Building on Basics

The problems that need to be addressed range from the basic, like teaching mothers to exclusively breast-feed their infants through at least the first six months of life, to building more adequate sanitation and water purification facilities. The latter is by far the most expensive goal.

Research shows that telling new mothers about the importance of breast-feeding has been particularly effective.

Breast-feeding seems so natural that it may be surprising to learn that "it's just not commonly done" in poor countries, Black says. "Other foods, teas and other things, are added to the diet of young babies. Mothers think they need to provide something else, and perhaps health workers are telling them that."

Thus the infant is denied the nutrition that should have been provided by the mother, and instead given tea that may be contaminated with bad water, or at best is less nutritious.

Mineral Support

In many parts of the world, young children do not receive adequate amounts of vitamin A or zinc, leaving them susceptible to a wide range of diseases. A study by UNICEF, for example, found that 100 million of the world's children under 5 are vitamin A deficient, which can cause blindness and damage the immunity system.

Attempts to provide an adequate supply of that critical vitamin have been encouraging, according to UNICEF. The number of poor nations participating in a UNICEF program to administer vitamin A soared from 11 in 1996 to 43 in 1999, the most recent year for which statistics are available.

Vitamin A can be administered as an infrequent supplement, so it's a fairly easy goal to reach. Zinc is a little more difficult because it may need to be given on a daily, or at least weekly, basis.

The solution, Black's group found, is to add both to the diets, as is already done in most of the world.

Fix the Fixable

The key to reducing costs in such an ambitious program, Black says, is to confine it to interventions that are known to work and can be carried out by community workers or existing health care programs. It's not necessary to build a new hospital to provide vaccinations.

But people tend to become "fixated" on specific diseases, like malaria or AIDS, and the result is the creation of a whole new infrastructure that is very expensive and may not be successful.

Globally, Black says, we're spending "probably $20 billion a year to fight AIDS. Most of that is coming from donors, the rich world, and frankly we haven't done very well in controlling the disease."

Huge sums have been pledged to the fight against malaria in Africa, even though there is no vaccine to protect against that dreaded disease.

"In the meantime," Black says, "even in Africa, pneumonia is a bigger cause of death than malaria. But nobody's talking about what we're going to do about pneumonia," which can be treated through antibiotics if the drugs are made available.

Diarrhea is another child killer, and when was the last time you heard a political leader talk about wiping out diarrhea?

What's needed, Black and his colleagues say, is an integrated program that will address many problems with proven interventions in a cost-effective way. As noted by Jennifer Bryce, one of the authors of the study, people should wake up to the fact that much can be done with existing community resources.

"If they don't," Bryce says, "16,000 children will continue to die each day as a result."

Lee Dye's column appears weekly on A former science writer for the Los Angeles Times, he now lives in Juneau, Alaska.

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