Malawi and Millennium Development Goal 4: A Countdown to 2015 country case study

Mercy Kanyuka, Jameson Ndawala, Tiope Mleme, Lusungu Chisesa, Medson Makwemba, Agbessi Amouzou, Josephine Borghi, Judith Daire, Rufus Ferrabee, Elizabeth Hazel, Rebecca Heidkamp, Kenneth Hill, Melisa Martínez Álvarez, Leslie Mgalula, Spy Munthali, Bejoy Nambiar, Humphreys Nsona, Lois Park, Neff Walker, Bernadette DaelmansJennifer Bryce, Tim Colbourn

Research output: Contribution to journalArticle

Abstract

Background: Several years in advance of the 2015 endpoint for the Millennium Development Goals (MDGs), Malawi was already thought to be one of the few countries in sub-Saharan Africa likely to meet the MDG 4 target of reducing under-5 mortality by two-thirds between 1990 and 2015. Countdown to 2015 therefore selected the Malawi National Statistical Office to lead an in-depth country case study, aimed mainly at explaining the country's success in improving child survival. Methods: We estimated child and neonatal mortality for the years 2000-14 using five district-representative household surveys. The study included recalculation of coverage indicators for that period, and used the Lives Saved Tool (LiST) to attribute the child lives saved in the years from 2000 to 2013 to various interventions. We documented the adoption and implementation of policies and programmes affecting the health of women and children, and developed estimates of financing. Findings: The estimated mortality rate in children younger than 5 years declined substantially in the study period, from 247 deaths (90% CI 234-262) per 1000 livebirths in 1990 to 71 deaths (58-83) in 2013, with an annual rate of decline of 5·4%. The most rapid mortality decline occurred in the 1-59 months age group; neonatal mortality declined more slowly (from 50 to 23 deaths per 1000 livebirths), representing an annual rate of decline of 3·3%. Nearly half of the coverage indicators have increased by more than 20 percentage points between 2000 and 2014. Results from the LiST analysis show that about 280 000 children's lives were saved between 2000 and 2013, attributable to interventions including treatment for diarrhoea, pneumonia, and malaria (23%), insecticide-treated bednets (20%), vaccines (17%), reductions in wasting (11%) and stunting (9%), facility birth care (7%), and prevention and treatment of HIV (7%). The amount of funding allocated to the health sector has increased substantially, particularly to child health and HIV and from external sources, but remains below internationally agreed targets. Key policies to address the major causes of child mortality and deliver high-impact interventions at scale throughout Malawi began in the late 1990s and intensified in the latter half of the 2000s and into the 2010s, backed by health-sector-wide policies to improve women's and children's health. Interpretation: This case study confirmed that Malawi had achieved MDG 4 for child survival by 2013. Our findings suggest that this was achieved mainly through the scale-up of interventions that are effective against the major causes of child deaths (malaria, pneumonia, and diarrhoea), programmes to reduce child undernutrition and mother-to-child transmission of HIV, and some improvements in the quality of care provided around birth. The Government of Malawi was among the first in sub-Saharan Africa to adopt evidence-based policies and implement programmes at scale to prevent unnecessary child deaths. Much remains to be done, building on this success and extending it to higher proportions of the population and targeting continued high neonatal mortality rates. Funding: Bill & Melinda Gates Foundation, WHO, The World Bank, Government of Australia, Government of Canada, Government of Norway, Government of Sweden, Government of the UK, and UNICEF.

Original languageEnglish (US)
Pages (from-to)e201-e214
JournalThe Lancet Global Health
Volume4
Issue number3
DOIs
StatePublished - Mar 1 2016

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Malawi
Infant Mortality
Child Mortality
Mortality
United Nations
Africa South of the Sahara
HIV
Women's Health
Malaria
Diarrhea
Pneumonia
Insecticide-Treated Bednets
Parturition
Growth Disorders
Survival
Quality of Health Care
Health
Norway
Sweden
Malnutrition

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Kanyuka, M., Ndawala, J., Mleme, T., Chisesa, L., Makwemba, M., Amouzou, A., ... Colbourn, T. (2016). Malawi and Millennium Development Goal 4: A Countdown to 2015 country case study. The Lancet Global Health, 4(3), e201-e214. https://doi.org/10.1016/S2214-109X(15)00294-6

Malawi and Millennium Development Goal 4 : A Countdown to 2015 country case study. / Kanyuka, Mercy; Ndawala, Jameson; Mleme, Tiope; Chisesa, Lusungu; Makwemba, Medson; Amouzou, Agbessi; Borghi, Josephine; Daire, Judith; Ferrabee, Rufus; Hazel, Elizabeth; Heidkamp, Rebecca; Hill, Kenneth; Álvarez, Melisa Martínez; Mgalula, Leslie; Munthali, Spy; Nambiar, Bejoy; Nsona, Humphreys; Park, Lois; Walker, Neff; Daelmans, Bernadette; Bryce, Jennifer; Colbourn, Tim.

