Malawi and Millennium Development Goal 4: a Countdown to 2015 country case study

Area of Science:

• Global Health
• Pediatric Mortality
• Sub-Saharan African Health Systems

Background:

• Malawi was projected to meet Millennium Development Goal 4 (MDG 4) for reducing under-five mortality.
• A case study was initiated to understand Malawi's success in improving child survival rates.
• The study focused on the period leading up to the 2015 MDG endpoint.

Purpose of the Study:

• To explain Malawi's success in reducing under-five mortality.
• To analyze the impact of various interventions on child survival.
• To document policy implementation and financing related to child health.

Main Methods:

• Utilized district-representative household surveys from 2000-2014 to estimate mortality rates.
• Recalculated coverage indicators for child health interventions.
• Employed the Lives Saved Tool (LiST) to attribute lives saved to specific interventions.

Main Results:

• Under-five mortality rate decreased from 247 to 71 deaths per 1000 livebirths between 1990 and 2013 (5.4% annual decline).
• Neonatal mortality declined from 50 to 23 deaths per 1000 livebirths (3.3% annual decline).
• Approximately 280,000 child lives were saved (2000-2013) due to interventions like diarrhea/pneumonia/malaria treatment, bednets, vaccines, and HIV prevention.

Conclusions:

• Malawi achieved MDG 4 by 2013, primarily through scaling up effective interventions against major child killers.
• Success was driven by programs addressing undernutrition, mother-to-child HIV transmission, and improved facility birth care.
• Malawi pioneered evidence-based policies and scaled-up programs for child survival in sub-Saharan Africa, though further efforts are needed for neonatal mortality.