The Difficult Task of Evaluating MDG-4

Background. The fourth Millennium Development Goal (MDG-4) proposed to reduce under-5 mortality rates (U5MR) by two thirds within 25 years. The article discusses changes in U5MR for 35 sub-Saharan African countries, for which DHS surveys are available. Methods. Analysis of DHS data, reconstruction of time series of U5MR, and comparison with other series. Findings. Few countries were able to achieve MDG-4 from 1985 to 2010, and the few who did seem to have achieved the goal apparently either because of abnormally high baseline or a surprisingly low endpoint. If all countries experienced significant mortality decline, only a minority had a steady decline, and many had periods of rising and falling mortality, for a variety of reasons. Interpretation. Discussion focuses on data quality, on methods for estimating levels and trends in under-5 mortality, and on the circumstances explaining rises and falls in mortality. MDG-4 appeared overambitious for Africa, given high mortality levels, political instability, economic crises, and above all emerging diseases, in particular HIV/AIDS. The last 10 years from 2000 to 2010 appeared as the most favorable period since 1960 in African countries, with the exception of countries with widespread HIV/AIDS.