Findings from the Bangladesh maternal newborn health exemplars study are now available from the Exemplars in Global Health website and have been accepted for publication in the journal BMJ Global Health. Improved availability and quality of health services, plus improvements of other socioeconomic indicators – such as access to electricity...
Uganda’s extensive work in monitoring progress in reproductive, maternal, newborn, child and adolescent health (RMNCAH) and other health services includes regular comprehensive annual health monitoring reports by the ministry of health, the district league table system to track local performance in place since 2003, and high-quality research by Makerere University....
Kenya’s 47 counties form the axis of planning and implementation of health programs, and progress is monitored at the county level. This is a challenging task, since population-based survey data are collected only once every five years. Health facility data are available for regular monitoring, but estimating service coverage from...
The three country profiles have been updated with data from 2022, plus new regional profiles, and are now available on the Countdown to 2030 website. All the profiles are derived from public datasets, such as the Demographic Health surveys. Watch the recording of the webinar: “It is vital that we...
To get a sense of what it’s like to attend a Countdown to 2030 analysis workshop, watch this short video: Since 2017 countdown to 2030 has organized nine virtual workshops and 17 in-person workshops with representatives from 65 countries. Footage was filmed during a workshop that took place in Nairobi...
Countdown to 2030 will expand the number of country collaborations, launch three multi-country analysis projects, and mentor African researchers within the Countdown network through a new fellowship program, as it enters a new funding phase for 2023-2026. The Countdown collaboration will continue its global monitoring, measurement and accountability work, such...
Countdown researchers published 31 peer-reviewed articles in 2022, advancing knowledge around measurement of reproductive, maternal, newborn, child and adolescent health, including: how the COVID-19 pandemic impacted use of health services in Africa; global trends in child survival and thriving; the relationships between gender, ethnicity and health; factors related to coverage...
On February 9th Countdown 2030 and the Paternership for Maternal, Newborn and Child Health (PMNCH) will release new country profiles for 2022, with a webinar to present the latest findings. To register for the webinar, click here and enter your details. For the first time, some regional data will be...
Methods for calculating effective coverage, which is also called quality-adjusted coverage, continue to be refined, and this approach is increasingly being used to inform country-level decision-making. The recording of a satellite session titled, “Measuring effective coverage and quality of care to improve the health of women, children, and adolescents in...
“We say, numbers don't lie,” reflected Charles Michelo, professor at the University of Zambia during a June 2022 dissemination event. “Yet numbers can be hidden. In hospitals, see how many files may be on the floor, inaccessible. This also may be true in our offices: we have the data, and...
The Geospatial Data and Analysis Center (DAC) recently published several resources about population estimation and how it can be applied to vaccine coverage. Here’s a quick summary: In this webinar, Andrew Tatem from WorldPop and the University of Southampton in the United Kingdom speak about different approaches to producing population...
Countdown 2030 and the Improve Project will hold a satellite session about effective coverage measurement at the Seventh Global Symposium on Health Systems Research (HSR 2022) in Bogotá, Colombia, on November 2 from 8:30 a.m. to 12 p.m. The session will be open to both in-person and virtual conference...
Since 2020 women’s and children’s health has suffered globally from the converging impacts of conflict, the COVID-19 pandemic and climate change, according to a new United Nations report for which Countdown is a contributing partner. “Almost three years on from the onset of COVID-19, the pandemic’s longterm impact on the...
Health systems are complex; thus, many research approaches are used understand and assess them. Three new Countdown to 2030 briefs aim to support researchers and policy makers, to understand the value of and approaches available using health policy and systems research in women’s, children’s and adolescents’ health. These briefs address...
The Countdown country collaboration in Tanzania met September 25-26, 2022, at Ifakara Health Institute in Dar es Salaam to develop its plan for years 2023-2025. Plans including supporting the Ministry of Health with monitoring regional and national progress based on the Health Sector Strategic Plan July 2021-June 2026 (HSSP V)...
(Note: this is part 2 of an article about calculating denominators. The first article is here, and a related article discusses how to assess data quality before beginning this kind of analysis.) If a health service is used by nearly all women or children and reporting completeness is near 100%, then...
Health facility data typically have provided only the numerator for indicators of interest, which makes it difficult to interpret time trends. But it is possible to calculate denominators based on two methods: population projection estimates and service utilization. This article explains how to calculate denominators using population data, and a...
