Tuesday, May 22, 2012

Africa is Experiencing Some of the Biggest Drops in Child Mortality Ever Seen, Anywhere in the World

The Economist has an article titled "The Best Story in Development" about a recent World Bank study finding that 16 of the 20 African countries that have had detailed surveys of living conditions since 2005 reported declines in their child-mortality rates (deaths of children under five per 1,000 live births).  Twelve countries had decreases of more than 4.4% a year (see vertical blue line in chart above), the rate of decline needed to meet the millennium development goal (MDG) of cutting child-mortality rates by two-thirds between 1990 and 2015. The top three countries in the group - Senegal, Rwanda and Kenya - have achieved declines of more than 8% a year, almost twice the MDG rate and enough to  cut child mortality by one-half in the next decade.
It is, says Gabriel Demombynes, of the World Bank’s Nairobi office, “a tremendous success story that has only barely been recognized." Michael Clemens of the Center for Global Development calls it simply “the biggest, best story in development.” It is the huge decline in child mortality now gathering pace across Africa.

The decline in African child mortality is speeding up. In most countries it now falling about twice as fast as during the early 2000s and 1990s. More striking, the average fall is faster than it was in China in the early 1980s, when child mortality was declining around 3% a year, admittedly from a lower base.
What are the factors responsible for some of the "biggest falls in child mortality ever seen, anywhere?"
What makes a big difference, Mr. Demombynes argues, is some combination of broad economic growth and specific public-health policies, notably the increase in the use of insecticide-treated bednets (ITNs) which discourage mosquitoes, which cause malaria.

Bednets are often taken as classic examples of the benefits of aid, since in the past they were pioneered by foreign charities. Consistent with the view that aid is vital, Jeffrey Sachs, an American economist, recently claimed that a big drop in child mortality in his Millennium Villages project (a group of African villages that his Earth Institute of Columbia University, New York, is helping) is the result of large increases in aid to villagers. In fact, argues Mr. Demombynes, the mortality decline in these villages was no better than in the countries as a whole.

The broad moral of the story is different: aid does not seem to have been the decisive factor in cutting child mortality. No single thing was. But better policies, better government, new technology and other benefits are starting to bear fruit. “This will be startling news for anyone who still thinks Africa is mired in unending poverty and death,” says Mr. Clemens. But “that Africa is slipping quickly away.”
MP: Another amazing success story of a significant improvement in a key health metric that contributes to a consistent increase in living standards around the world.  And the key factor in Africa's reduction in child mortality wasn't the standard solution of foreign aid, but more likely a combination of accelerating economic growth, advances in technology and more sensible government policies.  In other words, it seems like factors internal to Africa were more important than external factors like foreign aid. 


At 5/22/2012 9:20 PM, Blogger Hydra said...

and specific public-health policies,

Nice to see how useless government health policy is.

At 5/22/2012 9:57 PM, Blogger morganovich said...

it would be interesting to see how this trended right after our government, using totally flawed and false information, led the ban on DTT and allowed malaria to become an issue again with epic human cost.

that's government policy for you.

note that they started using ddt again a few years back that's likely a major factor here too.

"Within two years of starting DDT programs, South Africa, Mozambique, Zambia, Madagascar, and Swaziland slashed their malaria rates by 75 percent or more. With fewer people getting sick, they could get scarce ACT drugs to nearly all victims, cutting rates even further. By contrast, bed nets might reduce malaria rates by only 20 percent."


sorry hydra, but this is driven more by stopping bad government programs than starting new ones.

At 5/23/2012 4:48 AM, Blogger Larry G said...

"In the Kenya decomposition analysis, the growth in ITN ownership explains just over half of the infant mortality decline. That still leaves a large chunk of the drop not explained by the factors we have analyzed. In future work, we will examine the broader story of infant and under-5 mortality declines across many countries in the region, which allow us to consider the role of country-wide factors like the broad improvement in living standards that have come with renewed economic growth."


At 5/23/2012 4:51 AM, Blogger Larry G said...

