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Two thirds of child deaths in poor countries could be prevented using interventions that are readily available today, according to this article, the second in The Lancet child survival series.

The authors consider the effectiveness of available interventions in combating the main causes of death among children under five (diarrhoea, pneumonia, measles, malaria, HIV/AIDS and the underlying effects of undernutrition). Their research concentrated on those interventions that could feasibly be delivered to a high proportion of the population in the 42 low income countries where 90 per cent of child deaths occur. Using a statistical model the researchers went on to calculate how many child deaths could be prevented by universal delivery of these interventions.

Key findings include the following:

• Twenty-three preventative and therapeutic interventions were identified for which there is evidence of effectiveness in preventing child deaths.
• For each of the main causes of child death, there is at least one intervention which could feasibly be delivered at high levels of coverage in low income countries and for which there is sufficient evidence of effectiveness in preventing deaths from that disease.
• 5.5 million child deaths could be prevented by achieving universal coverage of these interventions in the 42 poorest countries.
• Two interventions, oral rehydration therapy and breastfeeding, could each prevent 10 per cent of deaths.
• Effective and integrated case management of childhood infections could save 3.2 million children each year.
• A group of effective nutrition interventions, including promotion of breastfeeding, complementary feeding, vitamin A and zinc supplements, applied together could prevent 2.4 million deaths.
• Currently coverage rates are high for a few interventions (breastfeeding promotion, measles vaccination) but for most countries and most interventions, coverage is very low.

One of the Millennium Development Goals (MDGs) is to reduce child mortality by two thirds between 1990 and 2015. The report emphasises that, without substantial change very soon, this MDG will not be met. It concludes that:

• The knowledge and means to reduce the number of child deaths are currently available but children in poor countries continue to die because these interventions are not reaching them.
• There are signs that the child survival effort has lost its focus. There is far greater effort being put into developing complex and expensive therapies to prevent the small number of child deaths from HIV and AIDS, for instance, than into making more widely available the very cheap interventions such as oral rehydration therapy and ITNs (insecticide treated malaria nets) that could save millions of lives.
• There is no need to wait for the development of new vaccines, drugs or technology to achieve the MDG on child survival. The challenge is to transfer what we already know into action and to deliver the currently available interventions to those who need them.

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