Resources to assess the quality of routine health facility data related to reproductive, maternal, newborn, child and adolescent health (RMNCAH) are now available, based on resources developed for a workshop hosted by Countdown and the Global Financing Facility (GFF) in Nairobi, Kenya, in June 2022 . Data from individual health...
With lots of Stata, Powerpoint, simultaneous translation, and expansive Kenyan scenery, Countdown to 2030 and our partners the Global Financing Facility (GFF) convened a group of more than 100 experts from across Africa to share best practices for analyzing health facility data and to conduct analysis in a collaborative setting....
The COVID-19 pandemic led to 2%–6%, reductions in use of maternal, newborn and child health services and 7%–17% reductions in outpatient consultations and hospitalizations in 12 African countries during March to December 2020, according to a Countdown study published in BMJ Global Health. The months immediately following the start of...
When assessing inequalities between subgroups, we’re often interested in relative measures of inequality. The simple relative measure is the ratio, in which we divide group one by group two. But what if we have more than two subgroups, and we want to consider all of them in our relative measure?...
Holistic action is needed to address reproductive, maternal, childhood, and adolescent health, as well as nutrition and development, according to the Optimising Child and Adolescent Health and Development series published in The Lancet on April 27, 2022. Arguing that global progress on child health had stalled even before the COVID-19...
This brief summarizes describes how a report by the Countdown collaboration in Pakistan was used to build consensus around key priorities and generate change in policy and programs. Content of the brief is reprinted below: Development of the report Pakistan does not have an annual review of progress and performance...
This blog post summarizes the findings of an article that Wendt and co-authors published in SSM – Population Health in September 2021. This blog post is reprinted from the PMNCH website; the original post is here. By Andrea Wendt and Cesar Victora, University of Pelotas, Brazil; PMNCH ART constituency member...
AlignMNH convened a virtual meeting on April 4-7 to share the data around measuring progress toward the Sustainable Development Goals, providing respectful maternal and newborn care, and strengthening quality of care. Several Countdown to 2030 researchers presented and helped plan the event. In the first session, Aluisio Barros from the...
Uganda has made steady progress during 2015/16-2019/20 on several key indicators of the reproductive, maternal, newborn, child and adolescent health (RMNCAH) continuum of care, but most did not reach the set targets, according to an endline review report published by the Countdown country collaboration in Uganda, in partnership with the...
One of the key methods employed by the Health Policy and Systems Data & Analysis Center is the policy and program timeline tool. In this 7-minute tutorial video, Mary Kinney from the University of the Western Cape in South Africa describes the timeline’s purpose and how to use it. The purpose of...
The Countdown collaboration contributed to the reproductive, maternal, newborn, child and adolescent health (RMNCAH) and nutrition scientific literature through four journal supplements and more than 20 standalone papers. The papers included topics that have long been central to Countdown’s work, such as child survival, and topics that have come...
Countdown to 2030 for Women’s Children’s and Adolescent’s Health and partner organizations published new and updated country profiles for: Reproductive, maternal, newborn child and adolescent health (RMNCAH) and nutrition Equity Early childhood development The profiles were first shared during a webinar on December 14, 2021, in collaboration with the Partnership...
Countdown is conducting a series of analysis workshops to understand RMNCH in 10 African cities Recent survey data suggests that progress toward the targets of the sustainable development goals related to maternal, newborn and child health in several cities in sub-Saharan Africa has been lagging.To understand this issue more thoroughly,...
The Countdown in Pakistan, led by the Health Services Academy in Islamabad, and partner organizations has supported the Ministry of Health Services Regulation and Coordination in the development of a framework of monitoring and evaluation (M&E) of progress toward implementation of the universal health coverage (UHC) basic package and equity...
A new three-part webinar series explains the key concepts of health financing analysis and provides step-by-step examples of how to conduct this analysis. These webinars were developed for Countdown GFF and maternal newborn health exemplar countries but may be useful for anyone who is trying to obtain a better understand...
The need to use routine health facility data for decision-making is stronger than ever, and advances in analytic methods have made the data easier to interpret, according to series of articles published this month in the BMC journal Health Services Research. Countdown to 2030 announced the journal supplement with a...