"he infant mortality decline took place chiefly in malaria high-risk zones and was entirely confined to postneonatal mortality (deaths after the 1st month.) Postneonatal mortality is much higher in malaria high-risk zones and much lower among households that own an ITN in malaria high-risk zones (both unconditionally and controlling for a wide variety of other factors). ITN ownership skyrocketed in Kenya between 2003 and 2008, going from 8 to 60 percent of households nationally and reaching 75 percent of households in high-risk zones. Malaria is known not to have any substantial effect on neonatal mortality (deaths during the 1st month), and neonatal mortality does not vary across malaria risk zones and has remained constant over time in Kenya. This collection of facts suggests that ITNs played an important role in the decline of infant mortality in Kenya"


At 5/23/2012 5:38 AM, Blogger Larry G said...

Not only "aid" but that nasty, evil "govt" is cited for the improvements.

No mention at all of the "free market" or "supply/demand" as the reason for the improvements, eh?

At 5/23/2012 9:25 AM, Blogger Hydra said...

using totally flawed and false information, led the ban on DTT and allowed malaria to become an issue again with epic human cost.


Cmon. The data on DDT toxicity is not TOTALLY flawed and false. We can arge about the costs and benefits of the response, but not by simply claiming that the increase in malaria had an EPIC human cost.

Spreading poison around is one way to reduce malaria, but not the only way, and might not be the best way. but with this kind of nonscientific argument leading the way, we will never learn the truth.

At 5/23/2012 9:35 AM, Blogger Hydra said...

Lessee, Private enterprise created DDT, most likely with some kind of government assistance, and the use of it created a large perceived problem.

Governments first approved the use of DDT, then banned it, and now allow limited use again.

So your point is that governments do learn from their mistakes, same as any other corporation?

At 5/23/2012 9:44 AM, Blogger Buddy R Pacifico said...

Larry G states:

" Not only "aid" but that nasty, evil "govt" is cited for the improvements.

No mention at all of the "free market" or "supply/demand" as the reason for the improvements, eh?

Larry, this May, 2012 World Bank Study states:

"...LLINs provide more ―treated net years than ITNs which leads to protection at lower annual costs in spite of LLINs‘ higher provision costs (Yukich et al 2008). Over time, ITN delivery initiatives lead to lower costs and prices of bednets due to an increasing demand and competition in the ITN and LLIN market."

LLIN are initials for Long Lasting Inseticide Treated netting.

At 5/23/2012 9:54 AM, Blogger Buddy R Pacifico said...

Who makes LLINs netting?

A to Z Textiles of Tanzania.

"Sumitomo, a Japanese company, transfers technology and chemicals to A to Z through a loan from Acumen Fund. Exxon Mobil sells resin for the nets to A to Z and donates funds to UNICEF to buy the treated nets for the most vulnerable children"

At 5/23/2012 11:24 AM, Blogger morganovich said...

"DDT toxicity is not TOTALLY flawed and false"

yes, it is. silent spring was entirely, totally wrong.

even the epa panel voted to keep dtt. they were then overruled by an autocratic director who based his decision on politics and ignored ALL the science and the consensus of the scientists at his own agency.

DTT was and is VERY safe, particularly in comparison to many of the less effective chemicals it was replaced with.

that decision alone cause 10's and maybe 100's of millions of preventable deaths because of one bureaucrat acting like a czar.

read wildavsky's book "but is it true" which look at a dozen or so public policy choices like this is great detail. you'll be stunned by how little they are based on and how frequently they ignore the data entirely.

At 5/23/2012 11:53 AM, Blogger Larry G said...


" Its 35,000 health extension workers have brought basic preventive and curative health packages to the rural population en masse. Case control studies have shown significant expansion of coverage of malaria interventions (artemisinin-based combination therapy and insecticide-treated bednets) and improvement in sanitation."

I wonder where the money comes from for the 35,000 health care workers and if they had anything to do with the improvement in infant mortality?


just imagine how much DDT could have been bought with the money they "squandered" on those health care folks, eh?

At 5/23/2012 11:59 AM, Blogger morganovich said...

also worth noting:

the majority of bednet programs are run by private charities and foreign aid.

calling this a success of arfican government is just flat out untrue, especially as, in many cases, that is the same government that caused the problems through corruption, theft, making commerce impossible and impoverishing the nations, and banning ddt in the first place.

AT BEST is is governments starting to turn away from past mistakes and the damage they did.

if you a mess and clean up half of it, you do not deserve to be hailed as the great cleaner upper. you are still the mess maker.


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