In: The Lancet Global Health, Vol. 4, No. 3, 01.03.2016, p. e201-e214.

Research output: Contribution to journalArticle

Kanyuka, M, Ndawala, J, Mleme, T, Chisesa, L, Makwemba, M, Amouzou, A, Borghi, J, Daire, J, Ferrabee, R, Hazel, E, Heidkamp, R, Hill, K, Álvarez, MM, Mgalula, L, Munthali, S, Nambiar, B, Nsona, H, Park, L, Walker, N, Daelmans, B, Bryce, J & Colbourn, T 2016, 'Malawi and Millennium Development Goal 4: A Countdown to 2015 country case study', The Lancet Global Health, vol. 4, no. 3, pp. e201-e214. https://doi.org/10.1016/S2214-109X(15)00294-6
Kanyuka, Mercy ; Ndawala, Jameson ; Mleme, Tiope ; Chisesa, Lusungu ; Makwemba, Medson ; Amouzou, Agbessi ; Borghi, Josephine ; Daire, Judith ; Ferrabee, Rufus ; Hazel, Elizabeth ; Heidkamp, Rebecca ; Hill, Kenneth ; Álvarez, Melisa Martínez ; Mgalula, Leslie ; Munthali, Spy ; Nambiar, Bejoy ; Nsona, Humphreys ; Park, Lois ; Walker, Neff ; Daelmans, Bernadette ; Bryce, Jennifer ; Colbourn, Tim. / Malawi and Millennium Development Goal 4 : A Countdown to 2015 country case study. In: The Lancet Global Health. 2016 ; Vol. 4, No. 3. pp. e201-e214.
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TY - JOUR

