Two ways to cut child deaths
One of the more ambitious targets of the United Nations’ sustainable development goals is the commitment to end preventable deaths of newborns and children over the next decade.
If this target is met, by 2030 no country will have a neonatal mortality rate above 12 deaths per 100 births — a quarter of the current rate in parts of sub-Saharan Africa.Given the magnitude of the problem, huge investments will be needed in healthcare infrastructure and planning.
Perhaps the most effective way to reduce infant mortality would be to encourage uptake of two readily available resources: maternal vaccinations and breast milk.
Protecting children from early deaths begins before they are born.
When a woman is vaccinated against common illnesses such as influenza, her body creates antibodies that recognise viruses and boost natural defences against pathogens.
When she becomes pregnant, these protective proteins are transferred to her baby across the placenta.
Remarkably, the benefits continue after birth. For example, although the flu shot is not approved for infants younger than six months, clinical trials have shown that children born to mothers who were vaccinated are better protected against the illness.
In one study of mothers and their babies in Bangladesh, researchers recorded a staggering 63% reduction in influenza cases among infants born to vaccinated mothers, a 36% reduction in the number of serious respiratory illnesses for mothers and a 29% reduction in such illnesses among infants.
Maternal immunisation against the flu also helps to protect infants from pneumonia, a common cause of childhood mortality. A 2018 analysis of flu-vaccine trials conducted in Nepal, Mali and South Africa found that infants were 20% less likely to develop pneumonia if their mothers had been inoculated. Children too young to be completely vaccinated against Streptococcuspneumoniae and influenza were the biggest beneficiaries.
Armed with data from these and other studies, governments in low-income countries should be able to plan smarter immunisation campaigns and substantially lower rates of infant morbidity and mortality.
The second way to reduce childhood mortality —breast-feeding —arguably has an even greater effect. Breast milk is the perfect nutrition for a baby, providing all the proteins, fats, vitamins, minerals and enzymes that a young body needs to stay healthy. Best of all, mothers create new antibodies in real time, which strengthens young immune systems.
Unfortunately, rates of breast-feeding and breast-milk consumption are well below desired levels. Only 40% of infants worldwide are breast-fed exclusively until they are at least six months old, as the World Health Organisation (WHO) recommends. The reasons are complex but in many countries poor knowledge together with aggressive marketing by makers of baby formula have contributed to a decline in breast-feeding. The United States was recently accused of siding with the formula industry by opposing a WHO resolution in support of breast-feeding.
Convincing mothers to breast-feed should be easier. For starters, breast-fed babies are less likely to contract ear infections and meningitis, or to suffer gastrointestinal illnesses and diarrhoea. These advantages continue for as long as a baby is breast-fed.
Mothers also benefit from breast-feeding. Research shows that women who have breast-fed during their lives are less likely to develop noncommunicable diseases such as cardiovascular illness, breast cancer and type 2 diabetes. Many of these gains derive from the fact that breast-feeding helps to break down the extra fat that accumulates in a woman’s body during pregnancy. In fact, producing milk for a single infant burns as many as 500 calories a day.
Even though the majority of new mothers are able to breast-feed, not all women can produce enough milk, because of exhaustion, depression or physical weakness following postpartum surgery.
Some mothers are simply unable to meet their child’s needs, and others don’t have the medical or social support to navigate the logistics of breast-feeding. Nonetheless, for those who can supply their babies with at least six months of breast milk, the benefits are significant.
If the international community is serious about meeting the health targets set by the UN’s sustainable development goals, it must redouble its efforts to encourage more mothers to be vaccinated against preventable illnesses and to feed their newborns breast milk. These two practices alone could do more to reduce infant mortality than just about any other global health initiative. — © Project Syndicate
Melvin Sanicas is a public health physician and vaccinologist and a regional expert at Sanofi Pasteur