How to Save a (Nigerien) Life
The Millennium Development Goals call for an ambitious reduction in child mortality by 2015. In West Africa, Niger is sweeping away the competition. What’s its secret?
Niger doesn’t often make headlines. And when it does, well, the news is rarely uplifting. Perhaps you read about the landlocked West African nation earlier this summer, when a failed harvest and sustained drought plunged more than six million Nigeriens—a third of the population—into a food crisis. Or more recently, when flooding along the Niger River swept away 40,000 homes and claimed 80 lives. The only bit of sunshine to come out of Niger this summer, it seems, was the story of Hamadou Issaka, a swimming pool attendant who took up rowing three months before the London Olympics, trained in an old fishing boat, and finished dead last in the men’s singles sculls wearing an enormous grin on his face.
Yet there may be something else to smile about in Niger. Researchers from Johns Hopkins Bloomberg School of Public Health and UNICEF report in The Lancet that childhood mortality in the deeply impoverished country is on the decline. In fact, it’s plummeting.
Let’s hit the low notes first. Niger ranks 186th out of the 187 countries in the U.N.’s Human Development Index. (Only the Democratic Republic of Congo is in worse shape.) It has faced three “food crises” in the last decade, owing to recurring droughts, and 66 percent of Nigeriens live on less than $1.25 per day. Save the Children estimates that 120,000 kids die annually before the age of five—and half of those deaths are linked to malnutrition. Long-simmering discontent among the desert-dwelling Tuareg, in northern Niger and Mali, led to hostilities in 2007 and recently toppled the latter’s government, leading many to wonder if Niger might be next. Poverty levels and per capita GDP haven’t budged much in the last 10 years, “child brides” are a chronic problem, and fertility rates are some of the highest in the world: an average of 7.1 children per woman.
In other words, Niger has lots of poor, young mothers, and lots of malnourished kids.
The fourth Millennium Development Goal is simply stated: to reduce by two-thirds, between 1990 and 2015, the rate of under-5 child mortality. It is not so simply achieved. But a massive, decade-long effort by the Nigerien Ministry of Public Health to combat childhood diseases is beginning to pay dividends.
As Johns Hopkins’ Agbessi Amouzou illustrates, between 1998 and 2009, Niger accomplished a 43 percent reduction in under-5 childhood mortality—from 226 deaths per 1,000 live births to 128—as well as gains in stunting and wasting. (To put that mortality rate in perspective, here in the United States, eight of every 1,000 newborns die before the age of 5.) It did so by instituting free, universal healthcare for all Nigerien mothers and children; creating a network of community health workers and medical “outposts” in rural areas; and launching mass campaigns that promoted vitamin A supplements, anti-malarial bed nets, and measles vaccination.
Amozou and his collaborators calculate that, owing of such extraordinary efforts, some 59,000 young lives were saved in 2009, half of which could be attributed to bed nets and nutritional supplements alone. Since 1998, they report, the number of mothers with access to skilled antenatal care has climbed dramatically, as have rates of breastfeeding. Far more households are receiving diphtheria, pertussis, and tetanus vaccines, and seeking care for fevers and pneumonia. More than 2,000 “outposts” were built in the last decade, and today, 80 percent of the population lives within five kilometers—easy walking distance—of a clinic. The cadre of paid community health workers went from fewer than 100 to more than 2,300. And in 2006 after medical fees were abolished for women and kids, the death rate from malaria among children dropped by nearly two-thirds.
Compared to its neighbors in the Sahel—Nigeria, Benin, Chad, and Mali—Niger is making enormous strides. Its falling rate of childhood mortality is on track to meet the target set by the fourth Millennium Development Goal. It’s only a start, of course: Amozou found that the rate of infant mortality has stagnated in recent years, even as maternal healthcare has improved, and as long as food security plagues the country, stunting and wasting will remain massive problems.
But it’s nice to know that change can, and will, come. In 1990, Niger had the highest child mortality rate of any country on in the world. It wears that badge no longer.