Global improvements have been measured in adolescent health during the past decade, yet wide inequalities exist for many indicators when data are disaggregated by gender, household wealth and urban-rural residence, demonstrates a supplement of six articles and a commentary published in BMC Reproductive Health. Countdown to 2030 hosted a webinar...
Health financing – where the money in the health system comes from, how the money is combined or pooled, and how health workers are paid – is a key consideration for understanding how health systems function. Josephine Borghi, Catherine Pitt, Melisa Martinez-Alvarez, Peter Binyaruka, and Federica Margini from the...
Traditionally antenatal care (ANC) has been measured as coverage indicator in RMNCAH+N programs, such as the number of women who received any ANC or received 4+ ANC visits. However, from Demographic Health Survey and other data sources it is clear that critical gaps in antenatal care quality often occur ....
Countdown to 2030 is participating in the AlignMNH Collective’s virtual opening forum on April 20-21, an event that the aims to foster solutions-focused discussion and promote the sharing of evidence, knowledge, and experiences in the promotion of global maternal and newborn health. With less than 10 years remaining to...
Uneven progress is occurring toward global targets for reducing maternal and newborn mortality and stillbirths at the regional and country level, according to a report that Countdown to 2030 and partners have released as part of the AlignMNH opening forum. However, all the world’s regions have made progress in the...
We have updated our website to describe our current work and to provide more resources to the global community of people working to improve the health of women children and adolescents. Countdown began a new phase of work in 2020 with a revised project structure which is explained here. Earlier...
In a one-hour webinar on March 23, Asha George and Mary Kinney from University of the Western Cape in South Africa gave an overview of: Countdown’s previous work around health systems and policy, Study designs and conceptual frameworks applied in health policy analysis, and Some examples of how these concepts...
Pakistan’s recent surges in antenatal care, skilled birth attendance, care seeking for common childhood illnesses and immunization coverage are notable. However, slow reductions in mortality rates, combined with stagnant contraceptive prevalence rates, mean that the country is not on pace to achieve the Sustainable Development Goal targets by 2030, based...
Effective coverage measures the proportion of women and children that are receiving the benefits of live-saving interventions. It can be measured by linking household survey data with health facility readiness assessments.In March 2021, Agbessi Amouzo, Aboudalaye Maiga, Elizabeth Hazel, Safia Jiwani, Emily Wilson, and Melinda Munos from the Institute for...
A series of three article and one commentary on maternal and child undernutrition reinforce the need to prevent undernutrition during the 1000 days from conception to age 2 years, with interventions both within and outside the health sector. Countdown researchers and their co-authors also issued a specific call for action...
In this webinar, Andy Tatem, Natalia Garavito, and Winfred Dotse-Gborgbortsi from WorldPop at the University of Southampton present an overview of available resources for incorporating geographical data into evaluation of reproductive, maternal, newborn, child and adolescent health and nutrition (RMNCAHN). Outline of the webinar, by time [minute:second] [1:23] Overview...
Health facility data is an important component of many health evaluations but can be complicated to use because of data quality and completeness issues, outlier values, and lack of clear denominators. Cheikh Faye from African Population and Health Research Center (APHRC), Martin Mutua from APHRC, Abdoulaye Maiga from Johns Hopkins...
The Pakistan Health Service Academy published its first annual report series, as part of the Countdown collaboration, assessing progress in reproductive, maternal, newborn and child health ….. read more https://www.countdown2030.org/wp-content/uploads/2021/02/Pakistan-CD-report-2020.pdf
Two new videos related to equity analysis are available on Countdown to 2030’s youtube channel. In an hour long webinar from January 2021, presenters from the International Center for Equity in Health at the Universidade Federal de Pelotas, Brazil, present an overview of methods for equity analysis. Topics presented include:...
A Lancet Series, Women’s and Children’s Health in Conflict Settings, discusses the requirements of providing sexual, reproductive, maternal, newborn, child and adolescent health and nutrition services in conflict settings. Drawing upon scholarship from the BRANCH Consortium, the series provides insights into the nature and dynamics of women’s and children’s...
Monday's annual meeting was a great opportunity to share goals and resources, learn more about @thegff strategy, and plan for the future. @aphrc pic.twitter.com/RppoxmeuY3 — Countdown to 2030 (@Countdown2030) November 18, 2020 On November 17, 2020, Countdown to 2030 (CD2030) and the African Population and Health Research Center (APHRC) organized...
