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 by reducing under-5 mortality by two-thirds between 1990 and 2015. In a paper published in Lancet Global Health, a Countdown to 2015 research team confirms that Malawi had met its MDG 4 target by as early as 2013, and seeks to explain Malawi’s success in improving child survival.
January 21, 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 by reducing under-5 mortality by two-thirds between 1990 and 2015. In a paper published in Lancet Global Health, a Countdown to 2015 research team confirms that Malawi had met its MDG 4 target by as early as 2013, and seeks to explain Malawi’s success in improving child survival.
The Countdown Country Case Study — one of a series of in-depth case studies that Countdown has supported in Niger, Bangladesh, Tanzania, Ethiopia, Peru, and several other countries — shows that Malawi has dramatically improved child survival since 1990, when 1 in 4 Malawian children died before reaching the age of five; by 2013, only 1 in 14 failed to survive to their fifth birthday. However, progress has been much slower in addressing newborn survival, and the research highlights Malawi’s need to provide universal access to high-quality care at birth, including for small and sick babies. The study notes that, at 18%, Malawi has the world’s highest recorded rate of babies born prematurely.
Malawi’s achievement of MDG 4 was driven by its early adoption and effective implementation of key evidence-based policies and programs to address the major causes of child deaths. Sharp increases in national coverage for treatment and prevention of childhood pneumonia, diarrhea, and malaria, and effective implementation of programs to reduce child undernutrition, were key contributors to the country’s success. Analysis with the Lives Saved Tool (LiST) showed that Malawi prevented an estimated 280,000 child deaths between 2000 and 2013 through scale-up of these and other high-impact child health interventions.
In contrast with many other countries in Africa, the rural poor in Malawi were not left behind in these advances in national coverage, and equity gaps were narrowed for a number of key child health interventions. However, the study also showed that wide geographic disparities still exist, and the authors suggest that more research is needed to better explain the determinants of success at the district level so that remaining inequities can be addressed and reduced.
This Countdown study is the first to synthesize and analyze data from nationally-representative surveys, a range of published articles, policy documents, and information gained from interviews with key national and district-level program and finance staff to document and investigate Malawi’s dramatic success in improving child survival. The study was led by the Malawi National Statistical Office, and the paper’s authors also include scholars from University College London, the Johns Hopkins Bloomberg School of Public Health, University of Malawi, Malawi College of Medicine, the London School of Hygiene and Tropical Medicine, the Malawi Ministry of Health, UNICEF, and the World Health Organization.
Preliminary findings from this Countdown Case Study were previewed in July 2015 at a high-level event in Lilongwe, Malawi’s capital, led by the Minister of Health, which also featured the launch of a new national Child Health Strategy. At that meeting, Countdown released a one-page Country Case Study Brief that summarizing the study’s key findings in infographic format. At the same time, MamaYe, a campaign to improve maternal and newborn survival in sub-Saharan Africa and a partner in the study, published a series of infographics to highlight the urgent need for political action to reduce stillbirths and improve newborn survival in Malawi.