Improving child survival through environmental and nutritional interventions: the importance of targeting interventions toward the poor.
BACKGROUND
The United Nations Millennium Development Goals (MDGs) set targets related to important global poverty, health, and sustainability issues. A critical but underinvestigated question for planning and allocating resources toward the MDGs is how interventions related to one MDG might affect progress toward other goals.


OBJECTIVE
To estimate the reduction in child mortality as a result of interventions related to the environmental and nutritional MDGs (improving child nutrition and providing clean water, sanitation, and fuels) and to estimate how the magnitude and distribution of the effects of interventions vary based on the economic status of intervention recipients.


METHODS
Population-level comparative risk assessment modeling the mortality effects of interventions on child nutrition and environmental risk factors, stratified by economic status. Data on economic status, child underweight, water and sanitation, and household fuels were from the nationally representative Demographic and Health Surveys for 42 countries in Latin America and the Caribbean, South Asia, and sub-Saharan Africa. Data on disease-specific child mortality were from the World Health Organization. Data on the hazardous effects of each MDG-related risk factor were from systematic reviews and meta-analyses of epidemiological studies.


METHODS
Child mortality, stratified by comparable international quintiles of economic status.


RESULTS
Implementing interventions that improve child nutrition and provide clean water and sanitation and clean household fuels to all children younger than 5 years would result in an estimated annual reduction in child deaths of 49,700 (14%) in Latin America and the Caribbean, 0.80 million (24%) in South Asia, and 1.47 million (31%) in sub-Saharan Africa. These benefits are equivalent to 30% to 48% of the current regional gaps toward the MDG target on reducing child mortality. Fifty percent coverage of the same environmental and nutritional interventions, as envisioned by the MDGs, would reduce child mortality by 26,900, 0.51 million, and 1.02 million in the 3 regions, respectively, if the interventions are implemented among the poor first. These reductions are 30% to 75% larger than those expected if the same 50% coverage first reached the wealthier households, who nonetheless are in need of similar interventions.


CONCLUSIONS
Interventions related to nutritional and environmental MDGs can also provide substantial gains toward the MDG of reducing child mortality. To maximize the reduction in childhood mortality, such integrated management of interventions should prioritize the poor.
Gakidou
Emmanuela
E
Initiative for Global Health, Harvard University, Cambridge, Massachusetts, USA.
Oza
Shefali
S
Vidal Fuertes
Cecilia
C
Li
Amy Y
AY
Lee
Diana K
DK
Sousa
Angelica
A
Hogan
Margaret C
MC
Vander Hoorn
Stephen
S
Ezzati
Majid
M
D002648:Child; D046688:Child Mortality; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D003906:Developing Countries; D004032:Diet; D004782:Environmental Health; D014943:Global Health; D006293:Health Promotion; D006801:Humans; D006815:Hunger; D007223:Infant; D011203:Poverty; D011634:Public Health; D018570:Risk Assessment; D012959:Socioeconomic Factors