The Countdown to 2030 team published a series of analyses titled, “Measuring and Monitoring Coverage and Quality of Care in Low and Middle Income Countries”. Journal of Global Health published the articles in 2020, and in October Countdown hosted a webinar to provide an overview of the findings. Topic included...
Leaving No Woman and Child Behind: Inequalities in Nutrition Coverage and Status Among Women, Children and Adolescents in West Africa Food and nutrition security, particularly for children, adolescent girls, and women of reproductive age remain a priority for all ECOWAS Member States as there has been limited progress in achieving...
EWEC Progress Report 2020 Protect the Progress: Rise, Refocus, Recover highlights that since the Every Woman Every Child movement was launched 10 years ago, spearheaded by the United Nations Secretary-General, there has been remarkable progress in improving the health of the world’s women, children and adolescents. However, conflict, climate instability...
Country profiles present in one place the latest evidence to assess country progress in improving women’s, children’s and adolescents’ health. An interactive version of the data is presented in the Country Profiles. View and download the Country Profiles, Data Sets, and Sources and Methods of data collection from the Country...
The Together for Nutrition: West African Data Forum was convened in Saly, Senegal in February 2020 to discuss best practices for nutrition improvement in the region. The group was led by Transform Nutrition West Africa, an initiative of the International Food Policy Research Institute (IFPRI) and also included participants such as Countdown to...
The Covid-19 pandemic has affected life around the globe and the work of the Countdown to 2030 is no exception. The impact is felt by women, children and adolescents around the world, directly and indirectly. Health and social services may be disrupted and communities, households and individuals are often affected...
Four methods have previously been used to track aid for reproductive, maternal, newborn, and child health (RMNCH). The new Mushkoka2 algorithm includes innovations to produce accurate, predictable, transparent, and up-to-date estimates to analyze donor and recipient perspectives on use of donor aid for RMNCH. New findings show that 46% of...
The BMJ’s new collection, Leaving No One Behind provides comprehensive reports on the progress made to meet 2030 global targets for women’s, children’s and adolescents’ health. Read more Press release
On November 2019, the 8th African Population Conference was held in Entebbe, Uganda with the theme, “Harnessing Africa’s Population Dynamics for Sustainable Development: 25 Years after Cairo and beyond.” Countdown to 2030 members made 4 presentations about ongoing analysis from different RMNCAH data analysis workshops which had been conducted over...
The concept of nurturing care for young children was outlined in the 2017 Lancet series Advancing Early Childhood Development: From Science to Scale and developed into a framework by WHO, UNICEF, the World Bank collaborating with a large number of academics and representatives of civil society. The Nurturing Care Framework...
In June 2019, BMJ Global Health published a supplement with six papers by the Countdown to 2030 to address the challenges in measurement and monitoring of reproductive, maternal, newborn and child health and nutrition (RMNCH&N) in the context of the sustainable development goals. The six-paper series seeks to advance the...
After two successful analysis workshops organized in November 2017 and July 2018 that brought together government officials and academics from ESA countries, APHRC has supported the dissemination and knowledge translation of the evidence generated further to the analysis workshops. In Uganda, APHRC supported the implementation of in-country dissemination activities targeting...
Global Symposium on Health Systems Research 2018 Satellite Session Liverpool, United Kingdom Leaving no woman, no child behind: what evidence on inequalities for RMNCH is needed to advocate and act?” Date: Monday, October 8, 2018 Time: 9:00-17:00 Location: ACC Liverpool, UK – Room 3B Kings Dock, Liverpool L3...
Countdown to 2030 lets the data speak. Read more in these recent thought pieces published in the Lancet: Countdown Commentary (May 2018) on analyzing inequalities in child mortality. Countdown Viewpoint (April 2018) on monitoring country progress and achievements through global predictions.
Research Priorities for RMNCAH – results from the Countdown to 2030 Measurement Conference Stellenbosch, South Africa January 31 – February 1, 2018 The objectives of the Improving measurement of reproductive, maternal, newborn, child and adolescent health & nutrition conference were to: Take stock of the current practices, advances and critical...
In The Lancet Global Health, Marilia Mesenburg and colleagues present Countdown analyses of the ethnic gaps in coverage of reproductive, maternal, and child health (RMNCH) services across 16 Latin American and Caribbean countries. This important study could help to address health equity problems for ethnic minority populations in these regions.”...
