A child born in Garki Local Government Area of Jigawa State has less chance of celebrating its fifth birthday than another born in Egor Local Government Area of Edo State, a new study has shown.

Although chances of newborns surviving to adulthood have been rising across the world, including Nigeria, in the past 20 years, the development disparities within so many countries have condemned many children to premature death, the study states.

The unprecedented study mapping child deaths over almost two decades finds that the likelihood of a child reaching age five varies nearly four-fold among local government areas in Nigeria.

The research, titled Global Burden of Disease, was conducted by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington’s School of Medicine.

The study published in the journal Nature showed that researchers looked at countries where more than 90 per cent of child deaths occurred in 2017, and Nigeria happenned to be one.

The study is the first of its kind, mapping child deaths in 99 low- and middle-income countries at the level of individual districts.

Researchers estimated that if every district in the low-and middle-income countries studied had met the Sustainable Development Goal (SDG) target of at least as low as 25 child deaths per 1,000 live births, 2.6 million fewer children would have died. If every district within a country rose to the level of the best-performing district in that country, the estimated number of deaths averted rises to 2.7 million.

The findings include precision maps illuminating health disparities within countries and regions often obscured by national-level analyses. An interactive visualisation accompanying the research compares child death rates from year to year.

Result

Across all countries studied, the likelihood of a child dying before age five varied more than 40-fold at the district level. However, the research shows that in Nigeria the national figure is still high as 789,037 children died before their fifth birthdays in 2017, as compared to 1,011,620 in 2000.

The research also confirmed that the locality a child is born within the country determines if the child will live to adulthood. This has a lot to do with the inequalities and disproportionate allocation of public resources within society.

For instance, the researchers found that Garki Local Government Area in Jigawa has the highest child mortality rate at 195.1 per 1,000 as compared to Egor in Edo State which had the lowest child mortality rate of 52.0 per 1,000.

This implies that children born in Garki have lower chances of survival than their counterparts born in Egor.

It also noted that neonatal disorders were the biggest causes of deaths before age five in both 2000 and 2017. Decreases in deaths from diarrhoea and lower respiratory infections accounted for 40 per cent of the overall drop in child deaths over the study period.

The study found out that poor governance can lead to the death of children as this worsens poverty in areas where minority ethnic or religious groups, indigenous peoples and other people who experience discrimination are likely to live.

Inequalities

“Discrimination against women leads to failure to prioritise maternal health; discrimination against ethnic or religious groups results in inadequate services for adults and children. And child deaths often accompany other human-rights violations. Insecurity, violence and conflict affect millions of children,” it said.

The highest estimated child death rate in 2000 at the local level was just over 300 deaths per 1,000 births. In 2017, the highest rate was 195 deaths per 1,000 births and both were in Nigeria.

The study showed that a growing proportion of child deaths are occurring in areas with low overall death rates. Neonatal mortality (death occurring in a child’s first 28 days) and infant mortality (death in the first year of life) are both increasing as a percentage of total child deaths.

“These trends highlight the need for tailored approaches,” it said.

Solution

The senior author and Director of the Local Burden of Disease (LBD) group at IHME, Simon Hay, said it is as reprehensible as it is tragic that, on average, nearly 15,000 children under age five die every day.

“Why are some areas doing so well, while others struggle? In order to make progress, we need to enable precise targeting of interventions, such as vaccines. Our findings provide a platform for nations’ health ministers, clinicians, and others to make focused improvements in health systems,” he said.

Mr Hay called on governments of countries still lagging behind to emulate Rwanda, Nepal and Peru where the study revealed success stories.

He said strategies that are working in Rwanda can be replicated by governments across and with countries.

“For example, in Rwanda, the highest district-level rate of child deaths in 2017 was less than half that of the lowest district-level death rate in 2000 – gains partially attributed to investments in children’s health in the poorest communities, expansion of health insurance, and increasing numbers of community health workers. Peru made major strides in reducing child mortality and inequality after implementing sustained, cross-cutting antipoverty and health programs,” he said.