Measuring progress towards equitable child survival: Where are the epidemiologists?

The fourth Millennium Development Goal (MDG) is to achieve a two-thirds reduction in the mortality of under the age of 5 years children between 1990 and 2015. Only 7 of the 60 priority countries are currently on track towards the goal, and intensified efforts are required both globally and nationally. Tackling inequities is essential for reaching this goal, because children from poor families are consistently at higher risk of dying. Efforts should be concentrated on achieving high and equitable coverage with low-cost, effective, off-the-shelf interventions, and on monitoring progress among different social groups. Measuring inequities in mortality, morbidity, nutritional status, and coverage, however, is fraught with methodologic difficulties in countries where routine statistics are unreliable-a group that includes all high-mortality countries. Key methodologic challenges are discussed, with arguments for greater involvement of epidemiologists in measurement exercise that so far has been led by demographers, statisticians, and economists.