Tracking donor aid for global health goals: A systematic comparison of four approaches applied to reproductive, maternal, newborn, and child health. How much aid really supports reproductive, maternal, newborn, and child health (RMNCH)? New research published in The Lancet Global Health shows that four high-profile estimates – from the Countdown...
Strengthening the tracking of official development assistance and domestic financing for women’s, children’s and adolescents’ health Countdown to 2030 and the Partnership for Maternal, Newborn & Child Health (PMNCH) organized a consultation on the tracking of global and domestic financing for women’s, children’s and adolescents’ health (WCAH) at the London...
11 Dec 2017 Countdown to 2030 launched its detailed country and equity profiles on women’s, children’s and adolescents’ health for the 81 countries that account for 95% of all maternal deaths and 90% of all child deaths at the PMNCH Board retreat in Lilongwe, Malawi on December 13th. Malawi stands out because of...
07 December 2017 The second regional initiative was launched to generate evidence and strengthen country analytical capacity for women’s, children’s and adolescents’ health at the African Population Health Research Centre (APHRC) in Nairobi, Kenya, 27 November – 1 December 2017. 19 countries nominated senior analysts from the Ministry of Health,...
04 April, 2017 The Countdown Financing Technical Workgroup has recently published their methodology for creating a database that can be used for analyzing official development assistance and private grants to RMNCH, including suggestions for how the database can be used by others.
03 November, 2016 New analyses from CD colleagues the Federal University of Pelotas conclude that a composite coverage index, based on the average value of separate coverage indicators, is easy to calculate and can be useful in monitoring progress and inequalities in universal health coverage.
28 October, 2016 "Measuring Inequalities in Coverage of Reproductive, Maternal, Newborn, Child and Adolescent Health Interventions" was the title of the first Countdown to 2030 Regional Hub Workshop convened in Medellín, Colombia, from October 18-22, with 21 participants from 10 LAC countries (Bolivia, Colombia, Ecuador, Guatemala, Haiti, Honduras, Mexico, Nicaragua,...
14 October 2016 CD colleagues at the London School of Hygiene and Tropical Medicine have published a dataset containing 2.1 million records used to generate estimates of official development assistance (ODA) to reproductive, maternal, newborn and child health (RMNCH) based upon donor, recipient country and activity type between 2003–2013.
12 September 2016 As Countdown to 2030 is launched, a supplement in the British Medical Journal published 12th September 2016, maps the challenges and opportunities for the SDG era. The supplement, entitled Countdown to 2015 country case studies: analysing progress towards maternal and child survival in the Millennium Development Goal era reflects on the...
9 September 2016 Access to water and sanitation during childbirth is poor across low and middle-income countries. Even when women travel to health facilities for childbirth, they are not guaranteed access to basic WATSAN infrastructure. Hygiene during childbirth is essential to the health of mothers and newborns, irrespective of where...
9 June 2016 Despite long standing conflict and poverty, Afghanistan has made reasonable progress in its reproductive, maternal, newborn, and child health indicators over the last decade based on contributions of factors within and outside the health sector.
9 June 2016 Access to water and sanitation during childbirth is poor across low and middle-income countries. Even when women travel to health facilities for childbirth, they are not guaranteed access to basic WATSAN infrastructure. Hygiene during childbirth is essential to the health of mothers and newborns, irrespective of where...
21 January 2016 Nearly a third of Malawi’s population lives in severe poverty, but the eyes of the global health community have turned to this small, land-locked nation of 16 million because it is one of only a few countries in sub-Saharan Africa that achieved Millennium Development Goal (MDG) 4...
26 September 2015 At the annual RMNCH Accountability Breakfast, held in conjunction with the yearly meeting of the UN General Assembly, which this year included the historic Summit for Sustainable Development, nearly 300 partners gathered to reflect on what accountability has delivered for women’s and children’s health, and on the...
July 27, 2015 Over 30% of Malawi's population lives in severe poverty, yet it is one of only a few countries in sub-Saharan Africa on track to achieve MDG 4 by reducing under-5 mortality by two-thirds between 1990 and 2015. New evidence from a Countdown case study, which sought to...
