Child death rates in EA: Newborns in Kenya, Burundi, have lowest chance of surviving until age 5

In the paediatric ward at Kenyatta National Hospital (KNH), the region’s largest referral hospital, the contradiction facing African countries in the battle against child mortality is evident.

It seems that the more countries battle child deaths, the harder preventable diseases like diarrhoea, malaria and pneumonia hit. At the KNH children’s ward, at least 55 per cent of the admissions — or at least 400 children — are a result of diarrhoea and pneumonia, officials said.

Statistics from the hospital show that on any given day, paediatricians attend to between 10 and 20 cases of diarrhoea in children below the age of five years. The numbers also show that three to five of these cases are severe, and are, therefore, referred for admission. The statistics get worse. Every week, the hospital records at least five deaths resulting from diarrhoea, malaria or pneumonia.

The KNH scenario mirrors the wider East African picture where health care officials are fighting to save face over the alarming rates of child deaths, barely two years ahead of the 2015 UN Millennium Development Goals deadline. As per Goal Four of the eight, all countries globally should have cut under-five mortality deaths by two thirds. 

The United Nations Children’s Fund (Unicef) says in a report released on Tuesday that despite the progress made in reducing child mortality rates, the three diseases remain the biggest killers among under-fives, thereby complicating a global push to drastically cut child deaths.

The new data from Unicef shows that a newborn in Kenya and Burundi has the lowest chance of surviving until the age of five, among the five East African countries.

Burundi, where at least 104 children out of 1,000 births are unlikely to live to their fifth birthday, is the worst place in EAC bloc to be a child. The country is ranked position 12 globally, in a survey that polled 194 countries. Kenya comes second in the region and is ranked 33 globally.

Unicef says that in Kenya, 73 children out of 1,000 births die before age five. Comparatively, Uganda with a child mortality rate of 69/1,000 is ranked 39, while Rwanda at 55/1,000 comes in at position 50. At position 51, Tanzania is the best place in the EAC for a child to be born, with 54 children out of 1,000 births likely to die before they are five — about half the number in Burundi.

Last year, Burundi was ranked 10, Kenya 38, Rwanda 51, Uganda 26 and Tanzania 41.

The Unicef report, Committing to Child Survival: A Promise Renewed, singles out Tanzania, Ethiopia, Liberia, Malawi and Nepal as countries that have already cut their under-five death rates by two-thirds or more since 1990, thereby achieving MDG Four.

Shortage of skills
The slow progress in East Africa’s battle to cut child mortality rates and deal with the preventable diseases crisis is a pointer to the challenges facing the region’s health sector.

The 2010 Kenya Service Provision Assessment (KSPA) survey shows there is a decrease in the number of specialists in the region’s public hospitals — medical officers, dentists, nurses and midwives — who are seeking greener pastures due to low pay. This has added to the inefficiencies in healthcare services provision in the EAC bloc.

“East Africa is dealing with an increasingly complex state of affairs in the health sector including dwindling development assistance targeting child health as well as rising threats from both non-communicable and communicable diseases,” said Felix Masiye, an assistant professor at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. “Governments need to look closely at which prevention and treatment interventions have been working, and how these can be scaled up most efficiently.”

Prof Masiye added that HIV/Aids-related illnesses and malaria remain a big threat in Tanzania and Uganda.

READ: HIV infection falls in Kenya, Burundi

“Tanzania is expanding prepayment schemes, increasing access to contraceptives and improving comprehensive emergency obstetric and new born care, but should now focus on increasing access to antiretroviral therapy for pregnant women living with HIV, in order to save their lives and those of their children,” said Prof Masiye. 

Healthcare officers say it has been a tough job fighting preventable diseases, mainly due to infrastructure challenges, lack of quick responses and constrained facilities.

“Although the cases and deaths have been decreasing over time, pneumonia and diarrhoea are still the main causes of child deaths,” said Antony Kimatu, a general practitioner at KNH. “Provision of vaccines and remedies including oral rehydration salts and zinc, while preventative measures such as the provision of safe drinking water and improved sanitation, need to be scaled up and better targeted to reach the most vulnerable populations.”

Top five countries

Unicef notes that the top five countries in sub-Saharan Africa with the highest child mortality rates are Sierra Leone, Angola, Chad, Somalia and the Democratic Republic of Congo, while the five countries with the least under-five deaths are Seychelles, Mauritius, Cape Verde, Namibia and South Africa.

While the UN agency singles out Tanzania, Ethiopia, Liberia, Malawi and Nepal as countries that achieved MDG Four, it notes that the level of deaths remains alarming.

READ: Child mortality falling, young adult deaths rising

According to Unicef regional advisor Tesfaye Shifraw, unequal distribution of health services in most countries in East Africa is the major reason for the slow progress in achieving the MDG.

