Study: Lowering Child Death Rate Not Costly

What is the life of a child worth?

How about $887?

That is but one astounding statistic in a major new study aimed at reducing the child mortality rate in 42 of the world's poorest countries, where 90 percent of the deaths occur.

But here's the show stopper:

A worldwide investment of $5.1 billion a year could save the lives of 6 million children in countries ranging from India to Congo.

That comes down to an annual cost of $1.23 per resident in all of those countries, a figure so paltry that failure to take action is criminal. The researchers say most of that cost is within reach -- and should be borne -- by the countries in which the children are dying.

The latest study is a response to a United Nations resolution calling for a major assault on the death rate among children below the age of 5.

"The resolution has now been signed by virtually every country in the world, and it calls for the achievement of a serious set of goals," says Robert Black, chairman of the department of international health in the Johns Hopkins Bloomberg School of Public Health, one of the authors of the study. "One of those goals is the reduction of child mortality by two-thirds between the years 1990 and 2015."

Investigating 'Interventions'

But how do you attack such a devastating problem, especially in countries where mere survival is a daily struggle? Black and several colleagues addressed that issue in a series of articles a couple of years ago in the medical journal Lancet. They found that a major impact on child mortality could be achieved much more easily than had been thought.

Relying largely on studies from the World Health Organization, UNICEF and other organizations, the researchers concluded that there are a number of measures -- called "interventions" -- that have been proven to reduce child mortality. If you can prevent or treat such common diseases as pneumonia, diarrhea and malaria, they found, you will reduce threats that now account for three-quarters of the child deaths around the world.

But those encouraging reports left a huge gap in the game plan. No one knew whether it was economically feasible to do it.

So Black and his colleagues set out to see if all of this is just wishful thinking. Black admits that task was somewhat "daunting." It's hard enough to predict the cost of a new highway, much less an international project with many, many unknowns.

A Budget of Billions

But the researchers say they found the answer. The project is "definitely feasible," Black says.

That's because no new scientific breakthroughs are needed. It's not necessary to build vast new medical complexes. Much of what is needed is already in place.

What seems to be lacking is the will to do it, and the relatively modest resources to make it work. Relying on proven results, the goal set by the United Nations is achievable at an annual cost of $5.1 billion, according to the research.

In the conclusion of their most recent report, published in the June 27 issue of Lancet, the researchers note that "$5 billion is about 6 percent of expenditures for tobacco products in the USA" during 2003.

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.