T1 - Malawi and Millennium Development Goal 4

T2 - A Countdown to 2015 country case study

AU - Kanyuka, Mercy

AU - Ndawala, Jameson

AU - Mleme, Tiope

AU - Chisesa, Lusungu

AU - Makwemba, Medson

AU - Amouzou, Agbessi

AU - Borghi, Josephine

AU - Daire, Judith

AU - Ferrabee, Rufus

AU - Hazel, Elizabeth

AU - Heidkamp, Rebecca

AU - Hill, Kenneth

AU - Álvarez, Melisa Martínez

AU - Mgalula, Leslie

AU - Munthali, Spy

AU - Nambiar, Bejoy

AU - Nsona, Humphreys

AU - Park, Lois

AU - Walker, Neff

AU - Daelmans, Bernadette

AU - Bryce, Jennifer

AU - Colbourn, Tim

PY - 2016/3/1

Y1 - 2016/3/1

N2 - Background: Several years in advance of the 2015 endpoint for the Millennium Development Goals (MDGs), Malawi was already thought to be one of the few countries in sub-Saharan Africa likely to meet the MDG 4 target of reducing under-5 mortality by two-thirds between 1990 and 2015. Countdown to 2015 therefore selected the Malawi National Statistical Office to lead an in-depth country case study, aimed mainly at explaining the country's success in improving child survival. Methods: We estimated child and neonatal mortality for the years 2000-14 using five district-representative household surveys. The study included recalculation of coverage indicators for that period, and used the Lives Saved Tool (LiST) to attribute the child lives saved in the years from 2000 to 2013 to various interventions. We documented the adoption and implementation of policies and programmes affecting the health of women and children, and developed estimates of financing. Findings: The estimated mortality rate in children younger than 5 years declined substantially in the study period, from 247 deaths (90% CI 234-262) per 1000 livebirths in 1990 to 71 deaths (58-83) in 2013, with an annual rate of decline of 5·4%. The most rapid mortality decline occurred in the 1-59 months age group; neonatal mortality declined more slowly (from 50 to 23 deaths per 1000 livebirths), representing an annual rate of decline of 3·3%. Nearly half of the coverage indicators have increased by more than 20 percentage points between 2000 and 2014. Results from the LiST analysis show that about 280 000 children's lives were saved between 2000 and 2013, attributable to interventions including treatment for diarrhoea, pneumonia, and malaria (23%), insecticide-treated bednets (20%), vaccines (17%), reductions in wasting (11%) and stunting (9%), facility birth care (7%), and prevention and treatment of HIV (7%). The amount of funding allocated to the health sector has increased substantially, particularly to child health and HIV and from external sources, but remains below internationally agreed targets. Key policies to address the major causes of child mortality and deliver high-impact interventions at scale throughout Malawi began in the late 1990s and intensified in the latter half of the 2000s and into the 2010s, backed by health-sector-wide policies to improve women's and children's health. Interpretation: This case study confirmed that Malawi had achieved MDG 4 for child survival by 2013. Our findings suggest that this was achieved mainly through the scale-up of interventions that are effective against the major causes of child deaths (malaria, pneumonia, and diarrhoea), programmes to reduce child undernutrition and mother-to-child transmission of HIV, and some improvements in the quality of care provided around birth. The Government of Malawi was among the first in sub-Saharan Africa to adopt evidence-based policies and implement programmes at scale to prevent unnecessary child deaths. Much remains to be done, building on this success and extending it to higher proportions of the population and targeting continued high neonatal mortality rates. Funding: Bill & Melinda Gates Foundation, WHO, The World Bank, Government of Australia, Government of Canada, Government of Norway, Government of Sweden, Government of the UK, and UNICEF.

AB - Background: Several years in advance of the 2015 endpoint for the Millennium Development Goals (MDGs), Malawi was already thought to be one of the few countries in sub-Saharan Africa likely to meet the MDG 4 target of reducing under-5 mortality by two-thirds between 1990 and 2015. Countdown to 2015 therefore selected the Malawi National Statistical Office to lead an in-depth country case study, aimed mainly at explaining the country's success in improving child survival. Methods: We estimated child and neonatal mortality for the years 2000-14 using five district-representative household surveys. The study included recalculation of coverage indicators for that period, and used the Lives Saved Tool (LiST) to attribute the child lives saved in the years from 2000 to 2013 to various interventions. We documented the adoption and implementation of policies and programmes affecting the health of women and children, and developed estimates of financing. Findings: The estimated mortality rate in children younger than 5 years declined substantially in the study period, from 247 deaths (90% CI 234-262) per 1000 livebirths in 1990 to 71 deaths (58-83) in 2013, with an annual rate of decline of 5·4%. The most rapid mortality decline occurred in the 1-59 months age group; neonatal mortality declined more slowly (from 50 to 23 deaths per 1000 livebirths), representing an annual rate of decline of 3·3%. Nearly half of the coverage indicators have increased by more than 20 percentage points between 2000 and 2014. Results from the LiST analysis show that about 280 000 children's lives were saved between 2000 and 2013, attributable to interventions including treatment for diarrhoea, pneumonia, and malaria (23%), insecticide-treated bednets (20%), vaccines (17%), reductions in wasting (11%) and stunting (9%), facility birth care (7%), and prevention and treatment of HIV (7%). The amount of funding allocated to the health sector has increased substantially, particularly to child health and HIV and from external sources, but remains below internationally agreed targets. Key policies to address the major causes of child mortality and deliver high-impact interventions at scale throughout Malawi began in the late 1990s and intensified in the latter half of the 2000s and into the 2010s, backed by health-sector-wide policies to improve women's and children's health. Interpretation: This case study confirmed that Malawi had achieved MDG 4 for child survival by 2013. Our findings suggest that this was achieved mainly through the scale-up of interventions that are effective against the major causes of child deaths (malaria, pneumonia, and diarrhoea), programmes to reduce child undernutrition and mother-to-child transmission of HIV, and some improvements in the quality of care provided around birth. The Government of Malawi was among the first in sub-Saharan Africa to adopt evidence-based policies and implement programmes at scale to prevent unnecessary child deaths. Much remains to be done, building on this success and extending it to higher proportions of the population and targeting continued high neonatal mortality rates. Funding: Bill & Melinda Gates Foundation, WHO, The World Bank, Government of Australia, Government of Canada, Government of Norway, Government of Sweden, Government of the UK, and UNICEF.

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