Interventions to improve child survival are not reaching the poorest children

Interventions to improve child survival are not reaching the poorest children that need them the most, concludes an article in this week’s issue of The Lancet.

In most low-income countries, coverage rates for child-survival interventions are low, and millions of children die every year from diseases for which there are effective interventions.

Cesar Victora (Federal University of Pelotas, Brazil) and colleagues looked at whether interventions, such as vitamin A supplements, safe water and immunisations, reached mothers and children in nine low and middle income countries. Researchers analysed data from Bangladesh, Benin, Brazil, Cambodia, Eritrea, Malawi, Nepal, and Nicaragua. The investigators found that though there are many child survival strategies running in each country, inequity is rife, with some children receiving no intervention and others receiving many. They also found that children from the poorest families received fewer interventions than their wealthier peers. In Cambodia, 31% of children received no intervention and 17% only one intervention. In Haiti, these figures were 15% and 17%, respectively. The researchers found that countries with higher rates of coverage had less inequity than those with lower coverage rates.

Professor Victora states: “Most of the interventions studied have been available for several decades. The fact that many children do not receive any intervention is a painful example of social exclusion as applied to child survival…New interventions are on the horizon for widespread dissemination but are likely to reach the same children who are already protected. Packaging several interventions through a single delivery strategy, while making economic sense, could contribute to increased inequities unless population coverage is high.”

“That one in every two poor children in Cambodia, or one in every three in Haiti, do not receive more than a single cost-effective preventive intervention is simply unacceptable,” he adds.