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The newspaper of The Johns Hopkins University July 25, 2005 | Vol. 34 No. 40
Child Survival Is Affordable: $5.1 Billion Would Save 6 Million

Experts say protection programs would cost $1.23 per capita in 42 countries

By Kenna Lowe
School of Public Health

Six million children could be saved if $5.1 billion in new resources for preventive and therapeutic interventions were provided each year, according to researchers from the Johns Hopkins Bloomberg School of Public Health and other institutions. Approximately 90 percent of all child deaths occur in 42 countries around the world. In those countries, the average cost per child saved would be $887, or $1.23 per capita. With the recent publication of the potential impact of proven interventions that are feasible to deliver in low-income settings to children younger than 5, this is the first time the global cost of implementing child survival programs could be estimated. The study is published in the June 25 issue of The Lancet.

One of the United Nations-based Millennium Development Goals is to reduce child mortality by two-thirds by 2015.

"Achieving the Millennium Development Goal for child survival is clearly affordable," said Robert E. Black, corresponding author of the study and chair of the Bloomberg School's Department of International Health. "Protecting child health should be the priority for countries with the highest rates of child death and for international donors. The biggest challenges are increasing the delivery of health services and the lack of readily available funds," he said.

Past studies completed by Black and his colleagues found that two-thirds of the almost 11 million child deaths worldwide could be prevented with existing knowledge and treatments. In order to decrease child death rates, the authors say, adequate funding must be available to provide comprehensive child survival interventions to the areas that need them most.

The researchers compiled child survival interventions previously shown to reduce mortality from the major causes of death in children younger than 5. They focused on preventive interventions that could be put in place during 18 visits with a primary care provider, from one month before the child's birth until he or she reaches age 5. In their cost analysis, the researchers ensured that treatment for the major causes of child death were available to all children who needed them. To obtain the average cost to save a child's life, universal coverage levels from 2000 for drugs and other materials, delivery of treatment, program management and support were calculated; the cost of some of the interventions, such as vaccines to prevent infection with Haemophilus influenzae type b, may drop substantially as more extensive use reduces the price.

According to the study authors, full implementation of preventive interventions would reduce the current annual cost of treatment by more than 60 percent, due to the projected reduction in child illnesses. Furthermore, the delivery of integrated preventive and therapeutic services would be far more efficient than parallel delivery of each intervention separately.

"The focus is on community-based resources, which decrease costs since building hospitals and other fixed resources isn't necessary. It is our hope that policy-makers, donors and governments will use our price estimates to strengthen their health systems. If they don't, 16,000 children will continue to die each day as a result," said Jennifer Bryce, lead author of the study.

This study follows a series of articles by Black, Bryce and their colleagues published by The Lancet, starting in June 2003, that examines the means to reduce global child mortality. They found that at least 6 million child deaths worldwide could be prevented with existing interventions to prevent and treat pneumonia, diarrhea, malaria, neonatal sepsis, preterm delivery and asphyxia at birth, disorders that annually cause almost three-quarters of child deaths worldwide. The researchers calculate that a two-thirds reduction in child death can be accomplished by new resources that are easily within the capability of low-income countries and their international development partners.

"Can the World Afford to Save the Lives of 6 Million Children Each Year?" was co-authored by Bryce, Black, Neff Walker, Zulfiqar A. Bhutta, Joy E. Lawn and Richard W. Steketee.


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