Millennium Development Goals: progress in Oceania.

To cite: Vince JD. Arch Dis Child 2015;100(Suppl 1): s63–s65. For the purposes of this commentary, Oceania is understood to encompass the Pacific Island states of Micronesia, Polynesia and Melanesia including Papua New Guinea (PNG) (but excluding the western half of mainland New Guinea, politically a province of Indonesia), Timor Leste, Australia and New Zealand. In geopolitical Oceania (which excludes Timor Leste), 25 countries, 12 with a population <100 000, are scattered over an area of 8 525 989 km (figure 1). The total population is 35 670 000, 27.5 million of whom are in Australia and New Zealand. PNG accounts for the large majority of the remainder. The great majority of the population in Australia and New Zealand are urban dwellers, while the majority of the population in the other countries is rural, the people often living in villages with very difficult access on small islands or atolls or in remote mountain ranges. The region includes countries with widely differing economies, infrastructure development, education, health service provision, and health indices. Table 1, based on data from Unicef ’s State of the World’s Children and the United Nations Development Programme reports, indicates some of the important indices relating to child health from a selection of the countries. 2 Only one country, Timor Leste, had reached the Millennium Development Goal (MDG)-4 target by 2012, but from a very high under 5 mortality rate in 1990. Australia, New Zealand and Vanuatu may reach the target, but most of the countries are unlikely to do so. Mortality rates and economic indicators in Australia and New Zealand are similar to those throughout the rest of the Organization for Economic Cooperation and Development (OECD) countries. However, the overall figures mask, as they do in most countries, mortality rates for their disadvantaged population: in the case of Australia, the Aboriginal and Torres Strait Island population, which are more than double the national figures. Nevertheless, mortality rates in this population have been reduced by almost 50% since 2002. Good child health is dependent on many interrelated factors, the most important of which are living conditions, the level of female literacy, and financing for, provision of, and accessibility to preventative and curative health services. Between 2007 and 2011, the proportion of the gross national product allocated to health varied from 3% in PNG and Fiji to 14% in Kiribati, with the majority of countries in the 5–8% range. In PNG, this translates to US$35–40$ per capita. Almost all the countries with low mortality have near 100% primary education, with many having high levels of secondary and tertiary education. Countries with higher mortality have poorer education levels, and even then the figures hide important gender disparities. There is often a higher proportion of male than female children enrolled, and girls are less likely than boys to complete primary education. The standard of primary education in a city school in Australia with state-of-the-art internet technology is vastly different from that in a remote village school in PNG, Solomon Islands or Vanuatu, where books and blackboards may be non-existent. Maternal mortality rates in some of the countries are high, and in PNG, where only 52% of women deliver in health facilities, and in Timor Leste, the rates are alarmingly high. Neonatal mortality rates are correspondingly high, accounting for 50% of infant mortality. The common causes of neonatal death are infection, birth asphyxia and problems associated with low birth weight. The death of a mother puts her child at risk not only of neonatal but also of later infant and child mortality. Transport systems to provide ready access to health services are essential. However, in many of the smaller island countries, transport is by dinghy or air. In the larger islands, road transport may simply not exist in some areas, and access is either by air to small airstrips or by foot. Where there are roads, they are likely to be unmetalled and at times unusable by vehicles. Security concerns may also hamper the delivery of services in some countries and some areas. Unfortunately, run down, inadequately staffed and inadequately supplied health facilities are common in some of the countries in the region, preventing health service delivery even when access is possible. For some of the region’s countries such as PNG, Solomon Islands and Vanuatu, population growth rates of >2.4% pose a major challenge to the provision of health, education and other services. Some of the smaller countries have much lower growth rates—in some, reflecting outward migration to countries such as Australia and New Zealand. The leading causes of child mortality in the lowincome countries in the region are communicable diseases: pneumonia, meningitis, diarrhoeal disease, malaria and, in some of the countries, tuberculosis (TB). Many deaths can be avoided with simple preventative and curative interventions. EPI programmes (immunisation programmes) are well established in all countries, but achieving high vaccination coverage has proved difficult in some. In several of the countries, fewer than 75% of children are protected by DPT3 (third dose of diphtheria, tetanus and pertussis vaccine, either as ‘triple vaccine’ or incorporated into other multiantigen vaccines), and, although routine measlescontaining vaccine coverage at the 95% level required has been reached in a few countries including Fiji and Samoa, it is well below this in Regional updates