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  Child Health

  Child Mortality
     Causes of Deaths
     Where Deaths Occur
  Impact of Disease
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  Interventions in Health
  Measuring Progress




Interventions in Health



Child health interventions are effective and highly cost-effective.1, 2
  • Since 1988, the number of polio cases worldwide has fallen by 99 percent. By 2002 the WHO had certified 124 countries polio-free, and predicts global savings reaching $3 billion annually by the year 2015.

  • For every dollar spent on the diphtheria/tetanus/pertussis vaccine, economists estimate a savings of $29; for the measles/mumps/rubella vaccine, $21.1
Highly effective and often “low-tech” solutions, as well as improvements in health delivery systems to make such innovations widely known and accessible, have enabled declines in child mortality to occur, even in poor countries.
  • Many interventions, such as breastfeeding, keeping newborns warm, complementary feeding, oral rehydration therapy, insecticide-treated materials, and community-based treatment of pneumonia, can be provided by family members and community workers, even where health systems are weak.
A recent study in a squatter settlement of Karachi, Pakistan found that soap and hand-washing reduced pneumonia by 50 percent and diarrhea by 53 percent. Yet half the residents lived on less than $.50 per day and could not afford even the $4 per month for hand soap.3 Most women in a Bangladesh study also said they could not afford to buy soap.4

Cost-effectiveness has been increased through providing packages of interventions that address multiple health issues.5 An integrated approach to child health reduces implementation costs and provides more comprehensive care.
  • Inexpensive, effective interventions that target common illnesses and could prevent more than two-thirds of all child deaths, saving 6.6 million lives.

  • Overall, 80 percent of the package costs are for preventing, rather than treating disease.6 While some preventive efforts, like vaccines, are easily affordable, others, such as improving access to clean water and sanitation, are initially costly but ultimately highly cost-effective.

  • For example, in just six years, measles vaccinations reduced child deaths due to measles by 60 percent, from nearly 900,000 in 1999 to about 400,000 in 2005.7

  • Currently, child health programs are vastly underfunded to achieve global commitments to reduce child mortality in poorest countries.
Major Causes of Child Deaths and the Cost to Treat or Prevent Illness

Disease Percentage
of deaths
under five
Number of
deaths annually
Cost to treat/prevent illness for one child
Pneumonia 19 percent 2 million Antibiotic treatment $ 0.30
Diarrhea 17 percent 1.8 million Oral rehydration packet $ 0.20
Malaria 8 percent 850,000 Insecticide treated bednet $ 5.00
Measles 4 percent 400,000 Measles vaccine $ 1.10
Birth Asphyxia 8 percent 830,000 Resuscitation mask and bag $10.00
HIV/AIDS 3 percent 350,000 Anti-retroviral drug $ 5.00
Tetanus 2 percent 250,000 Two tetanus toxoid injections $ 0.40


In the recent past, the interests of mothers and children have been forced to compete for a very limited pool of financial resources and international attention. Yet, we know that the survival of mothers, newborns and children is intertwined: all benefit from an essential package of care.8

Integrating Interventions for Mothers, Newborns, and Children

The health of mothers, newborns, and children is inextricably linked, and continuous care is necessary during the entire lifecycle. The continuum of care is a strategy to unite interventions for women and children in order to increase and improve coverage. It incorporates interventions from hospitals and clinics, outpatient and outreach services, and community care to create a streamlined package of services tailored to each individual’s needs.9 For example:
  • During the entire lifecycle, safe water, hygiene, sanitation, and access to food are important for both mother and child.
  • During delivery, skilled obstetric care at birth helps to prevent hemorrhage and sepsis for the mother, and asphyxia and birth trauma to the child.
  • During postpartum care visits, health care workers have an opportunity to administer childhood vaccinations and educate mothers on family planning.
Early evidence suggests that implementing maternal and child health interventions simultaneously is cost-effective and convenient, and some estimate that this model could prevent up to two-thirds of child deaths.9

A simple package of 32 well-understood prevention and treatment interventions that target each major cause of child and neonatal death could save 6.6 million lives in the 60 countries with 94 percent of under-five mortality.10, 11>
  • Full implementation of the package in low-income countries is feasible to deliver and scale up is affordable.

