Progress with Infant Mortality in Africa

According to United Nations statistics, almost nine million children die each year before they reach their fifth birthday. The highest rates of child mortality are found in sub-Saharan Africa, where, in 2008, one in seven children died before reaching their fifth birthday. One of the United Nations Millennium Development Goals (MD Gs) for 2000-2015 is to reduce child mortality by two thirds. The standard statistical measure for infant mortality is the number of deaths before reaching age five per 1000 live births. The main causes of deaths among children under age five, as reported for 2008, are neonatal causes, diarrhoeal diseases, pneumonia, malaria, AIDS, and measles. Of the 67 countries defined as having high child mortality rates, only ten are currently on track to meet the MDMDG target. Nevertheless, good progress is being made in reducing infant mortality, particularly in Africa. The number of children in developing countries who died before they reached the age of five dropped from 100 to 72 deaths per 1000 live births between 1990 and 2008, and this recent experience in reducing infant mortality indicates that some notable successes have been achieved in Africa.

According to the World Bank’s analysis of the most recent five-year demographic and health surveys, sixteen of twenty African countries reported falls in their infant mortality rates. Twelve of these African countries experienced declines in excess of the MD G target rate of reduction. In Senegal, Rwanda, and Kenya, the annual rate of reduction in infant mortality reached a remarkable level of 8%. The decline in African infant mortality is accelerating, having approximately doubled since the early 2000s and 1990s. Rwanda’s infant mortality rate more than halved between 2005-06 and 2010-11. Senegal cut its rate by 40% from 121 to 72 per 1000 live births between 2005 and 2010. The top African countries’ rates of decline in infant mortality are the fastest seen in the world over the last thirty years. These accomplishments have occurred in east, west, and central Africa and in the most populous countries, Nigeria and Ethiopia, as well as less populous countries such as Benin.

As developing countries make the demographic transition from poor and high-fertility status to more-developed and lower-fertility levels, it is expected that reductions in birth rates would engender some degree of comparable reduction in infant mortality rates. Senegal, Ethiopia and Ghana all reduced fertility and infant mortality rates substantially. However, Kenya and Uganda achieved substantial reductions in infant mortality notwithstanding a leveling-off of their fertility rates. Any expected direct link between reductions in infant mortality and fertility rates is not substantiated for all African countries. More important, as the World Bank concludes, is the influence of broad economic growth and specific public health policies. A notable factor in several countries in reducing infant mortality is the increase in the use of insecticide-treated bed nets that discourage malaria-causing mosquitoes.

Ethiopia, Ghana, Rwanda and Uganda have been among Africa’s best performing economies recently, with annual growth rates averaging over 6.5% in the period 2005-10. An increase in national income is generally associated with lower poverty and better nutrition. Good economic development policies that are instituted by accountable and democratic systems of government typically demonstrate a greater commitment to improving people’s living standards.

The World Bank has recently published a policy research working paper that studies the decline in infant immortality in Kenya as a case study to identify some of the factors contributing to the results that have been achieved. Kenya has reduced the mortality of infants under one year old by more than any other country and its annual economic growth rate has been 4.85% for the period 2005-10. Kenya’s use of insecticide-treated bed nets increased from 8.3% of households to 60.4% between 2003 and 2008; this factor alone is credited with about one-half of the reduction in infant mortality. The provision of aid by foreign charities is thought to have contributed also to the experience in Kenya, although its influence is not as decisive as those arising from better economic and public health policies, new technology and improved government effectiveness. The World Bank’s analysis of the Kenya case study shows that the increased utilization of treated bed nets in endemic malaria zones explains 39% of the decline in postneonatal mortality (within 28 days of birth) and 58% of the decline in infant mortality. Other factors that played a role in reducing infant mortality in Kenya include the use of iron supplements during pregnancy, immunization, intake of anti-malarial drugs during pregnancy, and access to improved sanitation and sources of drinking water. The rapid decline in infant mortality in recent years in many countries in Sub-Saharan Africa is an important and largely-unrecognized trend. As a result of its preliminary findings, the World Bank recommends further analysis to understand the underlying causes.