June 24, 2015 In September 2013, Ethiopia’s Federal Ministry of Health and UNICEF jointly announced that Ethiopia had succeeded in reducing its under-5 mortality rate by two-thirds between 1990 and 2012. Ethiopia had already achieved Millennium Development Goal 4, two years ahead of the MDG deadline.
June 16, 2015 New Countdown case study explores how this happened, and why maternal and newborn survival progress is much slower
June 16, 2015 New Countdown analysis shows RMNCH aid flows up in 2011-2012
November 26, 2014 Countdown to 2015 continues to move forward on a series of in-depth Country Case Studies that seek to understand and explain how progress on women’s and children’s health was achieved in priority countries. On November 26th, a research team led by the Universidad Peruana Cayetano Heredia in Lima presented...
September 21, 2014 For the fourth consecutive year, Countdown to 2015 was co-host of a high-level meeting that put women's and children's health at the front of the agenda for the annual meeting of the United Nations General Assembly. On the Sunday morning immediately before the General Assembly convened, senior...
June 30, 2014 Many developing countries have taken substantive action to save women’s and children’s lives, but vast areas of “unfinished business” still need to be addressed, according to a new report released at the Partnership for Maternal, Newborn and Child Health Partners’ Forum and summarized in The Lancet today....
London, 30 June 2014 The Lancet today published two new peer-reviewed Countdown papers, with their release timed to coincide with the launch of the 2014 Countdown Report at the PMNCH Partners’ Forum, held in Johannesburg, South Africa, from June 30 – July 1, 2014.
15 May 2014 President JM Kikwete of Tanzania, co-chair for the Commission on Information and Accountability for Women's and Children's Health (COIA), recently launched the Tanzanian "Countdown to 2015" and "A Promised Renewed" in relation to maternal, newborn and child survival in Tanzania at a high level event held in...
22 September, 2013 Ministers and government officials, leaders of UN agencies, NGOs and advocates, academic experts, and nearly 150 others came together in New York to vow greater efforts on accountability for women’s and children’s health. “Accountability for Results: Keeping our Promises to Women and Children” marked the second annual Sunday accountability...
28 August, 2013 More than 60 representatives of national parliaments, civil society, ministries of health, media, and development agencies from Kenya, Liberia, Sierra Leone, Tanzania, and Uganda met this week in Nairobi, Kenya, in a workshop that aimed to build their capacities to undertake budget advocacy for improved women’s and...
27 May 2013 Rapid expansion of programs to prevent HIV transmission to babies and vaccinate children show how results can be achieved in relatively little time
20 February 2013 To support countries in undertaking robust and effective Country Countdown processes, Countdown has developed Country Countdown—Accelerating progress to 2015 and beyond: A guide for countries and partners.
22 September 2012 There is a growing sense of urgency that some of the poorest countries in the world will not reach 2015 targets for reproductive, maternal, neonatal, and child survival. The Lancet marked the 67th UN General Assembly meeting by publishing a series of new Countdown papers…
13 June 2012Countdown launched its 2012 Report on June 14, 2012, at the Child Survival Call to Action, a two-day high-level meeting in Washington, D.C. This conference, convened by the governments of the U.S., Ethiopia, and India in collaboration with UNICEF, charted a course toward ending preventable child deaths around...
31 March 2012The global health community must increase its efforts to ensure that key maternal, newborn, and child health interventions are adequately reaching all social groups…
31 March 2012Countdown released Accountability for Maternal, Newborn & Child Survival, with updated profiles on 73 countries, at the IPU Assembly in Kampala…
22 November 2011A report by Countdown, Health Metrics Network, UNICEF, and WHO examines opportunities and challenges to effective monitoring of core MNCH indicators…
12 January 2011A Nigerian government report on newborn health showcased the power of Countdown data and methods for catalyzing action…
13 April 2010Countdown to 2015 : New Landscape Analysis released for the United Nations’ special meeting on maternal, newborn and child health
29 March 2010Countdown to 2015, PMNCH, Inter-Parliamentary Union and Government of Thailand host Special Session and Field Trip
7 April 2009Special Session of Countdown to 2015 - Maternal, Newborn & Child Survival at the 120th Assembly of the Inter-Parliamentary Union (IPU)
19 April 2008G8 action urged to avert 6 million mother and child deaths every year
16 April 2008Critical health care fails to reach most women and children in high mortality countries despite gains in fighting child killer diseases