  • This package includes a continuum of care – from pregnancy through post-partum care. Some of the interventions target the mother and others focus on the child.

  • The most expensive, expanding access to safe water and sanitation, can reduce long-term disease incidence and treatment costs by about 60 percent.12

The 32 Prevention & Treatment Interventions Targeting Causes of Child Death2, 11, 13

Preventive interventions
• Folic acid (vitamin B) supplementation
• Tetanus toxoid (neonatal)
• Syphilis screening and treatment
• Pre-eclampsia and eclampsia prevention (calcium supplementation)
• Intermittent presumptive treatment for malaria in pregnancy
• Antibiotics for premature rupture of membranes
• Detection and management of breech (caesarian section)
• Labor surveillance (including partograph) for early diagnosis of complications
• Clean delivery practices
• Breastfeeding (exclusively for 6 months)
• Prevention and management of hypothermia
• Kangaroo mother care (skin-to-skin contact) for low birth weight newborns
• Newborn temperature management
• Insecticide-treated materials
• Complementary feeding
• Zinc (micronutrient)
• Hib vaccine (for pneumonia prevention)
• Water, sanitation, hygiene
• Antenatal steroids (prevent preterm birth)
• Vitamin A
• Nevirapine and replacement feeding (where possible) to prevent HIV transmission
• Measles vaccine
Treatment interventions
• Detection and treatment of asymptomatic bacteriuria
• Corticosteroids for preterm labor
• Newborn resuscitation
• Community-based pneumonia case management, including antibiotics
• Oral rehydration therapy
• Antibiotics for neonatal sepsis
• Antimalarials
• Zinc for treatment of diarrhea
• Antibiotics for dysentery
• Vitamin A



1 Committee on International Science and Technology Working Group on Emerging and Re-emerging Infectious Diseases. Global Microbial Threats in the 1990s. Available from: http://clinton1.nara.gov/White_House/EOP/OSTP/CISET/html/iintro.html. (accessed May 9, 2007).
2 Jones G, Steketee RW, Black RE, et al. How many child deaths can we prevent this year? Lancet, 362(9377):65-71. 2003.
3 Luby SP, Agboatwalla M, Feikin DR, et al. Effect of handwashing on child health: a randomized controlled trial. Lancet, 366:225-33. 2005.
4 Hoque B. Hand-washing practices and challenges in Bangladesh. International Journal of Environmental Health Research, 13(Suppl 1 ):S81-7. 2003.
5 Bryce J, Terreri N, Victora CG, et al. Countdown to 2015: tracking intervention coverage for child survival. Lancet, 368:1067-76. 2006.
6 Bryce J, Black RE, Walker N, et al. Can the world afford to save the lives of 6 million children each year? Lancet, 365(9478):2193-99. 2005.
7 Elliman D, Bedford H. Achieving the goal for global measles mortality. Lancet, 369(165-166). 2007.
8 Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: when? where? why? Lancet, 365:891-900. 2005.
9 Kerber KJ, de Graft-Johnson JE, Bhutta ZA, Okong P, Starrs A, Lawn JE. 2007. Continuum of care for maternal, newborn, and child health: from slogan to service delivery. Lancet 370:1358-69.
10 UNICEF. Countdown to 2015: Tracking progress in maternal, newborn and child survival: the 2008 report.2008 Available from: www.countdown2015mnch.org/documents/2008report/2008Countdown2015FullReport_2ndEdition_1x1.pdf.
11 Lawn JE. A price tag for newborn and child survival. Available from: http://cs.server2.textor.com/alldocs/40%20Joy%20Lawn.ppt. (accessed May 9, 2007).
12 Laxminarayan R, Mills AJ, Breman JG, et al. Advancement of global health: key messages from the Disease Control Priorities Project. Lancet, 367:1193-208. 2006.
13 Darmstadt GL, Bhutta Z, Cousens S, et al. Evidence-based, cost-effective interventions: how many newborn babies can we save? Lancet, 365:977-88. 2005.