“Even though Kenya has rolled out free maternity care services, the healthcare facilities in all the counties are not well equipped and don’t have enough qualified health workers,” said Mr Shifraw. Burundi, he said, needs both the government and private partnerships to come up with programmes for reducing child mortality rates.

Mr Shifraw added that Uganda has made progress because of efforts being taken to reduce deaths, such as Saving Mothers, Giving Life, a programme that integrates interventions for child and maternal survival, including mobile health solutions.

Safe deliveries

Community health workers known as Village Health Teams have been trained to encourage birth preparedness as well as to collect data to track progress. Essential supplies and equipment including toolkits for the treatment of postpartum haemorrhage and eclampsia have been distributed to promote safe deliveries in health facilities.

“There are plans to scale up the programme in both Uganda and Zambia beyond the eight pilot districts, and to expand it to other countries in sub-Saharan Africa,” said Mr Shifraw.

According to the World Health Organisation, pneumonia and diarrhoea are diseases of the poor, meaning children from low income families in developing countries carry the highest risk of dying from them. The bulk of under-five deaths from these conditions occur in just a handful of countries including all the EAC countries, many of which are among the poorest in the world, says the WHO in its latest report.

WHO says the risk factors that are common to both conditions are preventable. The causes include under nutrition, suboptimal breastfeeding, poor hygiene and zinc deficiency.

A clean home environment, including access to safe water and to adequate sanitation helps to prevent both pneumonia and diarrhoea, the WHO says. Diarrhoea is, for example, most often caused by an infection of the intestinal tract, usually by a virus. Rotavirus is the top known cause of diarrhoea mortality in children, and is associated with 28 per cent of deaths.

Pneumonia, on the other hand, caused by bacteria, and affects the respiratory system, resulting in coughing and difficulty in breathing.

In Kenya, data in the Economic Survey 2013 shows that pneumonia is the leading killer disease, with one in every five deaths in the country attributed to it.

To reverse this trend, former President Mwai Kibaki launched the pneumococcal vaccine in February 2011, to be provided free in all public health centres as an addition to the schedule of vaccines given to babies shortly after birth. However, the numbers of new infections and deaths have not slowed, at least up to now.

“Among the other programmes he promoted are the prevention of mother to child HIV infections initiative in all the public hospitals, awareness programmes for mothers on the importance of breastfeeding exclusively for six months, immunisation initiatives and sanitation programmes to prevent water borne diseases like diarrhoea in children through hand washing and water boiling,” said Kenya’s Director of Public Health, Shanaz Shariff.

ALSO READ: Unicef ranks Rwanda highly on immunisation

“The free maternity services in public facilities have led to a 10-50 per cent rise in the number of women delivering in hospital across the country, which will in the end reduce child mortality rates,” said Dr Shariff.

In 2011,  Kenya entered into a deal with the Global Alliance for Vaccines and Immunisations for a Ksh3.2 billion ($37.6 million) annual grant for the supply of the vaccine over five-years.

William Maina, the head of Kenya’s National Aids and Sexually Transmitted Infection Control Programme, said that the country had cut infections in children following the scaling up of prevention programmes and awareness.

“Early diagnosis and linkage to HIV treatment has been the key to keeping children with HIV alive and healthy,” said Dr Maina. “Kenya is scaling up its Mentor Mother programme nationwide to boost support to HIV-positive women, and is also strengthening exclusive breastfeeding support for women living with HIV.”

According to a 2012 research paper by WHO on pneumonia, the involvement of community health workers can greatly influence health outcomes, especially of this respiratory disease. Titled Evidence Base for the Community Management of Pneumonia, the paper cited Uganda where there was a community intervention to train health workers to recognise pneumonia.

“The successful management of pneumonia in children is dependent on the child’s condition being recognised by the family, and the child being brought to someone who can provide correct care with antibiotics,” the researchers in Uganda said.

Globally, data by Unicef shows, the pace of decline has accelerated with the annual rate of decline tripling since the 1990s. Sub-Saharan Africa has also accelerated its rate of decline, which has increased more than five-fold since the early 1990s.

In the past seven years, East and Southern Africa have been among the best performing regions in the world, reducing under-five mortality at an annual rate of 5.3 per cent between 2005 and 2012, according to Unicef.

The WHO/ Unicef in April this year launched the Global Action Plan for Pneumonia and Diarrhoea (GAPPD), with the aim of eliminating preventable pneumonia and diarrhoea deaths by 2025, and to reduce associated morbidity.

The programme was launched in the 15 countries that have the highest number of deaths among children under five from pneumonia and diarrhoea, including Kenya and Uganda.

The initiative seeks to promote practices that protect children from disease and ensure that every child has access to proven and appropriate preventive and treatment measures