Identifying effective child survival interventions

The first paper in this series on child survival presented an unacceptable picture: more than 10 million children dying every year, almost all in low-income countries or poor areas of middle-income countries. 90% of these deaths occurred in just 42 countries, most from one of a short list of causes: diarrhoea, pneumonia, measles, malaria, HIV/AIDS, and the underlying cause of undernutrition for deaths among children younger than 5 years, and asphyxia, preterm delivery, sepsis, and tetanus for deaths among neonates. The assessment of deaths by cause provides a useful starting point for a stocktaking of available child survival interventions. In this paper we review the state of the evidence for interventions to reduce child mortality for each of the major direct and underlying causes of death in children younger than 5 years (under-5 deaths). The term intervention is used here in a limited sense to refer to a biological agent or action intended to reduce morbidity or mortality. Approaches used to reach children and mothers with the interventions they need are referred to as delivery strategies. We draw on existing research reports and systematic reviews to document the efficacy or effectiveness of each intervention in reducing mortality among children younger than 5 years, to summarise current coverage with these interventions, and to estimate how many child deaths could be prevented if proven interventions were delivered to all the children and mothers who need them. Delivery strategies are addressed in the next paper in the series.